Nuevos paradigmas de aprendizaje en medicina. Aspectos éticos y legales

Ya en la segunda mitad del siglo pasado, pero sobre todo en los albores del siglo xxi, asistimos a una evolución acelerada de la sociedad, con cambios que implican una mayor madurez y una mayor consciencia de sus limitaciones y de sus derechos. El presente trabajo de revisión docente trata de, adaptándose a los cambios sociales, revisar los antecedentes históricos de la formación en medicina, actualizando los nuevos paradigmas de aprendizaje y relacionándolos con los aspectos éticos y legales de la enseñanza en las ciencia de la salud. Para ello se revisan: Los motores de la formación, mostrando la importancia del discente como gestor ––de su propia formación. Los modelos de la formación, mostrando la relevancia del docente como modelo guía. Los principios bioéticos de la formación sanitaria. Los conflictos éticos más frecuentes, relacionados normalmente con los comportamientos antiéticos en la docencia sanitaria. Las disposiciones legales en la formación sanitaria.Medicin

Analysis of the Psychosocial Sphere of Older Adults in Extreme Poverty in the Peruvian Amazon

The situation of social exclusion in which older adults live in extreme poverty is a problem that leads to psychological alterations such as depression or cognitive deterioration. Our objective was to analyze the living conditions and the psychosocial sphere of older adult people living in extreme poverty in Requena del Tapiche in Peru. This was an observational, descriptive, cross-sectional study. Sixty participants between 60 and 100 years of age of both sexes were included who gave their informed consent. Sociodemographic variables were analyzed, and the Gijón, family Apgar, Yesavage, and Pfeiffer scales were used. The sample was composed of 55% women and 45% men, with a mean age of 79.2 years (SD 6.67). More than half live alone or with their spouse. Fifty-seven percent sleep on the floor or on wood, and about 82% do not have safe water. Family dysfunction is found in 40%, and 98% are at social risk or with an established social problem and a precarious economic situation. More than 60% suffer from depressive symptoms, which are more frequent in women. We conclude that older adults perceive deficient family support, observing a deteriorated social situation. Most of them are at risk of social exclusion and loneliness, making them more vulnerable. They show sadness, with a high rate of depression. People with more cognitive impairment live alone, and those in social exclusion suffer a higher degree of depression. More cooperative projects and health promotion interventions developed in the peripheral neighborhoods of Requena del Tapiche are needed to improve the impact on the health of older adult people in extreme poverty.The publication costs of this work have been financed by the Catholic University of Valencia under grant 2023-275-001.Medicin

Metodología docente cooperativa-colaborativa en el grado de medicina

El presente trabajo, analítico, prospectivo y de investigación docente, trata de comprobar la aceptación entre el alumnado de la metodología docente cooperativacolaborativa y estudio de casos, con el empleo de la plataforma de teleformación (ucv. net) basada en Moodle, para la docencia de Fisiología humana en el grado de Medicina de la Universidad Católica de Valencia “San Vicente Mártir”. Para ello, tras una introducción con el fin de centrar el marco teórico, se presentan los resultados de la calificación obtenida con tres modelos docentes, para la implementación de trabajos en el aula y fuera de ella: 1.º Individual-competitivo sobre ampliación de contenidos; 2.º Individual-competitivo sobre estudio de casos, y 3.º Cooperativo-colaborativo sobre estudio de casos, en una población de 84 alumnos de Fisiología humana de 2.º en el grado de Medicina y el curso 2010-11. Se observa en el análisis de las variables cuantitativas la falta de normalidad de la población, así como la ausencia de significación entre las calificaciones obtenidas con cada uno de los tres modelos docentes. En el análisis de las variables cualitativas referidas exclusivamente al modelo cooperativo-colaborativo para la resolución de casos también se detecta la enorme potencialidad de esta metodología activa para la adquisición de competencias en el aula universitaria y fuera de ella, por lo que se concluye que este método parece ser al menos tan eficaz como los otros métodos más experimentados de carácter individual, pero que además permite profundizar en el conocimiento de cómo trabajan los alumnos fuera del aula universitaria.The present work, analytical, prospective research and teaching, is to check the acceptance among students in collaborative co-teaching methodology and case studies, with the use of tele training platform (ucv.net) based on Moodle, for teaching Human Physiology in Medicine degree from the Catholic University of Valencia “San Vicente Martir”. Therefore, after an introduction in order to focus the theoretical framework, the results of the qualification obtained with three teaching models for the implementation of works in the classroom and beyond the presents: 1st Individual competitive on expanding content; 2nd Individual competitive on case studies; and 3 Co-collaborative on case studies in a population of 84 students in Human Physiology 2nd degree in Medicine and the 2010-11 academic year; observed in the analysis of quantitative variables non-normality distribution of the qualification obtained, and the lack of significance between the scores obtained with each of the three teaching models, and observing in the analysis of qualitative variables refer exclusively to the model cocollaborative to solve cases, the enormous potential of this active methodology for the acquisition of skills in the college classroom and beyond, so it is concluded that this method seems to be at least as effective as the more experienced individual character methods but also allows deeper understanding of how students work outside the university classroom.Medicin

Variability and evolution of acute myocardial infarction management in the PRIMVAC Study (Acute myocardial infarction register of Valencia, Alicante and Castellón)

En España existe escasa información sobre la variabilidad interhospitalaria en el tratamiento del infarto agudo de miocardio (IAM) y su evolución temporal. El objetivo de este trabajo es describir el coeficiente de variabilidad (CV) y su evolución en la utilización de trombolíticos, aspirina (AAS), bloqueadores beta e inhibidores de la enzima conversiva de la angiotensina (IECA) en los hospitales del registro PRIMVAC.Data about hospital differences in acute myocardial infarction (AMI) management are scarce in Spain. The aim of this study is to describe the variability in the use of thrombolytic therapy, aspirine (AAS), beta-blockers and angiotensin converting enzyme inhibitors (ACEI) in the management of AMI, and the changes observed along a 4-year period among 12 hospitals participating in the PRIMVAC registry.Medicin

Nuevos paradigmas de aprendizaje en medicina. Aspectos éticos y legales

During the last century, but mainly at the beginning of xxis, there has been an accelerated evolution of our society, based on maturity, more consciousness of limits and rights. The present work try to analyze the history of teaching of medicine making an update of learning process based on ethical and legal issues reviewing in health science: – The engines of training, highlighting the importance of the pupils in theirs own formation. – Methods of education remarking the relevance and the role of teachers as guide of training. – Bioethical aspects of training on health science. – The most frequent ethical problems, specially related with anti-ethical behaviors of the health teaching. – Legal considerations on the formation.Ya en la segunda mitad del siglo pasado, pero sobre todo en los albores del siglo xxi, asistimos a una evolución acelerada de la sociedad, con cambios que implican una mayor madurez y una mayor consciencia de sus limitaciones y de sus derechos. El presente trabajo de revisión docente trata de, adaptándose a los cambios sociales, revisar los antecedentes históricos de la formación en medicina, actualizando los nuevos paradigmas de aprendizaje y relacionándolos con los aspectos éticos y legales de la enseñanza en las ciencia de la salud. Para ello se revisan: – Los motores de la formación, mostrando la importancia del discente como gestor de su propia formación. – Los modelos de la formación, mostrando la relevancia del docente como modelo guía. – Los principios bioéticos de la formación sanitaria. – Los conflictos éticos más frecuentes, relacionados normalmente con los comportamientos antiéticos en la docencia sanitaria. – Las disposiciones legales en la formación sanitaria

Metodología docente cooperativa-colaborativa en el grado de Medicina

The present work, analytical, prospective research and teaching, is to check the acceptance among students in collaborative co-teaching methodology and case studies, with the use of tele training platform (ucv.net) based on Moodle, for teaching Human Physiology in Medicine degree from the Catholic University of Valencia "San Vicente Martir". Therefore, after an introduction in order to focus the theoretical framework, the results of the qualification obtained with three teaching models for the implementation of works in the classroom and beyond the presents: 1st Individual competitive on expanding content; 2nd Individual competitive on case studies; and 3 Co-collaborative on case studies in a population of 84 students in Human Physiology 2nd degree in Medicine and the 2010-11 academic year; observed in the analysis of quantitative variables non-normality distribution of the qualification obtained, and the lack of significance between the scores obtained with each of the three teaching models, and observing in the analysis of qualitative variables refer exclusively to the model co-collaborative to solve cases, the enormous potential of this active methodology for the acquisition of skills in the college classroom and beyond, so it is concluded that this method seems to be at least as effective as the more experienced individual character methods but also allows deeper understanding of how students work outside the university classroom.El presente trabajo, analítico, prospectivo y de investigación docente, trata de comprobar la aceptación entre el alumnado de la metodología docente cooperativa-colaborativa y estudio de casos, con el empleo de la plataforma de teleformación (ucv. net) basada en Moodle, para la docencia de Fisiología humana en el grado de Medicina de la Universidad Católica de Valencia "San Vicente Mártir". Para ello, tras una introducción con el fin de centrar el marco teórico, se presentan los resultados de la calificación obtenida con tres modelos docentes, para la implementación de trabajos en el aula y fuera de ella: 1.º Individual-competitivo sobre ampliación de contenidos; 2.º Individual-competitivo sobre estudio de casos, y 3.ºCooperativo-colaborativo sobre estudio de casos, en una población de 84 alumnos de Fisiología humana de 2.º en el grado de Medicina y el curso 2010-11. Se observa en el análisis de las variables cuantitativas la falta de normalidad de la población, así como la ausencia de significación entre las calificaciones obtenidas con cada uno de los tres modelos docentes. En el análisis de las variables cualitativas referidas exclusivamente al modelo cooperativo-colaborativo para la resolución de casos también se detecta la enorme potencialidad de esta metodología activa para la adquisición de competencias en el aula universitaria y fuera de ella, por lo que se concluye que este método parece ser al menos tan eficaz como los otros métodos más experimentados de carácter individual, pero que además permite profundizar en el conocimiento de cómo trabajan los alumnos fuera del aula universitaria

Comparison of pressure support ventilation and assist-control ventilation in the treatment of respiratory failure

Study objective: To assess whether pressure support ventilation (PSV) could be used as an alternative ventilatory mode to assist-control (A/C) ventilation in the treatment of respiratory failure. Design: A short-term (4-h) prospective study in which the beneficial effect of PSV on respiratory mechanics, gas exchange, arterial oxygenation, cardiovascular hemodynamics, and oxygen consumption was compared with A/C ventilation. Setting: ICU of a community hospital. Patients: Forty-five patients (mean age, 62.8 [11.8] years) with respiratory failure secondary to COPD, restrictive disorders, or neuromuscular disease requiring mechanical ventilatory support in the ICU were selected for study. Interventions: The mean duration of mechanical ventilation before the study was 7.16 (8.64) days. Patients were switched to the PSV mode of the mechanical ventilator for a period of 4 h after which conventional A/C ventilation was resumed. Results: Patients supported with PSV compared with A/C ventilation showed significantly higher tidal volume, minute ventilation, and inspiratory time in association with significantly lower pressure in the airway and I:E ratio. With regard to gas exchange data, an increase in dead space/tidal volume ratio (VD/VT), decrease in PaO2, and statistically but not clinically significant alteration of arterial oxygenation indexes were noted. However, when patients with COPD, restrictive disorders, and neuromuscular disease were compared, significant changes in arterial oxygenation parameters were found only in patients with restrictive disorders. There were significant decreases in heart rate, systolic pulmonary artery pressure, and pulmonary capillary wedge pressure when PSV was applied. Oxygen transport and oxygen consumption were unchanged. Conclusions: PSV could be a possible alternative to A/C ventilation in patients with respiratory failure. PSV caused an increase in VD/VT in association with a significantly lower pressure in the airway and I:E ratio. Randomized studies are needed to define the long-term benefits of both respiratory modes and the conditions in which PSV may be a valuable alternative to A/C ventilation.Medicin