Evaluación de competencias médicas mediante un sistema de ECOE con incorporación de imágenes

[SPA]La enseñanza de la medicina adaptada al marco del Espacio Europeo de Educación Superior (EEES) supone asumir métodos de trabajo adecuados para el desarrollo de competencias y para la evaluación de las mismas. Dentro de la evaluación de las competencias clínicas, el Examen Clínico Objetivo y Estandarizado (ECOE) se presenta en la Facultad de Medicina de Albacete con una metodología basada en casos clínicos con pacientes simulados y estandarizados en estaciones de habilidades clínicas. La realización de la prueba ECOE se basa en una correcta selección de los casos clínicos que deben ser representados por pacientes simulados bien entrenados. Para que la evaluación obtenga los resultados objetivos que busca y que se han establecido previamente, utilizamos una planilla de evaluación. También hemos podido comprobar que la prueba ECOE debe contar con diversas estaciones por las que los alumnos rotan con el fin de poder ser evaluados de la interpretación de imágenes médicas o de pruebas de habilidades clínicas de exploración o tratamiento. [ENG]Teaching of medicine in the European Superior Education Space should assume principles of development of working methods that permit the acquisition and evaluation of medical competences. In the process of evaluating medical competences at the Medical School of Castilla- La Mancha University, we have developed an Objective Structured Clinical Exam (OSCE). The correct application of an OSCE based system requires the selection of cases that drive to the evaluation of the educational objectives that have been previously proposed. In order to obtain and objective method of evaluation, simulated patients should be well trained, and a very well detailed template should be used. In our experience the students should rotate through different clinical stations that permit complete the evaluation of medical skills and the interpretation of medical images.Campus Mare Nostrum, Universidad Politécnica de Cartagena, Universidad de Murcia, Región de Murci

Observación y análisis de imágenes en el proceso de enseñanza-aprendizaje de medicina

[SPA]El desarrollo de contenidos multimedia y de espacios virtuales de enseñanza- aprendizaje permite la integración de diferentes disciplinas médicas que utilizan una metodología de exploración e interpretación de resultados común. Actualmente venimos desarrollando una metodología docente basada en el análisis de las representaciones visuales que el estudiante recibe a través de la observación directa de lesiones del paciente, o de la observación obtenida a través de las múltiples técnicas de imagen que existen en la actualidad. Hemos comprobado que la observación puede convertirse en un método de adquisición de determinadas competencias profesionales y puede ser además considerada como una competencia profesional en sí misma. La utilización de imágenes médicas facilita la adquisición de competencias genéricas en medicina, fundamentalmente en cuanto a la capacidad de resolución de problemas y de gestión de la información. Además contribuye a la adquisición de competencias de carácter sistémico, potenciando la capacidad de aprendizaje autónomo. Para el desarrollo del aprendizaje basado en la observación sistemática de imágenes organizadas, utilizamos una plataforma basada en la aplicación de gestión de contenidos Joomla y Oracle. La metodología que aplicamos asume principios de funcionamiento basados en la coordinación e integración de distintas áreas disciplinares (radiología, dermatología, anatomía patológica y oftalmología) en torno a una metodología de enseñanza-aprendizaje, y de evaluación común. [ENG]In the teaching and learning process of medicine, we have developed a methodology that uses visual representation of medical images obtained through the multiple areas that use this representations. We have corroborated that the observation may be a tool for the acquisition of certain competences, specially the capacity of autonomous learning, of problem solving learning, and of critical information processing. For the development of a systematic teaching based on the observation of images we have developed an application of contents processing based on Joomla y Oracle. The methodology that we use assume principles of integration and coordination between several medical areas (radiology, dermatology, pathology, and oftalmologhy) using a common teaching and evaluation methodology.Campus Mare Nostrum, Universidad Politécnica de Cartagena, Universidad de Murcia, Región de Murci

Casos clínicos estructurados, basados en la integración de imágenes, para la docencia de medicina

[SPA] La observación y descripción de posibles patologías es parte fundamental de la enseñanza y aprendizaje de medicina. Las técnicas de imagen están experimentando un notable incremento en la práctica de la medicina y su conocimiento resulta cada vez más importante en la docencia de las ciencias biomedicas. Se hace necesario encontrar metodologías de aprendizaje que permitan estructurar las imágenes, junto con otros datos de diagnóstico, de tal forma que el alumno integre los signos y síntomas de la enfermedad. Describimos un sistema de integración de imágenes médicas que hemos elaborado utilizando recursos de tecnologías de la información y comunicación (TIC). El objetivo es que el alumno adquiera competencias destinadas al diagnóstico de la enfermedad. El sistema se basa en una plataforma digital que permite la elaboración y presentación de casos clínicos concretos y estructurados para que aparezcan sin reseñas de filiación ni datos clínicos de los pacientes, y que conduzcan a la realización de un diagnóstico clínico. A estos casos clínicos se les asocian imágenes que habitualmente utilizan distintas disciplinas médicas, con especial referencia a los hallazgos histopatológicos. [ENG] Observation and description of human pathologies is an essential and fundamental part in teaching and learning medicine. The expansion of Imaging Techniques in the field of medicine makes it necessary to introduce new learning methodology. Thus, correct knowledge of these techniques is an important area to cover in the medicine studies. It is necessary to find teaching methodologies that permit learning of clinical diagnosis integrating images provided by image based techniques with symptoms and other signs of the illness. We describe a system that we have elaborated, and that permit the integration of medical images using information and communication technical resources. The system is directed toward the acquisition of diagnostic skills by the medical student. Using a digital platform, the system permits the presentation of a clinical history without affiliation data, and that induce the performance of a clinical differential diagnosis. Medical images used in diverse medical specialties, with special reference to histopathology, are linked to the main menu to permit the student making a correct diagnosis

Research on Devices for Handling Whole Slide Images on Pathology Workstations. An Ergonomic Outlook

Background Digital Pathology represents a technological innovation that introduces changes in the traditional tasks of pathologists. In this regard, an important issue that has not been enough emphasized is the image handling from an ergonomic point of view to avoid work-related musculoskeletal disorders (MSD). The aim of this study was to investigate a proper input device for digital pathology. Material & Methods Research was conducted in two phases: (1). A comparative study to find out an optimal external controller. Eight medical students analyzed 11 input devices: keyboard (Hewlett Packard, HP), conventional mouse (HP), vertical mouse (CLS), touchpad (Logitech), 3 trackballs (Logitech, Kensington Expert and Ulove), Rollermouse (Contour), Ergopointer (Märzhäuser Sensotech), gamepad (Logitech) and a touchless device (Leap Motion Controller), using them with the Image Viewer software (Ventana). The web-based Fitts´ law test (UC Berkeley) was used to objectify the accuracy of each used device, randomly. 12 items were included in the questionnaire: comfort, technical aspects (cursor movement and objective achievement), prospects, overall satisfaction, prior experience, and others. (2). Evaluation by two experienced pathologists of the best rated input device on the previous experiment and its comparison with a voice recognition system (Invox Medical Dictation, Vocali) using a headset microphone (Plantronics). Perceived workload was scored using the NASA Task Load Index on 28 whole slide images visualized on the Digital Image Hub (Leica) platform with a 4 MegaPixel display (Barco). Data were processed with SPSS 21.0. Results Correlation between technical aspects of the evaluated devices and accuracy (Fitts´ law test), and comfort with overall satisfaction, was demonstrated (p<0.05). Comparative analysis of the 11 input devices concluded that vertical mouse was the best rated input device. However, on the second phase of the study, we find a slightly higher perceived workload using this device than using the voice recognition system, which was the best controller in digital pathology from an ergonomic point of view in this study. Conclusions We describe a methodology that can study and compare input devices for future workstations in digital pathology. Pathologists should be involved in this process trying to find ergonomic devices that prevent MSD. Voice recognition can function as a good handsfree device for digital pathology and could be considered in physical disability situations. Further studies using electromyography, accelerometry and 3D reconstruction analysis could provide additional ergonomic information

High prevalence of human papillomavirus 16 in penile carcinoma

f Human Papillomavirus (HPV) in penile carcinoma, we studied 49 patients with penile carcinoma. Formalin-fixed, paraffin-embedded tissue samples were collected from 64 samples of penile carcinoma from the Hospital General Universitario (Albacete, Spain). Cases were histologically classified and the polymerase chain reaction (PCR) method was used to detect the presence of HPV. Two sets of consensus primers were used, the My09/My11, and the GP5+/GP6+. All positive cases were sequenced in order to establish the implicated genotype. Our results showed that 38 of the 49 cases were positive for HPV (77,5%). HPV16 appeared in 32 (84,2 %) of the 38 positive cases and HPV18 in 4 (10,5%). Our data demonstrate that the My09/My11 primers are more sensitive than GP5+/GP6+ primers, although the combination of the two sets of primers notably increased the total number of HPV positive cases detected

Hair follicle-containing punch grafts accelerate chronic ulcer healing: A randomized controlled trial

[EN] Background: A prominent role of hair follicle-derived cells in epidermal wound closure is now well established but clinical translation of basic research findings is scarce. Although skin punch grafts have been used as a therapeutic intervention to improve healing of chronic leg ulcers, they are normally harvested from nonhairy areas, thus not taking advantage of the reported role of the hair follicle as a wound-healing promoter. Objective: We sought to substantiate the role of hair follicles in venous leg ulcer healing by transplanting hair follicle-containing versus nonhairy punch grafts. Methods: This was a randomized controlled trial with intraindividual comparison of hair follicle scalp grafts and nonhairy skin grafts transplanted in parallel into 2 halves of the same ulcer. Results: Ulcer healing measured as the average percentage reduction 18 weeks postintervention was significantly increased (P = .002) in the hair follicle group with a 75.15% (SD 23.03) ulcer area reduction compared with 33.07% (SD 46.17) in the control group (nonhairy grafts). Limitations: Sample size was small (n = 12). Conclusion: Autologous transplantation of terminal hair follicles by scalp punch grafts induces better healing than punch grafts harvested from nonhairy areas. Hair punch grafting is a minimally invasive surgical procedure that appears to be effective as a therapeutic tool for chronic venous leg ulcers.Partially funded by grants from the Hospital General Universitario de Albacete.Martínez, M.; Escario, E.; Poblet, E.; Sánchez, D.; Buchón Moragues, FF.; Izeta, A.; Jimenez, F. (2016). Hair follicle-containing punch grafts accelerate chronic ulcer healing: A randomized controlled trial. Journal of the American Academy of Dermatology. 75(5):1007-1014. https://doi.org/10.1016/j.jaad.2016.02.1161S1007101475