Curso electivo para la realización de audiencias sanitarias sobre cáncer por estudiantes de medicina

Introducción: las enfermedades oncológicas se encuentran entre las principales causas de mortalidad tanto en Cuba como en el mundo.Objetivo: implementar un curso electivo para la realización de audiencias sanitarias sobre cáncer por estudiantes de Medicina.Método: se realizó un estudio cuasi-experimental de tipo pre-prueba y pos-prueba, en Ciego de Ávila, de enero 2016 a febrero 2017, en cuatro etapas: caracterización, diseño, valoración y evaluación de efectividad. En la caracterización se realizó un estudio descriptivo en 120 estudiantes de medicina de tercero y quinto año. Se diseñó el curso electivo y valoró por 15 expertos, a través de la metodología Delphi. Para evaluar la efectividad se trabajó con 30 estudiantes de cuarto año de medicina, quienes recibieron el curso y emitieron su criterio sobre el mismo.Resultados: los estudiantes se sentían motivados por aprender sobre el tema e incorporarse a la ejecución de audiencias sanitarias, refirieron no poseer los conocimientos necesarios, identificando el plan de estudio y la falta de cursos electivos limitaciones para su aprendizaje. El curso electivo se concibió como un curso de siete módulos temáticos y fue valorado positivamente por expertos. Tras su aplicación, en la pos-prueba la nota media fue 4,41 puntos con relación a 3,06 en la pre-prueba.Conclusiones: el curso electivo logró satisfacer necesidades de aprendizaje, alcanzó pertinencia e impacto y posibilitó que los estudiantes de Medicina se incorporaran a la ejecución de audiencias sanitarias.Introducción: las enfermedades oncológicas se encuentran entre las principales causas de mortalidad tanto en Cuba como en el mundo.Objetivo: implementar un curso electivo para la realización de audiencias sanitarias sobre cáncer por estudiantes de Medicina.Método: se realizó un estudio cuasi-experimental de tipo pre-prueba y pos-prueba, en Ciego de Ávila, de enero 2016 a febrero 2017, en cuatro etapas: caracterización, diseño, valoración y evaluación de efectividad. En la caracterización se realizó un estudio descriptivo en 120 estudiantes de medicina de tercero y quinto año. Se diseñó el curso electivo y valoró por 15 expertos, a través de la metodología Delphi. Para evaluar la efectividad se trabajó con 30 estudiantes de cuarto año de medicina, quienes recibieron el curso y emitieron su criterio sobre el mismo.Resultados: los estudiantes se sentían motivados por aprender sobre el tema e incorporarse a la ejecución de audiencias sanitarias, refirieron no poseer los conocimientos necesarios, identificando el plan de estudio y la falta de cursos electivos limitaciones para su aprendizaje. El curso electivo se concibió como un curso de siete módulos temáticos y fue valorado positivamente por expertos. Tras su aplicación, en la pos-prueba la nota media fue 4,41 puntos con relación a 3,06 en la pre-prueba.Conclusiones: el curso electivo logró satisfacer necesidades de aprendizaje, alcanzó pertinencia e impacto y posibilitó que los estudiantes de Medicina se incorporaran a la ejecución de audiencias sanitarias

Immunometabolic Profile Associated with Progressive Damage of the Intestinal Mucosa in Adults Screened for Colorectal Cancer: Association with Diet

Environmental factors such as diet and lifestyle have been shown to influence the development of some intestinal mucosal lesions that may be precursors of colorectal cancer (CRC). The presence of these alterations seems to be associated with misbalanced immunological parameter levels. However, it is still unclear as to which immunological parameters are altered in each phase of CRC development. In this work, we aimed to study the potential relationships of immunological and metabolic parameters with diet in a CRC-related lesion context. Dietary information was obtained using an annual semi-quantitative food-frequency questionnaire (FFQ) from 93 volunteers classified via colonoscopy examination according to the presence of intestinal polyps or adenocarcinoma. Cytokines, chemokines, and adipokines were determined from serum samples. We observed a reduction in adiponectin according to the damage to the mucosa, accompanied by an increase and decrease in C-X-C motif chemokine ligand 10 (CXCL10) and resistin, respectively, in CRC cases. The presence of aberrant crypt foci (ACF) in the polyp group was associated with higher tumor necrosis factor-alpha (TNF-α) concentrations. Vegetables were directly correlated with adiponectin and resistin levels, while the opposite occurred with red meat. A bioactive compound, soluble pectin, showed a negative association with TNF-α. Future dietary strategies could be developed to modulate specific immunological parameters in the context of CRC

Impact of the COVID-19 pandemic on vulnerable groups through the gaze of nursing students: an educational project with Photovoice

Número monográfico: Investigação Qualitativa em Saúde: Avanços e Desafios | Investigación Cualitativa en Salud: Avances y Desafíos[ES] Introducción: Las nuevas estrategias de enseñanza de los universitarios sugieren la integración de metodologías dinámicas en las que se trabaje activamente su pensamiento crítico. La fotografía reflexiva o Photovoice se ha utilizado en el ámbito educativo con el fin de formar conocimientos sobre la esfera social. Objetivo: desarrollar un proyecto educativo en la que, a través del Photovoice, se promoviera el pensamiento crítico en estudiantes de enfermería. Métodos: Investigación Acción Participativa, concretamente Photovoice. El proyecto educativo se llevó a cabo en tres contextos diferentes: estudiantes de enfermería de la Universidad de León (España), de Alicante (España) y de Southampton (Reino Unido). El tema elegido: el impacto que la pandemia COVID-19 estaba causando en grupos socioeconómicos bajos y minorías étnicas. Los alumnos salieron a la calle y fotografiaron dicho impacto. Cada fotografía la acompañaron de una explicación (narrativa). Posteriormente en el aula se realizó un grupo de discusión, mediante el que analizaron cualitativamente las fotografías/narrativas, estableciendo categorías. Para representar cada categoría, se seleccionaron fotografías. Finalmente se construyó una exposición fotográfica para promover la reflexión en el resto de la comunidad. Resultados: 84 alumnos participaron del proyecto. Las categorías “hambre”, “sin hogar”, “barrios desfavorecidos”, “trabajando en la calle”, “silencio en las calles” y “minorías étnicas” que emergieron de los datos sirvieron como hilo para que los estudiantes reflexionaran sobre el impacto que la pandemia COVID-19 estaba causando en grupos socioeconómicos bajos y minorías étnicas. Conclusiones: Este proyecto educativo mostró cómo, a través de la herramienta del Photovoice, se promovió el pensamiento crítico en estos estudiantes, en tres contextos diferentes. El Photovoice parece ser una herramienta original, simple y económica para promover pensamiento crítico de los universitarios respecto a las dimensiones sociales y culturales de la salud. Algo muy importante dado que ellos son futuros promotores de cambios de salud de la comunidad.[EN] New teaching strategies for higher education suggest integrating dynamic methodologies. Thus, university students’ critical thinking can be actively worked. Reflective photography or photovoice has been used in the educational field to form knowledge about the social context. Goals: To develop an educational project where critical thinking is promoted in nursing students using photovoice. Methods: Participatory Action Research, specifically photovoice. The educational project was carried out in three different geographical areas: nursing students from the University of León (Spain), Alicante (Spain) and Southampton (United Kingdom). The chosen topic was the impact of COVID-19 pandemic on lower socioeconomic groups and ethnic minorities. The students accessed the community context and photographed this impact. Each photograph was accompanied by an explanation (narrative). Then, a discussion group was conducted in seminars where they analysed the photographs/narratives qualitatively, establishing categories. Photographs were selected to represent each category. Finally, a photographic exhibition was built to promote reflection at the community level. Results: 84 students participated in the project. The categories "hunger", "homeless", "disadvantaged neighbourhoods", "working in the streets", "silence in the streets" and "ethnic minorities" emerged from the data and served as a thread for students to reflect on the impact of COVID-19 pandemic on these vulnerable groups. Conclusions: This educational project, which used the photovoice tool, showed how critical thinking was promoted in students across different countries. Photovoice seems to be an original, simple, and inexpensive tool to encourage university students' critical thinking regarding the social and cultural dimensions of health. This is relevant since they are the future promoters of community health changes.S

Demostraciones prácticas para la promoción de las titulaciones de Grado en Química y Grado en Ingeniería Química

Memoria ID12-0251. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2012-2013

Colaboración universidad/empresa para la promoción de las titulaciones de grado en química y grado en ingeniería química

Memoria ID-0018. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2013-2014

Implementación del método del caso en docencia virtual para asignaturas prácticas y teóricas del Grado en Química y del Grado en Ingeniería Química de la Facultad de Ciencias Químicas

Memoria ID-0073. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2014-2015

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Genomic and immune landscape Of metastatic pheochromocytoma and paraganglioma

The mechanisms triggering metastasis in pheochromocytoma/paraganglioma are unknown, hindering therapeutic options for patients with metastatic tumors (mPPGL). Herein we show by genomic profiling of a large cohort of mPPGLs that high mutational load, microsatellite instability and somatic copy-number alteration burden are associated with ATRX/TERT alterations and are suitable prognostic markers. Transcriptomic analysis defines the signaling networks involved in the acquisition of metastatic competence and establishes a gene signature related to mPPGLs, highlighting CDK1 as an additional mPPGL marker. Immunogenomics accompanied by immunohistochemistry identifies a heterogeneous ecosystem at the tumor microenvironment level, linked to the genomic subtype and tumor behavior. Specifically, we define a general immunosuppressive microenvironment in mPPGLs, the exception being PD-L1 expressing MAML3-related tumors. Our study reveals canonical markers for risk of metastasis, and suggests the usefulness of including immune parameters in clinical management for PPGL prognostication and identification of patients who might benefit from immunotherapy

Guía Mexicana de Práctica Clínica de Inmunoterapia 2011

Existen varias guías internacionales para la práctica clínica de in- munoterapia, que aplican solo parcialmente en México. La primera guía mexicana de inmunoterapia data de 1998

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio