Utilitat de la metodologia de simulació per adquirir competències en habilitats de comunicació

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524Metodología: Se describen los talleres y seminarios de simulación empleados desde el año académico 2010-11 en la Facultad de Medicina de la Universidad de Barcelona, que se ofrecen a los alumnos a partir de 2 año de grado, con el fin de ofrecer a los alumnos de forma transversal la adquisición y refuerzo continuo de competencias en habilidades de comunicación. Siguiendo las definiciones del Libro Blanco de las Facultades de Medicina y de la Guía de la Facultad de Medicina de la UB, se ofrece formación en los siguientes aspectos de la competencia de comunicación: • Escuchar con atención, obtener y sintetizar información pertinente acerca de los problemas que aquejan al enfermo, y comprender el contenido de esta información. • Comunicación de malas noticias • Obtener un consentimiento Informado • Comunicación entre profesionales Se describen el nivel de aprendizaje, el personal docente requerido, la duración de los seminarios o talleres, los objetivos docentes, el material necesario en cada actividad y el año de la formación de grado en que se aplica. Se describe la utilización de la estrategia de feed-back para la autoevaluación de la actividad práctica, empleando grabaciones de los talleres y simulaciones de los grupos de alumnos. Se describe así mismo, las encuestas empleadas para la evaluación por el docente y los compañeros de clase de las actividades de simulación y la metodología empleada de evaluación de los seminarios y su calificación dentro de la nota final de cada asignatura. Finalmente se describen las asignaturas optativas existentes en la Facultad de Medicina de la UB para reforzar las habilidades de comunicación y los planes futuros de desarrollo de actividades formativas complementarias y de refuerzo y las propuestas evaluativas de la competencia

An open-label, 1-year extension study of the long-term safety and efficacy of once-daily OROS® hydromorphone in patients with chronic cancer pain

<p>Abstract</p> <p>Background</p> <p>Opioid analgesics have proven efficacy in the short-term management of chronic cancer pain, but data on their long-term use is more limited. OROS^®hydromorphone is a controlled-release formulation of oral hydromorphone that may be particularly well suited to long-term management of chronic cancer pain because it provides stable plasma concentrations and consistent analgesia with convenient once-daily dosing. The objective of this study (DO-118X) was to characterise the pain control achieved with long-term repeated dosing of OROS^®hydromorphone in patients with chronic cancer pain.</p> <p>Methods</p> <p>In this multicentre, phase III, open-label, single treatment, 1-year extension study, OROS^®hydromorphone was administered to 68 patients with moderate-to-severe chronic cancer pain, who had successfully completed a short-term equivalence study, and whose pain was controlled with a stable dose of medication (≥ 8 mg OROS^®hydromorphone or equivalent controlled-release morphine). Patients were started on the dose of OROS^®hydromorphone equivalent to the opioid dose on which they achieved dose-stable pain control in the equivalence study; dose adjustments were made as necessary and breakthrough pain medication was permitted. Efficacy was assessed with the Brief Pain Inventory (BPI) and patient and investigator global evaluations of treatment effectiveness. No formal statistical analysis was done.</p> <p>Results</p> <p>The mean (standard deviation) duration of exposure to study medication was 139 (129.9) days and the mean (standard deviation) average daily consumption of OROS^®hydromorphone was 43.7 (28.14) mg/day. All scores were maintained at a mild to moderate severity throughout the study; however, BPI scores for pain at its worst, pain at its least, pain on average, pain right now, and pain relief were slightly worsened at end point compared with baseline. Mean BPI pain interference with daily activities and patient and investigator global evaluation scores also remained generally stable. Treatment effectiveness was rated as fair to good throughout the study. The most frequently reported adverse events were nausea (n = 24, 35.3%), constipation (n = 22, 32.4%), and vomiting (n = 15, 22.1%).</p> <p>Conclusion</p> <p>The results of this extension study suggest that long-term repeated dosing with once-daily OROS^®hydromorphone can be beneficial in the continuing management of persistent, moderate-to-severe cancer pain.</p

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution

Albert Tuca1, Ernest Guell2, Emilio Martinez-Losada3, Nuria Codorniu41Cancer and Hematological Diseases Institute, Hospital Cl&amp;iacute;nic de Barcelona, Barcelona, Spain; 2Palliative Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 3Palliative Care Unit, Institut Catal&amp;agrave; Oncologia Badalona, Barcelona, Spain; 4Medical Oncology Department, Institut Catal&amp;agrave; Oncologia L&amp;#39;Hospitalet, Barcelona, SpainAbstract: Malignant bowel obstruction (MBO) is a frequent complication in advanced cancer patients, especially in those with abdominal tumors. Clinical management of MBO requires a specific and individualized approach that is based on disease prognosis and the objectives of care. The global prevalence of MBO is estimated to be 3% to 15% of cancer patients. Surgery should always be considered for patients in the initial stages of the disease with a preserved general status and a single level of occlusion. Less invasive approaches such as duodenal or colonic stenting should be considered when surgery is contraindicated in obstructions at the single level. The priority of care for inoperable and consolidated MBO is to control symptoms and promote the maximum level of comfort possible. The spontaneous resolution of an inoperable obstructive process is observed in more than one third of patients. The mean survival is of no longer than 4&amp;ndash;5 weeks in patients with consolidated MBO. Polymodal medical treatment based on a combination of glucocorticoids, strong opioids, antiemetics, and antisecretory drugs achieves very high symptomatic control. This review focuses on the epidemiological aspects, diagnosis, surgical criteria, medical management, and factors influencing the spontaneous resolution of MBO in advanced cancer patients.Keywords: malignant bowel obstruction, cancer, intestinal obstruction, bowel occlusio

Current methods and trends for assessment of burned body surface and burn depth

William Wilson's Switchback circa 1907

Retinoid X receptors (RXRs) and T3 receptors (T 3Rs) mRNA expression during rat brown adipose tissue development

Tl is a transcriptional activator of the brown adipose tissue (BAT) uncoupJing protein gene (ucp) . Retinoid X receptor (RXR) is the heterodimeric partner of Tl receptor (T lR) in the T 1 response element (TRE) of thyroid hormone target genes. Present study demonstrates that RXRa, RXRj3 and RXRy genes are expressed in the developing BAT. RXRa mRNA expression was high in BAT from 18-day-old fetuses and decreased progressively during development, whereas RXRj3 mRNA levels were unmodified. mRNA levels of RXRy increased sharply between days 18 and 20 of fetal Jife, in concurrence with the onset of ucp gene transcription. Concomitantly, TlR a and ~I mRNA levels were lower in 18-day-old than in 20-day-old fetuses. Our results are compatible with the involvement of RXRs in the regulation of ucp gene transcription by Tl during ontogeny. The highly specific pattem of expression of each RXR isoform suggests a particular role for them in BAT ontogeny.La Tl es un activador transcripcional del gen de la proteína desacopladora (ucp) de tejido adiposo marrón (T AM). Los receptores de Tl (TlR) Y los receptores de retinoide X (RXR) interaccionan como heterodimeros con los elementos de respuesta a Tl (TRE) en los genes diana. Los mRNA de RXRa, RXRj3 y RXRy son detectables en T AM durante el desarrollo en la rata. Los niveles de mRNA de RXRa son altos en TAM de fetos a día 18 y decrecen posteriormente. La expresión de mRNA de RXR~ no varia con el desarrollo. Los niveles de mRNA de RXRy presentan un marcado aumento entre los días 18 y 20 de vida fetal, coincidiendo con el inicio de la transcripción del gen ucp. Paralelamente, los niveles de TlR a y ~I también aumentan entre día 18 y 20. Estos resultados sugieren que los RXRs pueden estar involucrados en la regulación de la transcripción del gen ucp por Tl durante la ontogenia. La alta especi- ficidad de los perfiles de expresión de cada isoforrna RXR es compatible con una función particular para cada uno de ellos en la ontogenia del T AM