Comprehensive analysis of clinical images contributions for melanoma classification using convolutional neural networks.

BACKGROUND: Timely diagnosis plays a critical role in determining melanoma prognosis, prompting the development of deep learning models to aid clinicians. Questions persist regarding the efficacy of clinical images alone or in conjunction with dermoscopy images for model training. This study aims to compare the classification performance for melanoma of three types of CNN models: those trained on clinical images, dermoscopy images, and a combination of paired clinical and dermoscopy images from the same lesion. MATERIALS AND METHODS: We divided 914 image pairs into training, validation, and test sets. Models were built using pre-trained Inception-ResNetV2 convolutional layers for feature extraction, followed by binary classification. Training comprised 20 models per CNN type using sets of random hyperparameters. Best models were chosen based on validation AUC-ROC. RESULTS: Significant AUC-ROC differences were found between clinical versus dermoscopy models (0.661 vs. 0.869, p < 0.001) and clinical versus clinical + dermoscopy models (0.661 vs. 0.822, p = 0.001). Significant sensitivity differences were found between clinical and dermoscopy models (0.513 vs. 0.799, p = 0.01), dermoscopy versus clinical + dermoscopy models (0.799 vs. 1.000, p = 0.02), and clinical versus clinical + dermoscopy models (0.513 vs. 1.000, p < 0.001). Significant specificity differences were found between dermoscopy versus clinical + dermoscopy models (0.800 vs. 0.288, p < 0.001) and clinical versus clinical + dermoscopy models (0.650 vs. 0.288, p < 0.001). CONCLUSION: CNN models trained on dermoscopy images outperformed those relying solely on clinical images under our study conditions. The potential advantages of incorporating paired clinical and dermoscopy images for CNN-based melanoma classification appear less clear based on our findings.

Use of sacubitril/valsartan in patients with heart failure: evidence from the real world.

BACKGROUND: To characterize the use of sacubitril/valsartan in a group of patients with heart failure in Colombia. RESEARCH DESIGN AND METHODS: Follow-up study of patients with heart failure who started sacubitril/valsartan and were affiliated with the Colombian health system between 2019 and 2021. Sociodemographic, clinical, and pharmacological variables and adherence and persistence of use were identified. RESULTS: A total of 514 patients were identified, with a mean age of 65.7 years, 73.7% of whom started sacubitril/valsartan at low doses, and only 12.5% reached the maximum dose. Adherence was 78.2% and persistence was 56.8% at 1 year of follow-up. The increase in systolic blood pressure (odds ratio (OR): 1.01; 95% CI: 1.00-1.03) and the use of ß-blockers (OR: 2.63; 95% CI: 1.42-4.85) were correlated with a greater persistence, while receiving furosemide (OR: 0.59; 95% CI: 0.39-0.89) and not having received renin - angiotensin - aldosterone system inhibitors in the 3 months before starting sacubitril/valsartan (OR: 0.48; 95% CI: 0.31-0.76) were associated with lower persistence. CONCLUSIONS: The persistence of treatment 1 year after starting sacubitril/valsartan was not high, and a small proportion of patients reached the target dose of the drug. Nontitration of the drug dose was common.

COVID-19 mortality in two waves of the pandemic in Cali, Colombia, before and during vaccination roll-out.

Objective: To describe the variation in COVID-19 mortality among residents of Cali, Colombia, in the second wave of the pandemic, before vaccines, and in the fourth wave, with vaccination roll-out in process, taking into account variables of sex, age group, comorbidities, and interval between onset of symptoms and death, and to estimate the number of deaths averted by vaccination. Methods: A cross-sectional study of second wave and fourth wave deaths and vaccination coverage. The frequencies of attributes of deceased population in the two waves were compared, including comorbidities. Machado's method was used to calculate an estimate of the number of deaths averted in the fourth wave. Results: There were 1 133 deaths in the second wave and 754 deaths in the fourth wave. It was calculated that approximately 3 763 deaths were averted in the fourth wave in Cali in the context of vaccination roll-out. Conclusions: The decline in COVID-19-associated mortality observed supports the continuation of the vaccination program. Given the lack of data to explain other possible reasons for this decline, such as on the severity of novel viral variants, the limitations of the study are discussed.

Telemedicine consultation for emergency patients' attention: a clinical experience from a high complex university hospital from Latin America.

INTRODUCTION: As a result of the new coronavirus pandemic, a highly complex academic hospital in Latin America implemented a telemedicine service for the care of obstetric, pediatric, and adult patients. In 2020, regional emergency services collapsed due to the increase in demand for care, generating the need to open expansion services and seek strategies to provide timely care to consulting patients. OBJECTIVE: We retrospectively describe the clinical experience of patients who consulted the emergency department via telemedicine across a videoconference tool using digital platforms. METHODS: A descriptive study with retrospective data collection was conducted to describe the implementation of the teleconsultation care model for patients. We constructed the clinical process indicators to evaluate the model. RESULTS: A total of 4652 teleconsultations were registered. Telemedicine consultation was above 50% in the country and department and above 90% in Cali city. The average waiting time for care was estimated to be 1:59:52 h. A total of 275 patients were transferred to the emergency room after consultation. The principal reasons for consultation in the institutional telemedicine program were respiratory and gastrointestinal symptoms. Teleconsultations related to SARS-COV 2 infections reported 3775 patients (3127 with unidentified virus and 648 with the identified virus). CONCLUSIONS: Telemedicine is a tool that provides support and guidance to patients who consult emergency departments, reducing barriers to access health care and decreasing emergency department collapse.

Effectiveness, persistence of use, and safety of orlistat and liraglutide in a group of patients with obesity.

BACKGROUND: To determine the effectiveness, persistence of use, adverse reactions, interactions of orlistat and liraglutide taken for weight loss by a group of obese patients in Colombia. RESEARCH DESIGN AND METHODS: A retrospective follow-up study of a cohort of patients with obesity treated with orlistat or liraglutide. Sociodemographic, clinical, and pharmacological variables were identified. The effectiveness for weight loss at 12-16 and 52 weeks, persistence of use, and safety were determined. RESULTS: A total of 294 patients were followed up. At 12-16 weeks after starting orlistat and liraglutide, weight losses of -1.2kg (p=0.002) and -4.1kg (p<0.001) were observed, respectively, and at 52 weeks, reductions of -1.6kg (p=0.208) and -7.8kg (p<0.001) were observed. A total of 8.8% and 31.3% of patients treated with orlistat and liraglutide, respectively, persisted with treatment 1 year after initiation. A total of 17.3% had adverse drug reactions. Older adults with grade II or III obesity who performed physical activity and those treated with liraglutide were more likely to have lost at least 5% of their body weight at 12-16 weeks. CONCLUSION: Orlistat and liraglutide users presented weight loss at 12-16 weeks. However, this effect was greater and sustained with liraglutide, especially when combined with physical activity.

Remote visualization of large-scale genomic alignments for collaborative clinical research and diagnosis of rare diseases.

The Solve-RD project objectives include solving undiagnosed rare diseases (RD) through collaborative research on shared genome-phenome datasets. The RD-Connect Genome-Phenome Analysis Platform (GPAP), for data collation and analysis, and the European Genome-Phenome Archive (EGA), for file storage, are two key components of the Solve-RD infrastructure. Clinical researchers can identify candidate genetic variants within the RD-Connect GPAP and, thanks to the developments presented here as part of joint ELIXIR activities, are able to remotely visualize the corresponding alignments stored at the EGA. The Global Alliance for Genomics and Health (GA4GH) htsget streaming application programming interface (API) is used to retrieve alignment slices, which are rendered by an integrated genome viewer (IGV) instance embedded in the GPAP. As a result, it is no longer necessary for over 11,000 datasets to download large alignment files to visualize them locally. This work highlights the advantages, from both the user and infrastructure perspectives, of implementing interoperability standards for establishing federated genomics data networks.

COVID-19 mortality in two waves of the pandemic in Cali, Colombia, before and during vaccination roll-out / Mortalidad por COVID-19 en dos olas de la pandemia en Cali, Colombia, antes y durante el despliegue de las vacunas / Mortalidade por COVID-19 em duas ondas da pandemia em Cali, Colômbia, antes e durante a disponibilização das vacinas

ABSTRACT Objective. To describe the variation in COVID-19 mortality among residents of Cali, Colombia, in the second wave of the pandemic, before vaccines, and in the fourth wave, with vaccination roll-out in process, taking into account variables of sex, age group, comorbidities, and interval between onset of symptoms and death, and to estimate the number of deaths averted by vaccination. Methods. A cross-sectional study of second wave and fourth wave deaths and vaccination coverage. The frequencies of attributes of deceased population in the two waves were compared, including comorbidities. Machado's method was used to calculate an estimate of the number of deaths averted in the fourth wave. Results. There were 1 133 deaths in the second wave and 754 deaths in the fourth wave. It was calculated that approximately 3 763 deaths were averted in the fourth wave in Cali in the context of vaccination roll-out. Conclusions. The decline in COVID-19-associated mortality observed supports the continuation of the vaccination program. Given the lack of data to explain other possible reasons for this decline, such as on the severity of novel viral variants, the limitations of the study are discussed.

RESUMEN Objetivo. Describir la variación en la mortalidad por COVID-19 en los residentes de Cali, Colombia, en la segunda ola de la pandemia (antes de las vacunas) y en la cuarta ola (durante el despliegue de las vacunas). Se tomaron en cuenta las variables referidas al sexo, grupo de edad, comorbilidades e intervalo entre el inicio de los síntomas y la muerte y se estimó el número de muertes evitadas por la vacunación. Métodos. Estudio transversal sobre las muertes en la segunda y cuarta olas de la pandemia de COVID-19 y la cobertura de vacunación. Se compararon las frecuencias de los atributos correspondientes a la población fallecida durante las dos olas, incluidas las comorbilidades. Se utilizó el método de Machado para estimar el número de muertes evitadas en la cuarta ola. Resultados. Se registraron 1 133 muertes en la segunda ola y 754 en la cuarta. Se calculó que, en el contexto del despliegue de las vacunas, en la cuarta ola se evitaron aproximadamente 3 763 muertes en Cali. Conclusiones. La disminución observada en la mortalidad asociada a la COVID-19 respalda la continuación del programa de vacunación. Dada la falta de datos para explicar otras posibles causas de esta disminución, como puede ser la gravedad causada por las nuevas variantes virales, se analizan las limitaciones del estudio.

RESUMO Objetivo. Descrever a variação da mortalidade por COVID-19 entre residentes de Cali, Colômbia, na segunda onda da pandemia (antes das vacinas) e na quarta onda (com a implantação da vacinação já em andamento), considerando as variáveis sexo, faixa etária, comorbidades e intervalo entre início dos sintomas e óbito, bem como estimar o número de óbitos evitados pela vacinação. Métodos. Estudo transversal de mortes e cobertura vacinal na segunda e quarta ondas da pandemia. Foram comparadas as frequências dos atributos da população que foi a óbito durante as duas ondas, incluindo comorbidades. Foi utilizado o método de Machado para estimar o número de mortes evitadas na quarta onda. Resultados. Houve 1.133 mortes na segunda onda e 754 mortes na quarta onda. Calcula-se que cerca de 3.763 mortes foram evitadas na quarta onda em Cali, no contexto da disponibilização das vacinas. Conclusões. A queda observada na mortalidade associada à COVID-19 apoia a continuidade do programa de vacinação. Considerando a falta de dados para explicar outros possíveis motivos para esta queda, como a gravidade das novas variantes do vírus, discutem-se as limitações do estudo.

Desde la pérdida de la fuerza hasta el compromiso sistémico: serie de casos del síndrome POEMS / From limb weakness to a systemic involvement: Poems syndrome case two report and review of the literature

El síndrome POEMS es un trastorno paraneoplásico raro y poco frecuente, que se presenta principalmente en la sexta década de la vida, caracterizado por el compromiso multisistémico con predominio de neuropatía desmielinizante. Abarca diversas y heterogéneas manifestaciones clínicas y su diagnóstico requiere un alto índice de sospecha. Se presentan dos casos de pacientes que consultaron por cuadros poco frecuentes en los que la pérdida de la fuerza orientó al acercamiento de una afectación multisistémica que concluyó con el diagnóstico de esta enfermedad(AU)

POEMS syndrome is a rare and infrequent paraneoplastic syndrome, which occurs mainly in the sixth decade of life, characterized by multisystem involvement with a predominance of demyelinating neuropathy, which encompasses diverse and heterogeneous clinical manifestations and whose diagnosis requires a high index of suspicion. We present two cases of patients who consulted due to unusual symptoms and whose loss of strength led to an approach due to multisystem involvement that concluded with the diagnosis of this disease(AU)

Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, and several sociodemographic variables, comorbidities and care variables have been associated with complications and mortality. OBJECTIVE: To identify the factors associated with admission to intensive care units (ICUs) and mortality in patients with COVID-19 from 4 clinics in Colombia. METHODS: This was a follow-up study of a cohort of patients diagnosed with COVID-19 between March and August 2020. Sociodemographic, clinical (Charlson comorbidity index and NEWS 2 score) and pharmacological variables were identified. Multivariate analyses were performed to identify variables associated with the risk of admission to the ICU and death (p<0.05). RESULTS: A total of 780 patients were analyzed, with a median age of 57.0 years; 61.2% were male. On admission, 54.9% were classified as severely ill, 65.3% were diagnosed with acute respiratory distress syndrome, 32.4% were admitted to the ICU, and 26.0% died. The factors associated with a greater likelihood of ICU admission were severe pneumonia (OR: 9.86; 95%CI:5.99-16.23), each 1-point increase in the NEWS 2 score (OR:1.09; 95%CI:1.002-1.19), history of ischemic heart disease (OR:3.24; 95%CI:1.16-9.00), and chronic obstructive pulmonary disease (OR:2.07; 95%CI:1.09-3.90). The risk of dying increased in those older than 65 years (OR:3.08; 95%CI:1.66-5.71), in patients with acute renal failure (OR:6.96; 95%CI:4.41-11.78), admitted to the ICU (OR:6.31; 95%CI:3.63-10.95), and for each 1-point increase in the Charlson comorbidity index (OR:1.16; 95%CI:1.002-1.35). CONCLUSIONS: Factors related to increasing the probability of requiring ICU care or dying in patients with COVID-19 were identified, facilitating the development of anticipatory intervention measures that favor comprehensive care and improve patient prognosis.

Encoding mu-opioid receptor biased agonism with interaction fingerprints.

Opioids are potent painkillers, however, their therapeutic use requires close medical monitoring to diminish the risk of severe adverse effects. The G-protein biased agonists of the µ-opioid receptor (MOR) have shown safer therapeutic profiles than non-biased ligands. In this work, we performed extensive all-atom molecular dynamics simulations of two markedly biased ligands and a balanced reference molecule. From those simulations, we identified a protein-ligand interaction fingerprint that characterizes biased ligands. Then, we built and virtually screened a database containing 68,740 ligands with proven or potential GPCR agonistic activity. Exemplary molecules that fulfill the interacting pattern for biased agonism are showcased, illustrating the usefulness of this work for the search of biased MOR ligands and how this contributes to the understanding of MOR biased signaling.

Charge-transfer electronic states in organic solar cells: a TDDFT study.

The prediction of new organic photovoltaic materials in organic solar cells (OSCs) must include a precise description of charge-transfer states because they are involved in electron-transfer processes such as charge separation and charge recombination which govern the device efficiency. Also, as the experimental performance of an optoelectronic device is measured for nonequilibrium nanostructures, computational approaches need models that can incorporate morphology effects. Usually, this aspect is treated by molecular dynamics simulation (MDS) methodologies; however, methodologies and formalisms to calculate the electron-transfer processes are still controversial and sometimes do not connect their information with the phase morphologies. In this work we propose a simple and fast characterization of electron-transfer processes to find the rate constants by analysing the distribution of vertical excitation energies of both local excitation (LE) and charge-transfer (CT) states using TD-DFT calculations in the donor-acceptor pair structures which were extracted from MDS. This proposal assumes that conformational changes are prevented and equilibria are not achieved while the electron-transfer events take effect, and thus the only pathway that connects the LE and CT states is their surface crossing point where an ideal distribution might exist. Different density functionals and dialectric models were tested. The results indicate a close relationship between the proposal and experimental data for electron-transfer events, suggesting the application of this method in the rational design of new photovoltaic materials.

Factors Associated with Survival in Patients Undergoing Invasive Mechanical Ventilation in an Intensive Care Unit in Colombia, 2017-2018: A Retrospective Cohort Study.

BACKGROUND: Critically ill patients are admitted to intensive care units so they can be comprehensively managed and provided with services not covered in general hospital wards, with the aim to increase their chances of survival. These procedures include invasive mechanical ventilation. OBJECTIVE: The aim of this study was to identify the factors associated with survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit of a tertiary-level hospital in Colombia. METHODS: This was a retrospective follow-up study of a cohort of adult patients who required invasive mechanical ventilation in an intensive care unit in San José de Buga Hospital, between 2017 and 2018. Sociodemographic, clinical, and pharmacological variables were identified. Using Cox regression, variables associated with survival and complications were identified. RESULTS: A total of 357 patients were analyzed. The average age was 64.8 ± 18.9 years, and 52.9% were male. The most frequent diagnoses were sepsis/septic shock (38.4%) and trauma (17.4%). The main factors associated with shorter survival were advanced age (HR 0.97; 95% CI 0.96-0.99), a diagnosis of septic shock (HR 0.29; 95% CI 0.18-0.48) or diabetes mellitus at admission (HR 0.57; 95% CI 0.33-0.98), a healthcare-associated infection (HR 0.51; 95% CI 0.33-0.80), and the need for vasopressors (HR 0.36; 95% CI 0.22-0.59). The administration of systemic corticosteroids was associated with a higher probability of survival (HR 1.93; 95% CI 1.15-3.25). CONCLUSIONS: The use of systemic corticosteroids was associated with a greater probability of survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit. The identification of the variables associated with a higher risk of dying should allow care protocols to be improved, thereby extending the life expectancy of these patients.

Effcacy of Manual Therapy in TemporomandibularJoint Disorders and Its Medium-and Long-TermEffects on Pain and Maximum Mouth Opening:A Systematic Review and Meta-Analysis.

The aim of this study was to conduct a systematic review of the medium- and long-term efficacy of manual therapy for temporomandibular joint disorders, alone or in combination with therapeutic exercise. Information was compiled from the PubMed, SCOPUS, Cochrane, SciELO and PEDro databases. The inclusion criteria were established: randomized controlled trials only; participants must present any kind of temporomandibular disorder; the treatments must include manual therapy in at least one of the experimental groups; a minimum of 3 months of follow-up; pain must be one of the primary or secondary outcomes; and the article must be available in English, Spanish, Italian, Portuguese or French. Six documents that fulfilled all the criteria were obtained for analysis, two of them considered low quality and four considered high quality. A significant improvement in pain and mouth opening compared to baseline was observed after manual therapy treatment. Manual therapy seems to be an effective treatment for temporomandibular disorders in the medium term, although the effect appears to decrease over time. However, when complemented with therapeutic exercise, these effects can be maintained in the long term. This review underlines the importance of manual therapy and therapeutic exercise for the medium- and long-term treatment of temporomandibular joint disorders in daily practice.

Market-crash forecasting based on the dynamics of the alpha-stable distribution.

This paper investigates on the alpha-stable distribution capacity to capture the probability of market crashes by means of the dynamic forecasting of its alpha and beta parameters. On the basis of the GARCH-stable model, we design a market crash forecasting methodology that involves three-stepwise procedure: (i) Recursively estimation the GARCH-stable parameters through a rolling window; (ii) alpha-stable parameters forecasting according to a VAR model; and (iii) Crash probabilities forecasting and analysis. The model performance for alternative crash definitions is assessed in terms of different accuracy criteria, and compared with a random walk model as benchmark. Our applications to a wide variety of stock indexes for developed and emerging markets reveals a high degree of accuracy and replicability of the results. Hence the model represents an interesting tool for risk management and the design of early warning systems for future crashes.

Atomistic simulations of bulk heterojunctions to evaluate the structural and packing properties of new predicted donors in OPVs.

Organic photovoltaic materials (OPVs), with low cost and structure flexibility, are of great interest and importance for their application in solar cell device development. However, the optimization of new OPV structures and the study of the structure arrangements and packing morphologies when materials are blended takes time and consumes raw materials, thus theoretical models could be of considerable value. In this work, we performed molecular dynamics simulations of present OPVs to understand the morphological packing of the donor-acceptor (DA) phases and DA heterojunction during evaporation and annealing processes, following inter and intramolecular properties like frontier orbitals, π-π stacking, coordination, distances, angles, and aggregation. Our considered donor molecules were selected from already proved experimental studies and also from predicted optimal compounds, designed through high throughput studies. The acceptor molecule employed in all our studied systems was PCBM ([6,6]-phenyl-C61-butyric acid methyl ester). Furthermore, we also analyze the influence of including different lateral aliphatic chains on the structural properties of the resulting DA packing morphologies. Our results can guide the design of new OPVs and subsequent studies applying charge transport and charge separation models.

Parameterization of prototype organic small molecules suitable for OPVs and molecular dynamics simulations: the BTT and BPT cases.

Organic photovoltaics (OPV) have been theoretically studied within the usual parameters: open circuit voltage (Voc), short circuit current (Jsc), and fill factor (FF). The first two refer mostly to electronic properties, whereas the last contains all other possible contributions to cell efficiency, importantly including molecular geometrical and topological structures, both within a single molecule as amongst a system of molecules. In order to study the effects of molecular morphology of the heterostructures used in OPVs, molecular dynamic simulations (MDS) are imperative, and therefore parameterization of force fields to account for the description of planarity between aromatic rings, both intra- and inter-molecules, is of key importance. In this work, we present quantum mechanical analysis of geometry for the ground, and singlet and triplet excited states, of two simple prototypical molecules used to parametrize the corresponding force-fields. Central for this parameterization is the assignment of local charges within molecules; we studied and compared six different methods to assign atomic charges. With the parameters obtained, we performed molecular dynamics simulations of nanosystems of these molecules. Planarity effects and comparison between different methods for deriving atomic charges are investigated. These results can be applied in future MDS to interpret and characterize charge-transfer models in molecules suitable for OPV design. Graphical Abstract Depiction of a replicated system of BTT and BPT molecules after simulation.

Distribución nerviosa interna del músculo temporal humano: consideraciones anatómicas y quirúrgicas / Internal nervous distribution of the human temporal muscle: anatomical and surgical considerations

Resumen Introducción: Conocer en detalle la inervación interna del músculo temporal humano permite realizar múltiples técnicas quirúrgicas y tratamientos de patologías que involucran al territorio craneofacial. Si bien en la literatura se ha descrito la inervación interna del músculo temporal humano basado en micro-disección directa, la técnica de tinción de Sihler es una herramienta ventajosa para el estudio anatómico ya que permite observar ramos nerviosos pequeños sin perder su relación tridimensional con las fibras musculares. Objetivo: Describir la distribución nerviosa al interior del músculo temporal humano en cadáveres al aplicar el método de Sihler y analizar su asociación anátomo quirúrgica. Materiales y Método: Ocho músculos temporales humanos previamente disecados fueron sometidos al método de tinción de Sihler. Cada una de las muestras se observó bajo lupa estereoscópica y transiluminación; finalmente para su descripción se dividió al músculo en tres regiones. Resultados: Se determinó la presencia de tres troncos nerviosos principales: el temporal profundo anterior, el temporal profundo medio y temporal profundo posterior, los que discurren de profundo a superficial. Además, se observaron ramos colaterales de menor calibre del nervio temporal profundo posterior que en forma de arco comunican las tres regiones del músculo. Conclusión: Se describió una distribución nerviosa interna común para los músculos estudiados en las tres dimensiones del espacio, conocimiento útil para innovar en terapias clínico-quirúrgicas del territorio craneofacial.

Introduction: Knowing in detail the inner innervation of the human temporal muscle allows to perform multiple surgical techniques and treatments of pathologies that involve the craniofacial territory. Although the internal innervation of the human temporal muscle based on direct microdissection has been described in the literature, the Sihler staining technique is an advantageous tool for anatomical study since it allows observing small nerve branches without losing its three-dimensional relationship with muscle fibers. Aim: To describe the nervous distribution within the human temporal muscle in cadavers by applying the Sihler method and analyzing its surgical anatomical association. Materials and Method: Eight previously dissected human temporal muscles were subjected to the Sihler staining method. Each one of the samples was observed under stereoscopic magnification and transillumination, finally for its description the muscle was divided into three regions. Results: The presence of three main nervous trunks was determined: the anterior deep temporal, the deep medium temporal and the posterior deep temporal, those that run from deep to superficial. In addition, collateral branches of lesser caliber of the posterior deep temporal nerve that in the form of an arc communicate the three regions of the muscle were observed. Conclusion: A common internal nervous distribution was described for the muscles studied in the three dimensions of space, useful knowledge to innovate in clinical-surgical therapies of the craniofacial territory.

Effectiveness of SIESTA on Objective and Subjective Metrics of Nighttime Hospital Sleep Disruptors.

We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic "nudges" to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one "SIESTAenhanced unit," nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleeppromoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTAenhanced unit, nighttime room entries dropped by 44% (-6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience.

Diseño de bitácora centrado en el residente: conociendo y mejorando la experiencia de usuario / Design of resident-centered surgical logbook: knowing and improving the user´s experience

Introducción. Las bitácoras quirúrgicas son poco y mal utilizadas en nuestro medio. Bien elaboradas, se convierten en una herramienta útil, tanto para el residente como para la universidad, que permite evaluar el desempeño y tomar medidas cuando se determine necesario. Método. Es un estudio descriptivo de corte transversal en el que se evaluó un antes y un después del uso de la bitácora Logbook como herramienta tecnológica para el registro de procedimientos quirúrgicos. Se hizo una encuesta previa y otra posterior a un periodo de prueba de un mes (abril 2017), y se obtuvieron datos sobre el uso personal de su bitácora y las calificaciones de la herramienta presentada. Resultados. Diecisiete residentes (R1-R4) contestaron la encuesta y participaron en la prueba piloto. Quince de ellos (88,2 %) llevaban bitácora, la gran mayoría de ellos en un medio electrónico. Ocho (50 % de los que la usaban) calificaron como "regular" la experiencia con la bitácora actual y todos estarían dispuesto a adoptar una nueva opción. Solo tres (17,6 %) sabían que el uso de la bitácora es obligatoria en su universidad. Diez (71,4 %) calificaron la herramienta como "excelente" y, cuatro (28,6 %), como "buena". Todos la recomiendan, la continuarían usando y dicen que la herramienta les facilita cumplir con la tarea. Durante el periodo de prueba, 17 médicos usuarios registraron 276 entradas. Discusión. Una herramienta adecuada logra un mejor cumplimiento de los residentes de cirugía, y les facilita una gestión rápida y eficaz de su información, lo que genera conocimiento de su proceso de formación. Hacen falta un periodo mayor y un grupo de estudiantes más amplio, para validar estos datos

Introduction: Surgical logbooks are under- and misused. When used appropriately, they can become helpful tools for both residents and universities, letting the evaluation of progress and performance, so as to take action when indicated. Methods: Cross-sectional, descriptive, observational study evaluating Logbook for surgical case logging. We conducted a pre- and post-test survey (April 2017), and the data obtained reflected how they used their current caselogs and how they graded ours. Results: 17 residents (PGY1-PGY4) took the surveys and used the platform during the test period. Fifteen of them (88.2%) actually registered their cases, mostly on an e-platform. Eight (50%) had an "average" experience with their current tool, and 100% would consider a different option. Only three (17.6%) know it's mandatory to register cases at their University. Ten (71.4%) and four (28.6%) graded our tool as "excellent" or "good". 100% would recommend it to peers, would continue using it and believe it makes them more adherent to registering. During the test period, we had 17 users, and 276 entries were registered. Discussion: An appropriate tool to register procedures allows a better residence adherence. This can be done in an easy and diligent way, so that residents can gain knowledge from their own progress. Larger number of residents and longer periods of time are needed in order to validate our results