Gender differences in workplace violence against physicians and nurses in Latin America: a survey from the Interamerican Society of Cardiology.

OBJECTIVES: To evaluate gender differences in workplace violence (WPV) against physicians and nurses in Latin America. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional electronic survey was conducted between January 11 and February 28, 2022. A prespecified gender analysis was performed. RESULTS: Among the 3056 responses to the electronic survey, 57% were women, 81.6% were physicians, and 18.4% were nurses. At least one act of violence was experienced by 59.2% of respondents, with verbal violence being the most common (97.5%). Women experienced more WPV than men (65.8% vs 50.4%; P < 0.001; odds ratio [OR]: 1.89; 95% confidence interval [CI]: 1.63-2.19). Women were more likely to report at least one episode of WPV per week (19.2% vs 11.9%, P < 0.001), to request for psychological help (14.5% vs 9%, P = 0.001) and to experience more psychosomatic symptoms. In addition, women were more likely to report having considered changing their job after an aggression (57.6% vs 51.3%, P = 0.011) and even leaving their job (33% vs 25.7%, P = 0.001). In a multivariate analysis, being a woman (OR: 1.76), working in emergency departments (OR: 1.99), and with COVID-19 patients (OR: 3.3) were independently associated with more aggressive interactions, while older age (OR: 0.95) and working in a private setting (OR: 0.62) implied lower risk. CONCLUSIONS: Women are more likely to experience WPV and to report more psychosomatic symptoms after the event. Preventive measures are urgently needed, with a special focus on high-risk groups such as women.

The family in preventing delirium in the intensive care unit: Scoping review.

INTRODUCTION: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS: A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

Evaluation of data quality in the Spanish EURECCA Esophagogastric Cancer Registry.

BACKGROUND: Although the number of nationwide clinical registries in upper gastrointestinal cancer is increasing, few of them perform regular clinical audits. The Spanish EURECCA Esophagogastric Cancer Registry (SEEGCR) was launched in 2013. The aim of this study was to assess the reliability of the data in terms of completeness and accuracy. METHODS: Patients who were registered (2014-2017) in the online SEEGCR and underwent esophagectomy or gastrectomy with curative intent were selected for auditing. Independent teams of surgeons visited each center between July 2018 and December 2019 and checked the reliability of data entered into the registry. Completeness was established by comparing the cases reported in the registry with those provided by the Medical Documentation Service of each center. Twenty percent of randomly selected cases per hospital were checked during on-site visits for testing the accuracy of data (27 items per patient file). Correlation between the quality of the data and the hospital volume was also assessed. RESULTS: Some 1839 patients from 19 centers were included in the registry. The mean completeness rate in the whole series was 97.8% (range 82.8-100%). For the accuracy, 462 (25.1%) cases were checked. Out of 12,312 items, 10,905 were available for verification, resulting in a perfect agreement of 95% (87.1-98.7%). There were 509 (4.7%) incorrect and 35 (0.3%) missing entries. No correlation between hospital volume and the rate of completeness and accuracy was observed. CONCLUSIONS: Our results indicate that the SEEGCR contains reliable data.

The family in preventing delirium in the intensive care unit: Scoping review. / La familia en la prevención del delirium en la unidad de cuidados intensivos: scoping review.

INTRODUCTION: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS: A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

Management of Psoriasis During Preconception, Pregnancy, Postpartum, and Breastfeeding: A Consensus Statement. / Consenso sobre las actuaciones a seguir durante la edad fértil, el embarazo, el posparto y la lactancia en pacientes con psoriasis.

OBJECTIVE: To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding. METHODS: The nominal group technique and the Delphi method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel. RESULTS: The resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one. CONCLUSIONS: These recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.

Cambios en el desempeño de estudiantes de pensamiento matemático desde la evaluación formativa con un banco de preguntas en línea / Changes in the performance of students of a mathematical thinking course through formative assessment with an online question bank

El uso de entornos digitales en línea en la Universidad Jorge Tadeo Lozano ha permitido implementar una base de preguntas con retroalimentación para apoyar al estudiante en el proceso de aprendizaje en la asignatura Pensamiento Matemático. Se desarrolló un proyecto de innovación pedagógica en dos semestres académicos, con el fin de observar si el uso de una base de preguntas con retroalimentación en línea mejora el proceso de apropiación de los conceptos matemáticos de los estudiantes. Las preguntas que conformaron la base se diseñaron siguiendo indicaciones sobre elaboración de preguntas de múltiples opciones con única respuesta; se utilizaron exámenes modelo con los temas vistos en cada uno de los tres momentos en que se divide un periodo académico de la Universidad; dichas evaluaciones formativas fueron puestas a disposición de los estudiantes dos semanas antes de cada evaluación. Debido al carácter del examen -en línea-, con múltiples intentos y accediendo desde cualquier dispositivo, el estudiante podía preparar sus evaluaciones con mayor autonomía y al ritmo que él estableciera. Se realizaron encuestas, entrevistas y grupos focales para identificar algunas características cualitativas que han permitido realizar ajustes y mejoras a la base de preguntas. Los datos obtenidos de cada modelo de examen y los resultados de los estudiantes durante los semestres fueron analizados estadísticamente. Los resultados, tanto cualitativos como cuantitativos, indican que en general, sí hay mejora en el desempeño y apropiación de los conceptos matemáticos en aquellos estudiantes que acceden a los exámenes en línea frente a aquellos que no los usan.

The use of online digital environments at Jorge Tadeo Lozano University has allowed the implementation of a question bank, with feedback, with the purpose of supporting students in their learning process for the subject of Mathematical Thinking; this subject is taught through lectures and workshops that are interrelated and leaded by different professors, one lecture session and two workshop sessions per week. A pedagogical innovation project was developed along two academic periods with the purpose of observing if the use of this online question bank with feedback improved the appropriation of mathematical concepts. The questions that are part of this bank were designed following recommendations for elaborating multiple choice questions with one answer; the selection of distractors for each question was made following conceptual or procedural reasons, which is where most of the difficulties for students are when solving an evaluation on this subject. For each question a detailed description was made, including conceptual aspects and key features such as type of question, question statement, answer choices, reasons for each choice, key information that must be included in feedback (graphics, concepts, solved examples, etc.), cognitive and conceptual domain, level of difficulty, date of elaboration and revision, name of who elaborated the question and name of who reviewed it. Each question was made available on this bank, located at the Virtual Classrooms System at Jorge Tadeo Lozano University (AVATA is the name of this Learning Management System working over Moodle) and corresponding to the Mathematical Thinking course, organized on folders separated by topics and levels of difficulty, according to the available syllabus of the subject. Evaluation models that gathered the topics covered on each of the three segments that form the academic period were used; such formative assessment was made available for students two weeks before each course evaluation. Due to the features of this evaluation, online, with multiple attempts and accessible from multiple devices, students were able to prepare their evaluations with a higher level of autonomy and at the pace, they would establish. Surveys, interviews and focus groups from students and professors that were part of the Mathematical Thinking course were carried out, with the purpose of identifying qualitative features that could eventually lead to adjustments and improvements to the question bank, although not many students participated in these interviews and surveys. Among the qualitative aspects that were highlighted is the fact that students felt comfortable when using this kind of evaluation, as they did not feel the pressure of the results; they also pointed out the role of workshop professors as a motivating element to consult the question bank in order to prepare the evaluations and strengthen mathematical concepts. The data obtained from each evaluation model and the results from students during the academic periods were analyzed statistically, allowing to conclude that there is a significant difference on course grades, both partial and finals, for students who used the evaluation models and students who did not. Results, both qualitative and quantitative, indicated that in general terms there is an improvement in performance for students who access to these online evaluation models compared to students who don't. In order to continue progressing on the work presented here, it is necessary to feed the bank with more questions, considering the aspects indicated from students and professors and also as a way of expanding the possibilities of randomizing the questions as students use the bank. It is also important to carry out statistical analysis to questions, with the purpose of establishing with better precision their levels of difficulty and the levels of difficulty of the evaluation models themselves.

Cost-effectiveness analysis of imaging strategy for an intensive follow-up of patients with American Joint Committee on Cancer stage IIB, IIC and III malignant melanoma.

BACKGROUND: Many follow-up guidelines for patients with high-risk melanoma include expensive imaging studies, serum biomarkers and regular visits to the dermatologist, with little attention to cost-effectiveness. OBJECTIVES: To establish the cost-effectiveness of chest-abdomen-pelvis computed tomography (CT) and brain magnetic resonance imaging (MRI) in a follow-up protocol for patients at high risk of relapse. METHODS: This was a prospective single-centre cohort study of 290 patients with clinicopathological American Joint Committee on Cancer (AJCC) stage IIB, IIC and III melanoma. Patients had a body CT scan and brain MRI every 6 months and were withdrawn from the study after completing a 5-year follow-up or when metastases were detected. A cost-effectiveness analysis for each follow-up radiological procedure was performed. RESULTS: Patients underwent 1805 body CT scans and 1683 brain MRIs. Seventy-six metastases (26·2%) were identified by CT or MRI. CT scan was cost-effective in the first 4 years (cost-effectiveness ratio €4710·70-€14 437·10/patient with metastasis); brain MRI was cost-effective during the first year (cost-effectiveness ratio €14 090·60/patient with metastasis). Limitations included lack of survival analysis and comparisons with willingness-to-pay thresholds. CONCLUSIONS: Six-monthly CT scan of the chest, abdomen and pelvis is a cost-effective technique for the early detection of metastases in the first 4 years of follow-up in patients with AJCC stage IIC and III melanoma, and in the first 3 years in patients with AJCC stage IIB melanoma. In addition, brain MRI has been shown to be cost-effective only in the first year of follow-up in patients with AJCC stage IIC and III melanoma.

Intraoperative Portal Vein Flow > 123 mL/min Per 100 g Predicts a Better Survival of Patients After Liver Transplantation.

OBJECTIVE: To assess the importance of intraoperative portal vein flow measurement during liver transplantation in relation to postoperative complications and graft and patient survival. MATERIALS AND METHODS: Retrospective review including 291 patients who had all the information and covering a period of 10 years (2007-2017). Using a receiver operating characteristic curve, a cut-off point that would have the greatest impact on the probability of being alive at 5 years was established. In relation to this value, 2 groups were formed (low and high flow) and demographic variables, intraoperative variables, postoperative complications, and graft and patient survival were compared. RESULTS: A portal flow of 123 mL/min per100 g of liver tissue was established (area under the curve = 0.58), obtaining a low-flow (n = 129) and a high-flow group (n = 162). The 2 groups were similar in their preoperative characteristics, except for a higher proportion of preoperative ascites, a higher Model for End-Stage Liver Disease score and a lower weight of donors in the high-flow group. The arterial and portal flows were significantly higher in the high-flow group. In the postoperative period, the high-flow group presented a higher rate of ascites. The 5-year survival rate of patients was significantly higher in the high-flow group (76% vs 84%, P = .03). CONCLUSIONS: Patients undergoing liver transplantation with an intraoperative portal vein flow measurement >123 mL/min per 100 g present a greater 5-year survival rate.

Are There Gender-Dependent Study Habits of Medical Students in Times of the World Wide Web?

This study evaluates how medical students rate the different types of teaching materials and methods available as well as possible gender-specific differences in the use of such materials. In this descriptive, cross-sectional study a questionnaire with short, one-dimensional questions with a 4-step Likert scale was developed by a presurvey within 493 students (4th year) at a University Medical School (January-December 2015). The anonymous survey was performed from July 2016 to February 2017 with 252 students within an orthopaedic surgery course at University Medical School. After exclusion of (1) nonnative speakers and (2) incomplete forms, 233 samples were included. Practical education was regarded as the most important (n=160/68.7%) teaching method followed by Internet research (n=147/63.1%) as the most important teaching material, while traditional frontal teaching (n=19/8.2%) and e-books (n=11/4.7%) ranked last. The evaluation of gender-specific differences in the use of teaching materials showed that female students prefer to highlight text (p<0.0001) as well as a trend to Internet research (p=0.053) and small-group teaching (p=0.057). Despite some gender-specific differences, traditional learning methods retain their importance besides new learning possibilities such as Internet research.

Coherent and incoherent charge transport in linear triple quantum dots.

One of the fundamental questions in quantum transport is how charge transfer through complex nanostructures is influenced by quantum coherence. We address this issue for linear triple quantum dots by comparing a Lindblad density matrix description with a Pauli rate equation approach and analyze the corresponding zero-frequency counting statistics of charge transfer. The impact of decaying coherences of the density matrix due to dephasing is also studied. Our findings reveal that the sensitivity to coherence shown by shot noise and skewness, in particular in the limit of large coupling to the drain reservoir, can be used to unambiguously evidence coherent processes involved in charge transport across triple quantum dots. Our analytical results are obtained by using the characteristic polynomial approach to full counting statistics.

Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study.

PURPOSE: Around a third of node-negative patients with colon cancer experience a recurrence after surgery, suggesting poor staging. Sentinel lymph node techniques combined with immunochemistry could improve colon cancer staging. We prospectively assessed the effect of Sentinel node mapping on staging and survival in patients with non-metastatic colon cancer. METHODS: An observational and prospective study was designed. 105 patients with colon cancer were selected. Patients were classified according to node involvement as: N1, with node invasion detected by the conventional techniques; up-staged, with node invasion detected only by sentinel node mapping; and N0, with negative lymph node involvement by both techniques. Five-year survival and disease-free survival rates were analysed. Multivariate regression analyses were performed to identify prognostic factors for disease-free and overall survival. RESULTS: Sentinel node mapping was successfully applied in 78 patients: 33 % were N1; 24.5 % were up-staged (18 patients with isolated tumour cells and 1 patient with micrometastases); and 42.5 % were N0. N1 patients had the poorest overall 5-year survival (65.4 %) and 5-year disease-free survival (69.2 %) rates compared with the other two groups. No significant 5-year survival differences were observed between N0 patients (87.9 %) and up-staged patients (84.2 %). CONCLUSIONS: Patients up-staged after sentinel node mapping do not have a poorer prognosis than patients without node involvement. Detection of isolated cancer cells was not a poor prognosis factor in these patients.

Survival Outcomes in Liver Transplantation With Elderly Donors: Analysis of Andalusian Transplant Register.

Recently, there has been a large discrepancy between the number of patients on the waiting list for a liver transplant and the availability of deceased donors, with an increase in annual wait list mortality rates. Elderly donor livers are thought to be marginal grafts; however, in recent years, their utilization has constantly increased. The aim of this study is to evaluate the utilization of elderly donors in Andalusia and post-transplant outcomes. This retrospective observational study of 2408 liver transplants, performed in Andalusia between 2000 and 2014, analyzes the outcomes from donors aged 70 plus (n = 423) in terms of survival rates of the graft and the recipient, the type of transplant, donor age, and D-MELD score (product of donor age and preoperative Model for End-stage Liver Disease score). The most frequent indications for transplant were alcoholic cirrhosis (49.2%), hepatitis C cirrhosis (13%), and hepatocellular carcinoma (12.5%). The overall survival at 5 years was 64%, with a significant fall in survival for recipients with a D-MELD greater than 1500 (57%; P = .045). In the 70-year-old-plus donor group, the overall patient survival was 58.4%. The retransplant rate increased proportionately with donor age. In the alcoholic cirrhosis recipient subgroup, the overall survival at 5 years was 67.6% (P < .05) compared with 33.5% in patients with hepatitis C. Use of elderly donors is a safe strategy to reduce the scarcity of donors, provided that a D-MELD score below 1500 is obtained. Retransplant rates increase progressively with donor age. It is necessary to carefully screen recipients of older organs, taking into account that the best results are obtained for alcoholic cirrhosis, negative viral load hepatitis C, and a D-MELD score below 1500.

Antitumoral gene-based strategy involving nitric oxide synthase type III overexpression in hepatocellular carcinoma.

Hepatocellular carcinoma develops in cirrhotic liver. The nitric oxide (NO) synthase type III (NOS-3) overexpression induces cell death in hepatoblastoma cells. The study developed gene therapy designed to specifically overexpress NOS-3 in cultured hepatoma cells, and in tumors derived from orthotopically implanted tumor cells in fibrotic livers. Liver fibrosis was induced by CCl4 administration in mice. The first-generation adenoviruses were designed to overexpress NOS-3 or green fluorescent protein, and luciferase complementary DNA under the regulation of murine alpha-fetoprotein (AFP) and Rous Sarcoma Virus (RSV) promoters, respectively. Both adenovirus and Hepa 1-6 cells were used for in vitro and in vivo experiments. Adenoviruses were administered through the tail vein 2 weeks after orthotopic tumor cell implantation. AFP-NOS-3/RSV-luciferase increased oxidative-related DNA damage, p53, CD95/CD95L expression and caspase-8, -9 and -3 activities in cultured Hepa 1-6 cells. The increased expression of CD95/CD95L and caspase-8 activity was abolished by Nω-nitro-l-arginine methyl ester hydrochloride, p53 and CD95 small interfering RNA. AFP-NOS-3/RSV-luciferase adenovirus increased cell death markers, and reduced cell proliferation of established tumors in fibrotic livers. The increase of oxidative/nitrosative stress induced by NOS-3 overexpression induced DNA damage, p53, CD95/CD95L expression and cell death in hepatocellular carcinoma cells. The effectiveness of the gene therapy has been demonstrated in vitro and in vivo.

Regulation of cell death receptor S-nitrosylation and apoptotic signaling by Sorafenib in hepatoblastoma cells.

Nitric oxide (NO) plays a relevant role during cell death regulation in tumor cells. The overexpression of nitric oxide synthase type III (NOS-3) induces oxidative and nitrosative stress, p53 and cell death receptor expression and apoptosis in hepatoblastoma cells. S-nitrosylation of cell death receptor modulates apoptosis. Sorafenib is the unique recommended molecular-targeted drug for the treatment of patients with advanced hepatocellular carcinoma. The present study was addressed to elucidate the potential role of NO during Sorafenib-induced cell death in HepG2 cells. We determined the intra- and extracellular NO concentration, cell death receptor expression and their S-nitrosylation modifications, and apoptotic signaling in Sorafenib-treated HepG2 cells. The effect of NO donors on above parameters has also been determined. Sorafenib induced apoptosis in HepG2 cells. However, low concentration of the drug (10nM) increased cell death receptor expression, as well as caspase-8 and -9 activation, but without activation of downstream apoptotic markers. In contrast, Sorafenib (10 µM) reduced upstream apoptotic parameters but increased caspase-3 activation and DNA fragmentation in HepG2 cells. The shift of cell death signaling pathway was associated with a reduction of S-nitrosylation of cell death receptors in Sorafenib-treated cells. The administration of NO donors increased S-nitrosylation of cell death receptors and overall induction of cell death markers in control and Sorafenib-treated cells. In conclusion, Sorafenib induced alteration of cell death receptor S-nitrosylation status which may have a relevant repercussion on cell death signaling in hepatoblastoma cells.

Portable gamma camera guidance in sentinel lymph node biopsy: prospective observational study of consecutive cases.

INTRODUCTION: Sentinel lymph node biopsy is the most important tool available for node staging in patients with melanoma. OBJECTIVES: To analyze sentinel lymph node detection and dissection with radio guidance from a portable gamma camera. To assess the number of complications attributable to this biopsy technique. METHODS: Prospective observational study of a consecutive series of patients undergoing radioguided sentinel lymph node biopsy. We analyzed agreement between nodes detected by presurgical lymphography, those detected by the gamma camera, and those finally dissected. RESULTS: A total of 29 patients (17 women [62.5%] and 12 men [37.5%]) were enrolled. The mean age was 52.6 years (range, 26-82 years). The sentinel node was dissected from all patients; secondary nodes were dissected from some. In 16 cases (55.2%), there was agreement between the number of nodes detected by lymphography, those detected by the gamma camera, and those finally dissected. The only complications observed were seromas (3.64%). No cases of wound dehiscence, infection, hematoma, or hemorrhage were observed. CONCLUSIONS: Portable gamma-camera radio guidance may be of use in improving the detection and dissection of sentinel lymph nodes and may also reduce complications. These goals are essential in a procedure whose purpose is melanoma staging.