Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services.

BACKGROUND: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.

Evaluación del aprendizaje en odontología: incidencia de las concepciones y creencias de los docentes / Learning assessment in dentistry: incidence of teacher's conceptions and beliefs

Objetivo: identificar concepciones y creencias de los docentes con respecto a la eva-luación del aprendizaje dentro de espacios formativos clínicos en la Facultad de Odon-tología de la Universidad del Zulia. Métodos: aplicación del enfoque cualitativo, funda-mentado en la fenomenología descriptiva. Uso de la técnica de frases incompletas en una muestra censal de 56 docentes. Se consideraron dos dimensiones: evaluación que realiza el docente y funciones de la evaluación. Las respuestas fueron codificadas y ca-tegorizadas según su relevancia y recurrencia, asignándoles un nombre que las reuniera y capturara su esencia. Cada categoría se asoció con códigos para ilustrar su repetición en las frases y reconstruir las concepciones implícitas de los docentes. Resultados: la evaluación que realiza el docente puede ser integral, dialógica, formativa, aparente y técnica. Se identificaron las siguientes funciones de la evaluación: comprobatoria, reflexiva, sinérgica, retroalimentadora, valorativa e integradora. Conclusiones: han sido identificadas concepciones y creencias del docente referentes a la evaluación del aprendizaje en ambientes clínicos que aportan una amplia visión en torno a este proceso elemental de la práctica educativa. Las mismas constituyen un gran avance al develar representaciones mentales convertidas en acción, que inciden positivamente en la comprensión, análisis e interpretación del hecho evaluativo. Aquí no se pretende agotar el estudio sobre la evaluación del aprendizaje, sino animar a que se inicien nue-vas investigaciones como mecanismos para descubrir otras concepciones y patrones de relación. Esto como un intento de aproximación hacia la consecución de un nuevo sistema de evaluación.

Objective: To identify the teachers' conceptions and beliefs regarding learning assessment within clinical training spaces of the Dentistry Faculty at the University of Zulia. Methods: The qualitative approach was applied, based on descriptive phenomenology. The incomplete sentences technique was used in a census sample of 56 teachers. Two dimensions were considered: assessment carried out by the teacher and assessment functions. The responses were coded and categorized according to their relevance and recurrence, assigning them a unifying name to capture their essence. Each category was associated with the codes to illustrate their repetition in the sentences and to reconstruct the teachers' implicit conceptions. Results: The assessment carried out by the teacher can be: comprehensive, dialogical, formative, apparent and technical. The following assessment functions were identified: evidential, reflective, synergistic, feedback, evaluative and integrative. Conclusions:Teachers' conceptions and beliefs on learning assessment within clinical spaces have been identified, providing a broad vision of what happens around this fundamental process of educational practice. They constitute a great advance when unveiling mental representations converted into action, positively influencing the understanding, analysis and interpretation of the assessment fact. It is not intended here to exhaust the study on learning assessment, but rather to encourage new researches to be initiated as a mechanism for discovering other conceptions and relationship patterns, this as an attempt to approach towards the achievement of a new assessment system.

Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.

[Bronchial carcinoid and type 1 multiple endocrine neoplasia syndrome. A case report]. / Carcinoide bronquial y síndrome de neoplasias endocrinas múltiples TIPO 1. Aportación de un caso.

Carcinoid tumours of bronchial origin are rare in type 1 multiple endocrine neoplasia (MEN1) syndrome. The prevalence of histologically confirmed cases is approximately 5-8%, although in more recent studies it is estimated that it could be much higher and a possible relationship with the presence of hypergastrinaemia is suggested. We report a patient with a type 1 MEN syndrome, with no respiratory symptoms, with hypergastrinaemia, and in whom a 5mm diameter nodule was detected in the wall of the left main bronchus by computed tomography. The bronchial biopsy confirmed that it was a typical bronchial carcinoid and the octreoscan showed a single focus of high uptake coinciding with this lesion. A bronchoplastic (sleeve) was performed with extirpation of 3 bronchial rings, which also demonstrated that it was a typical carcinoid.

[Endoscopic treatment of metastasis in the main bronchi from sarcoma: a report of 2 cases]. / Tratamiento endoscópico de metástasis en bronquios principales de sarcoma: aportación de 2 casos.

Leiomyosarcoma is a cancer that can affect the soft tissues or organs. The standard treatment is complete tumor resection. Prognosis is difficult to predict and distant metastases can occur after a long disease-free period. Lung metastases are common but metastasis to the main bronchi with pulmonary atelectasis is very rare. We describe 2 cases of pulmonary atelectasis and obstructive pneumonitis due to metastasis to the main bronchi from leiomyosarcoma of the uterus in one of the patients and leiomyosarcoma of the thigh in the other. Both patients were treated with endoscopic resection. We discuss the role of endoscopic laser treatment in the palliation of symptoms and as an initial procedure before other cancer treatments are started.

[Three cases of primary pulmonary plasmacytoma]. / Plasmocitoma pulmonar primario: aportación de 3 casos.

Extramedullary plasmacytoma is a plasma cell malignancy that most commonly occurs in the upper respiratory tract. Plasmocytoma located in the lung is an unusual finding, and in such cases the disease may be confined to the lung and regional lymph nodes or may be disseminated. When only located in the lower respiratory tract (primary pulmonary plasmacytoma), diagnosis is difficult and is usually based on the excised tissue. We present 3 cases, 2 of which were particularly unusual in that diagnosis was confirmed by bronchial biopsy. Other important findings included the detection of paraprotein in the blood and urine of 2 of the patients, and follow-ups over 10 and 15 years without recurrence of the disease in 2 of the cases.

[Annual review of Archivos de Neumología in interventional pneumology, interstitial diseases and lung transplantation]. / Revista del año de Archivos de Neumología en neumología intervencionista, enfermedades intersticiales y trasplante pulmonar.

A review has been made of original articles on invasive pneumology techniques, interstitial diseases and lung transplantation, published in the Archivos de Bronconeumología during the year 2008. We have selected the publication by Martínez-Olondrins et al on the mediastinal staging of bronchogenic carcinoma by <> transbronchial needle aspiration to highlight the role of this simple, safe and cost-effective technique at a time when aspiration by ultrasound-guided bronchoscopy is profiled as an alternative to staging by mediastinoscopy. Besides its usefulness in the study of lymph nodes, transbronchial needle aspiration increases the overall performance of bronchoscopy by 20%, which means that it should be considered as a basic tool in the study of lung cancer. We also comment on the work by Galvis-Caravajal et al, who describe percutaneous radiofrequency as an alternative to radiotherapy in small lung or metastasic tumours. In diffuse interstitial disease, Morell et al analysed the diagnostic methods in 500 patients with this clinical-radiological presentation in which a definitive diagnosis was achieved in 85%, with 25% of them being obtained by non-invasively. Baloira et al analysed the characteristics of 19 patients with desquamative interstitial pneumonia and respiratory bronchiolitis associated-interstitial lung disease obtained from the National register of Interstitial Diseases.

Proceso didáctico del docente en ambientes de aprendizaje clínico-odontológicos / Didactic process of the teacher in clinical-dental learning environments

Este trabajo tuvo como objetivo analizar la práctica pedagógica del docente en ambientes de aprendizaje clínico-odontológicos. Metodología: Se realizó un estudio descriptivo observacional que consideró los 28 docentes que tienen a su cargo alumnos del cuarto año de la carrera asignados en las clínicas intramuros de la Facultad de Odontología de la Universidad del Zulia; se empleó una guía de observación dirigida hacia la frecuencia de comportamientos pedagógicos, discriminada en seis categorías de análisis y 24 ítems. Se realizó un análisis estadístico descriptivo de los ítems, basado sobre frecuencias absolutas y relativas porcentuales, el cálculo de promedios y desviaciones estándar para permitir calificar cada categoría según la escala de valoración No adecuada, Adecuada y Muy Adecuada. Resultados: las categorías de análisis Explicación y orientación de los objetivos, Utilización de medios de enseñanza y Tratamiento metodológico, pudieron ser calificadas como adecuadas; la Forma de organización de la sesión práctica y las Relaciones interpersonales con los alumnos se calificaron como muy adecuadas. Un comportamiento atípico respecto al resto de las categorías se reflejó en la categoría Evaluación del aprendizaje, calificándose como no adecuada, lo que indica que hay aspectos en los que hay que trabajar para mejorar.

This work had as objective to analyze the pedagogic practice of the teacher in environments of clinical-dental learning. Methodology: It was carried out an observational descriptive study that considered the 28 teachers that are in charge of the fourth year students of the career assigned to private hospitals within the city of the Faculty of Dentistry of Zulia´s University; an observation guide was used directed toward the frequency of pedagogic behaviors, discriminated in six analysis categories and 24 items. A descriptive statistical analysis of the items was carried out, based on absolute and percent absolute and relative frequencies, the calculation of averages and standard deviations to allow qualifying each category according to the valuation scale "Non appropriate", "Appropriate" and "Very Appropriate". Results: the categories of analysis Explanation and orientation of the objectives, Use of teaching means and Methodological treatment, they could be qualified as "appropriate"; the Organization Form of the practical session and the Interpersonal Relationships with the students were qualified as "very appropriate". An atypical behavior regarding the rest of the categories was reflected in the category Learning Evaluation, qualifying as "not appropriate", it indicates that there are aspects in which is necessary to work for improving.

Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis.

INTRODUCTION: Genetic variations may influence clinical outcomes in patients with sepsis. The present study was conducted to evaluate the impact on mortality of three polymorphisms after adjusting for confounding variables, and to assess the factors involved in progression of the inflammatory response in septic patients. METHOD: The inception cohort study included all Caucasian adults admitted to the hospital with sepsis. Sepsis severity, microbiological information and clinical variables were recorded. Three polymorphisms were identified in all patients by PCR: the tumour necrosis factor (TNF)-alpha 308 promoter polymorphism; the polymorphism in the first intron of the TNF-beta gene; and the IL-10-1082 promoter polymorphism. Patients included in the study were followed up for 90 days after hospital admission. RESULTS: A group of 224 patients was enrolled in the present study. We did not find a significant association among any of the three polymorphisms and mortality or worsening inflammatory response. By multivariate logistic regression analysis, only two factors were independently associated with mortality, namely Acute Physiology and Chronic Health Evaluation (APACHE) II score and delayed initiation of adequate antibiotic therapy. In septic shock patients (n = 114), the delay in initiation of adequate antibiotic therapy was the only independent predictor of mortality. Risk factors for impairment in inflammatory response were APACHE II score, positive blood culture and delayed initiation of adequate antibiotic therapy. CONCLUSION: This study emphasizes that prompt and adequate antibiotic therapy is the cornerstone of therapy in sepsis. The three polymorphisms evaluated in the present study appear not to influence the outcome of patients admitted to the hospital with sepsis.

Investigación en pregrado: una propuesta para su inserción en la práctica odontológica / Research in under graduate programs: a proposal for its insertion in dental practice

Este trabajo tuvo como propósito diseñar una propuesta de inserción de las actividades de investigación en el currículo de pregrado de la Facultad de Odontología, específicamente dentro del eje de la Práctica Odontológica. El tipo de studio fue documental, dado el contenido de tipo teórico basada en bibliografías y textos legales que permiten construir el marco de referencia y orientan la práctica. Se plantean diversos aspectos que permiten cumplir la manera operacional esta importante función-misión universitaria, transformándola en una estrategia pedagógica que busque la creación del conocimiento, el abordaje de los problemas de salud bucal y el egresado que queremos que el país demanda. Con la finalidad de orientar la mecánica del contetido de la propuesta, se estructuraron tres dimensiones: dimensión teórico conceptual; que constituye el sustento teórico; dimensión práctica, donde se estructura la propuesta a través de seminarios y dimensión operativa, donde se plantean estrategias y recomendaciones. Bajo la forma de supuestos se esboza una metodología y organización de cuya ejecución se pueden obtener resultados significativos para mejorar el proceso de enseñanza-aprendizaje, mediante la incorporación de la actitud investigativa al quehacer académico de pregrado, superando así la visión escolarizante-profesionalizante del currículo actual.

Report on the incidence of interstitial lung diseases in Spain.

BACKGROUND AND AIM OF THE WORK: Almost no epidemiological data are available on a worldwide basis on the prevalence, incidence or relative frequency of interstitial lung diseases (ILD). We report the results of a registration of ILD by 23 centers of pulmonary medicine in Spain over one year (from October 2000 to September 2001). METHODS: A standardized questionnaire was sent to the centers, together with guidelines for classification and diagnostic evaluation. This questionnaire included questions about the explorations performed to establish the diagnosis. RESULTS: A total of 511 cases were registered. The mean age of the patients was 61 +/- 0.7 (x +/- SEM) yrs. The male to female ratio was 1.2:1. The estimated incidence of ILD was 7.6 per 100,000/year. The most frequent disease was idiopathic pulmonary fibrosis (38.6%), followed in decreasing order by sarcoidosis (14.9%), cryptogenic organizing pneumonia (10.4%), ILD associated with collagen vascular diseases (9.9%) and hypersensitivity pneumonitis (6.6%). In 5.1% of cases ILD was unclassified. HRCT scan was performed in 91.9% of cases, bronchoalveolar lavage in 67.9%, transbronchial lung biopsy in 59.9%, and surgical lung biopsy in 22.7%. CONCLUSIONS: This registration provides interesting information on the occurrence of ILD in Spain and on the procedures used to establish the diagnosis.

Agenda abierta para la educación de las niñas rurales / Open agenda for rural girls education

Documento base que permite informar sobre las condiciones en que viven y estudian las niñas rurales, identifica los principales problemas que afectan el logro de mayores niveles de escolaridad y aprendizaje efectivo, detecta cuestiones e instancias públicas yprivadas de la sociedad. Es un diagnóstico y una parte de propuesta

Protocolos de enfermeria para pacientes con lesion medular traumatica basado en el modelo de autocuidado de Dorothea Orem en el hospital Militar Central de Bogota 1986 / Nursing care protocol for patients with traumatic spinal cord injury, based on Dorothea Orem's selfcare model in Hospital Militar Central, Bogota 1986

Para la elaboracion de este trabajo se planteo como problema de investigacion la aplicabilidad de los elementos del modelo de Dorothea Orem, basados en el autocuidado para la elaboracion de protocolos de enfermeria en la atencion del paciente con lesion medular traumatica. Teniendo en cuenta la anterior apreciacion, se hizo una resena historica de la rehabilitacion desde al antiguedad hasta los ultimos avances en este aspecto. De igual forma se revisaron los diferentes modelos de enfermeria que en una u otra forma podrian tener utilidad en el manejo de estos pacientes, pero la eleccion del modelo se decidio en virtud a que el de Dorothea Orem se orienta mas enfaticamente al autocuidado que es basico en la rehabilitacion de los pacientes objeto de estudio. Dicho modelo fue motivo de revision y analisis, asi como los diferentes niveles de la lesion medular traumatica y sus consecuencias para orientar los protocolos que eran nuestra muestra . Estos componentes del estudio dieron las pautas para la posterior organizacion de los elementos del modelo, que ofrecieron la estructura del marco del instrumento con el cual se recogieron los datos. Con la interpretacion de los resultados que fueron dados en porcentaje, se procedio a elaborar tres protocolos que dan respuesta a los resultados obtenidos, concluyendose que los elementos del modelo de autocuidado de Dorothea Orem, sirven para dar una guia en la planeacion de las acciones a seguir en pacientes con lesion medular traumatica orientadas en los tres sistemas que sugiere la autora. Se sugiere que los protocolos sean ..