Longer is better than shorter: The added value of the seven-day pad test in the post-radical prostatectomy urinary incontinence.

AIMS: To investigate the feasibility and reliability of the seven-day pad test (7DPT), the correlation between 7DPT and 24-hour pad test (24HPT), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire, and the different categorization by the severity of each pad test. Pad weighting tests have been recommended in the evaluation of post-radical prostatectomy urinary incontinence severity, being considered the 24HPT gold standard. Some authors consider that the longer the testing, the better assessment. We propose a self-filled pad weight, the 7DPT. METHODS: A prospective study of incontinent male patients after radical prostatectomy. We carried out the study in two phases. All patients underwent urodynamic study. The first phase evaluated the feasibility and reliability of 7DPT. The second evaluated the correlation between 7DPT, 24HPT, and ICIQ-SF questionnaire in a larger sample. RESULTS: First phase: 32 patients were recruited. Test-retest reliability was excellent, with good agreement between mean 7DPT and 24HPT. The number of pads and mean 7DPT showed a good correlation. Second phase: 72 patients were screened, 51 (71%) met inclusion criteria. Mean 7DPT and 24HPT showed a strong association. Mean 7DPT and 24HPT correlated moderately with ICIQ-SF score. 7DPT and 24HPT agreement with ICIQ-SF groups was slight. As 7DPT captures better days with maximum urinary leakage, up to 12 patients would have been misclassified according to 24HPT (number need to treat for 7DPT was seven). CONCLUSIONS: 7DPT is a feasible and reliable tool to evaluate post-radical prostatectomy urinary incontinence, with a strong correlation with the 24HPT and moderate with the ICIQ-SF.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Neurological Entity?

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disorder of unknown physiopathology with multisystemic repercussions, framed in ICD-11 under the heading of neurology (8E49). There is no specific test to support its clinical diagnosis. Our objective is to review the evidence in neuroimaging and dysautonomia evaluation in order to support the neurological involvement and to find biomarkers serving to identify and/or monitor the pathology. The symptoms typically appear acutely, although they can develop progressively over years; an essential trait for diagnosis is "central" fatigue together with physical and/or mental exhaustion after a small effort. Neuroimaging reveals various morphological, connectivity, metabolic, and functional alterations of low specificity, which can serve to complement the neurological study of the patient. The COMPASS-31 questionnaire is a useful tool to triage patients under suspect of dysautonomia, at which point they may be redirected for deeper evaluation. Recently, alterations in heart rate variability, the Valsalva maneuver, and the tilt table test, together with the presence of serum autoantibodies against adrenergic, cholinergic, and serotonin receptors were shown in a subgroup of patients. This approach provides a way to identify patient phenotypes. Broader studies are needed to establish the level of sensitivity and specificity necessary for their validation. Neuroimaging contributes scarcely to the diagnosis, and this depends on the identification of specific changes. On the other hand, dysautonomia studies, carried out in specialized units, are highly promising in order to support the diagnosis and to identify potential biomarkers. ME/CFS orients towards a functional pathology that mainly involves the autonomic nervous system, although not exclusively.

Alpha and beta noradrenergic mediation of NMDA glutamatergic effects on lordosis behaviour and plasmatic LH concentrations in the primed female rat.

In previous studies we have found that blockade of NMDA (N-Methyl-D-Aspartic-Acid)-type glutamatergic receptor with intracerebroventricular (ICV) selective drugs induces an inhibition of lordosis in ovariectomized (OVX) estrogen primed rats receiving progesterone or luteinizing hormone releasing hormone (LHRH). By the opposite way, stimulation with NMDA in OVX estrogen primed rats induced a significant increase of lordosis. In the present study the action of an alpha1-noradrenergic antagonist, HEAT (BE 2254/2-beta-4-Hydroxyphenyl-Ethyl-Aminomethyl-1-Tetralone), and Metoprolol, a beta-noradrenergic antagonist, were studied injecting them ICV previously to NMDA administration in treated OVX estrogen primed rats. In experiment 1, the enhancing effect on lordosis induced by NMDA at high dose (1 microg) was abolished by HEAT administration (P < 0.001 for 3 and 6 microg), and the LH plasma levels were decreased only with the higher dose (P < 0.05), suggesting that behavioral effects are quite more sensitive to the alpha-blockade than hormonal effects. In experiment 2, enhancing effects on lordosis behavior were not observed with neither the NMDA at low dose (0.5 microg) nor the metoprolol alone (5.71 microg), but a synergism was observed when both were simultaneously administered (P < 0.001). The LH plasma levels were increased by Metoprolol alone (P < 0.05), and powered by the combination with NMDA at low dose (P < 0.01 vs. SAL and NMDA alone); no differences were observed with Metoprolol. LH increase was observed with Metoprolol even without behavioural modifications. These findings strongly suggest that facilitatory and inhibitory effects of NMDA in this model are mediated by alpha- and beta-adrenergic transmission in both, behavioral and hormonal effects.

El ambiente educativo en los contextos de formación médica / The educational environment in the contexts of medical training

El ambiente educativo es el conjunto de estructuras físicas y relaciones humanas en el que se desenvuelve una comunidad educativa, ya sea aula, servicio, facultad u hospital. Los procesos de enseñanza-aprendizaje son interdependientes con el contexto en el que se desarrollan. La evaluación de los ambientes educativos pretende analizar lo que está pasando en un entorno formativo determinado, y su objetivo es proporcionar un cuadro completo y sistemático de lo que está ocurriendo. La calidad del ambiente es un exponente de la calidad del proceso, es decir del curriculum. Dundee Ready Educational Environment Measure es un cuestionario diseñado para medir el ambiente educativo en las carreras de la salud. El cuestionario incluye 50 ítems divididos en 5 subescalas que exploran percepciones acerca del aprendizaje, los profesores, los estudiantes, el clima educacional y la autopercepción social de los estudiantes. Ha demostrado su utilidad para identificar fortalezas y debilidades en un determinado ambiente educativo. La aplicación del cuestionario permite generar un perfil institucional tal y como es percibido por el alumnado. Dado que los entornos clínicos introducen circunstancias muy específicas, se realizó una adaptación resultando el Postgraduate Hospital Educational Environment Measure. Este consta de 40 ítems estructurados en 3 dominios: la percepción de la autonomía, la de la enseñanza y la de apoyo social. Las conclusiones obtenidas con estos cuestionarios pueden orientar a las autoridades responsables de la formación en áreas biomédicas para fundamentar la adopción de medidas que faciliten el aprendizaje, la reflexión, la autocrítica y la toma de decisiones

The educational environment is the set of physical structures and human relationships in which an educational community develops, be it classroom, service, faculty or hospital. The teaching-learning processes are interdependent with the context in which they are developed. The evaluation of educational environments aims to analyze what is happening in a given training environment, and its objective is to provide a complete and systematic picture of what is happening. The quality of the environment is an exponent of the quality of the process, that is, of the curriculum. Dundee Ready Educational Environment Measure is a questionnaire designed to measure the educational environment in health careers. The questionnaire includes 50 items divided into 5 subscales that explore perceptions about learning, teachers, students, the educational climate and students' social self-perception. It has proven useful in identifying strengths and weaknesses in a given educational environment. The application of the questionnaire allows to generate an institutional profile as it is perceived by the students. Due to clinical environments introduce very specific circumstances, an adaptation was made resulting in Postgraduate Hospital Educational Environment Measure. This consists of forty items grouped in 3 domains: the perception of autonomy, teaching, and social support. The conclusions obtained with these questionnaires can guide the authorities responsible for training in biomedical areas to support the adoption of measures that facilitate learning, reflection, self-criticism and decision-making