RESUMEN
La modernización de la sanidad española en las décadas del 60 al 80 del siglo XX fue paralela a la creación y desarrollo de la formación sanitaria especializada (FSE) en España (sistema MIR-Médico Interno Residente). Este sistema fue una traslación del modelo de «aprender trabajando» de EE. UU. El Hospital General de Asturias (Oviedo) en 1963 (por iniciativa de Fernando Alonso Lej de las Casas y Carles Soler Durall) y la Clínica Puerta de Hierro (Madrid) en 1964 (por iniciativa de José María Segovia de Arana), fueron los primeros hospitales en iniciar el sistema MIR en España, que se generalizó en 1972 y se consolidó en 1984 como única vía legal de especialización. Desde entonces la FSE es responsabilidad exclusiva del Sistema Nacional de Salud y está dirigida y regulada por el Ministerio de Sanidad y los Departamentos de Salud de las comunidades autónomas (gobiernos regionales). La universidad española no tiene responsabilidad en la FSE. La formación se garantiza a través de un contrato de trabajo por el que el residente tiene la obligación de prestar un trabajo y el derecho a recibir una formación acorde a lo establecido en los programas nacionales de formación de cada especialidad
The modernisation of the National Health System (NHS) in Spain occurred in parallel with the creation and development of the Postgraduate Medical Education system (medical specialty training system, the so-called "residency system") throughout the 60's to 80's of the 20th century. The system was a translation of the "to learn by working" US model. The Hospital General de Asturias (Oviedo) in 1963 (an initiative by Fernando Alonso Lej de las Casas and Carles Soler Durall), and the Clínica Puerta de Hierro (Madrid) in 1964 (initiative of José María Segovia de Arana), were the first two hospitals to start the Spanish Specialty Training system, which was extended to the whole NHS in 1972, and was legally consolidated in 1984 as the only official specialisation route. Since them, the system continues to be developed by the NHS according to the Ministry of Health and the Departments of Health (Regional Governments) instructions and criteria. The Spanish university has no responsibility in this process. The training is guaranteed through an employment contract, whereby the resident has the obligation to be provided a job and the right to receive training according to the national residency programs of each specialty
Asunto(s)
Humanos , Historia del Siglo XX , Docentes Médicos/historia , Educación de Postgrado en Medicina/historia , Internado y Residencia , Educación de Postgrado en Medicina/métodos , Educación Médica/legislación & jurisprudencia , EspañaRESUMEN
PURPOSE: The aim of this study was to investigate the effects of fibrin glue on the prevention of postoperative peritoneal adhesion to prosthetic materials used in ventral hernia repair. METHODS: Ten pigs were included in this study. The abdomens of the animals were opened by means of a median subumbilical laparotomy to place four prostheses that were cut into square pieces of 4 x 4 cm. The two prostheses in the most cephalic position were polypropylene meshes, and the other two prostheses in a more caudal position were expanded polytetrafluoroethylene prostheses (Dualmesh Plus Corduroy). The prostheses on the right side of each animal were previously impregnated with fibrin glue. After 5 weeks, the animals were reoperated on to assess the quantity and quality (consistency) of the adhesions. RESULTS: There were fewer intraperitoneal adhesions and they were more labile in the case of prostheses impregnated with fibrin glue. Moreover, we also observed that in many of the animals the polypropylene mesh did not show any adhesions, although polypropylene has been considered to be a typical adhesion producing material. CONCLUSIONS: Fibrin glue reduces both the quantity and consistency of adhesions, even in the case of polypropylene meshes.