Identification and clinical relevance of naturally occurring human CD8+HLA-DR+ regulatory T cells.

The lack of responsiveness to self and non-self Ags is normally maintained by multiple mechanisms, including the suppressive activities of several T cell subsets. In this study, we show that CD8(+) T cells from both adult peripheral blood and umbilical cord blood mononuclear cells constitutively expressing HLA-DR represent a natural human CD8(+) regulatory T cell subset. Their suppressive effect appears to be cell-to-cell contact dependent and may involve CTLA-4 signaling between neighboring T cells. These regulatory T cells can be expanded in vitro and exhibit a suppressive capacity similar to that observed in ex vivo CD8(+)HLA-DR(+) T cells. The high frequency of CD8(+)HLA-DR(+) T cells that we detected in patients with non-small cell lung cancer deserves further work to confirm their putative suppressor effect within the tumor.

[Kolb's learning styles in medical students]. / Estilos de aprendizaje de Kolb en estudiantes de medicina.

The objective of this work was to study the relationship of Kolb's learning styles in academic success or failure in medical students. A prospective cohort study in 116 medical students of a private Argentine university was performed between March 2005 and March 2011. The follow-up included two cut-offs; during 2005-2006 the students' learning styles were determined and five years later, when individuals had to end their career, they were grouped into graduated, delayed or dropped status. At the end of the period, 50% of the students ended successfully, 24.1% abandoned and 25.9% was delayed. Learning styles were assimilator in 60.3% of cases, divergent in 14.7%, accommodator in 6.9%, convergent in 6.0% and undefined in 12.1%. In conclusion, the follow-up during the career demonstrated that convergent or undefined styles had a tendency to abandon the career, while delayed students had a more theoretical and reflexive style than successful individuals. The results observed in convergent students differed from other reports. This difference would be explained by a particular characteristic of the sample or by the teaching and evaluation profile of the university.

Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.

INTRODUCTION: Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation. METHODS: A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies. RESULTS: Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts. CONCLUSIONS: One-third of students expressed high altruistic motivations and should therefore be encouraged during their careers. Better remuneration and the assurance of a position at an urban hospital in the future may tip the choice in favor of underprivileged regions. Since most respondents said that neither government nor medical schools sufficiently encourage the practice of medicine in poor deprived regions, government policy-makers should recommend changes in resource allocation to better promote official proposals and opportunities to work.

[Factors associated with academic success of medical students at Buenos Aires University]. / Factores asociados con el éxito académico de los estudiantes de medicina de la Universidad de Buenos Aires.

The aim of this study was to identify common factors relating to the academic success of medical students who were distinguished with honors at the Buenos Aires University. In 2011, 142 graduates were surveyed; the questionnaire included 59 questions on their sociodemographic environment, living conditions and social integration, motivation to study, learning capacity and health quality during their career. Compared to other students, these distinguished students more often lived in the city, far from their families; had been educated at private or universitary high schools, their economic needs were financed by their parents, who were on the whole professionals. Most of them were single and childless. The possibility of future employment oportunities (work) did not influence their choice of a medical career, academic success was important to them and they believed that success depended largely on personal effort; they knew how to handle anxiety, were sociable but independent and preferred solid experience to abstract conceptuality in order to obtain information. Our conclusion, within the current system of candidate selection, these results serve to calculate the covert self-selection mechanisms during the career, or in a more restrictive regime, to select those likely to reach academic success due to their privileged ambience. The analysis of demographic factors indicates some degree of inequality for socially disadvantaged students. Perhaps, a selection system based only on intellectual abilities would help identify and support the best candidates regardless of their social context.

Choosing surgery as a specialty: opinions of medical students about surgery and surgeons.

INTRODUCTION: Since the number of applicants to residencies in general surgery in Argentina seems to be decreasing, we designed this work with the objective of studying the factors considered undesirable by students when choosing surgery as a specialty. MATERIAL AND METHODS: Between March and April 2012, one-hundred students were surveyed with a structured questionnaire with true/false binary answers in an observational case-control design. The survey contained 26 statements that made reference to characteristics of surgery as a specialty, or about the personality and lifestyle of surgeons, as they could be perceived by students. As a control group the same survey was applied to 20 surgeons who were in contact with the students and that could represent a role model for them during their rotation in surgery. RESULTS: Comparison between students and surgeons showed no difference in most answers, except in «surgery has poor reimbursement¼ (OR: 8,9; P=.0001), «there is not enough job demand¼ (OR: 8,1; P=.015), «surgery restrains intellectual development¼ (OR: 17,5; P=.014), «surgeons have too many non-scheduled activities¼ (OR: 9,36; P=.024), «they have a limited patient-physician relationship¼ (OR: 3,61; P=.009), «they have little time for family¼ (OR: 4,27; P=.036) and «they are exposed to infectious diseases¼ (OR: 5,90; P=.007). CONCLUSIONS: Women would be as interested as men in working as surgeons; a remarkable fact when considering that the surgical specialties have been predominantly filled by men. The fact that surgeons mostly coincide with the views of students means that role models should be reviewed to promote vocations.

[Cardiac surgery stratified by EuroSCORE. Long-term survival]. / Cirugía cardíaca estratificada por EuroSCORE. Supervivencia a largo plazo.

The objective was to explore the usefulness of the logistic EuroSCORE to stratify the long-term survival curves in a sample of patients undergoing cardiac surgery. The 8-year survival of 390 patients undergoing cardiac surgery between 2003 and 2004 was analyzed, according to the basal value of the EuroSCORE, patients were classified into three risk groups: < 5%, 5-14.9% and > 15%. Eight-years Kaplan-Meier's survival after coronary artery bypass grafting divided by the basal EuroSCORE was 83.5% for a basal risk < 5%, 65.2% for a basal risk 5 to 14.9% and 40.0% for a basal risk >15% (p = 0.000); whereas for valve or combined surgery it was 86.1%, 60.0% and 18.2% respectively (p = 0.0000). For all patients, ROC area was 0.759 (p = 0.000), for a EuroSCORE < 5% it was 0.689 (p = 0.002), between 5 and 14.9% it was 0.544 (p = 0.499) and for >15% it was 0.725 (p = 0.067). In conclusion, the logistic EuroSCORE allowed properly stratify the long-term survival curves in a sample of patients undergoing cardiac surgery, both the coronary and valve or combined surgery. Long-term results stratified by risk are a reasonable way to present late postoperative survival.

Tolerance for Uncertainty, Personality Traits and Specialty Choice Among Medical Students.

OBJECTIVE: The objective was to explore the tolerance for uncertainty in its different aspects (risk, ambiguity and complexity) in medical students at different times of their careers, and to relate these tolerance levels with their predominant personality traits and specialty choices. A secondary objective was to build a hypothetical model aimed at explaining the potential relationships of dependency between gender, personality traits, tolerance for uncertainty and specialty choice using a structural equation modeling (SEM) analysis. DESIGN/SETTING/PARTICIPANTS: A prospective cross-sectional study including two cohorts of second-year (n = 155) and sixth-year (n = 157) medical students was performed during 2017 at the Buenos Aires University School of Medicine. Both student cohorts completed instruments assessing tolerance for different types of uncertainty: (1) complexity (Tolerance for Ambiguity scale); (2) risk (Pearson Risk Attitude scale); and (3) ambiguity (Ambiguity Aversion in Medicine scale). Information on age, gender and specialty choice in sixth-year medical students was included, plus the Big Five Inventory-10 (BFI-10) personality test. RESULTS: Sixth-year students showed significantly lower scores than second-year students at tolerance for complexity (p = 0.0003) and ambiguity (p = 0.008). Sixth-year students choosing a surgical specialty were associated with low tolerance for risk and ambiguity, and moderate for complexity. Conversely, students choosing a clinical specialty were related with high tolerance for risk, moderate for ambiguity, and low for complexity. Logistic regression analysis including the uncertainty questionnaires plus BFI-10 categories demonstrated that only the "neuroticism" personality trait was independently associated with a surgical specialty choice (OR: 1.31, 95%CI: 1.03-1.67). The final SEM that best represented the data showed good fit statistics: chi-square (p = 0.108), and RMSEA (p = 0.047). CONCLUSIONS: Tolerance for uncertainty in its different dimensions was associated with personality traits and specialty choice among medical students. A SEM analysis could satisfactorily explain the hypothetical relationships of dependency between gender, personality traits, tolerance for uncertainty, and specialty choice.

Training in statistical analysis reduces the framing effect among medical students and residents in Argentina.

PURPOSE: The framing effect refers to a phenomenon wherein, when the same problem is presented using different representations of information, people make significant changes in their decisions. This study aimed to explore whether the framing effect could be reduced in medical students and residents by teaching them the statistical concepts of effect size, probability, and sampling for use in the medical decision-making process. Methods: Ninety-five second-year medical students and 100 second-year medical residents of Austral University and Buenos Aires University, Argentina were invited to participate in the study between March and June 2017. A questionnaire was developed to assess the different types of framing effects in medical situations. After an initial administration of the survey, students and residents were taught statistical concepts including effect size, probability, and sampling during 2 individual independent official biostatistics courses. After these interventions, the same questionnaire was randomly administered again, and pre- and post-intervention outcomes were compared among students and residents. RESULTS: Almost every type of framing effect was reproduced either in the students or in the residents. After teaching medical students and residents the analytical process behind statistical concepts, a significant reduction in sample-size, risky-choice, pseudo-certainty, number-size, attribute, goal, and probabilistic formulation framing effects was observed. Conclusion: The decision-making of medical students and residents in simulated medical situations may be affected by different frame descriptions, and these framing effects can be partially reduced by training individuals in probability analysis and statistical sampling methods.

Análisis de un curso virtual de metodología y ética profesional de posgrado / Analysis of a postgraduate e-learning course on methodology and professional ethics

Introducción. El objetivo es presentar la experiencia de un curso virtual de metodología de la investigación de la carrera de posgrado de Especialista en Cirugía General. Sujetos y métodos. Diseño del curso observacional descriptivo (no experimental), prospectivo, con análisis retrospectivo y planeamiento educativo durante 2021 a 2023 en modalidad virtual con plataforma digital y criterio de inclusión de ser médicos residentes de 3.er o 4.o año del programa que realizan la carrera de Especialista en Cirugía General. Son dos horas semanales durante 20 semanas consecutivas, divididas en 40 horas teóricas virtuales y 90 horas prácticas presenciales (en total, 130 horas) para elaborar individualmente un proyecto de investigación y su aprobación final en la sede asistencial donde cursa la carrera de especialista. Se requiere asistencia al 75% de las clases y evaluación sumativa mediante examen final virtual de elección múltiple con cuatro opciones de respuesta sobre temas de metodología de la investigación; además, hay una encuesta de satisfacción anónima y voluntaria.Resultados. De 253 inscritos, hubo 222 cursillistas habilitados (87,7%) para rendir examen final virtual al verificar presentismo: 175 aprobaron (78,8%). Al comparar los resultados con un curso presencial previo, no hubo diferencias significativas. El 93% de los encuestados estaba muy satisfecho con la experiencia virtual. Conclusión. La adaptación de un curso de modalidad presencial a otro digital mostró que es posible alcanzar los objetivos sin renunciar a estándares básicos de formación propuestos inicialmente en un planeamiento educativo definido y alcanzarlos como en una enseñanza presencial.(AU)

Introduction: The objective is to present the experience of a virtual course of Research Methodology of the postgraduate career of specialist in general surgery. Subjects and methods: Design of the descriptive observational course (non-experimental), prospective with retrospective analysis and educational planning during 2021 to 2023 in virtual modality with digital platform and inclusion criteria of being resident doctors of 3rd or 4th year of the program who carry out the career of specialist in general surgery; two hours weekly for 20 consecutive weeks, divided into 40 hours virtual theoretical and 90 hours face-to-face practices (a total of 130 hours) to individually develop a research project and its final approval at the healthcare headquarters where you are studying the specialist career. Attendance of 75% of the classes and summative evaluation through virtual final exam of multiple choice with 4 answer options on topics of research methodology. In addition, anonymous and voluntary satisfaction survey. Results: Of 253 enrollees, 222 trainees (87,7%) were authorized to take a virtual final exam when verifying present: 175 passed (78.8%). When comparing the results with a previous face-to-face course, there were no significant differences. 93% of respondents were very satisfied with the virtual experience. Conclusion: Adaptation of a face-to-face course to a digital one proved that it is possible to achieve the objectives without resigning basic training standards initially proposed in a defined educational planning and achieve them as face-to-face teaching.(AU)

Ética en instrumentación quirúrgica / Ethics in surgical instrumentation

Es imprescindible en la práctica de la cirugía no sólo estudiar técnicas e instrumental en profundidad, sino también lo referido a las virtudes y valores morales del grupo humano quirúrgico para proveer una conducta ética intachable en el quirófano. La calidad de asistencia se valora a través del resultado de los servicios propuestos y obtenidos, sin dejar de lado aspectos ético-morales del instrumentador quirúrgico, cuya función principal es no dañar al paciente no sólo desde el punto de vista técnico, sino también desde el moral. Durante la presencia del enfermo en el quirófano siempre se exigen respuestas éticas al coordinar y proporcionar los cuidados para cubrir las necesidades detectadas, ya sean fisiológicas, psicológicas (el miedo, la ansiedad ante la cirugía) e incluso espirituales, pero con respeto a sus creencias y valores morales. El instrumentador, como parte esencial del grupo quirúrgico, debe refinar esos valores personales (por ejemplo, no participar en una cirugía urgente de un delincuente si existe un conflicto de interés), identificar sin sesgos o prejuicios el conocimiento de las leyes y códigos de conducta (evitar el abandono de una persona necesitada) y comprender los valores, creencias y principios éticos de los demás para así tomar una decisión racional ante un dilema principalmente ético. El equipo quirúrgico ostentará tanto los valores científico-técnicos como los personales sin entrar en conflicto con las creencias del paciente, porque, al tomar decisiones moral y éticamente válidas, actuará como protector de los derechos del enfermo en una cirugía.(AU)

In the practice of surgery it is essential not only to study techniques and instruments in depth, but also that referred to the virtues and moral values of the surgical team to provide an impeccable ethical conduct in the operating room. The quality of care is assessed through the result of the services proposed and obtained, without neglecting ethical-moral aspects of the surgical instrumentator whose main function is not to harm the patient not only from the technical point of view but morally. During the presence of the patient in the operating room, ethical responses are always required when coordinating and providing care to cover the needs detected, whether physiological, psychological (fear, anxiety before surgery) or spiritual, but with respect for their beliefs and moral values. The assistant or auxiliary surgical, as an essential part of the surgical team, must refine these personal values (for example, not participate in an urgent surgery of an offender if there is a conflict of interest), identify without bias or prejudice the knowledge of the laws and codes of conduct (avoid abandonment of a person in need) and understand the values, beliefs and ethical principles of others in order to make a rational decision in the face of a mainly ethical dilemma. The surgical team will hold both scientific-technical and personal values with beliefs without conflicting with those of the patient, because when making morally and ethically valid decisions, act as a protector of the rights of the patient in a surgery.(AU)

The Incidence of Overconfidence and Underconfidence Effects in Medical Student Examinations.

BACKGROUND: Overconfidence is the tendency to overestimate the knowledge, capacity, or performance one really possesses. This cognitive bias could be potentially dangerous in medical decision-making, considering the impact it could have on patient health care. The aim of this study was to evaluate the incidence of overconfidence and underconfidence in medical student knowledge on general surgery by using traditional and new statistical approaches. METHODS: During the application of a multiple-choice examination, 251 next-to-graduate medical students were invited to express the accuracy of their responses by choosing their own perceived confidence level for a set of questions. Analysis was done by comparing the difference between percentage of right answers (student's actual knowledge or accuracy) and self-estimated confidence level (student's perceived knowledge or confidence). Overconfidence was defined as a positive difference between confidence and accuracy, and underconfidence as a negative difference. RESULTS: Nearly 12% of students showed significant overconfidence regarding their actual knowledge or accuracy levels. Better students showed a lower overconfidence effect than students with poorer performance. On the other hand, underconfidence was less likely than overconfidence (8.3% of students), and that effect was most frequently found in students who performed better in examinations. CONCLUSIONS: The small proportion of our students exhibiting overconfidence or underconfidence behaviors moderates the need for educational interventions. Nevertheless, promoting prudence in individualized students manifesting overconfidence, and trust in those reporting significant underconfidence could increase the reliability of medical judgment during their future professional life. Overconfidence in individuals with lower scores in examinations may depend on a ceiling-like effect, since worst ranked students have a wider upper margin to manifest their confidence perceptions. The most confident students showed higher scores in examinations than the less confident ones. From this point of view, confidence could be considered an essential ingredient of success in examination performance.

Enseñanza de cirugía por aula invertida en el grado de Medicina durante la pandemia de COVID-19. Estudio preliminar / Flipped classroom surgery in medical students during CoVID-19 pandemic. Preliminary study

Introducción: Ante la persistencia de una pandemia por COVID-19, también se adapta la educación médica a nuevas herramientas didácticas para consolidar estándares básicos de formación. El objetivo fue describir y analizar las características de enseñanza híbrida de cirugía y valorar su aceptación con una encuesta anónima de satisfacción por los alumnos.Sujetos y métodos.Es un diseño observacional descriptivo, transversal, con enseñanza híbrida en un hospital universitario estatal con alumnos cursantes de Cirugía entre el 30 de agosto y el 22 de octubre de 2021. Los estudiantes concurrieron durante dos horas/día, dos veces por semana, para sus actividades prácticas presenciales. Las clases teóricas, grabadas previamente con una duración de dos a cinco horas por día de clase, eran virtuales a través de una plataforma Moodle instalada en el campus de Ciencias Médicas sin restricciones de ningún tipo en cualquier horario y día. La asignatura duró un total de ocho semanas, con cuatro días hábiles a la semana, una carga horaria de 150 horas y un promedio de 30 alumnos por cada comisión (en total, seis comisiones, subdivididas en dos cada una). Se hicieron evaluaciones parciales con elaboración de una historia clínica sobre un tema definido y alternativamente un examen de elección múltiple. Se pedía regularidad, con presencialidad del 80%, y la aprobación de exámenes parciales. El examen final fue una historia clínica y un examen de elección múltiple. Se hizo una encuesta de evaluación de satisfacción anónima y voluntaria.(AU)

Introduction: Given the persistence of a CoVID-19 pandemic, medical education was also adapted to new didactic tools to consolidate basic training standards. The main objective was to describe and analyze the characteristics of surgery hybrid learning and assess their acceptance by students with an anonymous survey of satisfaction.Subjects and methods.Descriptive, cross-sectional observational design with hybrid learning surgery in a state university hospital between August 30 and October 22, 2021. The students attended for 2 hours / day, 2 times a week for their face-to-face practical activities. The theoretical classes were previously recorded with duration of 2 to 5 hours per class day by using a Moodle Platform installed in the Campus of Medical Sciences. Such facility was available without restrictions any time at all. The course lasted a total of 8 weeks, with 4 working days a week, an hourly load of 150 hours and an average of 30 students for each commission (in total 6 commissions, subdivided into 2 each). Partial evaluations thru of writing a clinical History on defined topic and alternatively multiple choice exam were offered. Regularity with 80% presentism and approval of partial exams were considered Final exam with medical history and multiple choice exam. Anonymous and voluntary satisfaction evaluation survey.Results.47 students completed the surveys; 100% considered that the learning objectives proposed were expressly met. Orderly, systematic and accessible thematic organization for 80.5% with new knowledge for 100% and learning approach stimulating study were considered; 100% thought that the concepts acquired will be useful in their professional future. Teacher-student interactivity in this mentioned modality was recognized by 95.7%.(AU)

Enseñanza virtual de cirugía en el grado de Medicina durante la pandemia de COVID-19 / Surgery virtual teaching in the degree during the COVID-19 pandemic

Introducción: La educación médica se adapta ante la aparición de una pandemia como la producida por la COVID-19 para asegurar estándares básicos de formación. Objetivo: Describir y analizar las características de enseñanza virtual de cirugía y evaluar su aceptación con una encuesta de satisfacción por los alumnos. Sujetos y métodos: Diseño observacional retrospectivo, descriptivo, transversal, con enseñanza virtual en dos hospitales con alumnos de Cirugía entre el 13 de marzo y el 27 de julio de 2020. Concurrieron en forma virtual a través de una plataforma de Zoom durante 2-4 horas/día, 40 días hábiles de cada curso, con una carga horaria mínima de 150 horas y diferentes actividades diarias. Tuvieron evaluaciones parciales, con la elaboración de una historia clínica sobre un tema definido o una evaluación virtual oral. Se obtuvo una regularidad con presencialidad del 80% y aprobación de los exámenes parciales. La encuesta de evaluación de satisfacción fue anónima y voluntaria. Resultados: Completaron las encuestas 50 de 67 alumnos (74,6%); el 90% consideró que los objetivos propuestos para el aprendizaje se mencionaron de forma expresa y se cumplieron. La organización temática fue ordenada, sistemática y accesible para el 90%, y aportó nuevos conocimientos para el 100%, con un planteamiento docente que estimulaba el estudio; el 98% piensa que los conceptos adquiridos serán de utilidad en su futuro profesional. Tanto la interactividad docente-alumno como la conectividad virtual, las destacaron el 96 y el 98% de los alumnos. Discusión y conclusiones: Los resultados y el diseño de la encuesta mostraron fortalezas de la enseñanza virtual por calidad académica y metodología usada, lo que permitió incorporar conocimientos. Destaca la necesidad presencial con el docente y el enfermo.(AU)

Introduction: Medical education adapts to the emergence of a CoVID-19 pandemic to ensure basic standards of training. Objective: The characteristics of a virtual surgery teaching model and evaluate its acceptance by students by survey satisfaction. Material and methods: Retrospective, descriptive, cross-cutting observational design, with virtual teaching in two hospitals studying surgery between March 13-July 27, 2020. Virtually through a Zoom Platform for 2-4 hours/day, 40 days of each course with a minimum 150 hours and different daily activities were attended. Partial evaluations with Clinical Record on defined topic or virtual oral evaluation were made. Regularity with 80% presentism and approval of partial examinations. Anonymous and voluntary satisfaction survey was analyzed. Results: 50 out of 67 students (74.6%) completed the surveys; 90% considered that the proposed learning objectives were expressly mentioned. Organization sujects ordered, systematic and accessible for 90% and provided new knowledge for 100%, with teacher training stimulating the study; 98% thinking that the concepts acquired will be useful in their professional future. Teacher-student interactivity as the outstanding virtual connectivity for 96 and 98%. Discussion and conclusions: Results and design of the survey showed strengths of virtual teaching given by academic quality and methodology used that allowed to incorporate knowledge; highlight face-to-face need with the teacher and the surgical patients.(AU)

CoVID - 19 en el Quirófano. ¿Cuál fue el impacto en el personal con el uso de un protocolo de seguridad? / CoVID - 19 in the O.R. was the impact on staff with the security protocol use?

Introducción: La pandemia por Coronavirus originada en 2019 fue reconocida como de alta contagiosidad y se definieron diferentes medidas de prevención de contagio. Objetivo: Evaluar su impacto en el personal de salud actuante en los quirófanos ante patologías quirúrgicas impostergables. Configuración y Diseño: Estudio observacional descriptivo prospectivo con análisis retrospectivo en el área quirúrgica desde 1/julio al 30/septiembre/2020. Material y Métodos: Se implementó́ un listado de verificación CoVID–19, en pacientes a operar sospechosos o confirmados con criterios del Ministerio de Salud de la Nación. Resultados: 582 personas intervinieron en el área quirúrgica para la asistencia de 80 pacientes CoVID–19 positivo. El 74% de los procedimientos se realizó en urgencias. No hubo informes de infección/contagio de los participantes en la atención sanitaria de los pacientes positivos según relevamiento diario realizado por la División Infectologia.Conclusión: Trabajar en forma coordinada con acatamiento de protocolos especiales y equipamiento de protección personal adecuado define las reglas y procedimientos para documentar la no contagiosidad del personal actuante en la asistencia de pacientes CoVID-19 positivos con patologías quirúrgicas.(AU)

Introduction: The Coronavirus pandemic originating in 2019 was recognized as highly contagious and different infection prevention measures were defined. Aims: Was to assess its impact on acting health workers in operating rooms against non- suspend surgical pathologies. Settings and Design: Prospective descriptive observational study with retrospective analysis in the surgical area from 1/July to 30/September/2020. Methods and Material: A CoVID–19 checklist was implemented in patients to be operated on, suspected or confirmed with criteria of the Nation's Ministry of Public Health. Results: 582 people surgically intervened in the operating room area for the assistance of 80 CoVID–19 positive patients. 74% of the procedures were performed in unscheduled emergencies. No reports of infection/contagion of participants in the health care of positive patients according to the daily survey carried out by the Infectology Division. Conclusions: working in a coordinated manner with compliance, special protocols and adequate personal protection equipment manages defining the rules and procedures to certificate the non-contagiousness of workers in the care of CoVID-19 patients positive with surgical pathologies.(AU)

Educación de residentes de cirugía general en un hospital universitario / General surgery resident education at a university hospital

INTRODUCCIÓN: Actualmente se plantean mejoras a los tradicionales sistemas de enseñanza-aprendizaje clinicoquirúrgicos. OBJETIVO: Demostrar un programa de formación basada en competencias durante la práctica clínico quirúrgica supervisada. Sujetos y métodos. Análisis cualitativo observacional (no experimental) seccional-transversal descriptivo del programa de residencia de cirugía general en un hospital universitario estatal con 17 médicos residentes, desde el 1 de junio de 2017 al 31 de mayo de 2018. RESULTADOS: Eficaz desempeño con evaluaciones durante los ateneos didácticos con casos clínicos validados como aceptable por la prueba alfa de Cronbach, así como en quirófanos. CONCLUSIÓN: Cumple con las condiciones exigibles para un proceso formativo con adquisición de una responsabilidad pro-gresiva independiente

INTRODUCTION: Improvements are currently being made to traditional clinical-surgical teaching-learning systems. AIM: To demonstrate a competency-based training program during supervised clinical-surgical practice. Subjects and methods. Descriptive sectional-cross-sectional qualitative analysis of the General Surgery Residence program at a state university hospital with 17 resident physicians from June 1st 2017 to May 31st 2018. RESULTS: Effective performance with evaluations during didactic clinical cases presentation validated as acceptable by the Cronbach's alpha test as well as in operating rooms. CONCLUSION: It sees the conditions required for a training process with acquisition of an independent progressive responsibility

Effects of presenting risk information in different formats to cardiologists. A Latin American survey.

OBJECTIVE: Previous publications demonstrated that the presentation of treatment benefits in terms of relative risk reduction (RRR) rather than in terms of absolute risk reduction (ARR) or number of patients to treat (NNT) might favor the perception of outcome effectiveness. The objective was to perform a cognitive evaluation to assess how the manner in which risks and benefits of screening methods and treatments are presented can affect medical care decision-taking in a sample of cardiologists. METHODS: Four-hundred and six Latin American cardiologists answered a questionnaire reporting the results of clinical trials presented as RRR, ARR or NNT, associated or not to biased graphs. RESULTS: Cardiologists' decision-taking was different when comparing treatment benefits presented as RRR (62.2%) vs. ARR (40.4%) (p=0.000000), and as RRR vs. NNT (44.4%) (p=0.000000). However, their decision-taking was similar when information was presented as NNT or ARR (p=0.073). The inclusion of biased graphs was misinterpreted as an actual data difference (RRR: 61.6% vs. ARR: 14.0%, p=0.000000). CONCLUSIONS: This study demonstrated that Latin American cardiologists could misinterpret statistical data when information of clinical trials is presented in terms of RRR. We emphasize the need to enhance cardiologists' training in quantitative techniques, to improve medical care decision-making.

COVID-19: nueva lista de verificación de cirugía segura / COVID-19: new checklist for safe surgery

INTRODUCCIÓN: Pandemia infectocontagiosa puede afectar a los equipos quirúrgicos actuantes. OBJETIVO: Presentar nuevo listado de verificación de cirugía segura. MÉTODO: Verificación en potenciales pacientes COVID-19 en el uso de instrumentos y vestuario tanto en la entrada como al finalizar el acto quirúrgico registrada en el reverso de la actual lista de verificación por el equipo quirúrgico actuante. CONCLUSIÓN: Aporte para prevención de equipos quirúrgicos actuantes

BACKGROUND: Infected pandemic may affect surgical team. OBJECTIVE: New safe surgery checklist was presented. METHOD: Checklist of safe surgery in potential COVID-19 patients with verification of the equipment surgical and the locker room used at the initial as well as in the removal end of surgical act registered on the back of the current checklist by the operating surgical team. CONCLUSION: Selfless contribution to protect the surgical team

Pandemia COVID-19. Planificación del área quirúrgica e implementación de nuevo listado de verificación para cirugía segura en un hospital universitario / COVID-19 pandemic. Planning for surgery and implementation of a novel surgical safety checklist in an university hospital

RESUMEN Antecedentes: la existencia de la pandemia infectocontagiosa COVID-19 puede afectar a los equipos quirúrgicos y pacientes. Objetivo: describir los cambios introducidos en la estructura y los procesos de una planta quirúrgica a fin de adaptarla a la atención segura de pacientes positivos y sospechosos, así como los resultados iniciales de su implementación. Material y métodos: se realizó un estudio prospectivo, descriptivo, observacional entre el 1° de abril y el 31 de mayo de 2020. Fueron registrados los cambios estructurales y en los procesos de funciona miento adaptados a la atención de pacientes sospechosos y COVID-19 positivos, así como las activida des desarrolladas en dicha área. Resultados: se registró una disminución en el número de cirugías programadas y de urgencia en el período. Entre 173 cirugías de urgencia, hubo 17 pacientes sospechosos (9,8%) y 3 positivos (1,7%), confirmados por la prueba de PCR. No hubo pacientes con resultados ni sospechosos ni confirmados en 136 cirugías programadas. La adhesión al cumplimiento de la lista de verificación fue del 100%. No se registraron contagios entre el personal actuante. Conclusiones: los cambios implementados en la planta quirúrgica permitieron la atención adecuada de pacientes tanto sospechosos como confirmados durante el período, con completa adhesión a las recomendaciones y disminución en el riesgo de transmisión de la enfermedad para dar seguridad a los pacientes y al equipo de salud.

ABSTRACT Background: COVID-19 pandemic may affect the surgical teams and patients. Objective: The aim of this report was to describe the changes introduced in the structure and proces ses of a surgical facility for the safe care of suspected and positive COVID-19 patients, and to describe the initial results of their implementation. Material and methods: We conducted a prospective, descriptive and observational study between April 1 and May 31, 2020. The structural changes and the modifications introduced in the functioning processes within the surgical area of a university hospital adapted to the care of suspected and positi ve COVID-19 patients, and the activities developed in such area were documented. Results: There was a reduction in the number of scheduled and emergency surgeries performed du ring the study period. Of the 173 emergency surgeries, 17 (9.8%) were suspected cases and 3 (1.7%) resulted positive COVID-19 patients confirmed by PCR tests. None of the 136 patients undergoing scheduled surgeries were suspected or confirmed cases. Compliance with the checklist was 100%. There were no infections among the personnel working in the facility. Conclusions: The changes implemented in the surgical facility allowed for adequate care of suspected and confirmed COVID-19 patients during the period, with complete adherence to recommendations and reduced risk of disease transmission in order to provide safety to patients and the health care team.

Implementación del listado de verificación preoperatorio de enfermería para cirugía segura / Nursing preoperative checklist for safe surgery

ANTECEDENTES: La seguridad en la atención de los pacientes es un aspecto prioritario en la organización y funcionamiento de todo sistema de salud. La valoración de enfermería en las salas de internación permite detectar dificultades o problemas en el preoperatorio que pueden poner en riesgo la vida del paciente o el resultado esperado de la intervención. Se deben generar protocolos que garanticen seguridad para los pacientes disminuyendo al máximo los errores. OBJETIVO: Implementar la lista de verificación preoperatoria de enfermería para disminuir los errores en el ingreso de pacientes a quirófanos. LUGAR: Hospital Universitario-. División Quirófanos - Departamento de Cirugía - Dirección de Enfermería. POBLACIÓN: Pacientes internados para cirugías programadas. MÉTODO: Observacional, exploratorio, longitudinal prospectivo con análisis retrospectivo. Implementación preoperatoria de lista de verificación en sala de internación por enfermería. RESULTADOS: En Mayo de 2018 se operaron 355 pacientes en los quirófanos centrales. Hubo 183 errores de un total de 158 cirugías programadas. La falla más frecuente fue el ingreso de pacientes con ropa interior o ropa de cama en 59 (32,2%), seguido por falta de gorro o cofia en 22 (12%), e ingreso de pacientes con prótesis dental en 21 (11,5%). En la segunda etapa aún con la planilla de verificación de enfermería preoperatoria implementada persistieron los errores en un 48 %. CONCLUSIÓN: se deben promover acciones específicas para que los equipos quirúrgicos alcancen de forma sistemática las medidas de seguridad esenciales sin poner en riesgo la vida y bienestar de los pacientes quirúrgicos

BACKGROUND: The safety of patient care is a priority aspect in the organization and functioning of all health systems with direct implications on the quality of care. The assessment of nursing in the internment rooms allows to detect difficulties or problems in the preoperative that can endanger the life of the patient or the expected outcome of the intervention. This is where protocols must be generated to ensure safety for patients, minimizing errors. OBJECTIVE: To implement the pre-operative nursing checklist to reduce errors in the admission of patients to operating room. SETTING: University Hospital. Surgical Division - Department of Surgery - Nursing management. POPULATION: internal patients for scheduled surgeries. METHOD: Observational, exploratory, longitudinal prospective with retrospective analysis. Checklist preoperative nursing implementation. RESULTS: In May 2018, 355 patients were operated in the central operating rooms. 183 errors were found on 158 surgeries scheduled in a first stage. The most frequent failure was the admission of patients with underwear or bedding 59 (32.2%), followed by lack of cap or cap 22 (12%), and admission of patients with dental prosthesis 21 (11.5%). In the second stage, the nursing check list form was implemented but which could reduce the number of errors in the preoperative period to 48%. CONCLUSION: Specific actions should be promoted so that surgical teams systematically reach essential safety measures that jeopardize the life and well-being surgical patients

Presentación oral como evaluación comunicacional del médico residente de cirugía general / Oral presentation as communication evaluation of surgery medical resident

Objetivo: Describir la presentación oral de un caso clínico-quirúrgico en la reunión de un servicio asistencial y el desempeño comunicacional del médico residente. Sujetos y métodos: Estudio observacional descriptivo longitudinal prospectivo, con análisis transversal en diferentes momentos de la presentación de casos clínicos. Participaron 10 médicos residentes de cirugía general en su cuarto año de residencia en un mismo hospital universitario entre el 30 de marzo de 2016 y el 30 de septiembre de 2017. El caso clínico se presentaba oralmente en una reunión general semanal del Servicio de Cirugía General con sólo dos casos clínicos por reunión, sin posibilidad de debate por el médico residente. La evaluación se basaba en la calificación de la presentación oral del caso clínico con seis criterios y cuya verificación de calidad de cada ítem oscilaba entre 1 (deficiente) y 10 (excelente). Hubo un solo evaluador. Resultados: De las 76 presentaciones realizadas, la nota calificadora media obtenida por los médicos residentes fue de 8,2, con claros signos de mejor desempeño al presentar más casos clínicos. Con las notas observadas se creó un listado calificador del desempeño de los médicos residentes en sus distintas actuaciones. La fiabilidad como instrumento de valor fue aceptable (0,76). Conclusión: La presentación oral de un caso clínico por médicos residentes de cirugía es un instrumento de evaluación comunicacional con un elevado grado de validez y fiabilidad debido a los criterios preestablecidos para una evaluación objetiva y efectiva. Mayor cantidad de presentaciones, mayor experiencia y mejor desempeño

Aim: To describe the oral presentation of a clinical case in a meeting and medical resident communication performance. Subjects and methods: Prospective observational study descriptive longitudinal, cross-sectional analysis in different times of clinical cases oral presentation. Ten general surgery resident physicians take part in his 4th year of residence at a university hospital between March 30, 2016 and September 30, 2017. The clinical case was showed in the weekly general meeting of the General Surgery service with oral presentation exclusively two clinical cases were made. Evaluation of medical residents was based on the qualification of the oral presentation of the clinical case through 6 criteria and whose quality of each item check ranged between 1 (poor) and 10 (excellent). There was only one evaluator. Results: From 76 presentations, it is observed that the note obtained by medical residents average oral presentations of clinical cases rating was 8.2, with clear signs of improved performance by presenting more clinical cases. Observed notes created a ranking of the performance of medical residents. Reliability as an instrument of value was acceptable (0.76). Conclusion: The oral presentation of a clinical case for surgery medical resident in a weekly meeting as its performance assessment tool has a high degree of validity and reliability due to objectively and effective criteria evaluation preestablished. More oral presentations, more experience and better performance