Beyond lectures and practical courses: Teaching pharmacology using imaginative pedagogical tools.

Pharmacology has broadened its scope considerably in recent decades. Initially, it was of interest to chemists, doctors and pharmacists. In recent years, however, it has been incorporated into the teaching of biologists, molecular biologists, biotechnologists, chemical engineers and many health professionals, among others. Traditional teaching methods, such as lectures or laboratory work, have been superseded by the use of new pedagogical approaches to enable a better conceptualization and understanding of the discipline. In this article, we present several new methods that have been used in Spanish universities. Firstly, we describe a teaching network that has allowed the sharing of pedagogical innovations in Spanish universities. A European experience to improve prescribing safety is described in detail. The use of popular films and medical TV series in biomedical students shows how these audiovisual resources can be helpful in teaching pharmacology. The use of virtual worlds is detailed to introduce this new approach to teaching. The increasingly important area of the social aspects of pharmacology is also considered in two sections, one devoted to social pharmacology and the other to the use of learning based on social services to improve understanding of this important area. Finally, the use of Objective Structured Clinical Evaluation in pharmacology allows to know how this approach can help to better evaluate clinical pharmacology students. In conclusion, this article allows to know new pedagogical methods resources used in some Spanish universities that may help to improve the teaching of pharmacology.

Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists.

BACKGROUND: Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function. METHODS: It is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were used. RESULTS: Up to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05). CONCLUSION: The incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively registered.

High levels of alcohol consumption in pregnant women from a touristic area of Southern Spain.

The prevalence of alcohol intake in women who become pregnant is similar to that found in the general population, especially in cases of unplanned pregnancies. Consequently, foetal exposure is high during the period of maximum vulnerability. The present study was carried out to determine the prenatal level of exposure to alcohol in Málaga, a Mediterranean region whose economy is based on the touristic sector (Costa del Sol). A cross-sectional, observational design was used to investigate the consumption of alcohol during pregnancy, based on a self-reporting questionnaire. A total of 451 women in the first, second or third trimesters of pregnancy were recruited. Consumption prevalences in each trimester were 40.7%, 25.5% and 17.1%. A higher educational level was associated with greater exposure to alcohol (risk ratio, 1.87 [1.30-2.69]). These results should alert the providers of obstetric care in touristic areas to the need for the adoption of adequate preventive measures.

[Pain and anxiety in pediatric surgery]. / Dolor y ansiedad en cirugía pediátrica.

INTRODUCTION: Postsurgery pain is a common complaint in children and significant postoperative pain may last for weeks. Severe perisurgery pain may aggravate long-lasting negative effects. In order to prevent harmful effects, children should be provided with effective-secure analgesia. The aim of this work was to determine current practice of postsurgery pain management in children. MATERIAL AND METHODS: An observational prospective study in pediatric patients undergoing surgery in our hospital was performed. Children's (< 14 years old) having elective major surgery and outpatient surgery were collected prospectively. Clinical stage, surgery and anaesthesia procedures, postsurgery analgesia and perioperative complications were recorded. Pain control was measured by an analogic visual scale (AVS) before surgery, in post-anaesthesia recovery unit (PARU), in one-day unit (ODU) and 24 h after surgery (24hU). STATISTICAL ANALYSIS: mean values +/- sem or SD, frequency and percentage of incidence of N cases, t-test, ANOVA of one and several ways, chi-square, correlations of two variables, linear and logistic regressions depending of variables' types. RESULTS: 77 patients with mean age of 5 years old and mean weight of 22 kg were studied. The most frequently employed anesthetic technique was the general one. Forty per cent of the patients were pre-medicated with midazolam. Little pain before surgery is observed and after surgery it is moderate. Anxiety is higher after surgery and immediately after it in the recovery room or the Post Anesthesia Care Unit (PACU), subsequently it diminishes, especially patients with same-day admission surgery. Positive correlations between pain and anxiety intensities were found in each determination done. CONCLUSIONS: Is observed that pain and anxiety round surgery in children had insufficient treatment, reason why we think we should make treatment protocols, adapted at this population, its necessities and the different types of procedures they can be subjected.

Dolor y ansiedad en cirugía pediátrica / Pain and anxiety in pediatric surgery

Introducción. El dolor postoperatorio es una complicación muy frecuente en el paciente pediátrico, tanto en el postquirúrgico inmediato como en los días posteriores. El dolor peri-quirúrgico enlentece y dificulta la evolución postquirúrgica de los pacientes. Para prevenir esta complicación el paciente pediátrico debe ser analgesiado con eficacia y seguridad. El objetivo de este trabajo fue determinar la influencia dela ansiedad presente en el paciente pediátrico previo a la cirugía con respecto a la sensación dolorosa y a la duración e intensidad de la analgesiaperioperatorias. Material y métodos. Se realizó un estudio observacional descriptivo prospectivo en pacientes pediátricos sometidos a cirugía en nuestro centro hospitalario. Se emplearon variables: demográficas, clínicas, quirúrgicas, anestésicas, álgicas, postoperatorias, régimen de ingreso. Los datos se expresan como el valor medio ±sem o ±DE, frecuencia y porcentaje de incidencia de N casos. Las comparaciones entre grupos se realizaron mediante los test de t-student, ANOVA de una y varias vías, chi-cuadrado, correlaciones bivariadas, regresiones lineales y logísticas y función del tipo de variable. Resultados. Se estudiaron 77 pacientes con una edad media de 5años y peso medio de 22 kg. La técnica anestésica más usada fue la anestesia general. Sólo el 40% de los pacientes fue premedicado con midazolam. Se observó que la intensidad de dolor era leve en la fase previa a la cirugía y que tras ésta era moderado. La ansiedad fue más elevada antes de la cirugía y en el postoperatorio inmediato en la sala de recuperación postanestésica (URPA), disminuyendo posteriormente, sobretodo en los pacientes de cirugía mayor ambulatoria. La intensidad del dolor y la ansiedad aparecieron relacionadas positivamente en los tres periodos de seguimiento. Conclusiones. El dolor y la ansiedad periquirúrgicos en los niños están infratratados. Se deberían confeccionar protocolos de tratamiento, adaptados a las características de esta población, en función de sus necesidades y de los diferentes tipos de cirugía a los que pueden ser sometidos (AU)

Introduction. Postsurgery pain is a common complaint in children and significant postoperative pain may last for weeks. Severe perisurgery pain may aggravate long-lasting negative effects. In order to prevent harmful effects, children should be provided with effective-secure analgesia. The aim of this work was to determine current practice of postsurgerypain management in children. Material and methods. An observational prospective study in pediatric patients undergoing surgery in our hospital was performed. Children’s(<14 years old) having elective major surgery and outpatient surgery were collected prospectively. Clinical stage, surgery and anaesthesia procedures, postsurgery analgesia and perioperative complications were recorded. Pain control was measured by an analogic visual scale(AVS) before surgery, in post-anaesthesia recovery unit (PARU), in onedayunit (ODU) and 24 h after surgery (24hU). Statistical analysis: mean values ± sem or SD, frequency and percentage of incidence of N cases,t-test, ANOVA of one and several ways, chi-square, correlations of two variables, linear and logistic regressions depending of variables’ types. Results. 77 patients with mean age of 5 years old and mean weight of 22 kg were studied. The most frequently employed anesthetic technique was the general one. Forty per cent of the patients were pre-medicated with midazolam. Little pain before surgery is observed and after surgery it is moderate. Anxiety is higher after surgery and immediately after it in the recovery room or the Post Anesthesia Care Unit (PACU),subsequently it diminishes, especially patients with same-day admission surgery. Positive correlations between pain and anxiety intensities were found in each determination done. Conclusions. Is observed that pain and anxiety round surgery in children had insufficient treatment, reason why we think we should make treatment protocols, adapted at this population, its necessities and the different types of procedures they can be subjected (AU)