Digital Quality Resources Resulting from Standardized Program for Rubric Training in Medical Residents.

INTRODUCTION: In the health care area, tuition is an essential part to provide the instrument that proves the graduates have acquired the necessary skills in their specialties. OBJECTIVE: Evaluation of the improvement in quality of resources for residents after standardized digital training program with rubrics. METHODS: Prospective observational study of first year medical residents in seven medical specialties in four different training centers. Five dimensions were considered to scale the quality of medical resident research: Validation of rubric in investigation methodology topics for each block in b-learning mode; initial and ending evaluation; colloquium investigation rubric; results of final investigation; satisfaction survey of 360 degrees. The instruments were validated using the delphi method with a minimum agreement of 0.8. We considered global values greater than 80 points as good quality. RESULTS: 85 medical residents participated and obtained a final average of 80.62 (±9.59), and the satisfaction of the course was qualified as excellent/good in 82.5%. A positive relation was observed between the scope of the evaluation and the level of satisfaction. Mean quality score for the course was good. There is no relationship between the research experience of the students and the final average r = 0.123 (p = 0.291). CONCLUSIONS: The implementation of research seminars in b-learning mode results in improving the education program for health residents after a training program with a rubric system and their acquiring research skills, and, as a consequence, the final product also showed better quality, even when the student did not have any experience in a scientific publication.

Openreuma consensus on the role of nursing in the care of patients with rheumatoid arthritis and diffuse interstitial lung disease / Consenso de Openreuma sobre el papel de la enfermería en el cuidado de pacientes con artritis reumatoide y enfermedad pulmonar intersticial difusa / Consenso Openreuma sobre o papel da enfermagem no cuidado de pacientes com artrite reumatoide e doença pulmonar intersticial difusa

Objective.To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). Methods. The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations. Results.Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%. Conclusion.This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.

Objetivo.Desarrollar recomendaciones prácticas, basadas en la mejor evidencia y experiencia disponible, sobre el manejo de enfermería de los pacientes con artritis reumatoide (AR) y enfermedad pulmonar intersticial (EPI). Métodos. Se utilizó la metodología de consenso en la que un panel de expertos (formado por enfermeras de reumatología, reumatólogos, una psicóloga, una fisioterapeuta y una paciente) definió el ámbito, los usuarios, los temas sobre los que explorar la evidencia y sobre los que emitir recomendaciones. Tres preguntas PICO evaluaron la eficacia y seguridad de la rehabilitación pulmonar y las medidas no farmacológicas para el tratamiento de la tos crónica y el reflujo gastroesofágico mediante la búsqueda de revisiones sistemáticas, excluyendo aquellas cuya calidad era baja, muy baja o críticamente baja, según la herramienta AMSTAR-2. Posteriormente, se hizo una reunión para la formulación de recomendaciones que se presentaron con un resumen de la evidencia a la encuesta Delphi. Resultados.Con los resultados de las revisiones se establecieron 15 recomendaciones cuyo grado de acuerdo osciló entre el 77% y el 100% en la una encuesta Delphi. Tres recomendaciones fueron rechazadas en la segunda ronda: una por la evidencia disponible y los dos restantes se basaron en la opinión de expertos. Las 12 recomendaciones restantes aprobadas se referían a la evaluación del paciente (n=4), a la educación del paciente (n=4) y a la gestión del riesgo (n=4). Conclusión. El conocimiento del consenso Openreumapor parte de enfermería y la aplicación sus 12 recomendaciones basadas en la mejor evidencia y experiencia puede mejorar el seguimiento y el pronóstico de los pacientes con AR que presentan EPI.

Objetivo.Desenvolver recomendações práticas, baseadas na melhor evidência e experiência disponíveis, sobre o manejo de enfermagem de pacientes com artrite reumatoide (AR) e doença pulmonar intersticial (DPI). Métodos.Foi utilizada a metodologia de consenso, com grupo nominal, revisões sistemáticas e levantamento Delphi. O painel de especialistas, formado por enfermeiros reumatologistas, reumatologistas, psicólogo, fisioterapeuta e paciente, definiu o escopo, os usuários, os tópicos sobre os quais explorar as evidências e sobre os quais emitir recomendações. Três questões do PICO avaliaram a eficácia e segurança da reabilitação pulmonar e medidas não farmacológicas para o tratamento da tosse crônica e refluxo gastroesofágico por meio de RS. Aqueles cuja qualidade era baixa, muito baixa ou criticamente baixa, de acordo com a ferramenta AMSTAR-2, foram excluídos. Posteriormente, realizou-se uma reunião para formular recomendações que foram apresentadas com um resumo das evidências ao inquérito Delphi. Resultados. Com os resultados das revisões, foram estabelecidas 15 recomendações cujo grau de concordância entre 77% e 100% foi obtido com uma pesquisa Delphi. Três recomendações foram rejeitadas na segunda rodada. As 12 recomendações referiam-se à avaliação do paciente (n=4); à educação do paciente (n=4); e ao gerenciamento de risco (n=4). Apenas uma recomendação foi baseada nas evidências disponíveis, enquanto as demais foram baseadas na opinião de especialistas. Conclusão. Este documento apresenta uma série de recomendações com o objetivo de melhorar o prognóstico e a qualidade de vida dos pacientes com AR-ILD. O conhecimento da enfermagem e a aplicação dessas recomendações podem melhorar o acompanhamento e o prognóstico de pacientes com AR com DPI.

Openreuma Consensus on the role of nursing in the care of patients with rheumatoid arthritis and diffuse interstitial lung disease.

OBJECTIVES: To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). METHODS: The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations. RESULTS: Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%. CONCLUSIONS: This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.

Auditory effects of recreational and occupational noise exposure among dental students: a cross-sectional study / Efectos auditivos producto de la exposición a ruido recreacional y dental en estudiantes de odontología: un estudio transversal

ABSTRACT Purpose: to determine the auditory effects of noise exposure from recreational and occupational sources among dentistry students. Methods: forty-two dentistry students, routinely exposed to occupational noise, and 72 students from other health science schools were recruited (control group). Audiometric testing, otoacoustic emissions and questionnaires to assess recreational and occupational noise were applied to the sample. The presence of a notch was determined for each participant audiometry´s test based on the criteria proposed by Coles et al. Differences in notch prevalence were analyzed by applying univariate regression models as well as a multivariate model adjusted by covariates. Results: non-significant differences in auditory thresholds between groups were found. The controls exhibited a significantly higher prevalence of a notch at 4 kHz than the group exposed to noise. However, the differences were not statistically significant in the multivariate model adjusted by recreational noise exposure. Conclusions: the occupational noise exposure was not significantly associated to auditory system dysfunction. In addition, the differences in notch prevalence could be related to recreational noise exposure.

RESUMEN Objetivo: determinar los efectos auditivos producto de la exposición a ruido recreacional y ocupacional en estudiantes de Odontología. Métodos: se reclutó a 42 estudiantes de odontología expuestos rutinariamente a ruido ocupacional, y a 72 estudiantes de otras carreras del área de la salud (grupo control). Se evaluó mediante audiometría, emisiones otoacústicas, junto con aplicar cuestionarios para determinar la exposición a ruido ocupacional y recreacional. A partir de los umbrales audiométricos e determinó la presencia de escotoma usando el criterio de Coles et al. Se analizaron las diferencias en prevalencia de escotomas entre los grupos mediante regresiones logísticas, ajustando por otras variables. Resultados: no existieron diferencias significativas en los umbrales audiométricos entre los grupos estudiados. El grupo control mostró mayor prevalencia de escotoma en 4 kHz al ajustar por sexo y edad, sin embargo, dejó de ser significativa al ajustar adicionalmente por exposición a ruido recreacional. Conclusiones: la exposición a ruido ocupacional no se asoció a alteraciones auditivas. Además, las diferencias en prevalencia de escotomas estarían relacionadas a exposición a ruido recreacional.

Prolactin stimulates the vascularisation of the retina in newborn mice under hyperoxia conditions.

The hormone prolactin (PRL) is emerging as an important regulator of ocular blood vessels. PRL is pro-angiogenic and acquires anti-angiogenic properties after undergoing proteolytic cleavage to the PRL fragment, vasoinhibin. The vascularisation of the rodent retina develops after birth when it rapidly expands until completion at the end of the first postnatal week. Exposure of newborn mice to high oxygen levels lowers the rate of blood vessel growth. In the present study, we investigated whether PRL treatment modifies the vascularisation of the retina in newborn mice exposed to high oxygen or to normoxia and whether the retinal conversion of PRL to vasoinhibin may be altered in the neonate. Newborn mice and their nursing mothers were subjected to 75% oxygen or to normoxia from postnatal day (P) 6 to P8 (group 1) or from P2 to P5 (group 2). PRL (2 µg g-1 , i.p., twice a day) or vehicle was injected from P5 to P8 in group 1 and from P1 to P5 in group 2. PRL treatment reduced the retinal inhibition of blood vessel growth and the increase in vascular regression induced by hyperoxia as revealed by immunofluorescence staining of blood vessels and the expression of angiogenesis and apoptosis markers. The pro-angiogenic effect may involve a reduced conversion of PRL to vasoinhibin. Incubation of PRL with retinal extracts showed reduced activity of the PRL-cleaving protease, cathepsin D, in the neonate vs the adult retina that was further reduced under hyperoxia. PRL and the PRL receptor mRNA were expressed at higher levels in the retina at P8 than in the adult, whereas endogenous PRL was undetectable in the circulation at P8. We conclude that PRL has a pro-angiogenic effect in the neonate retina as a result of its reduced conversion to vasoinhibin and that PRL produced by the retina may help promote physiological vascularisation after birth.

Aporte del pediatra en la prevención de la mordida abierta anterior / Contribution of the pediatrician in the prevention of the anterior open bite

Históricamente es bien sabido que la mordida abierta anterior, conocida como la falta de contactos de los dientes anteriores superiores e inferiores es uno de los tipos de maloclusión que, aunque prevenible, afecta a gran parte de la población. La mayoría de los casos está asociada con la presencia de hábitos orales como la deglución atípica, la succión digital y la respiración bucal; así como, en menor proporción, con trastornos hereditarios y congénitos. El odontólogo especialista en ortodoncia es el profesional que tiene la tarea de aplicar el tratamiento correctivo adecuado una vez instalada la mordida abierta anterior ya que la misma afecta no sólo la cavidad bucal, sino también el aspecto facial del paciente, dependiendo de la severidad. Este podrá variar desde tratamientos ortopédicos, tratamientos ortodónticos, inclusive con extracción de premolares hasta cirugía ortognática. Afortunadamente este trastorno se puede prevenir y es el médico pediatra quien conjuntamente con el odontopediatra tiene el mayor peso en este sentido, a través del diagnóstico oportuno de los hábitos parafuncionales mediante una simple evaluación intra y extra oral del paciente. El trabajo preventivo del médico pediatra ayudaría a disminuir notoriamente la morbilidad de la mordida abierta anterior.

It is well known that the anterior open bite, previously known as lack of contact of upper and lower anterior teeth is one of the types of malocclusions that, although preventable, affects a large part of the population. Most cases are associated with the presence of oral habits such as atypical swallowing, thumb sucking and mouth breathing as well as hereditary and congenital disorders in a lesser extent. The dental specialist in orthodontics is the professional who has the task of applying the appropriate treatment after the anterior open bite is installed. According to its severity it not only affects the oral cavity but also the patient's facial appearance. Treatment may range from orthopedic treatments, including orthodontic treatment with premolar mutilation to orthognathic surgery. Fortunately this condition is preventable and it is the pediatrician together with the pediatric dentist who has the greatest importance in regard to the early diagnosis of parafunctional habits through a simple intra and extra oral assessment. The preventive approach of the pediatrician would help reduce the morbidity due to the anterior open bite.

Situación de la formación en las escuelas de enfermería terciarias no universitarias de la República Argentina, 2007 / State of the education in tertiary non university nursing schools of Argentina, 2007

INTRODUCCIÓN: la formación en enfermería en Argentina se realiza en universidades públicas y privadas (título de enfermero/a y de licenciado/a) y en escuelas de enfermería terciarias no universitarias (título de enfermero/a). El informe de la Federación Argentina de Enfermería (FAE. 2004) señala que la formación en enfermería se caracteriza por la falta de un sistema de acreditación profesional y por un diseño curricular que se centra en la enfermedad en detrimento de la salud comunitaria. También refiere la existencia de una deficiente información sobre los programas de formación. OBJETIVOS: el objetivo del estudio fue describir la situación de la formación de las escuelas de enfermería terciarias no universitarias, principalmente a partir de indicadores de estructura, recursos y planes de estudios. MÉTODOS: estudio descriptivo de tipo cuantitativo. Se realizó un relevamiento de las escuelas de enfermería terciarias existentes en Argentina. Posteriormente, se encuestó a los directivos, docentes y alumnos de 66 de los 109 establecimientos identificados, los que fueron seleccionados según criterios de factibilidad y accesibilidad. RESULTADOS: 27 (40,9%) instituciones pertenecían al estado provincial y 39 (59,1%) eran de dependencia privada. El 51% de los directores señaló que los planes de estudios no están orientados hacia la Atención Primaria de la Salud. Sólo el 38% de los establecimientos tienen convenios firmados con universidades estatales o privadas para la obtención del título de licenciado en enfermería. El 76,8% del personal docente posee la licenciatura en enfermería. CONCLUSIONES: los resultados muestran la necesidad de revisar y ordenar los planes de estudio, a través de una formación innovadora, interdisciplinaria, centrada en los intereses de los alumnos y orientada también a las problemáticas de salud comunitaria.

INTRODUCTION: Nursing education in Argentina takes place in public and private universities (title of nurse andlicensed) and nursing school non university tertiary (diploma nurse). The report of the Argentina Federation of Nursing (FAE, 2004) notes that nursing education is characterized by the absence of a system of professional accreditation and a curricula that focuses on the disease at the expenseof community health. He also notes the existence of poor information on training programs. OBJECTIVE: The aim of this study was to describe the situation of vocational nursing school non-university tertiary, mainly based on indicators of structure, resources and curricula. METHODS: A descriptive quantitative study. We conducted a survey of existing tertiary nursing schools in Argentina. Subsequently, we interviewed the principals, teachers and students from 66 of the 109 facilities identified, which were selected on the basis of feasibility and affordability. RESULTS: 27 (40.9%) belonged to the provincial government institutions and 39 (59.1%) were private agency. 51% of the directors noted that the curricula are not oriented towards primary health care. Only 38% of establishments have signed agreements with state and private universities to obtain a bachelor’s degree in nursing. 76.8% of teachers has a degree in nursing. CONCLUSIONS: The results show the need to review and organize the curriculum through innovative training, interdisciplinary, focusing on student interests and aimed also to community health problems.

Situación de la formación en las escuelas de enfermería terciarias no universitarias de la República Argentina, 2007 / State of the education in tertiary non university nursing schools of Argentina, 2007

INTRODUCCION: la formación en enfermería en Argentina se realiza en universidades públicas y privadas (título de enfermero/a y de licenciado/a) y en escuelas de enfermería terciarias no universitarias (título de enfermero/a). El informe de la Federación Argentina de Enfermería (FAE. 2004) señala que la formación en enfermería se caracteriza por la falta de un sistema de acreditación profesional y por un diseño curricular que se centra en la enfermedad en detrimento de la salud comunitaria. También refiere la existencia de una deficiente información sobre los programas de formación. OBJETIVOS: el objetivo del estudio fue describir la situación de la formación de las escuelas de enfermería terciarias no universitarias, principalmente a partir de indicadores de estructura, recursos y planes de estudios. METODOS: estudio descriptivo de tipo cuantitativo. Se realizó un relevamiento de las escuelas de enfermería terciarias existentes en Argentina. Posteriormente, se encuestó a los directivos, docentes y alumnos de 66 de los 109 establecimientos identificados, los que fueron seleccionados según criterios de factibilidad y accesibilidad. RESULTADOS: 27 (40,9%) instituciones pertenecían al estado provincial y 39 (59,1%) eran de dependencia privada. El 51% de los directores señaló que los planes de estudios no están orientados hacia la Atención Primaria de la Salud. Sólo el 38% de los establecimientos tienen convenios firmados con universidades estatales o privadas para la obtención del título de licenciado en enfermería. El 76,8% del personal docente posee la licenciatura en enfermería. CONCLUSIONES: los resultados muestran la necesidad de revisar y ordenar los planes de estudio, a través de una formación innovadora, interdisciplinaria, centrada en los intereses de los alumnos y orientada también a las problemáticas de salud comunitaria (AU)

INTRODUCTION: Nursing education in Argentina takes place in public and private universities (title of nurse andlicensed) and nursing school non university tertiary (diploma nurse). The report of the Argentina Federation of Nursing (FAE, 2004) notes that nursing education is characterized by the absence of a system of professional accreditation and a curricula that focuses on the disease at the expenseof community health. He also notes the existence of poor information on training programs. OBJECTIVE: The aim of this study was to describe the situation of vocational nursing school non-university tertiary, mainly based on indicators of structure, resources and curricula. METHODS: A descriptive quantitative study. We conducted a survey of existing tertiary nursing schools in Argentina. Subsequently, we interviewed the principals, teachers and students from 66 of the 109 facilities identified, which were selected on the basis of feasibility and affordability. RESULTS: 27 (40.9%) belonged to the provincial government institutions and 39 (59.1%) were private agency. 51% of the directors noted that the curricula are not oriented towards primary health care. Only 38% of establishments have signed agreements with state and private universities to obtain a bachelorÆs degree in nursing. 76.8% of teachers has a degree in nursing. CONCLUSIONS: The results show the need to review and organize the curriculum through innovative training, interdisciplinary, focusing on student interests and aimed also to community health problems (AU)

[HIV-infection and its implications on allergic diseases]. / Infección por VIH y sus implicaciones en enfermedades alérgicas.

INTRODUCTION: In 1980 AIDS appeared in the USA in the homosexual community. CHARACTERISTICS OF THE VIRUS: A particle of HIV is formed by two identical RNA chains that are packed within a center of viral proteins, and surrounded by a double layer of fosfolipids derived from the cellular membrane of the host. CLINICAL SYMPTOMS: It starts with a severe infection, evolving in a progressive chronic infection reaching a final phase with a T CD4+ cellular count under 200 cells per mm3, with incident infections, neoplasias, consumption syndrome, renal dysfunction, and degeneration of the central system. CONSEQUENCES IN ALLERGIC REACTION: Reactions to the use of drugs are the most frequent form of hypersensitivity caused by HIV compared to the general population. In this condition, a profile of TH2 cytocines are produced and they induce the synthesis of IgE against the drugs. IgE levels have been related to the progression of this condition. CONCLUSION: The increase of IgE is a risk factor to allergic reactions against these medications, as well as a severity index.

Estudio abierto de la eficiencia y seguridad de la amlodipina en el tratamiento de la isquemia miocárdica sintomática / Clinical study with amlodipine in the treatment of symptomatic angina

En el siguiente estudio de 12 semanas de duración, se seleccionaron 20 pacientes con un cuadro sintomático de cardiopatía isquémica, manifiesta angina pectoris de leve a moderada asociada al ejercicio y con alivio sintomático al utilizar nitroglicerina subingual (NTG) La mayoría de los pacientes se encontraban entre los 51 y 60 años, los cuales 11 eran hombres y 9 mujeres. Fueron evaluados durante 7 sesiones y previa semana basal, tomando en cuenta el número de episodios angiosos, el número de NTG utilizados y limitación de la actividad junto a la eficacia y tolerancia al utilizar amlodipina. Se observó una clara disminución tanto...