Fundamentos para un currículo nacional en Cirugía General basado en competencia: Consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía / Foundations for a national competence-based curriculum in General Surgery: Delphi Consensus of the Division of Education of the Colombian Association of Surgery

Frente a los desafíos de la Educación Basada en Competencia, este consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía informa sobre las mínimas competencias profesionales esperadas del cirujano egresado de los veinte programas de Especialización en Cirugía General en Colombia. Un total de 105 profesores de los programas de especialización evaluaron tres áreas de competencia profesional: 1) atributos profesionales generales del residente durante su formación, 2) competencias prácticas (procedimientos quirúrgicos) que los residentes deben realizar al final de su entrenamiento y 3) Actividades Profesionales Confiables (APC) que los residentes deben ejecutar sin supervisión al final de su entrenamiento. Los resultados informan un alto nivel de consenso en el 100 % los atributos profesionales generales y APC, y del 75 % en diferentes procedimientos quirúrgicos. El consenso abre la puerta para el desarrollo de un currículo nacional de la especialidad y tiene implicaciones para la práctica educativa e investigación futura

Faced with the challenges of Competence-Based Education, this Delphi consensus from the Education Division of the Colombian Association of Surgery reports on the minimum professional competencies expected of the surgeon who graduated from the twenty residency programs in General Surgery in Colombia. A total of 105 professors from the training programs evaluated three areas of professional competence: 1) general professional attributes of the resident during their training, 2) practical skills (surgical procedures) that residents must perform at the end of their training, and 3) Activities Trusted Professionals (APC) that residents must run unsupervised at the end of their training. The results report a high level of consensus in 100% general professional attributes and APC, and 75% in different surgical procedures. The consensus opens the door for the development of a national specialty curriculum and has implications for educational practice and future research

Fundamentos para un currículo nacional en Cirugía General basado en competencia: Consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía / Foundations for a national competence-based curriculum in General Surgery: Delphi Consensus of the Division of Education of the Colombian Association of Surgery

Frente a los desafíos de la Educación Basada en Competencia, este consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía informa sobre las mínimas competencias profesionales esperadas del cirujano egresado de los veinte programas de Especialización en Cirugía General en Colombia. Un total de 105 profesores de los programas de especialización evaluaron tres áreas de competencia profesional: 1) atributos profesionales generales del residente durante su formación, 2) competencias prácticas (procedimientos quirúrgicos) que los residentes deben realizar al final de su entrenamiento y 3) Actividades Profesionales Confiables (APC) que los residentes deben ejecutar sin supervisión al final de su entrenamiento. Los resultados informan un alto nivel de consenso en el 100 % los atributos profesionales generales y APC, y del 75 % en diferentes procedimientos quirúrgicos. El consenso abre la puerta para el desarrollo de un currículo nacional de la especialidad y tiene implicaciones para la práctica educativa e investigación futura

Faced with the challenges of Competence-Based Education, this Delphi consensus from the Education Division of the Colombian Association of Surgery reports on the minimum professional competencies expected of the surgeon who graduated from the twenty residency programs in General Surgery in Colombia. A total of 105 professors from the training programs evaluated three areas of professional competence: 1) general professional attributes of the resident during their training, 2) practical skills (surgical procedures) that residents must perform at the end of their training, and 3) Activities Trusted Professionals (APC) that residents must run unsupervised at the end of their training. The results report a high level of consensus in 100% general professional attributes and APC, and 75% in different surgical procedures. The consensus opens the door for the development of a national specialty curriculum and has implications for educational practice and future research

"Plan pantera", trauma militar en Colombia / "Panther strategy": military trauma in Colombia

Introducción. El impacto en la atención médica de los heridos en una larga guerra irregular de Colombia con la guerrilla y, más recientemente, con los narcotraficantes y las bandas criminales emergentes, originó el desarrollo de una estrategia de atención médica que garantizara un tratamiento rápido, eficaz y óptimo, con la mayor probabilidad de supervivencia del herido de guerra y una rehabilitación satisfactoria. Método. El plan estratégico de atención del trauma militar se empezó a desarrollar en el año 2000 y se implementó en el 2004 bajo el nombre de Plan Pantera. Se basó en el modelo de Haddon, conformando siete pasos sucesivos de acción y atención médica militar. Se presentan los resultados del proyecto, desde su inicio hasta el año 2010. Resultados. En el periodo comprendido entre enero del 2005 y diciembre del 2010, hubo 8.631 heridos en combate de las Fuerzas Militares de Colombia; 2.462 fueron muertos en la escena de las operaciones militares (28,5 %). Las acciones de los equipos EMEREVAC y GATRA permitieron una reducción muy significativa de la mortalidad en el campo de batalla. La mortalidad hospitalaria del último nivel de atención para pacientes con trauma mayor (ISS>15), fue de 2,3 %. Conclusiones. La estrategia de desarrollo del plan de atención médica en el paciente herido en combate, debe contemplar todas las variables que se pueden incluir dentro de un análisis de la matriz de Haddon. El Plan Pantera, como pilar de atención en las Fuerzas Militares de Colombia, ha sido exitoso y ha permitido una mayor probabilidad de supervivencia del herido en combate. Todo plan de atención médica del paciente traumatizado y críticamente enfermo, en especial en la medicina militar, debe estar fundamentado en la fortaleza de la formación continua académica y educativa de cada uno de los integrantes de los equipos de trabajo.

Background. The impact on medical care for the wounded resulting from a guerrillas and, more recently, drug trafficking and criminal gangs, long irregular warfare in Colombia originated the development of a strategy of health care oriented to ensure optimal, quick, and effective treatment seeking the most likely possibility of survival of the wounded and a satisfactory rehabilitation. Methods. The strategic military trauma care plan began to be developed in the year 2000 and was implemented in the year 2014 under the name of Panther strategy, and was based on the Haddon model that establishes seven successive steps of action and military health care. We present the results of this project, from its inception until the year 2010. Results. In the period from January 2005 to December 2010 there were 8631 combat injuries of the military forces of Colombia; 2462 were killed at the scene of the military operations (28.5%). The actions of EMEREVAC and GATRA teams resulted in a very significant reduction in mortality in the battle field. In-hospital mortality for patients with major trauma (ISS >15) at the last level of attention (Hospital Militar Central) was 2.3%. Conclusions. The strategy of developing the plan of care of patients wounded in combat should take into account all possible variables that ca be included in an analysis of the Haddon matrix. The "Panther plan" as a pillar of care in the military forces of Colombia has been successful, allowing a better chance of survival of the wounded in combat. All health care plans for the traumatized and critically ill patients, and especially in military medicine, must be based on the strength of the continuing education and academic formation of each one of the members of the teams.

An epidemic outbreak of canine cutaneous leishmaniasis in Colombia caused by Leishmania braziliensis and Leishmania panamensis.

The largest recorded outbreak of cutaneous leishmaniasis in Colombia's history occurred during 2005-2009 in soldiers of the Colombian Army, with ~40,000 cases. This outbreak was caused by the influx of military personnel into the jungle with the mission of combat illicit crops and the guerrilla. The soldiers remain for long periods within the rainforest and are exposed to the bite of infected sand flies. During the military activities, soldiers work with dogs specially trained to detect landmines, and therefore, dogs are also exposed to the infected sand flies and show high incidence of cutaneous leishmaniasis (CL). This work describes an epidemic outbreak of canine CL caused by Leishmania braziliensis and Leishmania panamensis in Colombia, South America. The clinical features of the disease and the response to treatment with pentavalent antimonials observed in 72 guard dogs from the Colombian Army are described. A program for prevention and control of canine CL is also discussed.

Efficacy of miltefosine for the treatment of American cutaneous leishmaniasis.

Miltefosine is an oral agent used for cutaneous leishmaniasis treatment. An open-label, randomized, phase III clinical trial was carried out in the Colombian army population. Miltefosine, 50 mg capsule was taken orally three times per day for 28 days (N = 145) or meglumine antimoniate, 20 mg/kg body weight per day for 20 days by intramuscular injection (N = 143). The efficacy of miltefosine by protocol was 69.8% (85/122 patients) and 58.6% (85/145 patients) by intention to treat. For meglumine antimoniate, the efficacy by protocol was 85.1% (103/121 patients) and 72% (103/143 patients) by intention to treat. No association was found between drug efficacy and L. (V.) braziliensis or L. (V.) panamensis species of Leishmania responsible for infection. Adverse gastrointestinal events were associated with the use of miltefosine, the meglumine antimoniate treatment was associated with adverse effects on the skeletal musculature, fever, cephalea, and higher toxicity in kidney, liver, pancreas, and hematological system.