¿Comunicamos correctamente las malas noticias en medicina? Resultados de un taller de formación basado en videos y debriefing / Are bad news correctly communicated in medicine? Results of a traning workshop based on videos and debriefing

OBJETIVO: Valorar la formación de profesionales médicos en comunicación de malas noticias (CMN), y evaluar la utilidad de un taller de videos y debriefing para su enseñanza. MATERIAL Y MÉTODOS: Estudio descriptivo de la formación previa, metodología, e importancia de la CMN en estudiantes, residentes y facultativos en Medicina. También se ha realizado un estudio antes-después para evaluar la utilidad de un taller práctico basado en videos de diferentes situaciones con CMN, aplicación del protocolo SPIKES, y posterior debriefing, y una encuesta de satisfacción a los estudiantes de dicho taller. RESULTADOS: Participaron 135 personas, siendo 102 (75,6%) estudiantes de Medicina. Ciento diecisiete participantes (92,9%) no utilizaban ninguna metodología en CMN, 99 (79,2%) no habían recibido formación en CMN, y 113 (89,7%) no conocían el protocolo SPIKES. Tras el taller, 112 encuestados (85,5%) consideraron muy importante la formación en CMN. Todos los participantes encontraron útil el taller y consideraron que la metodología fue adecuada (3-5 en escala de Likert). Al comparar las evaluaciones, encontramos una media de 5,8 (IC95% 5,6-5,9) pretaller, y de 5,9 (IC95% 5,9-6,0) postaller (p < 0,01). CONCLUSIÓN: Existe poca formación en la actualidad para la CMN. Su enseñanza debe ser práctica, siendo el modelo de videos un método adecuado

AIM: To evaluate the training of medical professionals in Breaking Bad News (BBN), and the usefulness of a workshop based on clinical-case' videos and debriefing. MATERIAL AND METHODS: Descriptive study of previous training, methodology used, and importance of BBN in students, residents and physicians. A before-after study was also performed to evaluate the usefulness of a practical workshop based on videos of different situations with BBN, application of the SPIKES protocol, and subsequent debriefing. A satisfaction survey was answered by all participants. RESULTS: 135 people participated in the workshop, of which 102 (75.6%) were medical students. 117 participants (92.9%) did not use any methodology in BBN, 99 (79.2%) had not received previous training in BBN, and 113 (89.7%) did not know the SPIKES protocol. After the workshop, 112 (85.5%) considered BBN very important. All participants found the workshop useful and considered that the methodology was adequate (3-5 on Likert scale). Comparing the evaluations, we have found an average of 5.8 (95% CI 5.6-5.9) pre-workshop, and 5.9 (95% CI 5.9-6.0) post-workshop (p < 0.01). CONCLUSION: Currently, training in BBN is poor. Its teaching should be practical, being the video model an appropriate method

Genetic Factors Associated with Postoperative Nausea and Vomiting: a Systematic Review.

BACKGROUND: In previous studies, there seems to be a relationship between different genetic polymorphisms and postoperative nausea and vomiting (PONV). We perform a systematic review of the current literature about the relationship between genetic polymorphisms and the presence of PONV. METHODS: Two bibliographic searches were carried out in three databases (PubMed, Web of Science, and Scopus) of studies, preferably prospective, about PONV following abdominal surgery. It was completed with a backward citation searching. A total of 73 articles were found of which 6 were selected after their critical lecture using CASPe network criteria. Relative frequency and relative risk were taken in each study according to the polymorphism. RESULTS: Studies about 5-HT3B gene receptor polymorphisms, ABCB1 transporter, and dopamine D2 receptor showed a significant association with the presence of PONV (p = 0.02, 0.01, and 0.034 respectively). In relation to cytochrome P-450 2D6 (CYP2D6) polymorphisms, two of the three analysed articles showed a significant association with postoperative vomiting (p = 0.007). CONCLUSION: Genetic polymorphisms could play an important role in PONV. The AAG deletion in both alleles of the 5-HT3B receptor gene, the Taq IA polymorphism of the dopamine D2 receptor, and the presence of three or more functional alleles of CYP2D6 seem to be related with a higher incidence of PONV, especially in the first 24 h after surgery. The 2677TT and 3435TT genotypes of the ABCB1 transporter could reduce the PONV due to their association with a greater effectiveness of ondansetron. However, new quality studies are needed to consider this relationship.

Perfil clínico y anatomopatológico de los tumores estromales gastrointestinales de un hospital de área: Estudio descriptivo y revisión de la literatura / Clinical and pathological features of gastrointestinal stromal tumors (GIST) in a single institution: A descriptive study and review of the literature

Introducción: Describir las principales características clínicas, anatomopatológicas, terapéuticas y evolutivas de una serie amplia de tumores estromales gastrointestinales (GIST). Métodos: Estudio observacional de una serie de 66 casos de GIST tratados en nuestro hospital de 2002 a 2015. Seleccionamos variables relacionadas con los antecedentes personales, las manifestaciones clínicas, el tratamiento médico y quirúrgico, la anatomía patológica y la morbimortalidad. Añadimos una revisión de la literatura para correlacionarla con nuestros resultados. Resultados: La localización más frecuente fue el estómago (65,2%), en el que destacó como región predominante el fondo. La manifestación clínica más habitual fue la hemorragia digestiva (45,5%), seguida del hallazgo casual tras la realización de alguna prueba de imagen o procedimiento invasivo (33,3%). Recibieron cirugía 58 pacientes (90,6%), el 15,5% de carácter urgente. El 69% de los GIST tenían un tamaño entre 2 y 10 cm. La mortalidad al año debida al tumor fue de un 7,9% (5 casos), todos ellos relacionados con extensión local o a distancia, o complicación quirúrgica. Conclusiones: La variabilidad clínica de los GIST es muy amplia. El tratamiento de primera elección es la cirugía, que es factible en la mayoría de los casos y debe ser lo más conservadora posible. El pronóstico es variable, dependiendo del tamaño y del índice de proliferación, por lo que debe realizarse un seguimiento estrecho. No existe un marcador tumoral claramente asociado a un peor pronóstico, por lo que se necesitan nuevos estudios de biología molecular con el objetivo de encontrar dianas terapéuticas (AU)

Introduction: This study was aimed to assess the main clinical, pathological and therapeutic characteristics of a cohort of gastrointestinal stromal tumors (GIST). Methods: Observational study including 66 patients diagnosed with GIST admitted to our hospital between 2002 and 2015. Parameters related to medical history, clinical manifestations, medical and surgical treatment, histopathology, and morbi-mortality were studied. A review of the literature was included to correlate with the results. Results: The most frequent location of GIST in our patients was the stomach (65.2%), in which the gastric fondo was the predominant region. The most common clinical manifestation was gastrointestinal hemorrhage (45.5%), followed by incidental finding after imaging or invasive procedures (33.3%). 58 patients underwent surgery (90.6%), 15.5% were urgent. A total of 69% of the GISTs had a size between 2 and 10 cm. The one-year mortality was 7.9%, all cases related to local or remote extension, or surgical complications. Conclusion: There is a large clinical variability among GIST cases. The first choice of treatment is surgery, which is feasible in most cases and should be as conservative as possible. The prognosis varies depending on the size and proliferation index, thus close follow-up should be performed. No tumor marker is clearly associated with a poor prognosis. New molecular biology studies are needed in order to find therapeutic targets (AU)

[Clinical and pathological features of gastrointestinal stromal tumors (GIST) in a single institution: A descriptive study and review of the literature]. / Perfil clínico y anatomopatológico de los tumores estromales gastrointestinales de un hospital de área: Estudio descriptivo y revisión de la literatura.

INTRODUCTION: This study was aimed to assess the main clinical, pathological and therapeutic characteristics of a cohort of gastrointestinal stromal tumors (GIST). METHODS: Observational study including 66 patients diagnosed with GIST admitted to our hospital between 2002 and 2015. Parameters related to medical history, clinical manifestations, medical and surgical treatment, histopathology, and morbi-mortality were studied. A review of the literature was included to correlate with the results. RESULTS: The most frequent location of GIST in our patients was the stomach (65.2%), in which the gastric fondo was the predominant region. The most common clinical manifestation was gastrointestinal hemorrhage (45.5%), followed by incidental finding after imaging or invasive procedures (33.3%). 58 patients underwent surgery (90.6%), 15.5% were urgent. A total of 69% of the GISTs had a size between 2 and 10cm. The one-year mortality was 7.9%, all cases related to local or remote extension, or surgical complications. CONCLUSION: There is a large clinical variability among GIST cases. The first choice of treatment is surgery, which is feasible in most cases and should be as conservative as possible. The prognosis varies depending on the size and proliferation index, thus close follow-up should be performed. No tumor marker is clearly associated with a poor prognosis. New molecular biology studies are needed in order to find therapeutic targets.

Papel de la tomografía computarizada en el diagnóstico del hamartoma de las glándulas de Brunner / Role of computed tomography in the diagnosis of Brunner gland hamartoma

No disponible

Nudo del catéter ventrículo-peritoneal con obstrucción y necrosis intestinal: una inusual y grave complicación / Ventriculo-peritoneal catheter knot with obstruction and intestinal necrosis: an unusual and serious complication

No disponible

Uso del plasma rico en plaquetas autólogo en abdominoplastías / Using platelet rich plasma in abdominoplasty

Objective: Evaluation of the effectiveness of autologous platelet rich plasma administered topically in the healing and prevention of complications of abdominoplasty after bariatric surgery. Material and Methods: The data from 30 patients who underwent abdominoplasty were analyzed: Group I: Rich plasma was administered autologous platelets in the surgery. Group II: Control. Study variables: complications (seroma, local infection and bleeding), length of stay and cost. Results: No significant differences were observed in the frequency of complications or length of stay. The use of platelet rich plasma raises the cost of the procedure. Conclusion: Even considering the limitations of the study because of its small sample size and lack of blinding, the results do not support the use of this complementary technique. Further studies are needed in the field of adhesives, sealants and local hemostatic.

Objetivo: Evaluación de la eficacia del plasma rico en plaquetas autólogo administrado de forma tópica en la cicatrización y prevención de las complicaciones de la abdominoplastía y dermolipectomía tras cirugía bariátrica. Material y Método: Serie de 30 pacientes afectos de faldón abdominal tras cirugía bariátrica, a los que se practicó dermolipectomía y abdominoplastía, divididos en dos grupos de 15 casos con aletorización simple. Grupo I: Se administró plasma rico en plaquetas autólogo en el lecho quirúrgico. Grupo II: Control. Variables de estudio: complicaciones (seroma, infección local y hemorragia), tiempo de estancia y coste. Resultados: No se aprecian diferencias significativas en la frecuencia de complicaciones ni en estancia media. El uso de plasma rico en plaquetas eleva el coste del procedimiento. Conclusión: Aun considerando las limitaciones del estudio por su corto número de casos y no cegamiento, los resultados no apoyan el uso de esta técnica complementaria. Estudios más avanzados son necesarios en el campo de los adhesivos, sellantes y hemostáticos locales.

Dificultad en el diagnóstico de la hernia de Spiegel abscesificada / Difficulty in the diagnosis of an abscessed Spigelian hernia

No disponible

No disponible