ABSTRACT
England switched to an opt-out system of consent in 2020 aiming to increase the number of organs available. Spain also operates an opt-out system yet has almost twice the organ donations per million population compared with England. We aimed to identify both differences and similarities in the consent policies, documents and procedures in deceased donation between the two countries using comparative qualitative content and discourse analysis. Spain had simpler, locally tailored documents, the time taken for families to review and process information may be shorter, there were more pathways leading to organ donation in Spain, and more robust legal protections for the decisions individuals made in life. The language in the Spanish documents was one of support and reassurance. Documents in England by comparison appeared confusing, since additions were designed to protect the NHS against risk and made to previous document versions to reflect the law change rather than being entirely recast. If England's ambition is to achieve consent rates similar to Spain this analysis has highlighted opportunities that could strengthen the English system-by giving individuals' decisions recorded on the organ donor register legal weight, alongside unifying and simplifying consent policies and procedures to support families and healthcare professionals.
Subject(s)
Informed Consent , Tissue and Organ Procurement , Humans , Tissue and Organ Procurement/legislation & jurisprudence , Spain , England , Informed Consent/legislation & jurisprudence , Tissue Donors/legislation & jurisprudence , Decision MakingABSTRACT
Objective: A novel simulator developed to offer hands-on practice for the stapled side-to-side cervical esophagogastric anastomosis was tested previously in a single-center study that supported its value in surgical education. This multi-institutional trial was undertaken to evaluate validity evidence from 6 independent thoracic surgery residency programs. Methods: After a virtual session for simulation leaders, learners viewed a narrated video of the procedure and then alternated as surgeon or first assistant. Using an online survey, perceived value was measured across fidelity domains: physical attributes, realism of materials, realism of experience, value, and relevance. Objective assessment included time, number of sutures tearing, bubble test, and direct inspection. Comparison across programs was performed using the Kruskal-Wallis test. Results: Surveys were completed by 63 participants as surgeons (17 junior and 20 senior residents, 18 fellows, and 8 faculty). For 3 of 5 tasks, mean ratings of 4.35 to 4.44 correlated with "somewhat easy" to "very easy" to perform. The interrupted outer layer of the anastomosis rated lowest, suggesting this task was the most difficult. The simulator was rated as a highly valuable training tool. For the objective measurements of performance, "direct inspection" rated highest followed by "time." A total of 90.5% of participants rated the simulator as ready for use with only minor improvements. Conclusions: Results from this multi-institutional study suggest the cervical esophagogastric anastomosis simulator is a useful adjunct for training and assessment. Further research is needed to determine its value in assessing competence for independent operating and associations between improved measured performance and clinical outcomes.
Subject(s)
Organ Transplantation , Tissue and Organ Procurement , Humans , Tissue and Organ Procurement/legislation & jurisprudence , Tissue and Organ Procurement/ethics , Organ Transplantation/ethics , Organ Transplantation/legislation & jurisprudence , Tissue Donors/legislation & jurisprudence , Tissue Donors/ethicsABSTRACT
Resumen Desde la declaración de pandemia del coronavirus el mundo entero ha encaminado sus esfuerzos a ayudar a mitigar sus efectos, especialmente el personal de la salud. En ese intento por ayudar, buscan evitar su propio contagio por medio del uso de materiales de protección como mascarillas, gafas y guantes. Aunque protectores, éstos materiales y sus componentes pueden ser altamente perjudiciales para la piel, causando dermatitis de contacto, ulceraciones y erosiones. En esta revisión se abordan dichas manifestaciones y se proponen medidas para prevenirlas o tratarlas.
Abstract Since the declaration of coronavirus as a pandemic the entire world has directed its efforts to help mitigate the effects of it to the best of its ability, especially health personnel. In that attempt to help, we seek to avoid their own contact through the use of protective materials such as masks, goggles, and gloves. Although protective, this equipmment and its components can be highly damaging to the skin, causing contact dermatitis. This review addresses manifestations and reviews measures to prevent and cure them.
ABSTRACT
No disponible
Subject(s)
Humans , Students, Medical , Communication , Social Skills , Education, Medical/methods , SpainABSTRACT
Introducción: La comunicación es una competencia fundamental en la formación de los futuros médicos. Objetivos: Conocer la percepción de la comunidad universitaria e identificar la situación actual de la formación en habilidades de comunicación en el Grado de Medicina de la Facultad de Medicina y Ciencias de la Salud de la Universitat de Barcelona. Sujetos y métodos: Análisis descriptivo de las respuestas a tres encuestas diseñadas por método Delphi, dirigidas a profesorado y estudiantes de cuarto y sexto curso durante el período académico 2017-2018. Resultados: La encuesta de profesorado fue respondida por 43 docentes; la de cuarto curso, por 87 alumnos, y la de sexto curso, por 79 alumnos. Los alumnos que respondieron suponían un tercio de los matriculados en esos cursos. Había acuerdo entre los encuestados respecto a la alta importancia de la comunicación y del feedback clínico. Los profesores daban más valor formativo a las clases teóricas que los alumnos, quienes otorgaban más valor a las herramientas con participación activa. Los mini-CEX y el feedback clínico fueron las herramientas consideradas más útiles. La falta de feedback en las evaluaciones clínicas objetivas estructuradas limitaba su utilidad. Los alumnos de cuarto curso utilizaban más herramientas de formación activa que los de sexto. Conclusión: Se detecta una mejora progresiva en la formación en habilidades de comunicación y en la utilización de herramientas docentes activas, pero se identifican áreas y medidas de mejora en la formación de competencias de comunicación de fácil implementación en el grado
Introduction: Communication is a fundamental competence for the university education of the future doctors. Aims: To know the university community perception and to identify the current situation of education regarding communication abilities in the Medicine Bachelor of the Faculty of Medicine and Health Sciences of Barcelona University. Subjects and methods: Descriptive analysis of the obtained answers to three surveys designed by Delphi method, addressed to three subgroups of the university population: professors and students in their fourth and sixth years of the academic year 2017-2018. Results: The survey was answered by 43 professors, 87 fourth-year students and 79 sixth-year students. Around a third of the enrolled students participated. The three populations commonly scored high the importance of communication and feedback of the clinical performance. The professors gave more value to theoretical classes than students did, who scored higher the active teaching tools. Mini-CEX and feedback were the more useful considered tools. The lack of feedback after the objective structured clinical examination limits its use. Fourth-grade students used more active training tools than the sixth-grade students. Conclusion: Evidence shows a progressive improvement in the education in communication abilities and suggests areas of improvement of easy implementation in the education of these skills
Subject(s)
Humans , Communication , Education, Medical/methods , Perception , Analysis of Situation , Delphi Technique , Faculty/statistics & numerical data , Students/statistics & numerical data , Faculty, Medical/statistics & numerical dataABSTRACT
El presente ensayo tiene como objetivo plantear una reflexión entre la Medicina Tradicional y Complementaria y la Medicina convencional mediada por la Bioética Global, en la cual el paciente, su salud y el restablecimiento será el eje central; dicha deliberación facilitará un diálogo entre ambas corrientes, porque aún no se ha dado un acuerdo visible, más allá de la polarización y defensa unilateral de cada una de ellas por parte de sus defensores y detractores
Subject(s)
Humans , Bioethics , Ethics, Clinical , Integrative Medicine , Medicine, TraditionalABSTRACT
La comunicación forma parte de la actividad clínica y en ocasiones determina el éxito o fracaso del proceso asistencial. Sin embargo, no ha sido reconocida en los planes de estudio del Estado español hasta muy recientemente, sobre todo con el impulso del llamado 'Plan Bolonia'. En el año 2009 se aprobó en la Facultad de Medicina de la Universitat de Barcelona un nuevo plan docente que proponía incorporar la enseñanza de la comunicación en las materias clínicas y preclínicas, contabilizando entre 3 y 6 créditos europeos (ECTS), como competencia transversal. El presente artículo aborda el diseño de esta competencia, los pros y contras, cómo se inserta en diferentes asignaturas y cómo puede evaluarse (AU)
Communication is part of the clinical activity and sometimes determines the healthcare success or failure. However it has not been recognized in the Spanish curricula until recently, in the context of the so called Plan Bologna. In 2009 a new teaching plan was approved at Medical School of Barcelona University which intended to incorporate communication in clinical and preclinical areas (3-6 ECTS). In this article we explain pros and cons to introduce communication not as a subject, but as a competency, how can be integrated in different subjects and how can be evaluated (AU)
Subject(s)
Humans , Education, Medical/trends , Communication , Curriculum/trends , Teaching/methods , Educational Measurement/methods , Education, Medical, Undergraduate/trends , Schools, Medical/organization & administrationABSTRACT
La donación y trasplante de órganos se enfrenta a nuevos escenarios que pueden inducir la crisis del llamado «Modelo Español». El descenso de los accidentes de tráfico; las campañas de prevención de los factores de riesgo cardiovascular; la mejoría en el tratamiento médico y quirúrgico del paciente neurocrítico; la aplicación de protocolos de «limitación del tratamiento de soporte vital» al final de la vida; el control del ingreso de pacientes sin pronóstico vital en Urgencias; la actuación precoz desde los Servicios de Emergencia extrahospitalarias en el manejo de los pacientes isquémicos con la implementación de protocolos desde la creación de los «códigos infarto agudo de miocardio» o las Unidades de Ictus; son factores que pueden causar descenso de la potencialidad de donación con la consiguiente pérdida del liderazgo mundial si no se produce un proceso de reinvención por parte de las instituciones y del personal involucrado a pesar de las circunstancias médicas y socioeconómicas actuales(AU)
New challenges confronting the process of organ donation and transplantation could lead to a crisis situation in the so called Spanish Model. The reduction in traffic accidents; better campaigns to prevent cardiovascular risk factors; improvement in the medical and surgical approach of neurocritical patients; application of protocols for withdrawal of therapeutic efforts together with a restricted hospitalization of patients without vital prognosis performed in Emergency Departments; better acute management of ischaemic patients in extra-hospital emergencies, together with the development of Acute Myocardial Infarction and Stroke Units, are all factors that could have a negative impact in potential organ donors and threaten Spains leadership if the institutions and personnel involved do not work to reinvent the process by confronting the medical and socioeconomic circumstances(AU)