El shock cardiogénico como problema de salud. Fisiología, clasificación y detección / Cardiogenic shock as a health issue: Physiology, classification, and detection

El shock cardiogénico (SC) es un síndrome heterogéneo con elevada mortalidad y creciente incidencia. Se trata de una situación en la que existe un desequilibrio entre las necesidades tisulares de oxígeno y la capacidad del sistema cardiovascular para satisfacerlas debido a una disfunción cardiaca aguda. Históricamente, los síndromes coronarios agudos han sido la causa principal de SC; sin embargo, los casos no isquémicos han aumentado en incidencia. Su fisiopatología implica el daño isquémico del miocardio, una respuesta tanto simpática como del sistema renina-angiotensina-aldosterona e inflamatoria, que perpetúan la situación de hipoperfusión tisular conduciendo finalmente a la disfunción multiorgánica. La caracterización de los pacientes con SC mediante una valoración triaxial y la universalización de la escala SCAI ha permitido una estandarización de la estratificación de la gravedad del SC que, sumada a la detección precoz y el enfoque Hub and Spoke, podrían contribuir a mejorar el pronóstico de los pacientes en SC. (AU)

Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and increasing incidence. It is a condition where there is an imbalance between tissue oxygen demands and the cardiovascular system's capacity to meet them due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS; however, non-ischemic cases have seen a rise in incidence. Its pathophysiology involves myocardial ischemic damage, a sympathetic, renin–angiotensin–aldosterone system, and inflammatory response, perpetuating the situation of tissue hypoperfusion, ultimately leading to multiorgan dysfunction. Characterizing CS patients through a triaxial assessment and the widespread use of the SCAI scale has allowed standardization of CS severity stratification, which, coupled with early detection and the “Hub and Spoke” approach, could contribute to improve the prognosis of CS patients. (AU)

Aspectos de la vida y obra del Dr. Bernardo Alberto Houssay / Aspects of the life and work of Dr. Bernardo Alberto Houssay

Con motivo del Día Mundial de la Ciencia y la Tecnología, se realizó en la Casa Museo Bernardo Houssay un conversatorio en el que expertos biógrafos resaltaron algunos aspectos de la trayectoria profesional del Premio Nobel de Medicina de 1947, destacando su actividad como investigador en fisiología y sus cualidades humanas. Estos importantes estudiosos del tema compartieron sus conocimientos en un selecto auditorio. (AU)

On the occasion of World Science and Technology Day, a discussion was held at the Bernardo Houssay House Museum in which expert biographers highlighted some aspects of the professional career of the 1947 Nobel Prize in Medicine, highlighting his activity as a researcher in physiology and his human qualities. These important scholars of the subject shared their knowledge in a select audience. (AU)

Oscilometría: de la teoría a la práctica / Oscillometry: from theory to practice

La oscilometría es una herramienta que, poco a poco, se está abriendo paso en las consultas de neumología y alergología. Se trata de una técnica sencilla de realizar para el paciente, que, además, aporta información adicional a las pruebas de función respiratoria clásicas. No solamente nos indica la alteración que existe en la vía aérea, sino que localiza a qué altura se produce (central o periférica). El objetivo es acercar esta técnica al personal sanitario y hacer más sencilla su interpretación. (AU)

Oscillometry is a tool that is gradually making its way into the daily routine of pneumology and allergology. It is a simple technique for the patient, which also provides additional information to the classic respiratory function tests. It not only indicates if there is an alteration in the airway, but also locates where it occurs (central or peripheral). The aim is to bring this technique closer to healthcare professionals and facilitate its interpretation. (AU)

Alignment of learning objectives, assessments, and active learning to promote critical thinking in a first-year medical physiology course: lessons learned.

Medical students must be adept at critical thinking to successfully meet the learning objectives of their preclinical coursework. To encourage student success on assessments, the course director of a first-year medical physiology course emphasized the use of learning objectives that were explicitly aligned with formative assessments in class. The course director introduced the physiology discipline, learning objectives, and evidence-based methods of studying to students on the first day of class. Thereafter, class sessions started with a review of the learning objectives for that session and included active learning opportunities such as retrieval practice. The instructor provided short answer formative assessments aligned with the learning objectives, intended to help the students apply and integrate the concepts. Midsemester, students received a link to an online survey with questions on studying habits, class attendance, and student engagement. After finals, students were invited to participate in focus groups about their class experience. A qualitative researcher moderated focus groups, recorded responses, and analyzed the narrative data. Of 175 students, 95 submitted anonymous online surveys. Student engagement was significantly correlated with in-person class attendance (r = 0.26, T = 2.5, P = 0.01) and the completion of open-ended formative assessments (r = 0.33, T = 3.3, P = 0.001). Focus groups were held via videoconference. From the class, 14 students participated in 4 focus groups; focus group participants were mostly women (11 of 14) and mostly in-class attendees (13 of 14). The students in this sample valued critical thinking but misunderstood expectations on exams and few students used learning objectives to study.NEW & NOTEWORTHY We introduced formative assessments and study techniques to first-year medical students in a physiology course. Mastery of learning objectives was emphasized as the key to success. We asked how they studied physiology through an anonymous online survey and focus group interviews. The students enjoyed physiology but had difficulty with exam expectations. Helping students use learning objectives to guide their study may lead to improved exam scores. It may also help administrators meet their curriculum goals.

Diabetes and obesity pathophysiology as a teaching tool to emphasize physiology core concepts.

Diabetes mellitus and obesity are major public health issues that significantly impact the health care system. The next generation of health care providers will need a deep understanding of the pathophysiology of these diseases if we are to prevent, treat, and eventually cure these diseases and ease the burden on patients and the health care system. Physiology core concepts are a set of core principles, or "big ideas," identified by physiology educators that are thought to promote long-term retention, create a deeper understanding, and help with formation of critical thinking skills. Here we describe our scaffolded teaching approach in an upper year undergraduate pathophysiology course to educate students about these two diseases and discuss how learning about the basis of these highly integrative diseases from the biochemical to whole body level is a meaningful tool in the physiology educator toolbox to reinforce physiology core concepts. This teaching strategy is designed to engage students in the scientific process and hone their problem-solving skills such that they are hopefully equipped to treat and eventually cure these diseases as they move forward in their careers.NEW & NOTEWORTHY Students often struggle with integration of physiological systems. Type 2 diabetes mellitus and obesity are two related diseases that are useful to explore the interdependence of physiological systems and multiple physiology core concepts. Deep learning about these diseases has the potential to dramatically improve the health care system of the future.

Relationship of emotional intelligence and capability of answering higher-order knowledge questions in physiology among first-year medical students.

Emotional intelligence (EI) has a positive correlation with the academic performance of medical students. However, why there is a positive correlation needs further exploration. We hypothesized that the capability of answering higher-order knowledge questions (HOQs) is higher in students with higher EI. Hence, we assessed the correlation between EI and the capability of medical students to answer HOQs in physiology. First-year undergraduate medical students (n = 124) from an Indian medical college were recruited as a convenient sample. EI was assessed by the Schutte Self-Report Emotional Intelligence Test (SSEIT), a 33-item self-administered validated questionnaire. A specially designed objective examination with 15 lower-order and 15 higher-order multiple-choice questions was conducted. The correlation between the examination score and the EI score was tested by Pearson's correlation coefficient. Data from 92 students (33 females and 59 males) with a mean age of 20.14 ± 1.87 yr were analyzed. Overall, students got a percentage of 53.37 ± 14.07 in the examination, with 24.46 ± 9.1 in HOQs and 28.91 ± 6.58 in lower-order knowledge questions (LOQs). They had a mean score of 109.58 ± 46.2 in SSEIT. The correlation coefficient of SSEIT score with total marks was r = 0.29 (P = 0.0037), with HOQs was r = 0.41 (P < 0.0001), and with LOQs was r = 0.14 (P = 0.19). Hence, there is a positive correlation between EI and the capability of medical students to answer HOQs in physiology. This study may be the foundation for further exploration of the capability of answering HOQs in other subjects.NEW & NOTEWORTHY This study assessed the correlation between emotional intelligence (EI) and the capability of medical students to answer higher-order knowledge questions (HOQs) in the specific context of physiology. The finding reveals one of the multifaceted dimensions of the relationship between EI and academic performance. This novel perspective opens the door to further investigations to explore the relationship in other subjects and other dimensions to understand why students with higher EI have higher academic performance.

A century of exercise physiology: key concepts in neural control of the circulation.

Early in the twentieth century, Walter B. Cannon (1871-1945) introduced his overarching hypothesis of "homeostasis" (Cannon 1932)-the ability to sustain physiological values within a narrow range necessary for life during periods of stress. Physical exercise represents a stress in which motor, respiratory and cardiovascular systems must be integrated across a range of metabolic stress to match oxygen delivery to oxygen need at the cellular level, together with appropriate thermoregulatory control, blood pressure adjustments and energy provision. Of these, blood pressure regulation is a complex but controlled variable, being the function of cardiac output and vascular resistance (or conductance). Key in understanding blood pressure control during exercise is the coordinating role of the autonomic nervous system. A long history outlines the development of these concepts and how they are integrated within the exercise context. This review focuses on the renaissance observations and thinking generated in the first three decades of the twentieth century that opened the doorway to new concepts of inquiry in cardiovascular regulation during exercise. The concepts addressed here include the following: (1) exercise and blood pressure, (2) central command, (3) neurovascular transduction with emphasis on the sympathetic nerve activity and the vascular end organ response, and (4) tonic neurovascular integration.

Nursing students' experiences with test-enhanced learning in teams: A cross-sectional study.

BACKGROUND: Many nursing students struggle with the disciplines of biosciences, particularly Anatomy, physiology, and biochemistry, which are introduced in the first year. Nursing students' motivation, prior knowledge, and academic performance matter, but teaching methods may also influence students' learning process. Retrieving knowledge through testing has previously proven to enhance learning to a greater extent than time spent on other classroom activities. OBJECTIVE: The aim of this study was to explore nursing students' experiences with test-enhanced learning as a way of enhancing learning in Anatomy, physiology, and biochemistry. DESIGN: The lectures in each topic were followed by testing five days later. The tests were typically multiple-choice tests with short reply-times. The effect was measured in terms of students' self-reported level of satisfaction with test-enhanced learning, and their performance on the final exam in Anatomy, physiology, and biochemistry. The tests were performed in teams to avoid stressful situations that could negatively affect the students' learning process. RESULTS: A key achievement from introducing test-enhanced learning in the Anatomy, physiology, and biochemistry course was a perceived higher learning outcome and increased engagement and motivation among the students, resulting in resulting in more students achieving the highest grades (A and B). However, the students' academic results from upper secondary school also seemed to matter for their achievements on the final exam. CONCLUSION: These results indicated that many students benefited from test-enhanced learning, suggesting that test-enhanced learning can be an important teaching strategy in nursing education, particularly for biosciences.

Sourcebook update: RBC hemolysis studies using a simple modified blood film technique.

Water movement across the cell membrane is crucial, with red blood cells (RBCs) experiencing the flow of water in both directions at a rate of approximately 100 times their volume per second. This process typically results in no net water flow due to an equal balance of water movement in opposite directions, a phenomenon known as osmosis, driven by water potential or impermeant solute concentration. Understanding osmosis is essential for both physiology and medical practice, yet its complexity may not be effectively conveyed to the students through traditional teaching methods. This study presents a novel approach to observing the osmotic effect on RBCs using a simple, modified blood film technique. Aimed at enhancing educational understanding of cellular behavior in different osmotic environments, this method provides a practical hands-on learning experience. By applying various osmotic solutions to prepared blood films and observing the resultant morphological changes in RBCs under a microscope, this technique allows for direct visualization of osmosis in action.NEW & NOTEWORTHY This study presents an innovative teaching approach for understanding osmosis and its effects on red blood cells. Using a simple, modified blood film technique, students can visually observe and engage with the dynamic process of osmosis. This hands-on method enhances learning, making complex physiological concepts accessible and practical. Ideal for resource-limited settings, it bridges theoretical knowledge and practical application, transforming physiology education.

PharmaMemory: an interactive, animated web application for learning autonomic physiology and pharmacology.

Medical students face challenging but important topics they must learn in short periods of time, such as autonomic pharmacology. Autonomic pharmacology is difficult in that it requires students to synthesize detailed anatomy, physiology, clinical reasoning, and pharmacology. The subject poses a challenge to learn as it is often introduced early in medical school curricula. To ease the difficulty of learning autonomic pharmacology, we created a free web application, PharmaMemory (www.pharmamemory.com), that interactively depicts the effects of high-yield autonomic drugs on the human body. PharmaMemory provides users with the opportunity to read and quiz themselves on the mechanisms, side effects, indications, and contraindications of these drugs while interacting with the application. We provided PharmaMemory to first-year medical students for three consecutive years of quality improvement and assessed the application's perceived effects on learning via user surveys. Survey feedback showed that users viewed PharmaMemory favorably and self-reported increased knowledge and confidence in the subject of autonomic pharmacology. Comments revealed that users liked the website's visuals, opportunity for challenged recall, and conciseness. PharmaMemory utilizes challenged recall, visual stimulation, and interactive learning to provide users with a multifaceted learning tool. Preliminary data suggest that students find this method of learning beneficial. Further studies are needed to assess PharmaMemory compared with more traditional learning methods such as PowerPoint or text-based learning. Additionally, further research is needed to quantitatively assess reduction in cognitive load.NEW & NOTEWORTHY PharmaMemory (www.pharmamemory.com) is a free web application that interactively depicts the effects of high-yield autonomic drugs on the human body.

Diseño curricular de un diplomado en enseñanza de fisiología / Curricular design of a physiology training diploma course

Introducción: Los conceptos fundamentales de la fisiología representan un avance significativo en la pedagogía de esta disciplina, y proporcionan una base sólida para la enseñanza y el aprendizaje. Estos conceptos enfatizan los principios metodológicos y disciplinarios necesarios para que los estudiantes comprendan la fisiología de manera efectiva. Además, guían tanto a estudiantes como a profesores, e influyen en el diseño de programas académicos de pregrado y posgrado. Materiales y métodos: Diseño curricular basado en las necesidades formativas de docentes de la carrera de médico cirujano de México. El análisis de necesidades formativas se desarrolló según el perfil de egreso de médicos mexicanos. Resultados: Como resultado primario, se obtuvo el programa académico de posgrado llamado ‘Diplomado en enseñanza de fisiología’, con un enfoque constructivista y que utiliza los conceptos fundamentales de la fisiología como su piedra angular. Este programa ha estado en funcionamiento durante cuatro años y ha capacitado a 35 profesores de más de 10 universidades en México. Está estructurado en cinco etapas de formación, que abarcan desde la ciencia del aprendizaje hasta la planificación de sesiones teóricas y prácticas, y en cada etapa se explora y se reflexiona sobre los conceptos fundamentales de la fisiología. Conclusiones: Los académicos valoran positivamente la inclusión de los conceptos fundamentales de la fisiología como ejes de enseñanza y aprendizaje trasversales.(AU)

Introduction: The core concepts of physiology represent a significant advancement in the pedagogy of this discipline, providing a solid foundation for teaching and learning. These concepts emphasize the methodological and disciplinary principles necessary for students to effectively understand physiology. Moreover, they guide both students and teachers, influencing the design of undergraduate and postgraduate academic programs.Materials and methods: Curricular design based on the training needs of professors in the medical career in Mexico; the analysis of training needs was developed according to the profile of graduating Mexican doctors. Results: The primary outcome was the academic program for the postgraduate program called ‘Certificate in Physiology Teaching’, with a constructivist approach that uses the core concepts of physiology as its cornerstone. This program has been in operation for four years and has trained 35 professors from more than ten universities in Mexico. It is structured in five training stages that range from the science of learning to the planning of theoretical and practical sessions, and in each stage, the core concepts of physiology are explored and reflected upon. Conclusions: Academics positively value the inclusion of the core concepts of physiology as cross-cutting teaching andlearning axes.(AU)

Undergraduate students' perception of cardiorespiratory physiology during exercise: teleological vs. mechanistic thinking.

BACKGROUND: Physiology is widely recognized as a difficult course, which can potentially increase students' withdrawal and failures rates. Several factors are likely contributing to the difficulties in learning physiology, including inherent features of the discipline as well as aspects related to instructions and/or students' perception. With regards to the later, it is currently unknown how students of exercise physiology think and explain physiology in terms of its cause or consequence (i.e., teleological or mechanistic thinking). Therefore, the aims of the present study were to determine 1) whether undergraduate students' perception of cardiorespiratory physiology during exercise follows a predominant teleological or mechanistic thinking, and 2) whether prior enrollment in physiology courses can influence the predominance of teleological vs. mechanistic thinking. METHODS: The test instrument was an online questionnaire about exercise physiology consisting of nine incomplete sentences about exercise physiology where students had to choose between a teleological or a mechanistic complement. The questionnaire was administered to undergraduate students in the following areas: 1) Movement Sciences (n = 152), 2) Health-related (n = 81) and, 3) Health-unrelated programs (n = 64). Students in Movement Sciences and Health-related programs were also analyzed separately in the following categories: 1) students who previously undertook physiology courses, and 2) students who did not take physiology courses. RESULTS: Overall, all groups presented a percentage of teleological thinking above 58%, which is considerably high. Teleological thinking was significantly higher in health-unrelated programs than health-related and movement sciences programs (76 ± 16% vs. 58 ± 26% vs. 61 ± 25%; P < 0.01). Further, students with prior enrollment in physiology classes presented a significantly lower percentage of teleological thinking than students without physiology classes (59 ± 25% vs. 72 ± 22%, respectively; P < 0.01), but the overall teleological reasoning remained predominant. CONCLUSIONS: These results confirm the hypothesis that undergraduate students tend to present teleological as opposed to mechanistic thinking in exercise physiology. Furthermore, although undergraduate students with prior enrollment in physiology classes presented significantly lower teleological thinking, it remained highly predominant suggesting that teleological thinking is partially independent of the degree of familiarity with this discipline.