Implementing a challenge-based learning experience in a bioinstrumentation blended course.

BACKGROUND: Bioinstrumentation is essential to biomedical engineering (BME) undergraduate education and professional practice. Several strategies have been suggested to provide BME students with hands-on experiences throughout the curriculum, promoting their preparedness to pursue careers in industry and academia while increasing their learning and engagement. This paper describes the implementation of challenge-based learning (CBL) in an undergraduate bioinstrumentation blended course over the COVID-19 pandemic. METHODS: The CBL experience was implemented in a third-year bioinstrumentation course from the BME program at Tecnologico de Monterrey. Thirty-nine students enrolled in two sections formed fourteen teams that tackled blended learning activities, including online communication, lab experiments, and in-person CBL activities. Regarding the latter, students were challenged to design, prototype, and test a respiratory or cardiac gating device for radiotherapy. An institutional student opinion survey was used to assess the success of our CBL implementation. RESULTS: Student responses to the end-of-term survey showed that they strongly agreed that this course challenged them to learn new concepts and develop new skills. Furthermore, they rated the student-lecturer interaction very positively despite the blended format. Overall, students assessed their learning experience positively. However, implementing this CBL experience required a substantial time increase in planning, student tutoring, and constant communication between lecturers and the industry partner. CONCLUSION: This work provides an effective instance of CBL for BME education to improve students' learning experience despite decreased resource efficiency. Our claim is supported by the student's performance and the positive feedback from our industrial partner.

Association of Acute Respiratory Disease Events with Quantitative Interstitial Abnormality Progression at CT in Individuals with a History of Smoking.

Background Acute respiratory disease (ARD) events are often thought to be airway-disease related, but some may be related to quantitative interstitial abnormalities (QIAs), which are subtle parenchymal abnormalities on CT scans associated with morbidity and mortality in individuals with a smoking history. Purpose To determine whether QIA progression at CT is associated with ARD and severe ARD events in individuals with a history of smoking. Materials and Methods This secondary analysis of a prospective study included individuals with a 10 pack-years or greater smoking history recruited from multiple centers between November 2007 and July 2017. QIA progression was assessed between baseline (visit 1) and 5-year follow-up (visit 2) chest CT scans. Episodes of ARD were defined as increased cough or dyspnea lasting 48 hours and requiring antibiotics or corticosteroids, whereas severe ARD episodes were those requiring an emergency room visit or hospitalization. Episodes were recorded via questionnaires completed every 3 to 6 months. Multivariable logistic regression and zero-inflated negative binomial regression models adjusted for comorbidities (eg, emphysema, small airway disease) were used to assess the association between QIA progression and episodes between visits 1 and 2 (intercurrent) and after visit 2 (subsequent). Results A total of 3972 participants (mean age at baseline, 60.7 years ± 8.6 [SD]; 2120 [53.4%] women) were included. Annual percentage QIA progression was associated with increased odds of one or more intercurrent (odds ratio [OR] = 1.29 [95% CI: 1.06, 1.56]; P = .01) and subsequent (OR = 1.26 [95% CI: 1.05, 1.52]; P = .02) severe ARD events. Participants in the highest quartile of QIA progression (≥1.2%) had more frequent intercurrent ARD (incidence rate ratio [IRR] = 1.46 [95% CI: 1.14, 1.86]; P = .003) and severe ARD (IRR = 1.79 [95% CI: 1.18, 2.73]; P = .006) events than those in the lowest quartile (≤-1.7%). Conclusion QIA progression was independently associated with higher odds of severe ARD events during and after radiographic progression, with higher frequency of intercurrent severe events in those with faster progression. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Little in this issue.

Unveiled: A Case of N-Methyl-D-Aspartate Receptor Antibody Encephalitis With Delayed Diagnosis of Ovarian Teratoma.

N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis is an autoimmune syndrome with potentially fatal sequelae causing profound dysregulation of neurotransmission. Patients most often present with a constellation of neuropsychiatric signs and symptoms, including behavioral changes, motor disturbances, and seizures. Frequently, the development of anti-NMDAR antibodies has been linked to specific malignancies, although the exact event that triggers the production of these antibodies remains unknown. We present a case of a 25-year-old female who came into the emergency room with behavioral changes and fever. The patient had non-convulsive seizures, catatonia, and orofacial dyskinesias during the course of the admission and was treated as a case of autoimmune anti-NMDAR encephalitis. Cranial and abdominal MRI with contrast initially showed negative results, while the serum and cerebrospinal fluid studies were positive for anti-NMDAR antibodies. The patient was noted to have significant clinical improvement after being treated with high-dose intravenous steroid therapy followed by intravenous immunoglobulin (IVIg) and rituximab infusion. She was discharged stable with the resolution of neurologic symptoms four months after the diagnosis. On follow-up with her neurologist two years later, an abdominal CT scan was done and showed mature cystic teratoma. This is one of the few documented cases of anti-NMDAR encephalitis with a good response to medical treatment but had a delayed diagnosis of ovarian teratoma seen on surveillance work-up years after the diagnosis. A high index of suspicion is warranted for the diagnosis, and treatment should be started early as soon as there is clinical suspicion of the disease. Also, surveillance pelvic or abdominal imaging is important in patients who have negative initial screening but have high risks for teratomas.

Implant retention in a rabbit model of fracture-related infection.

Aims: Fracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant biofilms. For delayed infections (two to ten weeks), recommendations are unclear. In this study we compared infection clearance and bone healing in early and delayed FRI treated with DAIR in a rabbit model. Methods: Staphylococcus aureus was inoculated into a humeral osteotomy in 17 rabbits after plate osteosynthesis. Infection developed for one week (early group, n = 6) or four weeks (delayed group, n = 6) before DAIR (systemic antibiotics: two weeks, nafcillin + rifampin; four weeks, levofloxacin + rifampin). A control group (n = 5) received revision surgery after four weeks without antibiotics. Bacteriology of humerus, soft-tissue, and implants was performed seven weeks after revision surgery. Bone healing was assessed using a modified radiological union scale in tibial fractures (mRUST). Results: Greater bacterial burden in the early group compared to the delayed and control groups at revision surgery indicates a retraction of the infection from one to four weeks. Infection was cleared in all animals in the early and delayed groups at euthanasia, but not in the control group. Osteotomies healed in the early group, but bone healing was significantly compromised in the delayed and control groups. Conclusion: The duration of the infection from one to four weeks does not impact the success of infection clearance in this model. Bone healing, however, is impaired as the duration of the infection increases.

Proteomics and Machine Learning in the Prediction and Explanation of Low Pectoralis Muscle Area.

Low muscle mass is associated with numerous adverse outcomes independent of other associated comorbid diseases. We aimed to predict and understand an individual's risk for developing low muscle mass using proteomics and machine learning. We identified 8 biomarkers associated with low pectoralis muscle area (PMA). We built 3 random forest classification models that used either clinical measures, feature selected biomarkers, or both to predict development of low PMA. The area under the receiver operating characteristic curve for each model was: clinical-only = 0.646, biomarker-only = 0.740, and combined = 0.744. We displayed the heterogenetic nature of an individual's risk for developing low PMA and identified 2 distinct subtypes of participants who developed low PMA. While additional validation is required, our methods for identifying and understanding individual and group risk for low muscle mass could be used to enable developments in the personalized prevention of low muscle mass.

Isocyanide-Based Multicomponent Reactions Coupled One-Pot Process: Efficient Tools to Diversity-Oriented Synthesis of Structural Peptidomimetics.

Multicomponent diversity-oriented synthesis (DOS) of conformationally anchored structural peptidomimetics like 2,5-diketopiperazines (2,5-DKP) containing heterocyclic bioisosteres of the amide bond, such as 1,2,3-triazoles and 1,5-disubstituted tetrazoles (1,5-DS-T) is described. Structural peptidomimetics are synthesized from similar available starting materials, via a strategy based on isocyanide-based multicomponent reactions (IMCRs): Ugi-4CR and Ugi-Azide (UA), followed by a one-pot process: SN 2/intramolecular alkyne-azide cycloaddition (IAAC). The sequential aligning of two powerful synthetic tools (IMCR and IAAC) has parallelly contributed to generate anchored conformation and complexity in target molecules, which are considered structural peptidomimetics of 2,5-DKP. Herein, the 1,2,3-triazole ring plays a key role in the preference for the boat conformation. Furthermore, the use of UA reaction generates scaffold diversity at the N-1 α-carbon of the pyrazinone ring, replacing a linear amide bond with a heterocyclic bioisostere such as 1,5-DS-T leading to the synthesis of novel tricyclic peptidomimetics. The DFT calculations confirmed the boat conformation of the synthesized molecules.

Quantification of Emphysema Progression at CT Using Simultaneous Volume, Noise, and Bias Lung Density Correction.

Background CT attenuation is affected by lung volume, dosage, and scanner bias, leading to inaccurate emphysema progression measurements in multicenter studies. Purpose To develop and validate a method that simultaneously corrects volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT in a longitudinal multicenter study. Materials and Methods In this secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, lung function data were obtained from participants who completed baseline and 5-year follow-up visits from January 2008 to August 2017. CT emphysema progression was measured with volume-adjusted lung density (VALD) and compared with the joint volume-noise-bias-adjusted lung density (VNB-ALD). Reproducibility was studied under change of dosage protocol and scanner model with repeated acquisitions. Emphysema progression was visually scored in 102 randomly selected participants. A stratified analysis of clinical characteristics was performed that considered groups based on their combined lung density change measured by VALD and VNB-ALD. Results A total of 4954 COPDGene participants (mean age, 60 years ± 9 [SD]; 2511 male, 2443 female) were analyzed (1329 with repeated reduced-dose acquisition in the follow-up visit). Mean repeatability coefficients were 30 g/L ± 0.46 for VALD and 14 g/L ± 0.34 for VNB-ALD. VALD measurements showed no evidence of differences between nonprogressors and progressors (mean, -5.5 g/L ± 9.5 vs -8.6 g/L ± 9.6; P = .11), while VNB-ALD agreed with visual readings and showed a difference (mean, -0.67 g/L ± 4.8 vs -4.2 g/L ± 5.5; P < .001). Analysis of progression showed that VNB-ALD progressors had a greater decline in forced expiratory volume in 1 second (-42 mL per year vs -32 mL per year; Tukey-adjusted P = .002). Conclusion Simultaneously correcting volume, noise, and interscanner bias for lung density change estimation in emphysema progression at CT improved repeatability analyses and agreed with visual readings. It distinguished between progressors and nonprogressors and was associated with a greater decline in lung function metrics. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Goo in this issue.

Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes.

Background: Abnormal lung function trajectories are associated with increased risk of chronic obstructive pulmonary disease (COPD) and premature mortality; several risk factors for following these trajectories have been identified. Airway under-sizing dysanapsis (small airway lumens relative to lung size), is associated with an increased risk for COPD. The relationship between dysanapsis and lung function trajectories at risk for adverse outcomes of COPD is largely unexplored. We test the hypothesis that dysanapsis differentially affects distinct lung function trajectories associated with adverse outcomes of COPD. Methods: To identify lung function trajectories, we applied Bayesian trajectory analysis to longitudinal FEV1 and FVC Z-scores in the COPDGene Study, an ongoing longitudinal study that collected baseline data from 2007 to 2012. To ensure clinical relevance, we selected trajectories based on risk stratification for all-cause mortality and prospective exacerbations of COPD (ECOPD). Dysanapsis was measured in baseline COPDGene CT scans as the airway lumen-to-lung volume (a/l) ratio. We compared a/l ratios between trajectories and evaluated their association with trajectory assignment, controlling for previously identified risk factors. We also assigned COPDGene participants for whom only baseline data is available to their most likely trajectory and repeated our analysis to further evaluate the relationship between trajectory assignment and a/l ratio measures. Findings: We identified seven trajectories: supranormal, reference, and five trajectories at increased risk for mortality and exacerbations. Three at-risk trajectories are characterized by varying degrees of concomitant FEV1 and FVC impairments and exhibit airway predominant COPD patterns as assessed by quantitative CT imaging. These trajectories have lower a/l ratio values and increased risk for mortality and ECOPD compared to the reference trajectory. Two at-risk trajectories are characterized by disparate levels of FEV1 and FVC impairment and exhibit mixed airway and emphysema COPD patterns on quantitative CT imaging. These trajectories have markedly lower a/l ratio values compared to both the reference trajectory and airway-predominant trajectories and are at greater risk for mortality and ECOPD compared to the airway-predominant trajectories. These findings were observed among the participants with baseline-only data as well. Interpretation: The degree of dysanapsis appears to portend patterns of progression leading to COPD. Assignment of individuals-including those without spirometric obstruction-to distinct trajectories is possible in a clinical setting and may influence management strategies. Strategies that combine CT-assessed dysanapsis together with spirometric measures of lung function and smoke exposure assessment are likely to further improve trajectory assignment accuracy, thereby improving early detection of those most at risk for adverse outcomes. Funding: United States National Institute of Health, COPD Foundation, and Brigham and Women's Hospital.

Early Evidence of Chronic Obstructive Pulmonary Disease Obscured by Race-Specific Prediction Equations.

Rationale: The identification of early chronic obstructive pulmonary disease (COPD) is essential to appropriately counsel patients regarding smoking cessation, provide symptomatic treatment, and eventually develop disease-modifying treatments. Disease severity in COPD is defined using race-specific spirometry equations. These may disadvantage non-White individuals in diagnosis and care. Objectives: Determine the impact of race-specific equations on African American (AA) versus non-Hispanic White individuals. Methods: Cross-sectional analyses of the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) cohort were conducted, comparing non-Hispanic White (n = 6,766) and AA (n = 3,366) participants for COPD manifestations. Measurements and Main Results: Spirometric classifications using race-specific, multiethnic, and "race-reversed" prediction equations (NHANES [National Health and Nutrition Examination Survey] and Global Lung Function Initiative "Other" and "Global") were compared, as were respiratory symptoms, 6-minute-walk distance, computed tomography imaging, respiratory exacerbations, and St. George's Respiratory Questionnaire. Application of different prediction equations to the cohort resulted in different classifications by stage, with NHANES and Global Lung Function Initiative race-specific equations being minimally different, but race-reversed equations moving AA participants to more severe stages and especially between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 and preserved ratio impaired spirometry groups. Classification using the established NHANES race-specific equations demonstrated that for each of GOLD stages 1-4, AA participants were younger, had fewer pack-years and more current smoking, but had more exacerbations, shorter 6-minute-walk distance, greater dyspnea, and worse BODE (body mass index, airway obstruction, dyspnea, and exercise capacity) scores and St. George's Respiratory Questionnaire scores. Differences were greatest in GOLD stages 1 and 2. Race-reversed equations reclassified 774 AA participants (43%) from GOLD stage 0 to preserved ratio impaired spirometry. Conclusions: Race-specific equations underestimated disease severity among AA participants. These effects were particularly evident in early disease and may result in late detection of COPD.

Impact of a cuff-based device calibration method on the agreement between invasive and noninvasive aortic and brachial pressure.

INTRODUCTION: Brachial cuff-based methods are increasingly used to estimate aortic systolic blood pressure (aoSBP). However, there are several unresolved issues. AIMS: to determine to what extent the scheme used to calibrate brachial records (1) can affect noninvasive obtained aoSBP levels, and consequently, the level of agreement with the aoSBP recorded invasively, and (2) how different ways of calibrating ultimately impact the relationship between aoSBP and cardiac properties. METHODS: brachial and aortic blood pressure (BP) was simultaneously obtained by invasive (catheterisation) and noninvasive (brachial oscillometric-device) methods (89 subjects). aoSBP was noninvasive obtained using three calibration schemes: 'SD': diastolic and systolic brachial BP, 'C': diastolic and calculated brachial mean BP (bMBP), 'Osc': diastolic and oscillometry-derived bMBP. Agreement between invasive and noninvasive aoSBP, and associations between BP and echocardiographic-derived parameters were analysed. CONCLUSIONS: 'C' and 'SD' schemes generated aoSBP levels lower than those recorded invasively (mean errors: 6.9 and 10.1 mmHg); the opposite was found when considering 'Osc'(mean error: -11.4 mmHg). As individuals had higher invasive aoSBP, the three calibration schemes increasingly underestimated aoSBP levels; and viceversa. The 'range' of invasive aoSBP in which the calibration schemes reach the lowest error level (-5-5 mmHg) is different: 'C': 103-131 mmHg; 'Osc': 159-201 mmHg; 'SD':101-124 mmHg. The calibration methods allowed reaching levels of association between aoSBP and cardiac characteristics, somewhat lower, but very similar to those obtained when considering invasive aoSBP. There is no evidence of a clear superiority of one calibration method over another when considering the association between aoSBP and cardiac characteristics.

Diagnóstico de la evaluación del desempeño profesional pedagógico del tutor de Medicina General Integral

Introducción: La evaluación del desempeño profesional pedagógico del tutor es vital para elevar la calidad del proceso educativo. Objetivo: Diagnosticar el estado actual de la evaluación del desempeño profesional pedagógico del tutor de Medicina General Integral. Materiales y métodos: Se realizó una investigación descriptiva de corte transversal, con enfoque mixto, entre marzo y septiembre de 2022, en la Filial de Ciencias Médicas Dr. Eusebio Hernández Pérez, de Colón, en la provincia de Matanzas. Variable: el desempeño profesional pedagógico del tutor de Medicina General Integral. Unidades de estudio: 78 tutores, 275 residentes y 44 directivos. Dimensiones: cognoscitiva, procedimental y comportamental. Métodos: teóricos: análisis-síntesis e inducción-deducción; empíricos: análisis documental, encuesta, entrevista, observación; estadísticos: medidas de resumen para variables cualitativas y cuantitativas: frecuencias absolutas y relativas. Procedimientos: parametrización, triangulación metodológica. Resultados: Se identificaron problemas según las dimensiones cognoscitiva (poco dominio de las modalidades de educación en el trabajo y en la didáctica en la tutoría; poca preparación en metodología de la investigación y en buscadores de información científica en salud), procedimental (no correspondencia entre actividades presenciales y las de tutoría, poco nivel para planificar, ejecutar y controlar actividades), y comportamental (poca participación en superación relacionada con la tutoría, en eventos y poca producción científica). Las potencialidades se identificaron según las dimensiones procedimental (nivel de integración de conocimientos; promoción de cooperación y trabajo en equipo; relación entre temas de investigación y el banco de problemas del policlínico), y comportamental (nivel en que estimula el reforzamiento de valores y la ética médica; promoción de empatía y comunicación efectiva con el residente). Conclusiones: El diagnóstico permitió identificar problemas y potencialidades del objeto estudiado. Se propone una alternativa propia de las ciencias de la educación médica para resolver el problema científico, que es la elaboración de una metodología.

Introduction: The evaluation of the professional pedagogical performance of the tutor is vital to raise the quality of the educative process. Objective: To diagnose the current status of the professional pedagogical performance of the tutor of Comprehensive General Medicine. Materials and methods: A descriptive, cross-sectional research, with mixed approach, was carried out between March and September 2022, in the Campus of Medical Sciences Dr. Eusebio Hernández Pérez, from Colon, in the province of Matanzas. Variable: professional pedagogical performance of the tutor of Comprehensive General Medicine. Units of study: 78 tutors, 275 residents and 44 members of the management staff. Dimensions: cognitive, procedural, and behavioral. Methods: theoretical methods: analysis-synthesis and induction-deduction; empirical methods: documentary analysis; surveys; interviews; observation. Statistical methods: summary measures for qualitative and quantitative variables; absolute and relative frequencies. Procedures: parameterization, methodological triangulation. Results: Problems were identified according to the cognitive dimensions (little mastery of the modalities of education at work and tutorship didactics; little training in research methodology and in search engines for scientific information in health); procedural dimension: no correspondence between face-to-face and tutoring activities, low level of planning, executing and controlling activities); and behavioral dimension (little participation in upgrading activities related to tutorship, in events, and little scientific production). Potentialities were identified according to procedural dimensions (level of knowledge integration; promotion of cooperation and teamwork promotion; relationship between research topics and policlinic's problem bank), and behavioral (level at which it stimulates the reinforcement values and medical ethics; promotion of empathy and effective communication with the resident). Conclusions: The diagnosis allowed the authors to identify problems and potentialities of the object studied. An alternative specific of the medical education sciences is proposed to solve the scientific problem, which is the elaboration of a methodology.

Supervisión de salud de niños/as con Síndrome de Down realizado por enfermera, desde la mirada de sus cuidadores / Caregivers' perspectives about the health supervision of children with Down Syndrome carried out by a nurse

INTRODUCCION: Los niños con Síndrome de Down (SD) y sus cuidadores requieren de una atención de salud multidisciplinaria que responda a sus necesidades desde una perspectiva integral. OBJETIVO: conocer las experiencias y expectativas que tienen los cuidadores de niños con SD en relación con los cuidados brindados por la enfermera durante el control de supervisión de salud infantil. METOLOGÍA: Estudio cualitativo fenomenológico, muestra intencionada de casos por criterios conformada por 11 cuidadores de niños con SD entre 0 y 9 años, que recibieron prestaciones en el Control de Salud Infantil. Se realizaron entrevistas semiestructuradas, los datos se analizaron siguiendo el esquema de reducción progresiva. Contó con la aprobación de la Dirección de Carrera de Enfermería, Universidad Santo Tomás (Temuco-Chile) (Acta 07-2018). RESULTADOS: se generaron dos categorías: "Experiencia de atención otorgada por la enfermera" y "Expectativas vinculadas a la atención proporcionada por la enfermera", se develó que los cuidadores de niños con SD perciben que los cuidados brindados por la enfermera durante la atención son insuficientes en relación con las necesidades que estos niños presentan. Esto estaría vinculado con la falta de conocimientos sobre esta condición y su abordaje integral. Con respecto a sus expectativas, refieren necesidad de acompañamiento, apoyo, educación y de profesionales de enfermería capacitados. CONCLUSIONES: urge abordar las brechas con respecto a las competencias del profesional de enfermería que realiza controles de salud del niño para poder entregar una atención de calidad a ellos y sus familias.

INTRODUCTION: Children with Down Syndrome (DS) and their caregivers require multidisciplinary health care that meets their needs from a comprehensive perspective. OBJECTIVE: to know the experiences and expectations that caregivers of children with DS have concerning the care provided by the nurse in the Child Health Supervision Attention. METHOD: A qualitative phenomenological study was conducted, an intentional sample of cases by criteria made up of 11 caregivers of children with DS between 0 and 9 years of age, who received benefits at the Child Health Control. Semi-structured interviews were carried out; the data were analyzed following the progressive reduction scheme. It had the approval of the Nursing Career Department, Santo Tomás University (Temuco-Chile) (Acta 07-2018). RESULTS: two categories were generated: "Experience of care provided by the nurse" and "Expectations linked to the care provided by the nurse", it was revealed that caregivers of children with DS perceive that the care provided by the nurse during the control is insufficient with the children's needs also, data showed a link to the lack of knowledge about this condition and its comprehensive approach. Regarding their expectations, they report the need for accompaniment, support, and education from the nurse, in addition to being a trained professional. CONCLUSION: It is urgent to address the gaps regarding the competencies of the nursing professional who performs child health checks to deliver quality care to them and their families.

Construcción y validación de un instrumento para evaluar el desempeño pedagógico del tutor de Medicina General Integral

Introducción: Para evaluar resulta imprescindible la construcción de herramientas en función de establecer resultados medibles. Objetivo: Construir y validar un instrumento para evaluar el desempeño profesional pedagógico del tutor de la especialidad de Medicina General Integral. Materiales y métodos: Enfoque mixto, diseño transversal analítico. Métodos: teóricos: análisis y síntesis, inducción-deducción, enfoque sistémico; empíricos: análisis documental, encuesta a tutores y residentes, observación y criterio de expertos; estadísticos: estadística descriptiva (valores absolutos y porcentuales), coeficiente alfa de Cronbach, coeficiente W de Kendall. Procedimientos: parametrización y triangulación metodológica. Fases: revisión bibliográfica, parametrización, análisis de validez de contenido, confiabilidad y aplicabilidad. Resultados: Se elaboró un instrumento con tres dimensiones (cognoscitiva, procedimental y comportamental) y 19 indicadores. Se seleccionaron 15 expertos. Más del 70 % evaluaron los ítems según los criterios de Moriyama en la categoría Mucho. El cálculo del coeficiente W de Kendall sugirió una alta concordancia entre los jueces. El instrumento final contó con 18 ítems. El coeficiente alfa de Cronbach resultó en 0,83 (alta confiabilidad). Con su aplicación se identificaron siete problemas y seis potencialidades, lo cual demostró su validez en la práctica para el diagnóstico. Conclusiones: El instrumento construido evidenció buenas condiciones de validez teórica y práctica, lo cual permitirá direccionar las acciones de superación para los tutores de la especialidad de Medicina General Integral. También puede complementar la evaluación profesoral, al particularizar en el cumplimiento de las funciones del tutor.

Introduction: To evaluate, the construction of tools able to establish measurable results is essential. Objective: To build and validate an instrument to evaluate the professional pedagogical performance of the tutor of the Comprehensive General Medicine specialist. Materials and methods: Mixed approach, cross-sectional, analytical design. Theoretical methods: analysis and synthesis; induction-deduction; systemic approach. Empirical methods: documentary analysis; survey to tutors and residents; observation, and experts' judgment. Statistical methods: descriptive statistics (absolute and percentage value), Cronbach Alpha coefficient; Kendall's W coefficient. Procedures: parametrization and methodological triangulation. Phases: bibliographic review; parametrization; analysis of content validity; reliability, and applicability. Results: An instrument was developed with three dimensions (cognitive, procedural and behavioral) and 19 indicators. 15 experts were chosen. More than 70% evaluated the items according to Moriyama criteria in the category A lot. The calculation of the Kendall's W coefficient suggested a high concordance between judges. The final instrument had 18 items. Cronbach Alpha coefficient resulted in 0.83 (high reliability). With its application, seven problems and six potentialities were identified, which demonstrated its validity in practice for diagnostic. Conclusions: The built document showed good conditions of theoretical and practical validity, which will allow directing the training actions for the tutors in the specialty of Comprehensive General Medicine. It can also complement the professorial evaluation, by particularizing in the fulfillment of the tutor's functions.

Gastric inflammatory myofibroblastic tumor, a rare mesenchymal neoplasm: A case report.

BACKGROUND: The inflammatory myofibroblastic tumor (IMT) is a rare mesenquimal tumor of doubtful biological behaviour. It's characterised for affecting mainly children and young adults, although it can appear at any age, being the lungs the primary affected organ (in children it represents 20% of all primary pulmonary tumors). CASE SUMMARY: We present the case of a 45 year old woman, with a computed tomography (CT) finding of injury on the anterior surface of the fundus/gastric body and a solid perigastric injury of 12 mm in the ecoendoscopy. The case is presented in the tumor committee deciding to perform a laparoscopic wedge resection. The histological diagnosis was a IMT. The diagnosis is based on imaging tests like the abdominal CT, abdominal ecography and the ecoendoscopy but to confirm the diagnosis a pathological study is necessary. CONCLUSION: Due to the unpredictable nature of this tumor, surgical resection is the best therapeutic option.