Aprendizaje basado en la simulación: valoración de los objetivos docentes en un programa de abdomen agudo y oclusión intestinal en cirugía general / Simulation-based learning: assessment of the teaching objectives in a program of acute abdomen and intestinal occlusion in general surgery, in medicine degree students

Introducción y objetivo: Analizar el logro de los objetivos docentes desarrollados durante el escenario de los casos de simulación a través de la valoración del profesor, los participantes observadores y quien realiza la propia simulación. Sujetos y métodos: Estudio observacional, prospectivo, descriptivo y unicéntrico, realizado con estudiantes de tercer curso de Medicina de la Universitat Autònoma de Barcelona. Se evalúan los objetivos docentes para cada caso clínico simulado por parte de los estudiantes que realizan la simulación, los observadores y el profesor. La evaluación numérica sigue una escala de tipo escala visual analógica y la categórica los clasifica en conseguidos, parcialmente conseguidos y no conseguidos. El estado nervioso y la comodidad de los alumnos también se evalúan numéricamente. Resultados: Se ha registrado la valoración de los objetivos de 929 participantes. La evaluación de los objetivos tiene un valor medio superior a 7 para cada uno de ellos. Existe una diferencia de 1,5-2 puntos en la valoración media entre el primer caso y el último, y no hay ningún alumno que no consiga los objetivos en el último caso. Se describe un estado de nervios alrededor de 4,5 y de comodidad alrededor de 7, sin diferencias entre los distintos evaluadores. Conclusiones: El logro de los objetivos se consigue de forma notable. Entre el primer caso y el último existe una significativa diferencia en el grado de obtención de los objetivos. No hay una relación entre el estado emocional de los participantes y la consecución de los objetivos.(AU)

Introduction and aim: To analyze the achievement of the educational objectives developed during the scenario of the simulation cases through the assessment of the teacher, the observer participants and the person who performs the simulation itself. Subjects and methods: Observational, prospective, descriptive and single-center study, carried out with 3rd year Medicine students at the Universitat Autònoma de Barcelona. The teaching objectives for each simulated clinical case are evaluated by the students who carry out the simulation, the observers and the teacher. The numerical evaluation follows a VAS-type scale and the categorical one classifies them as achieved, partially achieved and not achieved. The nervous state and comfort of the students are also evaluated numerically. Results: The evaluation of the objectives of 929 participants has been registered. The evaluation of the objectives has an average value greater than 7 for each one of them. There is a difference of 1.5-2 points in the average assessment between the first case and the last, with no student not achieving the objectives in the last case. A state of nerves around 4.5 and comfort around 7 is described, with no differences between the different evaluators. Conclusions: The achievement of the objectives is achieved in a remarkable way. Between the first case and the last, there is a significant difference in the degree of achievement of the objectives. There is no relationship between the emotional state of the participants and the achievement of the objectives.(AU)

Single-dose intravenous ferric carboxymaltose infusion versus multiple fractionated doses of intravenous iron sucrose in the treatment of post-operative anaemia in colorectal cancer patients: a randomised controlled trial.

BACKGROUND: Recent clinical guidelines suggest that treatment of postoperative anaemia in colorectal cancer surgery with intravenous iron reduces transfusion requirements and improves outcomes. The study aimed at comparing two intravenous iron regimens in anaemic patients after colorectal cancer surgery. MATERIALS AND METHODS: This was a single-centre, open-label, randomised, controlled trial in patients undergoing elective colorectal cancer surgery. Patients with moderate to severe anaemia (haemoglobin [Hb] <11 g/dL) after surgery were randomly assigned 1:1 to receive ferric carboxymaltose (FC; 1,000 mg, single dose) or iron sucrose (IS; 200 mg every 48 hours until covering the total iron deficit or discharge). Randomisation was stratified by Hb level: <10 g/dL (Group A) or ≥10-10.9 (Group B). The primary endpoint was the change in Hb concentration at postoperative day 30. Secondary endpoints included iron status parameters, transfusion requirements, complications, and length of hospital stay. RESULTS: From September 2015 to May 2018, 104 patients were randomised (FC 50, IS 54). The median intravenous iron dose was 1,000 mg and 600 mg in the FC and IS groups, respectively. There were no between-group differences in mean change in Hb from postoperative day 1 to postoperative day 30 (FC: 2.5 g/dL, 95% CI: 2.1-2.9; IS: 2.4 g/dL, 95% CI: 2.0-2.8; p=0.52), in transfusion requirements or length of stay. The infection rate was lower in the FC group compared with the IS group (9.8% vs 37.2%, respectively). DISCUSSION: The administration of approximately 500 mg of IS resulted in an increase in Hb at postoperative day 30 similar to that of 1,000 mg of FC, but it was associated with a higher infection rate. Future research will be needed to confirm the results, and to choose the best regime in terms of effectiveness and side effects to treat postoperative anaemia in colorectal cancer patients.

Body image of people over 50 in Spain measured using the BSQ test.

OBJECTIVES: To show the body image of people over 50 in Spain using the Body Shape Questionnaire test (BSQ), taking into account attribute variables of great interest such as age, gender, sentimental status, habitat (rural or urban) and the season of the year in which the test is done (winter or summer). DATA DESCRIPTION: The results obtained show the current state of the body image of 176 people in the process of ageing in Spain. The data collected from the participants are organised taking into account attribute variables of significant impact on body image such as age, gender, having a stable partner, habitat (rural or urban) and the season of the year in which the test is done (winter or summer). These data are especially useful to show how body image changes over the time, depending on the different attributes and according to diverse emotional and social situations. They can be used in studies on body image, eating disorders or studies that assess the importance of physical appearance in someone's self-esteem regardless of age group, geographic area or personal emotional circumstances.

Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients. / Comparación de 2 protocolos de insulina intravenosa: variabilidad de la glucemia en pacientes críticos.

OBJECTIVE: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. MATERIAL AND METHODS: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. RESULTS: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). CONCLUSION: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability.

Comparación de 2 protocolos de insulina intravenosa: variabilidad de la glucemia en pacientes críticos / Comparison of 2 intravenous insulin protocols: Glycemia variability in critically ill patients

Objetivo: La variabilidad glucémica es un predictor independiente de la mortalidad en pacientes críticos. El objetivo del presente estudio es comparar 2 protocolos de administración de insulina intravenosa en críticos en cuanto a la variabilidad glucémica se refiere. Material y métodos: Se trata de un estudio observacional retrospectivo realizado mediante revisión de historias clínicas de los pacientes de una unidad de críticos durante 4 meses consecutivos. Primero se revisó un protocolo de insulina más simple o protocolo de insulina intravenosa basado en una escala (PIVBE), que fue comparado con los mismos meses del siguiente año donde se utilizó protocolo insulina intravenosa basado en escalas dinámicas (PIVBED). Se incluyó a todos los pacientes, adultos, ingresados en la unidad durante los meses referidos. Se excluyó a los pacientes en los que el protocolo no se siguió correctamente. Se revisó a 557 pacientes, de los cuales habían necesitado insulina intravenosa 73 en el primer grupo y 52 en el segundo. Fueron excluidos 4 y 2 pacientes en cada grupo, respectivamente. Resultados: La variabilidad glucémica tanto del primer día (DS1) como la total de la estancia (DST) fue menor en aquellos pacientes tratados con el PIVBED frente al PIVBE: DS1 34,88 frente a 18,16 y DST 36,45 frente a 23,65 (p<0,001). Conclusión: Un protocolo de manejo de glucemia en pacientes críticos basado en escalas dinámicas disminuye la variabilidad glucémica (AU)

Objective: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. Material and methods: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. Results: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). Conclusion: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability (AU)

Broncoespasmo desencadenado por anestesia espinal. Informe de caso y revisión de la literatura / Bronchospasm triggered by spinal anaesthesia. Case report and review of the literature

Bronchospasm is a clinical condition that can occur unexpectedly during general anaesthesia, but is extremely rare after spinal anaesthesia. The following is a case presentation of a patient who developed bronchospasm after undergoing spinal anaesthesia not attributable to other causes, and that adds another case to the limited literature. Most publications allude to asthmatic patients, and this is probably the first description about a patient with emphysema-type COPD. Our case shows that although spinal anaesthesia is considered safe for patients with respiratory disease, specifically in asthmatic patients there is a possibility of bronchospasm in susceptible patients.

El broncoespasmo es una condición clínica que puede aparecer inesperadamente durante la anestesia general, pero es extremadamente rara tras la anestesia espinal. Presentamos un paciente que desarrolló broncoespasmo tras ser sometido a anestesia espinal, no atribuible a otras causas y que añade un caso más a la escasa literatura al respecto. La mayoría de las publicaciones se refieren a pacientes asmáticos, y esta sea probablemente la primera descripción en un paciente con EPOC tipo enfisematoso. Nuestro caso muestra que aunque la anestesia espinal se considere más segura para pacientes con patología respiratoria, en concreto en pacientes asmáticos, existe la posibilidad de que ésta produzca broncoespasmo en pacientes susceptibles.