Learning outcomes evaluation of a simulation-based introductory course to anaesthesia. / Evaluación de los resultados de aprendizaje de un curso de introducción a la anestesiología basado en simulación clínica.

OBJECTIVE: An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated. MATERIAL AND METHOD: Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed. RESULTS: Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues. CONCLUSIONS: A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.

[Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT')]. / Incumplimiento del tratamiento antibiótico sistémico prescrito en servicios de urgencias de Atención Primaria (Estudio INCUMAT).

INTRODUCTION: Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. MATERIAL AND METHODS: A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. RESULTS: Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). CONCLUSIONS: Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance.