Autoevaluación de adquisición de competencias en estudiantes de grado de Medicina mediante simulación clínica / Self-assessment of skill acquisition in clinical simulations for medical undergraduate students

Introducción: La autopercepción que tienen los estudiantes para desarrollar su práctica clínica es la manera más acertada de evaluar cuán preparados se sienten y cuáles son sus habilidades. La universidad desarrolla un programa de simulación que permite a los alumnos potenciar su propio aprendizaje, con situaciones de feedback de los instructores de simulación.Sujetos y métodos.El estudio tuvo lugar en el curso académico 2019-2020. Los estudiantes de tercer año completaron tres escenarios de simulación; los de cuarto año, cuatro; y los de quinto año, tres. Antes y después de cada sesión de simulación, completaron un cuestionario electrónico de autopercepción de competencias técnicas y no técnicas.Resultados.De los 121 estudiantes de tercer curso, 79 (65,3%) contestaron a la encuesta inicial y 68 (61,2%) a la encuesta final. En cuarto curso participaron 111 alumnos, y contestaron la encuesta inicial 63 alumnos (56,8%) y 68 la final (61,2%). El quinto curso estuvo compuesto por 97 estudiantes, de los cuales 94 (96,9%) contestaron la encuesta inicial y 69 (71,1%) la final. Todos los ítems de la encuesta de autopercepción mejoraron de forma estadísticamente significativa (p < 0,001) en la encuesta final. Las puntuaciones iniciales medias en la dimensión no técnica fueron más altas que las puntuaciones medias en la dimensión técnica para todos los cursos de estudio.Conclusiones.Los resultados que obtuvimos mostraron una mejora en la autopercepción de las habilidades de los estudiantes y en su confianza para realizar las tareas de las simulaciones. Los alumnos de cursos superiores se sienten más seguros tanto en habilidades técnicas como en no técnicas, como la comunicación. (AU)

Introduction: The self-perception that students have to develop their clinical practice is the most accurate way to assess how prepared they feel and what their abilities are. The University develops an innovative and complete simulation program that allows students to enhance their own learning and that of their classmates, with feedback situations from the simulation instructors of the faculty itself.Subjects and methods.The study took place in the academic year 2019-2020. During the study period, 3rd-year students completed 3 simulation scenarios, 4th-year students 4 cases, and 5th-year students completed 3 scenarios. Before and after each simulation session, they anonymously and voluntarily completed an electronic questionnaire on self-perception of technical and non-technical skills.Results.Of the 121 third-year students, 79 (65.3%) answered the initial questionnaire and 68 (61.2%) the final questionnaire. In the fourth year, 111 students participated, and 63 students (56.8%) answered the initial questionnaire and 68 (61.2%) the final one. The fifth course was composed of 97 students, of which 94 (96.9%) answered the initial questionnaire and 69 (71.1%) the final one. All the items of the self-perception survey improved in a statistically significant way (p < 0.001) in the final survey. The mean baseline scores on the non-technical dimension were higher than the mean scores on the technical dimension for all study courses.Conclusions.The results we obtained showed an improvement in the self-perception of the students' abilities and in their confidence to perform the tasks of the simulations. Higher grade students feel more confident in both technical and non-technical skills, such as communication. (AU)

Association Between the Interleukin-17 Gene Polymorphism -197G>A and the Risk of Prostate Cancer in a Galician Population.

A case-control study was carried out in which the role of the Single Nucleotide Polymorphism rs2275913 in the pathogenesis of prostate cancer was analysed for the first time. This polymorphism is located in -197 position of IL-17A gene and implies a A>G change. The sample consists of 433 Galician men, 241 of whom are prostate cancer patients and 192 are healthy men with no tumours. Besides the influence of this marker, directly involved in the inflammatory process, other variables that were described as prostate cancer risk factors were also studied: age, smoking and Body Mass Index (BMI). By the analysis of Odds Ratio (OR) (CI 95%) a protective effect of heterozygous genotype AG was observed in comparison with homozygous genotypes AA and GG. As regards other risk factors, a significant increased risk was observed in smokers homozygous between 10 and 32 pack-years (p = 0.032). Age and BMI show interesting patterns, but not significant ones. This study shows a possible link between the rs2275913 and the onset of PCa which could be influenced by age, BMI and above all, smoking.

Resultados de las entrevistas familiares en donación en asistolia no controlada / Results of interviews with families of non-heart-beating donor candidates

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Association of CASP3 genetic polymorphisms rs1049216, rs2705897 and rs4647603 with the risk of prostate cancer in Galicia (NW Spain).

Malfunction of apoptosis plays a key role in carcinogenesis. Previous studies have reported that polymorphisms in caspase genes could lead to poor apoptotic signaling, thus facilitating the onset of several human cancers. The aim of this study was to evaluate the association between three polymorphisms (rs1049216, rs2705897 and rs4647603) of the CASP3 gene and the risk of prostate cancer (PCa) in Galicia (NW Spain).The relationship between these single nucleotide polymorphisms (SNPs) and PCa in European populations has yet to be studied. To test this hypothesis, we carried out a case-control study on a total of 243 patients with PCa and 191 healthy individuals, genotyping all polymorphisms using the matrix assisted laser desorption ionization time-of-flight (MALDI-TOF) method. Overall, none of the polymorphisms were clearly associated with the risk of PCa. Nevertheless, the results drawn from this study suggest that genetic variability in the CASP3 gene, in combination with lifestyle and environmental factors may influence the predisposition to develop PCa in the Galician population. Specifically, the results of study seem to hint at a higher risk of PCa in smokers of up to 20 pack-years (PY) and carriers of both the CASP3-rs1049216 GG genotype and the G allele (OR = 3.61, p = 0.044; OR = 1.71; p = 0.018). In addition, the GG and AG genotypes showed increased predisposition to PCa in overweight individuals (OR = 4.43, p = 0.040; OR = 2.00; p = 0.022). Finally, the CASP3-rs4647603 CT genotype and T allele were associated with a higher susceptibility to PCa in obese individuals (ORCT/TT = 4.30, p = 0.003; ORT/C = 3.58, p = 0.004). Further replication studies in other populations are required to assess these findings.

La enseñanza del manejo de la vía aérea en situaciones de emergencia / Teaching airway mangement skills for emergency situations

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Evolución del injerto hepático procendente de donante en asistolia / Evolution of the liver graft from a asystole donor

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Lung transplant of extrahospitalary donor after cardiac death.

Non-heart-beating donors (NHBDs) have to meet the predefined criteria for organ donation including death from irreversible cessation of the beating heart. The Maastricht conference defined 4 NHBD categories to differentiate their viability and ethical-legal support. In Spain, NHBDs who originate from an out-of-hospital setting correspond to type II donors. These are patients who have had a cardiac arrest outside hospital and, after failed CPR attempts, are transferred with hemodynamic support measures to the hospital for organ donation. The Hospital Clínico San Carlos also has a lung donation program in collaboration with the Hospital Puerta de Hierro in Madrid and the Hospital Marques de Valdecilla in Santander. The objective of this study is to describe the results of lung transplantation of after cardiac death program, specifically the section regarding lung extraction donation. Twenty potential lung donors were obtained during the study. Most patients were male (19 cases), with a mean age of 42 years (36.5-49.5 years). A total of 33 lungs were donated (18 right and 15 left lungs). Most extractions were multiorganic (19 cases). One liver, 19 kidneys, 2 pancreas, and 19 corneas were obtained from these donors; bone tissue was obtained from all donors. The transplantation was bipulmonary in 13 cases and unipulmonary in 7. Thirty days after transplantation, 2 recipients died, 1 died of stroke associated with bilateral pneumonia and 1 died of hypovolemic shock resulting from hemothorax. The remaining 18 patients were progressing well at 30 days. Our data suggest that lung transplantation from patients after extrahospitalary cardiac death is feasible.

Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review.

OBJECTIVE: The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL: A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS: A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION: This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.

Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca extrahospitalaria / Mechanical cardiopump use in organ donation after prehospital cardiac death

Objetivo: El Servicio de Urgencias Médicas de Madrid SUMMA112, en colaboración con dos hospitales de Madrid, está inmerso en un programa de donación de órganos de pacientes que han sufrido una parada cardiaca extrahospitalaria y no han respondido a las maniobras de resucitación. El objetivo de este estudio es valorar los resultados de la aplicación de cardiocompresores mecánicos. Metodología: Estudio descriptivo retrospectivo basado en la base de datos del SUMMA112 de donantes tras muerte cardiaca. El estudio se realizó durante el año 2008 y 2009, año este último en el que se generalizó el uso de estos cardiocompresores. Se usaron dos cardiocompresores, el LUCAS© de Physio-Control y el Autopulse© de Zoll. Se estudiaron como variables independientes la edad, el sexo, el uso de cardiocompresión mecánica (CCM) y el tipo de cardiocompresor, el tiempo de llegada a la escena y el tiempo desde la alerta a la llegada al hospital. Como variables dependientes se registraron si fueron donantes válidos, número de órganos y tipo de órganos. Se compararon los resultados de media por donantes en el año 2008 (periodo sin CCM) y 2009 (periodo con CCM). Resultados: Se registraron un total de 108 casos. El 87% del total de pacientes eran varones, y la mediana (RIQ) de la edad era 40 años (35-49,7). Se obtuvieron un total de 82 donantes válidos, lo que corresponde a 3,18 órganos por donante. La media de órganos en el periodo sin CCM fue de 3,4 y en el de CCM de 2,9 (p < 0,05). No encontramos diferencia significativa en la comparación entre los dos cardiocompresores. Conclusión: Según nuestra serie, el número de órganos extraídos y trasplantados por donante es menor con CCM. Se necesitan más estudios para demostrar que estos dispositivos mejoran el número o la calidad de los órganos extraídos (AU)

Objective: The SUMMA112 emergency health service of Madrid is working with area hospitals on a program to facilitate organ donation from persons who have suffered cardiac death outside the hospital and who have not responded to resuscitation maneuvers. The aim of this study was to assess the usefulness of mechanical cardiopumps. Methods: Retrospective, descriptive study based on SUMMA112 data available for organ donors after cardiac death. The data analyzed were from 2008, before cardiopumps, and 2009, the year when cardiopumps became widely used. Two models were available; one was the LUCAS pump, from Physio-Control, and the other was the Autopulse, from Zoll. Independent variables studied were age, sex, cardiopump use and model, time from arrival at the emergency site until notification of arrival at the hospital. Dependent variables were categorization as a valid donor, number of organs donated, and types of organs donated. We compared the mean number of organs donated in 2008 (period without mechanical cardiopumps) to the number donated in 2009 (with cardiopumps). Results: A total of 108 cases were on record. Eighty-seven percent of the patients were men. The median (interquartilerange) age was 40 (35-49.75) years. Overall, 82 cadavers were valid donors and a mean of 3.18 organs per donor were obtained. In the period without cardiopumps, the mean number of organs obtained was 3.4; with cardiopumps themean was 2.9 organs (P<0.05). There were no significant differences between the 2 cardiopumps. Conclusion: Fewer organs per donor were extracted and transplanted in the year the mechanical cardiopumps were used. Further studies are needed to demonstrate whether or not these devices can increase the number or quality ofextracted organs (AU)

[Relationship of preoperative PSA velocity to histopathological findings in the surgical specimen and survival after radical prostatectomy]. / Relación de la velocidad preoperatoria de PSA con los hallazgos histopatológicos de la pieza quirúrgica y la supervivencia tras prostatectomía radical.

OBJECTIVE: To assess whether PSA velocity (PSV) is related to pathological findings in surgical specimen, biochemical recurrence-free survival (BRFS), cancer-related survival (CRS), and overall survival (OS). MATERIALS AND METHODS: A retrospective and prospective observational cohort study on 265 patients with prostate cancer (PCa) who underwent radical prostatectomy (RP) from 2000 to 2008. PSAV was calculated arithmetically and by linear regression analysis, using PSA values in the year prior to diagnosis. A multivariate logistic regression analysis was performed to detect variables associated to extracapsular disease (ECD). Variables related to BRFS, CRS, and OS were analyzed using Kaplan-Meier methodology (PSAV 3 ng/mL/year) and a multivariate Cox regression analysis. The ability of PSA velociy to predict BRFS, CRS, and OS was evaluated by c-index. RESULTS: Median follow-up was 56.16 months (9.14-106.75). Median PSAV was 0.65 and 0.63 ng/ml/year using the arithmetic and regression methods respectively. ECD was detected in 74 specimens (27.92%), and biochemical recurrence in 50 patients (18.87%). Cancer-related mortality was seen in 4 patients (1.52%) and overall mortality in 16 (6.08%). In the multivariate analysis, PSAV was not related to ECD. PSAV was an independent predictor for BRFS (RR: 1.06, 95% CI: 1.02-1.13, p=0.008), CRS (RR: 1.22, 95% CI: 1.00-1.50, p=0.048), and OS (RR: 1.35, 95% CI: 1.18-1.55, p<0.001) in the multivariate Cox regression analysis. CONCLUSIONS: PSAV is a preoperative parameter that predicts for BFRS, CRS, and OS in patients undergoing RP. No association was found between PSA velocity and presence of ECD.

Relación de la velocidad preoperatoria de PSA con los hallazgos histopatológicos de la pieza quirúrgica y la supervivencia tras prostatectomía radical / Relationship of preoperative PSA velocity to histopathological findings in the surgical specimen and survival after radical prostatectomy

Objetivo: Determinar si la velocidad de antígeno prostático específico (PSAV) se relaciona con los hallazgos histopatológicos de la pieza, la supervivencia libre de recidiva bioquímica (SLRB), la supervivencia cáncer-relacionada (SCR) y la supervivencia global (SG). Material y métodos: Estudio observacional de cohorte retrospectivo y prospectivo formado por 265 pacientes con cáncer de próstata a los que se practicó prostatectomía radical (PR) entre 2000–2008. La PSAV fue calculada de forma aritmética y mediante regresión lineal, utilizando valores de antígeno prostático específico del año previo al diagnóstico. Se realizó un análisis multivariado de regresión logística para detectar variables asociadas a enfermedad extracapsular (EEC). Las variables asociadas a SLRB, SCR y SG fueron estudiadas mediante análisis de Kaplan-Meier (PSAV≤3 vs. >3ng/ml/año) y multivariado de regresión de Cox. La capacidad de PSAV para predecir SLRB, SCR y SG fue determinada mediante c-index. Resultados: La mediana de seguimiento fue 56,16 meses (9,14–106,75). La mediana de PSAV fue 0,65 y 0,63ng/ml/año con los métodos aritmético y de regresión, respectivamente. Se detectó EEC en 74 casos (27,92%) y recidiva bioquímica en 50 (18,87%). Se observó mortalidad cáncer-relacionada en 4 pacientes (1,52%) y mortalidad global en 16 (6,08%). En el análisis multivariado, la PSAV no se relacionó con EEC, asociándose de forma independiente con la SLRB (RR: 1,06; IC 95%: 1,02–1,13; p:=0,008), SCR (RR: 1,22; IC 95%: 1,00–1,50; p=0,048) y SG (RR: 1,35; IC 95%: 1,18–1,55; p<0,001). Conclusiones: La PSAV es una variable preoperatoria que predice SLRB, SCR y SG en los pacientes tratados mediante PR. No se observa asociación entre PSAV y la presencia de EEC (AU)

Objective: To assess whether PSA velocity (PSV) is related to pathological findings in surgical specimen, biochemical recurrence-free survival (BRFS), cancer-related survival (CRS), and overall survival (OS). Materials and methods: A retrospective and prospective observational cohort study on 265 patients with prostate cancer (PCa) who underwent radical prostatectomy (RP) from 2000 to 2008. PSAV was calculated arithmetically and by linear regression analysis, using PSA values in the year prior to diagnosis. A multivariate logistic regression analysis was performed to detect variables associated to extracapsular disease (ECD). Variables related to BRFS, CRS, and OS were analyzed using Kaplan-Meier methodology (PSAV ≤3 vs. >3ng/mL/year) and a multivariate Cox regression analysis. The ability of PSA velociy to predict BRFS, CRS, and OS was evaluated by c-index. Results: Median follow-up was 56.16 months (9.14–106.75). Median PSAV was 0.65 and 0.63ng/ml/year using the arithmetic and regression methods respectively. ECD was detected in 74 specimens (27.92%), and biochemical recurrence in 50 patients (18.87%). Cancer-related mortality was seen in 4 patients (1.52%) and overall mortality in 16 (6.08%). In the multivariate analysis, PSAV was not related to ECD. PSAV was an independent predictor for BRFS (RR: 1.06, 95% CI: 1.02–1.13, p=0.008), CRS (RR: 1.22, 95% CI: 1.00–1.50, p=0.048), and OS (RR: 1.35, 95% CI: 1.18–1.55, p<0.001) in the multivariate Cox regression analysis. Conclusions: PSAV is a preoperative parameter that predicts for BFRS, CRS, and OS in patients undergoing RP. No association was found between PSA velocity and presence of ECD (AU)