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Introduction: The diagnosis of giant cell arteritis (GCA) by ultrasonography including large vessels, apart from the temporal artery increases the sensibility of the study and informs about the risk of specific complications. However, there is less information about the study of these arteries, whose affection carries higher proportion of severe complications. Objectives: To describe and analyze the value of the diameter of the cervical vertebral canal of the vertebral artery (VA) as a sign of vertebral vasculitis (VV) related to GCA and estimate the risk of stroke complications. Materials and methods: Observational study of a population that includes patients with GCA with and without VA vasculitis as well as healthy subjects. We evaluated whether there were differences in VA diameter in the groups and, if so, we estimated the diagnostic capacity of the variable that best defines VA diameter using a ROC curve. Cut-off points with their associated reliability chosen thereafter. Results: There were 347 subjects included:107 with GCA of whom 37 had vertebral vasculitis, 240 healthy controls. In patients with GCA and VV, the VA diameter was increased (No GCA 3.4 mm, GCA without VV 3.6 mm, GCA with VV 5.2 mm p < 0.01). According to the ROC curves, the variable defining vertebral diameter with best diagnostic accuracy is the sum of both sides (area under the curve of 0.98). With a cut-off point of 8.45 mm, the reliability values are: sensitivity 94.1%, specificity 94.5%, PPV 82.1% and NPV 98.4%. With a cut-off point of 9.95 mm, the sensitivity is 52.9% and the specificity is 100%. Likewise, VA diameter is independently associated with the presence of stroke in the vertebrobasilar territory (OR 1.6, range 1.2-2.2). Conclusion: The VA diameter, measured as the sum of both sides, is an objectively measurable sign with very high reliability for detect vertebral vasculitis in patients with GCA. It is proposed here as a novel echographic sign, which can aid the detection of the involvement of an artery where the complications are especially serious.
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Resumen: Introducción: En el siglo XX el parto pasó de ser atendido en casa al ámbito hospitalario. Se adoptaron de forma acrítica intervenciones inapropiadas e innecesarias que condujeron a una deshumanización del parto. Este es el modelo que existe actualmente en la mayoría de los hospitales españoles y que fue cuestionado por la OMS ya en 1996. Objetivo: Describir las diferencias que existen en los resultados obstétricos y neonatales en primíparas en dos modelos distintos de asistencia al parto (biomédico y humanizado). Método: Se llevó a cabo un estudio descriptivo, de corte transversal. Se obtuvo una muestra por conveniencia de 205 primíparas, 110 del modelo biomédico y 95 del humanizado. Se compararon los resultados obstétricos y neonatales en dos hospitales con modelos diferentes de asistencia al parto en España. Resultados: En el modelo humanizado de asistencia al parto se obtuvieron unos mejores resultados obstétricos (inicio espontáneo, parto eutócico, periné íntegro o desgarro de I grado y menos episiotomías) que en el biomédico. No hubo diferencias en los resultados neonatales. Conclusión: Los beneficios de instaurar un modelo humanizado de asistencia al parto deberían ser considerados por los responsables de políticas sanitarias y reflejados en la mujer y su criatura.
Resumo: Introdução: No século XX, o parto deixou de ser realizado em casa para ser realizado no ambiente hospitalar. Intervenções inadequadas e desnecessárias foram adotadas acriticamente, levando a uma desumanização do parto. Este é o modelo que existe atualmente na maioria dos hospitais espanhóis e que foi questionado pela Organização Mundial da Saúde já em 1996. Objetivo: O objetivo principal desse estudo é descrever as diferenças existentes nos resultados obstétricos e neonatais em primíparas em dois modelos distintos de assistência ao parto (biomédico e humanizado). Método: Foi realizado um estudo descritivo, transversal. Obteve-se uma amostra por conveniência de 205 primíparas, 110 do modelo biomédico e 95 do modelo humanizado. Os resultados obstétricos e neonatais foram comparados em dois hospitais com diferentes modelos de assistência ao parto na Espanha. Resultados: No modelo humanizado de assistência ao parto obtiveram-se melhores resultados obstétricos (início espontâneo, parto eutócico, períneo íntegro ou laceração grau I e menos episiotomias) do que no modelo biomédico. Não houve diferença nos resultados neonatais. Conclusão: Os benefícios da implementação de um modelo humanizado de assistência ao parto devem ser considerados pelos formuladores de políticas de saúde e refletidos na mulher e em seu bebê.
Abstract: Introduction: In the 20th century, childbirth went from being attended at home to the hospital setting. Inappropriate and unnecessary interventions were uncritically adopted, leading to a dehumanization of childbirth. This is the model that currently exists in most Spanish hospitals, which has been questioned by the World Health Organization as early as 1996. Objective: The aim is to describe the differences in obstetrical and neonatal results across two different models of maternity care (biomedical model and humanised birth). Method: A correlational descriptive and multicenter study was carried out. A convenience sample of 205 primiparous women, 110 biomedical model and 95 humanised model, were recruited. Obstetrical and neonatal results were compared in two hospitals with different models of maternity care in Spain. Results: The humanised model of maternity care produces better obstetrical outcomes (spontaneous beginning of labour, normal vaginal birth, intact perineum and I degree tear and less episiotomies) than the biomedical model. There were no differences in neonatal outcomes. Conclusion: The benefits of implementing a humanised model of delivery care should be considered by health policy makers and reflected in the woman and her baby.
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Introduction: Laparoscopic surgery is an increasingly used technique, but it requires a high degree of learning, and communication between the operating room crew is considerably difficult. The use of eye tracking has been proposed as a didactic and evaluation tool in several settings, including in laparoscopy in simulators. Objectives: This study aimed to evaluate the usefulness of the use of eye tracking systems (Tobii glasses 2) in laparoscopic surgery as a didactic and assessment tool to improve communication in the operating room and improve patients' security. Methodology: An anonymous survey was sent to the students and medical teachers of a faculty of medicine and practicing doctors and residents. The message contained an explanation about the use of the Tobii glasses, a link to watch the video showing its use in a laparoscopic surgery, and the survey to complete after watching the video. Results: The survey was answered by 113 participants (51.3% medical students, 27.4% medical teachers, 18.6% practicing doctors, and 2.7% medicine residents). Eighty-three percent agreed with the usefulness of the "Tobii glasses" in the operating room for improving communication between the main surgeon and the assistant, for learning complex surgery techniques, for obtaining didactic videos, and for indicating anatomical structures. The item scored worst was the price of the glasses. Conclusions: It is possible to record and project expert gaze patterns in the operating room in real time using the Tobii glasses. This device allows improving communication among the surgical crew and the learning of residents and also improving the security of surgical patients.
