Utility of artificial intelligence for detection of pneumothorax on chest radiopgraphs done after transthoracic percutaneous transthoracic biopsy guided by computed tomography.

OBJETIVE: To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. MATERIAL AND METHODS: We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. RESULTS: A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. CONCLUSIONS: The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.

Teaching radiology in integrated educational programs.

Radiology is a medical discipline, an area of transversal knowledge integrated into any clinical situation. The optimal training of learning knowledge, skills and aptitudes in Radiology in the Degree in Medicine requires the integration of any imaging modality in the different areas of knowledge; from the basic subjects to any clinical subject of the Degree. This article describes the integration of Radiology teaching into the curriculum throughout the Medicine Degree at the University of Girona (UdG), describing the different radiology teaching activities that are taught. The specific activities of the subject "Radiology" are detailed; through workshops, seminars, practices, interactive computer game; and describing the characteristics of the main teaching methodological activity of the UdG, Problem-Based Learning.

Didactic model based on study techniques: an analysis in nursing student from Ecuador / Modelo didáctico basado en técnicas de estudio: un análisis en estudiantes de Enfermería de Ecuador / Modelo didático baseado em técnicas de estudo: uma análise em estudantes de enfermagem do Equador

Objective: To design a didactic model for the teaching of study techniques in the students of the Bachelor of Nursing career of a university in Ecuador. Methodology: A quasi-experimental study with pre- and post-intervention evaluation of a particular group and experts in pedagogy validated the proposed didactic model. Results: The data obtained before and after the application of the model were significant, the didactic model combines through the diagnosis, planning, execution and control of actions a system of relationships between understanding, analysis and health needs, with emphasis on communication and people skills, emotional stability and physical endurance . It consists of personal aspects (teacher and students, techniques and learning styles, activities and approaches) Discussion: the implementation contributed to the improvement of the organization, planning of activities, the adoption of study techniques and the motivation of students to carry out the academic activities of independent work of the Bachelor of Nursing career, as well as project the articulation of knowledge learned at university in their working life.

Objetivo: Diseñar un modelo didáctico para la enseñanza de técnicas de estudio en los estudiantes de la carrera de Licenciatura en Enfermería de una universidad de Ecuador. Metodología: Estudio cuasi experimental con evaluación pre y post intervención de un solo grupo y se contó con expertos en pedagogía que validaron el modelo didáctico propuesto. Resultados: Los datos obtenidos antes y después de la aplicación del modelo fueron significativos, el modelo didáctico conjuga a través del diagnóstico, planificación, ejecución y control de acciones un sistema de relaciones entre la comprensión, análisis y necesidades de salud, con énfasis en las Habilidades de comunicación e interpersonales, estabilidad emocional y resistencia física. Se compone de aspectos personales (profesor y estudiantes, técnicas y estilos de aprendizaje, actividades y enfoques) Discusión: la implementación contribuyó al mejoramiento de la organización, planificación de actividades, la adopción de técnicas de estudio y la motivación de los estudiantes para realizar las actividades académicas de trabajo independiente de la carrera de Licenciatura en Enfermería, así como proyectar la articulación de los conocimientos aprendidos en la universidad en su vida laboral.

Objetivo: Elaborar um modelo didático para o ensino de técnicas de estudo nos alunos do curso de Bacharelado em Enfermagem de uma universidade do Equador. Metodologia: Estudo quase-experimental com avaliação pré e pós-intervenção de um único grupo e especialistas em pedagogia validou o modelo didático proposto. Resultados: Os dados obtidos antes e após a aplicação do modelo foram significativos, o modelo didático combina através do diagnóstico, planejamento, execução e controle das ações um sistema de relações entre compreensão, análise e necessidades de saúde, com ênfase na comunicação e habilidades interpessoais, estabilidade emocional e resistência física. Consiste em aspectos pessoais (professor e alunos, técnicas e estilos de aprendizagem, atividades e abordagens) Discussão: a implementação contribuiu para a melhoria da organização, planejamento das atividades, adoção de técnicas de estudo e motivação dos alunos para realizar as atividades acadêmicas de trabalho independente da carreira de Bacharel em Enfermagem, bem como projetar a articulação de saberes aprenderam na universidade em sua vida profissional.

Prediction and simulation of PEEP setting effects with machine learning models / Predicción y simulación de los efectos de la configuración de la PEEP con modelos de aprendizaje automático

Objective To establish a new machine learning-based method to adjust positive end-expiratory pressure (PEEP) using only already routinely measured data. Design Retrospective observational study. Setting Intensive care unit (ICU). Patients or participants 51811 mechanically ventilated patients in multiple ICUs in the USA (data from MIMIC-III and eICU databases). Interventions No interventions. Main variables of interest Success parameters of ventilation (arterial partial pressures of oxygen and carbon dioxide and respiratory system compliance). Results The multi-tasking neural network model performed significantly best for all target tasks in the primary test set. The model predicts arterial partial pressures of oxygen and carbon dioxide and respiratory system compliance about 45 min into the future with mean absolute percentage errors of about 21.7%, 10.0% and 15.8%, respectively. The proposed use of the model was demonstrated in case scenarios, where we simulated possible effects of PEEP adjustments for individual cases. Conclusions Our study implies that machine learning approach to PEEP titration is a promising new method which comes with no extra cost once the infrastructure is in place. Availability of databases with most recent ICU patient data is crucial for the refinement of prediction performance. (AU)

Objetivo Establecer un nuevo método basado en el aprendizaje automático para ajustar la presión positiva al final de la espiración (PEEP según sus siglas en inglés) utilizando únicamente datos ya obtenidos de forma rutinaria. Diseño Estudio retrospectivo de observación. Ámbito Unidad de cuidados intesivos (UCI) Pacientes o participantes 51811 pacientes ventilados mecánicamente en múltiples UCIs de EE.UU. (tomados de las bases de datos MIMIC-III y eICU). Intervenciones Sin intervenciones. Variables de interés principales Parametros de éxito de la ventilación (presiones parciales arteriales de oxígeno y dióxido de carbono y distensibilidad del sistema respiratorio). Resultados El modelo de red neuronal multitarea obtuvo los mejores resultados en todos los objetivos del conjunto de pruebas primario. El modelo predice las presiones parciales arteriales de oxígeno y dióxido de carbono así como la distensibilidad del sistema respiratorio con aproximadamente 45 minutos de anticipación, mostrando errores porcentuales absolutos medios de aproximadamente 21.7%, 10.0% y 15.8%, respectivamente. El uso propuesto del modelo se demostró en situaciones hipotéticas en las que se simularon los posibles efectos de los ajustes de PEEP para casos individuales. Conclusiones Nuestro estudio implica que el enfoque de aprendizaje automático para el ajuste de la PEEP es un método nuevo y prometedor que no supone ningún coste adicional una vez que se dispone de la infraestructura necesaria. La disponibilidad de bases de datos con información de pacientes de UCI más recientes es crucial para perfeccionar el rendimiento de la predicción. (AU)

La enseñanza de la radiología en los programas docentes integrados / Teaching Radiology in integrated educational programs

La radiología es una disciplina médica, un área de conocimiento transversal integrada en cualquier situación clínica. El aprendizaje óptimo del conocimiento, habilidades y aptitudes en radiología en el Grado en Medicina requiere la integración de cualquier modalidad de imagen en las distintas áreas del conocimiento: desde las asignaturas básicas hasta cualquier asignatura clínica del grado. El presente artículo describe la integración de la docencia en radiología del plan de estudios en todo el grado de medicina de la Universidad de Girona (UdG), describiendo las distintas actividades docentes de radiología que se imparten en las distintas asignaturas; desde primero a sexto curso. Se detallan las actividades específicas de la asignatura de «radiología», incluyendo talleres, seminarios, prácticas, juego de ordenador interactivo, y describiendo las características de la actividad metodológica docente principal de la UdG, el aprendizaje basado en problemas.(AU)

Radiology is a medical discipline, an area of transversal knowledge integrated into any clinical situation. The optimal training of learning knowledge, skills and aptitudes in Radiology in the Degree in Medicine requires the integration of any imaging modality in the different areas of knowledge; from the basic subjects to any clinical subject of the Degree. This article describes the integration of Radiology teaching into the curriculum throughout the Medicine Degree at the University of Girona (UdG), describing the different radiology teaching activities that are taught. The specific activities of the subject «Radiology» are detailed; through workshops, seminars, practices, interactive computer game; and describing the characteristics of the main teaching methodological activity of the UdG, Problem-Based Learning.(AU)

Estudios normativos españoles (proyecto NEURONORMA-Plus): Normas para el Wisconsin Card Sorting Test (WCST), la Figura Compleja Modificada de Taylor (FCMT) y el Ruff-Light Trail Learning Test (RULIT) / Spanish normative studies (NEURONORMA-Plus project): norms for the Wisconsin Card Sorting Test, the Modified Taylor Complex Figure, and the Ruff-Light Trail Learning Test

Objetivo: El presente estudio tiene como objetivo proporcionar normas y ajustes para edad, educación y género para el Wisconsin Card Sorting Test (WCST), la Figura Compleja Modificada de Taylor (FCMT) y el Ruff-Light Trail Learning Test (RULIT) como parte del proyecto NEURONORMA-Plus. Método: La muestra consiste en 308 individuos cognitivamente sanos de entre 18 y 92 años. Se proporcionan tablas para convertir las puntuaciones brutas en puntuaciones escalares ajustadas por edad y ajustes por educación y género tras aplicar modelos de regresión independientes en 2 grupos de edad (< 50 y ≥ 50 años). Resultados: La edad tuvo un efecto negativo en el rendimiento en ambos grupos etarios. Observamos un efecto positivo de la educación en el rendimiento del WCST en el grupo más joven (< 50 años), y en todas las medidas del FCMT (con la excepción de la tarea de reconocimiento) en el grupo de mayor edad (≥ 50 años). La educación no influyó en el rendimiento en el RULIT, pero sí el género, que tuvo un efecto leve, aunque significativo, mostrando los hombres jóvenes un mayor rendimiento en una variable. Conclusión: Los datos normativos aportados pueden contribuir en la interpretación clínica del rendimiento en estas pruebas en población española.(AU)

Objective: The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project. Methods: We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (< 50 and ≥ 50 years). Results: Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (< 50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥ 50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable. Conclusion: The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population.(AU)

Results during the learning curve in the laparoscopic common bile duct exploration for choledocolithiasis.

OBJECTIVES: To analyze the results obtained in terms of efficacy and safety during the learning curve of a surgical team in the technique of laparoscopic common bile duct exploration with cholecystectomy (LCBDE+LC) using choledochoscopy for the treatment of patients with cholelithiasis and choledocolithiasis or common bile duct stones (CBDS) (CDL). METHODS: Single-center prospective analysis of patients treated with LCBDE+LC during the first 4 years of implementation of the technique. A descriptive and comparative analysis was carried out between groups according to the transcystic (TCi) or transcolecocal (TCo) approach, and also evolutionary by periods. The effectiveness of the technique was evaluated using the variable success rate and safety through the analysis of the overall complication rate and the bile leak rate as the most frequent adverse effect. RESULTS: A total of 78 patients were analyzed. The most frequent approach was TCo (62%). The overall success rate was 92%. The TCi group had a shorter operating time, a lower overall complications rate and a shorter hospital stay. The TCo approach was related to a higher rate of clinically relevant bile leak (8%). Complex cases increased significantly during the learning curve without effect on the overall results. CONCLUSIONS: LCBDE+LC is an effective and safe technique during the learning curve. Its results are comparable to those published by more experienced groups and do not present significant differences related to the evolution during learning period.

Artificial intelligence in paediatrics: Current events and challenges.

This article examines the use of artificial intelligence (AI) in the field of paediatric care within the framework of the 7P medicine model (Predictive, Preventive, Personalized, Precise, Participatory, Peripheral and Polyprofessional). It highlights various applications of AI in the diagnosis, treatment and management of paediatric diseases as well as the role of AI in prevention and in the efficient management of health care resources and the resulting impact on the sustainability of public health systems. Successful cases of the application of AI in the paediatric care setting are presented, placing emphasis on the need to move towards a 7P health care model. Artificial intelligence is revolutionizing society at large and has a great potential for significantly improving paediatric care.

How nurses perceive the gap between knowledge and practice.

BACKGROUND: Identifying nurses' perceptions of the knowledge-practice gap is a critical step toward developing evidence-based practice. Currently, multiple factors contribute to the gap between nursing education and actual practice. Addressing this gap requires a new perspective, not yet adequately represented in the literature, that includes nurses' perceptions. AIM: This study aims to describe nurses' perceptions of the knowledge-practice gap in the domains of knowledge, practice, environment, and learning. And it analyzes how nurses' professional characteristics are associated with their perceptions of the gap in each of these domains as well as the relationships between the domains themselves. METHODS: The study used a cross-sectional descriptive correlational design. A sample of 513 staff nurses recruited through a convenience sampling technique provided information on professional variables such as education and experience and completed a Likert-scale survey about their perceptions of the knowledge-practice gap. RESULTS: Their answers were found to vary with educational level and history of workshop attendance. Items from the knowledge domain were positively and significantly correlated with items from the environment and learning domains, which were also positively and significantly correlated with each other. However, the knowledge and practice domains were not significantly correlated. In addition to showing correlations among the major domains (or aspects) of the knowledge-practice gap, the study highlights how nurses' professional characteristics contribute to differences in their perceptions of this gap. CONCLUSION: These findings can guide hospital-specific measures for bridging the gap. In addition, the scale can be employed by leaders as a tool for the purpose of conducting assessments.

Exploring the potential for online data sources to enhance species threat mapping through the case study of global bat exploitation.

Expanding digital data sources, including social media and online news, provide a low-cost way to examine human-nature interactions, such as wildlife exploitation. However, the extent to which using such data sources can expand or bias understanding of the distribution and intensity of threats has not been comprehensively assessed. To address this gap, we quantified the geographical and temporal distribution of online sources documenting the hunting and trapping, consumption, or trade of bats (Chiroptera) and compared these with the distribution of studies obtained from a systematic literature search and species listed as threatened by exploitation on the International Union for Conservation of Nature Red List. Online records were collected using automated searches of Facebook, Twitter, Google, and Bing and were filtered using machine classification. This yielded 953 relevant social media posts and web pages, encompassing 1099 unique records of bat exploitation from 84 countries. Although the number of records per country was significantly predicted by the number of academic studies per country, online records provided additional locations and more recent records of bat exploitation, including 22 countries not present in academic literature. This demonstrates the value of online resources in providing more complete geographical representation. However, confounding variables can bias the analysis of spatiotemporal trends. Online bat exploitation records showed peaks in 2020 and 2014, after accounting for increases in internet users through time. The second of these peaks could be attributed to the COVID-19 outbreak, and speculation about the role of bats in its epidemiology, rather than to true changes in exploitation. Overall, our results showed that data from online sources provide additional knowledge on the global extent of wildlife exploitation, which could be used to identify early warnings of emerging threats and pinpoint locations for further research.

Sondeo del potencial de las fuentes virtuales de datos para mejorar el mapeo de amenazas para las especies por medio del estudio de caso de la explotación mundial de murciélagos Resumen La expansión de las fuentes virtuales, incluidas las redes sociales y las noticias en línea, proporciona una forma asequible de analizar las interacciones entre el humano y la naturaleza, como la explotación de fauna. Sin embargo, no se ha analizado por completo el rango al que dichas fuentes pueden expandir o sesgar el conocimiento de la distribución e intensidad de las amenazas. Para abordar este vacío cuantificamos la distribución geográfica y temporal de las fuentes virtuales que documentan la caza, captura, consumo o mercado de murciélagos (Chiroptera) y las comparamos con la distribución de los estudios obtenidos de una búsqueda sistemática en la literatura y con las especies catalogadas como amenazadas por la explotación según la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza. Recolectamos los registros virtuales por medio de búsquedas automatizadas en Facebook, Twitter, Google y Bing y después las filtramos con clasificaciones automatizadas. Esto arrojó 953 publicaciones relevantes en redes sociales y sitios web que englobaban 1099 registros únicos de la explotación de murciélagos en 84 países. Aunque pronosticamos de forma significativa el número de registros por país con el número de estudios académicos por país, los registros virtuales proporcionaron localidades adicionales y registros más recientes de la explotación de murciélagos, incluyendo a 22 países que no se encuentran en la literatura académica. Lo anterior demuestra el valor que tienen los recursos en línea para proporcionar una representación geográfica más completa. Sin embargo, las variables confusas pueden sesgar el análisis de las tendencias espaciotemporales. Los registros virtuales de la explotación de murciélagos mostraron picos en 2020 y en 2014, esto después de considerar el incremento de usuarios de internet con el tiempo. El segundo pico podría atribuirse al brote de COVID-19 y la especulación en torno al papel que tenían los murciélagos en su epidemiología y no tanto a un verdadero cambio en la explotación. En general, nuestros resultados mostraron que los datos de las fuentes virtuales proporcionan conocimiento adicional sobre el alcance mundial de la explotación de fauna, el cual podría usarse para identificar señales tempranas de amenazas emergentes y ubicar localidades para su mayor investigación.

Methodological Characteristics of the Teaching of Professional Reasoning in Kinesiology: Qualitative Study / Características metodológicas de la enseñanza del razonamiento profesional en kinesiología: Estudio cualitativo / Características metodológicas do ensino do raciocínio profissional em cinesiologia: Estudo qualitativo

Background. The initial training of healthcare professionals has maintained a declared dysfunction since the Alma Ata declaration, which exposed the difficulties of conditioned reasoning due to mimetic assimilation in problem-solving. Objective. To understand the methodological characteristics of the processes used in teaching Professional Reasoning (PR) in Kinesiology students. Methodology. A qualitative interpretive study was conducted using a purposive sampling method, through Semi-Structured Interviews (SSI) with 9 expert teachers (ET) in PR, belonging to accredited universities, using recordings made on the Microsoft TEAMS® platform. These data were collected during 2020-2023 in 5 selected Chilean Kinesiology schools based on curricular evidence and ranking. Results. The emerging themes identified in the interviews with teachers were transcribed and coded using the Atlas.ti® software. It was found that the characteristics of Case Study-Analysis in different applications stood out as the predominant methodology in teaching PR, while the most recurrent assessment instrument was the Rubric. Conclusions. There is a wide range of strategies used by expert ETs to teach PR, which consist of both traditional methodologies and more student-centered active resources, with theoretical and practical aspects characterized by the formative moment, the selected model, and the imprecise taxonomic articulation of strategies and assessment instruments. This highlights the need for a greater integration of factors for the learning of PR.

Antecedentes. La formación inicial de profesionales de la salud ha mantenido una disfunción declarada en Alma Ata que expuso las dificultades del razonamiento condicionado por la asimilación mímica en la resolución de problemas. Objetivo. Conocer las características metodológicas de los procesos que son utilizados en la enseñanza del Razonamiento Profesional (RP) en estudiantes de Kinesiología. Metodología. Estudio cualitativo interpretativo realizado con un muestro razonado, mediante Entrevistas Semiestructuradas (ESE) a 9 docentes referentes (DR), expertos en RP, pertenecientes a universidades acreditadas por medio de grabaciones realizadas en plataforma Microsoft TEAMS®. Estos datos fueron recogidos durante 2020-2023 en 5 escuelas de Kinesiología chilenas seleccionadas por evidencias curriculares y ranking. Resultados. Las temáticas emergentes identificadas en las entrevistas de profesores, fueron transcritas y codificadas utilizando el Software Atlas. ti®. Constatando que las características del Estudio-Análisis de Casos en distintas aplicaciones, se destaca como la metodología predominante en la enseñanza del RP, mientras que el instrumento de evaluación que tuvo mayor recurrencia fue la Rúbrica. Conclusiones:. Existe una variada gama de estrategias utilizadas por DR expertos para enseñar RP las cuales están compuestas por metodologías tradicionales y recursos activos de mayor protagonismo para el estudiante, con vertientes teóricas y prácticas que se caracterizan por el momento formativo, el modelo seleccionado, y la imprecisa articulación taxonómica de estrategias e instrumentos de evaluación lo que advierte respecto de una necesaria mayor integralidad de factores para el aprendizaje del RP.

Enquadramento. A formação inicial dos profissionais de saúde manteve uma disfunção declarada em Alma Ata que expôs as dificuldades de raciocínio condicionadas pela assimilação da mímica na resolução de problemas. Objetivo. Conhecer as características metodológicas dos processos que são utilizados no ensino de Raciocínio Profissional (RP) em alunos de Cinesiologia. Metodologia. Estudo qualitativo interpretativo realizado com uma amostra fundamentada, através de Entrevistas Semiestruturadas (ESE) a 9 professores de referência (DR), especialistas em RP, pertencentes a universidades acreditadas através de gravações efetuadas na plataforma Microsoft TEAMS®. Esses dados foram coletados durante 2020-2023 em 5 escolas chilenas de Cinesiologia selecionadas por evidência curricular e classificação. Resultados. Os temas emergentes identificados nas entrevistas com os professores foram transcritos e codificados com o software Atlas. você®. Observando que pelas características do EstudoAnálise de Casos em diferentes aplicações, destaca-se como a metodologia predominante no ensino de RP, enquanto o instrumento de avaliação que teve maior recorrência foi a Rubrica. Conclusões. Existe uma ampla gama de estratégias utilizadas por especialistas em DR para ensinar RP, que são compostas por metodologias tradicionais e recursos ativos de maior destaque para o aluno, com aspectos teóricos e práticos que se caracterizam pelo momento formativo, o modelo selecionado, e a articulação taxonômica imprecisa de estratégias e instrumentos de avaliação, que alertam para uma maior abrangência necessária de fatores para a aprendizagem de PR.

THE INTEGRATION OF ESCAPE ROOMS IN NURSING UNDERGRADUATE EDUCATION: AN INTEGRATIVE REVIEW / LA INTEGRACIÓN DEL ESCAPE ROOM EN LA LICENCIATURA EN ENFERMERÍA: UNA REVISIÓN INTEGRATIVA / A INSERÇÃO DO ESCAPE ROOM NA GRADUAÇÃO EM ENFERMAGEM: REVISÃO INTEGRATIVA

Trata-se de uma revisão integrativa da literatura que teve como objetivo investigar a utilização da Sala de Escape (SE) no ensino universitário, com foco na formação de profissionais de enfermagem. Foram analisados ​​artigos primários publicados entre 2018 e 2022 em português, inglês e espanhol, provenientes das bases de dados PubMed, CINAHL e Scopus, seguindo uma abordagem metodológica. Os estudos destacaram a adaptação do ensino devido à pandemia da COVID-19, enfatizando a transição para métodos ativos e colaborativos e sugerindo um interesse crescente pela ER. O tema principal foram doenças crônicas, especialmente doenças cardiovasculares em adultos; porém, os estudos também apontaram a versatilidade da RE em diversos contextos. Predominantemente, foi utilizado o formato presencial com atividades em grupos de cinco pessoas e duração média de 60 minutos, visando principalmente avaliar a experiência dos participantes. Os resultados indicam uma experiência positiva, enfatizando a importância do debriefing. Portanto, conclui-se que a RE mostra-se uma estratégia promissora no ensino de enfermagem, proporcionando benefícios significativos aos estudantes. Recomenda-se a integração cuidadosa das RE nos currículos acadêmicos, considerando os objetivos de aprendizagem e o conteúdo específico.

Trata-se de uma revisão integrativa da literatura, com o objetivo de investigar o uso do Escape Room (ER) no ensino universitário, com enfoque na formação de profissionais de enfermagem. Foram analisados ​​artigos primários publicados entre 2018 e 2022, em português, inglês e espanhol, nas bases de dados PubMed, CINAHL e Scopus, seguindo uma abordagem metodológica. Os estudos evidenciaram a adaptação do ensino devido à pandemia de COVID-19, destacando a transição para métodos ativos e colaborativos e sugerindo um interesse crescente no pronto-socorro. A questão principal era doenças crônicas, especialmente cardiovasculares em adultos; No entanto, os estúdios também sinalizam a versatilidade do ER em diversos contextos. Principalmente, foi utilizado o formato presencial com atividades em grupos de cinco pessoas e uma duração média de 60 minutos, com o objetivo predominante de avaliar a experiência dos participantes. Os resultados indicam uma experiência positiva, realçando a importância do debriefing. Por isso, como conclusão, o ER se apresenta como uma estratégia promissora no ensino de enfermagem, proporcionando benefícios significativos aos estudantes. Se recomenda a integração de cuidados de ER nos planos de estudos acadêmicos, considerando os objetivos de aprendizagem e os conteúdos específicos.

Trata-se de uma revisão integrativa da literatura, com o objetivo de investigar o uso do Escape Room (ER) no ensino universitário, com foco na formação de profissionais de enfermagem. Foram analisados ​​artigos primários publicados entre 2018 e 2022, em português, inglês e espanhol, nas bases de dados PubMed, CINAHL e Scopus, seguindo um percurso metodológico. Os estudos evidenciaram a adaptação do ensino devido à pandemia de COVID-19, ressaltando a transição para métodos ativos e colaborativos e aumentando o interesse crescente no ER. A temática principal foram doenças crônicas, especialmente cardiovasculares em adultos; contudo, os estudos apontam também para as especificidades do ER em diversos contextos. Predominantemente, o formato presencial foi utilizado com atividades em grupos de cinco pessoas e duração média de 60 minutos, com o objetivo predominante de avaliar a experiência dos participantes. Os resultados indicam uma experiência positiva, enfatizando a importância do debriefing . Portanto, como concluir, o ER mostra-se como uma estratégia promissora no ensino de enfermagem, proporcionando benefícios benéficos aos estudantes. Recomenda-se a integração cuidadosa do ER nos currículos acadêmicos, considerando os objetivos de aprendizagem e conteúdos específicos. 

Alfabetización en salud: proceso de aprendizaje significativo personal y comunitario / Health literacy: meaningful personal and community learning process

El aprendizaje y la salud son dos elementos vinculados entre sí. El hecho de cuidar de la salud requiere del aprendizaje de conocimientos, habilidades, comportamientos y actitudes que se desarrollan a lo largo de nuestra vida. Los aprendizajes relacionados con la salud comportan estilos de vida más saludables, la mejora del bienestar, la calidad de vida y la salud de la comunidad. El aprendizaje significativo transforma las vidas, abriendo nuevas oportunidades, posibilitando nuevas competencias y formando nuevas redes sociales. Este artículo pretende reflexionar sobre la relación entre elementos de la alfabetización en salud y el proceso de aprendizaje significativo. (AU)

Learning and health are both interrelated aspects. The act of looking after health requires learning knowledge, skills, behaviors, and attitudes that develop throughout our lives. Health-related learning leads to healthier lifestyles, improved well-being, better quality of life and community health. Significant learning transforms lives, paving the way towards new opportunities, enabling new skills and forming new social networks. This paper aims to reflect on the relationship between aspects of health literacy and the meaningful learning process. (AU)

Infants’ early associations between segments of words and referents: Precursors of morphology acquisition / Asociación entre segmentos de palabras y referentes en bebés: precursores de la adquisición de morfología

Antecedents and objective: During morphology acquisition, children must learn to segment and associate the morphemes of a word to its meaning or grammatical function, despite the complex morphological variability children may encounter in their linguistic environment. The present study explores the ability of 9–12-month-old infants to segment a morpheme-like syllable of varying pseudowords and associate it to a novel object. Participants and method: Thirty-nine Spanish-learning infants participated in an experiment involving a preferential looking task. During each of five training trials per category, infants were presented to one of two novel objects while simultaneously heard two instances of pseudowords with a common morpheme-like segment either at the beginning or the end of the pseudoword (e.g., /tabi/, /babi/, for object 1; or /sato/, /same/, for object 2). Children were then tested in five trials per object. The two trained objects were presented side-by-side while infants heard new pseudowords that followed the pattern of the pseudowords that were heard during training. Results: Results show an effective association between a referent and a group of pseudowords with a repeating morpheme-like segment. This association is observed both with beginning and final segments. Conclusions: These findings show infants’ basic abilities for the processing of morphology at an earlier age than it has been suggested. The potential influence of morphologically rich languages such as Spanish is considered.(AU)

Antecedentes y objetivo: Durante la adquisición de la morfología, los niños deben aprender a segmentar y a asociar los morfemas de una palabra a su significado o función gramatical, a pesar de la compleja variabilidad morfológica que los niños pueden encontrar en su entorno lingüístico. El presente estudio explora la capacidad de los bebés de 9 a 12 meses para segmentar una sílaba tipo morfema de varias palabras y asociarla a un objeto novedoso. Participantes y método: Treinta y nueve bebés aprendices del español participaron en un experimento que implicaba una tarea de preferencia de mirada. Se realizaron cinco ensayos de entrenamiento por categoría, en los que se presentaba uno de dos objetos novedosos, mientras que simultáneamente escuchaban dos instancias de palabras con un segmento tipo morfema común (e.g., /tabi/, /babi/, para el objeto 1, o /sato/, /same/, para el objeto 2). Luego, los niños fueron evaluados en cinco ensayos de prueba por categoría. Los dos objetos del entrenamiento aparecían, uno al lado del otro, mientras escuchaban nuevas palabras que seguían el patrón de las palabras escuchadas durante el entrenamiento. Resultados: Los resultados muestran una asociación efectiva entre un referente y un grupo de palabras con un segmento repetitivo similar a un morfema. Conclusiones: Estos hallazgos muestran las habilidades básicas de los bebés para el procesamiento de la morfología a una edad más temprana de lo que se había sugerido. Se considera la potencial influencia de lenguas morfológicamente ricas, como el español.(AU)

Chronic liver disease-associated severe thrombocytopenia in Spain: Results from a retrospective study using machine learning and natural language processing / Trombocitopenia grave asociada a enfermedad hepática crónica en España: Resultados de un estudio retrospectivo utilizando aprendizaje automático y procesamiento de lenguaje natural

Background Patients with chronic liver disease (CLD) often develop thrombocytopenia (TCP) as a complication. Severe TCP (platelet count<50×109/L) can increase morbidity and complicate CLD management, increasing bleeding risk during invasive procedures. Objectives To describe the real-world scenario of CLD-associated severe TCP patients’ clinical characteristics. To evaluate the association between invasive procedures, prophylactic treatments, and bleeding events in this group of patients. To describe their need of medical resource use in Spain. Methods This is a retrospective, multicenter study including patients who had confirmed diagnosis of CLD and severe TCP in four hospitals within the Spanish National Healthcare Network from January 2014 to December 2018. We analyzed the free-text information from Electronic Health Records (EHRs) of patients using Natural Language Processing (NLP), machine learning techniques, and SNOMED-CT terminology. Demographics, comorbidities, analytical parameters and characteristics of CLD were extracted at baseline and need for invasive procedures, prophylactic treatments, bleeding events and medical resources used in the follow up period. Frequency tables were generated for categorical variables, whereas continuous variables were described in summary tables as mean (SD) and median (Q1–Q3). Results Out of 1,765,675 patients, 1787 had CLD and severe TCP; 65.2% were male with a mean age of 54.7 years old. Cirrhosis was detected in 46% (n=820) of patients and 9.1% (n=163) had hepatocellular carcinoma. Invasive procedures were needed in 85.6% of patients during the follow up period. Patients undergoing procedures compared to those patients without invasive procedures presented higher rates of bleeding events (33% vs 8%, p<0.0001) and higher number of bleedings. While prophylactic platelet transfusions were given to 25.6% of patients undergoing procedures, TPO receptor agonist use was only detected in 3.1% of them... (AU)

Antecedentes Los pacientes con enfermedad hepática crónica (EHC) a menudo desarrollan trombocitopenia (TCP) como agravante de su enfermedad. La TCP grave (definida por un recuento de plaquetas < 50 x 109/L) puede aumentar la morbilidad y complicar el manejo de la EPC, incrementando el riesgo de hemorragia durante los procedimientos invasivos. Objetivos Describir el escenario de mundo real de las características clínicas de los pacientes con TCP grave asociado a EHC. Evaluar la asociación entre procedimientos invasivos, tratamientos profilácticos y eventos hemorrágicos en este grupo de pacientes, así como describir el uso de recursos médicos en España. Métodos Se plantea un estudio multicéntrico retrospectivo que incluye pacientes con diagnóstico confirmado de EHC y TCP grave en cuatro hospitales de la Red Nacional de Salud de España desde enero de 2014 hasta diciembre de 2018. Analizamos la información de texto libre de la Historia Clínica Electrónica (HCE) de pacientes que utilizan procesamiento de lenguaje natural (PLN), técnicas de aprendizaje automático y terminología de SNOMED-CT. Los datos demográficos, las comorbilidades, los parámetros analíticos y las características de la EHC se extrajeron al inicio del estudio, así como la necesidad de procedimientos invasivos, tratamientos profilácticos, eventos hemorrágicos y recursos médicos utilizados en el periodo de seguimiento. Se generaron tablas de frecuencia para las variables categóricas, mientras que las variables continuas se describieron en tablas resumen como media (SD) y mediana (Q1-Q3). Resultados De 1.765.675 pacientes identificados, 1.787 tenían EHC y TCP grave, siendo el 65,2% varones con una edad media de 54,7 años. Se detectó cirrosis en el 46% (n = 820) de los pacientes y el 9,1% (n = 163) de ellos presentaron un diagnóstico de carcinoma hepatocelular... (AU)

Inteligencia artificial en pediatría: actualidad y retos / Artificial intelligence in paediatrics: Current events and challenges

Se examina el uso de la inteligencia artificial (IA) en el campo de la atención a la salud pediátrica dentro del marco de la «Medicina de las 7P» (Predictiva, Preventiva, Personalizada, Precisa, Participativa, Periférica y Poliprofesional). Se destacan diversas aplicaciones de la IA en el diagnóstico, el tratamiento y el control de enfermedades pediátricas, así como su papel en la prevención y en la gestión eficiente de los recursos médicos con su repercusión en la sostenibilidad de los sistemas públicos de salud. Se presentan casos de éxito de la aplicación de la IA en el ámbito pediátrico y se hace un gran énfasis en la necesidad de caminar hacia la Medicina de las 7P. La IA está revolucionando la sociedad en general ofreciendo un gran potencial para mejorar significativamente el cuidado de la salud en pediatría.(AU)

This article examines the use of artificial intelligence (AI) in the field of paediatric care within the framework of the 7P medicine model (Predictive, Preventive, Personalized, Precise, Participatory, Peripheral and Polyprofessional). It highlights various applications of AI in the diagnosis, treatment and management of paediatric diseases as well as the role of AI in prevention and in the efficient management of health care resources and the resulting impact on the sustainability of public health systems. Successful cases of the application of AI in the paediatric care setting are presented, placing emphasis on the need to move towards a 7P health care model. Artificial intelligence is revolutionizing society at large and has a great potential for significantly improving paediatric care.(AU)

ChatGPT's learning and reasoning capacity in anesthesiology

Introduction: Over the past few months, ChatGPT has raised a lot of interest given its ability to perform complex tasks through natural language and conversation. However, its use in clinical decision-making is limited and its application in the field of anesthesiology is unknown. Objective: To assess ChatGPT's basic and clinical reasoning and its learning ability in a performance test on general and specific anesthesia topics. Methods: A three-phase assessment was conducted. Basic knowledge of anesthesia was assessed in the first phase, followed by a review of difficult airway management and, finally, measurement of decision-making ability in ten clinical cases. The second and the third phases were conducted before and after feeding ChatGPT with the 2022 guidelines of the American Society of Anesthesiologists on difficult airway management. Results: On average, ChatGPT succeded 65% of the time in the first phase and 48% of the time in the second phase. Agreement in clinical cases was 20%, with 90% relevance and 10% error rate. After learning, ChatGPT improved in the second phase, and was correct 59% of the time, with agreement in clinical cases also increasing to 40%. Conclusions: ChatGPT showed acceptable accuracy in the basic knowledge test, high relevance in the management of specific difficult airway clinical cases, and the ability to improve after learning.

Introducción: En los últimos meses, ChatGPT ha suscitado un gran interés debido a su capacidad para realizar tareas complejas a través del lenguaje natural y la conversación. Sin embargo, su uso en la toma de decisiones clínicas es limitado y su aplicación en el campo de anestesiología es desconocido. Objetivo: Evaluar el razonamiento básico, clínico y la capacidad de aprendizaje de ChatGPT en una prueba de rendimiento sobre temas generales y específicos de anestesiología. Métodos: Se llevó a cabo una evaluación dividida en tres fases. Se valoraron conocimientos básicos de anestesiología en la primera fase, seguida de una revisión del manejo de vía aérea difícil y, finalmente, se midió la toma de decisiones en diez casos clínicos. La segunda y tercera fases se realizaron antes y después de alimentar a ChatGPT con las guías de la Sociedad Americana de Anestesiólogos del manejo de la vía aérea difícil del 2022. Resultados: ChatGPT obtuvo una tasa de acierto promedio del 65 % en la primera fase y del 48 % en la segunda fase. En los casos clínicos, obtuvo una concordancia del 20 %, una relevancia del 90 % y una tasa de error del 10 %. Posterior al aprendizaje, ChatGPT mejoró su tasa de acierto al 59 % en la segunda fase y aumentó la concordancia al 40 % en los casos clínicos. Conclusiones: ChatGPT demostró una precisión aceptable en la prueba de conocimientos básicos, una alta relevancia en el manejo de los casos clínicos específicos de vía aérea difícil y la capacidad de mejoría secundaria a un aprendizaje.

Applicability of an unsupervised cluster model developed on first wave COVID-19 patients in second/third wave critically ill patients.

OBJECTIVE: To validate the unsupervised cluster model (USCM) developed during the first pandemic wave in a cohort of critically ill patients from the second and third pandemic waves. DESIGN: Observational, retrospective, multicentre study. SETTING: Intensive Care Unit (ICU). PATIENTS: Adult patients admitted with COVID-19 and respiratory failure during the second and third pandemic waves. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Collected data included demographic and clinical characteristics, comorbidities, laboratory tests and ICU outcomes. To validate our original USCM, we assigned a phenotype to each patient of the validation cohort. The performance of the classification was determined by Silhouette coefficient (SC) and general linear modelling. In a post-hoc analysis we developed and validated a USCM specific to the validation set. The model's performance was measured using accuracy test and area under curve (AUC) ROC. RESULTS: A total of 2330 patients (mean age 63 [53-82] years, 1643 (70.5%) male, median APACHE II score (12 [9-16]) and SOFA score (4 [3-6]) were included. The ICU mortality was 27.2%. The USCM classified patients into 3 clinical phenotypes: A (n = 1206 patients, 51.8%); B (n = 618 patients, 26.5%), and C (n = 506 patients, 21.7%). The characteristics of patients within each phenotype were significantly different from the original population. The SC was -0.007 and the inclusion of phenotype classification in a regression model did not improve the model performance (0.79 and 0.78 ROC for original and validation model). The post-hoc model performed better than the validation model (SC -0.08). CONCLUSION: Models developed using machine learning techniques during the first pandemic wave cannot be applied with adequate performance to patients admitted in subsequent waves without prior validation.

Histerectomía laparoscópica en patología benigna en un hospital universitario terciario. Análisis y evolución de un periodo de 8 años / Laparoscopic hysterectomy for benign pathology in a tertiary university hospital: Analysis and evolution in a period of 8 years

Objetivo: Reflexionar desde el análisis de los datos del número de histerectomías laparoscópicas que puede realizar cada miembro de un servicio de ginecología de un hospital terciario sobre la conveniencia de limitar este procedimiento a un número limitado de profesionales. Material y métodos: Estudio retrospectivo, descriptivo, sobre las histerectomías realizadas por cualquier indicación en nuestro hospital en el periodo comprendido entre el 1 de mayo del año 2014 y el 30 de abril del año 2022. Resultados: En este periodo hemos realizado 1548 histerectomías, de las que 760 se efectuaron por vía laparoscópica; y de ellas, 289 fueron indicadas por patología benigna. Considerando el total de profesionales que conforman el pool de cirujanos que realizan cirugía por patología benigna, la media de histerectomías laparoscópicas por cirujano y año sería de 1,4 casos. Conclusiones: Para garantizar la adecuada calidad de la cirugía, el número de profesionales que realizan histerectomías laparoscópicas en un hospital terciario debe ser limitado.(AU)

Objective: To reflect from the analysis of the data of the number of laparoscopic hysterectomies that each member of a gynaecology service of a tertiary hospital can perform on the convenience of limiting this procedure to a limited number of professionals. Material and methods: Retrospective, descriptive study on hysterectomies performed for any indication in our hospital in the period between May 1, 2014 and April 30, 2022. Results: In this period, we have performed 1548 hysterectomies of which 760 were performed laparoscopically and of these, 289 were indicated for benign pathology. Considering the total number of professionals that make up the pool of surgeons who perform surgery for benign pathology, the average number of laparoscopic hysterectomies per surgeon per year would be 1.4 cases. Conclusions: To ensure adequate quality of surgery, the number of professionals performing laparoscopic hysterectomies in a tertiary hospital should be limited.(AU)

Impacto de retroalimentación integral (debriefing) frente al modelo de enseñanza tradicional en la mejora de la calidad en estudios de ultrasonido obstétrico / Impact of comprehensive feedback (debriefing) vs traditional teaching model on quality improvement in obstetric ultrasound studies

Introducción: El debriefing es una técnica que permite mejorar los resultados en el proceso de aprendizaje a través de un proceso de reflexión y retroalimentación. El objetivo del estudio es comparar la efectividad del debriefing frente al modelo tradicional de enseñanza para mejorar el cumplimiento de calidad en ultrasonido obstétrico. Sujetos y métodos: Se evaluaron los resultados del control de calidad de 45 médicos recién egresados de diplomados de ultrasonido durante tres meses. Los médicos fueron divididos en dos grupos para llevar a cabo la retroalimentación de áreas de oportunidad: el grupo de control sólo recibió educación a través del modelo tradicional y el grupo de intervención recibió retroalimentación con metodología de debriefing. Resultados: Al comparar, ambos métodos mostraron ser efectivos para la mejora global del cumplimiento de calidad (42,9% el tradicional; p = 0,0083; 75% el de debriefing; p = 0,0002). El grupo de debriefing fue significativamente mejor en los rubros de calidad global (el 56,7 frente al 38,1%; p = 0,009 frente a p = 0,0432) y error de medición (el 88,1 frente al 68,7%, con significancia estadística; p = 0,349). Conclusión: Ambas técnicas de retroalimentación tuvieron un impacto positivo para la mejora del cumplimiento de la calidad en estudios de ultrasonido obstétrico, y la técnica de debriefing mostró ventajas significativas sobre el modelo deenseñanza tradicional en la retroalimentación de las áreas de oportunidad detectadas.(AU)

Introduction: Debriefing is a technique to improve learning outcomes through a process of reflection and feedback. The aim of the study is to compare the effectiveness of debriefing vs. the traditional teaching model to improve quality compliance in obstetric ultrasound. Subjects and methods: Forty-five recent graduates of ultrasound diploma courses were evaluated during three months of quality control. The physicians were divided into two groups to carry out feedback on areas of opportunity: the control group only received education through the traditional model and the intervention group, which received feedback with debriefing methodology. Results: When compared, both methods were shown to be effective for the overall improvement of quality compliance (42.9% traditional, p = 0.0083, 75% debriefing, p = 0.0002). The debriefing group was significantly better in the areas of overall quality (56.7% vs. 38.1%, p = 0.0090 vs. p = 0.0432), measurement error (88.1% vs. 68.7%, with statistical significance p = 0.349). Conclusion: Both feedback techniques offered positive results for the improvement of quality compliance in obstetric ultrasound studies, with the debriefing technique showing significant advantages over the traditional teaching model in the feedback of detected areas of opportunity.(AU)