Beyond lectures and practical courses: Teaching pharmacology using imaginative pedagogical tools.

Pharmacology has broadened its scope considerably in recent decades. Initially, it was of interest to chemists, doctors and pharmacists. In recent years, however, it has been incorporated into the teaching of biologists, molecular biologists, biotechnologists, chemical engineers and many health professionals, among others. Traditional teaching methods, such as lectures or laboratory work, have been superseded by the use of new pedagogical approaches to enable a better conceptualization and understanding of the discipline. In this article, we present several new methods that have been used in Spanish universities. Firstly, we describe a teaching network that has allowed the sharing of pedagogical innovations in Spanish universities. A European experience to improve prescribing safety is described in detail. The use of popular films and medical TV series in biomedical students shows how these audiovisual resources can be helpful in teaching pharmacology. The use of virtual worlds is detailed to introduce this new approach to teaching. The increasingly important area of the social aspects of pharmacology is also considered in two sections, one devoted to social pharmacology and the other to the use of learning based on social services to improve understanding of this important area. Finally, the use of Objective Structured Clinical Evaluation in pharmacology allows to know how this approach can help to better evaluate clinical pharmacology students. In conclusion, this article allows to know new pedagogical methods resources used in some Spanish universities that may help to improve the teaching of pharmacology.

[Visual hallucinations in the works of Oliver Sacks]. / Las alucinaciones visuales en la obra de Oliver Sacks.

INTRODUCTION: Hallucinations are one of the most bizarre experiences in several diseases. They appear in mental diseases as well as in physical illnesses and may be the consequence of the usage of drugs of abuse. However, a detailed analysis of how patients feel under hallucinations caused by different diseases is uncommon. AIM: This article analyses how visual hallucinations are considered in the works of the neurologist and writer Oliver Sacks, with special attention to his book Hallucinations. DEVELOPMENT: Hallucinations have been under consideration by culture, religion and arts, which has led to multiple interpretations. Sacks's interest in perception of sensations led him to work on the analysis of hallucinations, given the limited knowledge on the topic. References to hallucinations appeared in several of his books like Migraine, Awakenings and A leg to stand on. In Musicophilia Sacks approached the auditory hallucinations and in Hallucinations he considered them in depth. In the latter work, Sacks analyses especially those present in Charles Bonnet syndrome, in situations of sensory deprivation, in patients with epilesy, those present during treatment with levodopa and those caused by drug of abuse. CONCLUSIONS: Hallucinations is one of Sacks's books with greater neuroophthalmological content. The descriptions of the hallucinations of his patients or those experienced by himself, as well as the reflective analysis on the world of perception make this book one of the most fascinating works of Oliver Sacks.

TITLE: Las alucinaciones visuales en la obra de Oliver Sacks.Introducción. Las alucinaciones visuales constituyen una de las manifestaciones más singulares de diversas situaciones clínicas, ya sea en el ámbito de las enfermedades mentales, de las alteraciones físicas o del consumo de drogas. Sin embargo, el análisis detallado de su vivencia en relación con las causas que pueden producirlas es poco frecuente. Objetivo. Considerar la representación de las alucinaciones visuales en las publicaciones del neurólogo y escritor Oliver Sacks, con especial atención a su obra Hallucinations. Desarrollo. Las alucinaciones han llamado la atención de la cultura, la religión y el arte, lo que ha conllevado múltiples interpretaciones. El interés de Sacks por la percepción de las sensaciones le llevó a investigar los mecanismos por los que se producen las alucinaciones, debido al escaso conocimiento que se tenía sobre el tema. Las alucinaciones aparecieron ya en obras como Migraine, Awakenings o A leg to stand on. En Musicophilia abordó las alucinaciones auditivas, y en Hallucinations las consideró de forma monográfica. En esta última obra, Sacks analizó especialmente las presentes en el síndrome de Charles Bonnet, en situaciones de privación sensorial y en pacientes con epilepsia, las precipitadas por la levodopa y las causadas por drogas de abuso. Conclusiones. Hallucinations es una de las obras de Oliver Sacks con mayor contenido neurooftalmológico. La descripción de las alucinaciones de sus pacientes o las experimentadas en su propia piel y la reflexión sobre el mundo de la percepción hacen de Hallucinations una de las obras más fascinantes de Sacks.

Influence of behavioral traits in the inter-individual variability of nociceptive, emotional and cognitive manifestations of neuropathic pain.

Neuropathic pain is a complex disorder associated with emotional and cognitive deficits that may impair nociceptive manifestations. There is high inter-individual variability in the manifestations of human neuropathic pain, which largely depends on personality traits. We aim to identify the influence of different behavioral traits in the inter-individual vulnerability to neuropathic pain manifestations using behavioral, electrophysiological and genetic approaches. We first selected mice with extreme social and emotional traits and look for correlation with the spontaneous neuronal activity in the central amygdala. Neuropathic pain was induced to these mice to evaluate the influence of behavioral traits on nociceptive manifestations and gene expression profiles in the amygdala. Our results show an association of the spontaneous central amygdala neuronal activity with the sociability behavior. We demonstrate that low sociable, high anxious and low depressive phenotypes develop enhanced nociceptive hypersensitivity after nerve injury. However, greater emotional alterations and cognitive impairment are observed in high sociable, anxious-like and depressive-like mice, indicating that nociceptive, emotional and cognitive manifestations of neuropathic pain do not correlate with each other. Gene analyses identify high Pdyn and Il6 levels in the amygdala as indicative of enhanced nociceptive hypersensitivity and reveal an association between high Gadd45 expression and attenuated emotional and cognitive manifestations of neuropathic pain.

[The scotomas as a metaphor in the work of Oliver Sacks]. / Los escotomas como metafora en la obra de Oliver Sacks.

INTRODUCTION: The use of medical metaphors is common in the social discourse and in the media. However, the use by physicians themselves to define different concepts to the original meaning of the medical word is rare. AIM: To analyze the term «scotoma¼ in its metaphorical sense in the works of the neurologist and writer Oliver Sacks. DEVELOPMENT: Sacks used scotoma metaphorically in two works, in the autobiographical book A leg to stand on and in an essay Scotoma: forgetting and neglect in science. In the first case, he used it to define the sensorial loss of his leg after an accident, which could be interpreted as a «mental scotoma¼. In the second case, Sacks analyzed the process and the reasons of forgetting the works of some early scientific discoverers and discussed why this happened. In this case, Sacks made an analogy with the process suffered by scientific discoveries and the reasons why some of them are largely ignored, in a situation that he called «historical¼ or «social scotoma¼. CONCLUSIONS: Sacks does not use the term «scotoma¼ uniformly. When used to describe the sensorial loss of his leg, it might be considered that scotoma is there a second, although minor but accepted, meaning of the word. However, its use in the definition of historical neglect of early discoveries can be clearly defined as a medical metaphor in full sense.

TITLE: Los escotomas como metafora en la obra de Oliver Sacks.Introduccion. La utilizacion de metaforas medicas es frecuente en el discurso social y en los medios de comunicacion. Sin embargo, su empleo por los propios medicos para definir conceptos distintos al significado original del termino resulta poco habitual. Objetivo. Analizar el empleo del termino «escotoma¼, en su sentido metaforico, en las obras del neurologo y escritor Oliver Sacks. Desarrollo. Sacks uso escotoma metaforicamente en dos obras, en el libro autobiografico A leg to stand on y en un ensayo, Scotoma: forgetting and neglect in science. En el primer caso, lo utilizo para describir la situacion de perdida sensorial de su extremidad inferior, que experimento despues de un accidente, lo que podria interpretarse como un «escotoma mental¼. En el segundo caso, Sacks analizo el proceso y las razones del olvido de las obras de algunos descubridores cientificos precoces y comento por que habia sucedido, una situacion que denomino «escotoma historico¼ o «social¼. Conclusiones. Sacks no utiliza el termino «escotoma¼ de forma uniforme y, si bien en el caso de su accidente podria considerarse como una acepcion menor, pero aceptada, es indudable su uso como metafora medica para describir el olvido y la ignorancia de algunos descubrimientos cientificos en determinadas situaciones historicas.

[Evaluation of pain during mobilization and endotracheal aspiration in critical patients]. / Evaluación del dolor durante la movilización y la aspiración endotraqueal en pacientes críticos.

OBJECTIVES: 1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. METHODS: A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of ≥3 indicating pain. Various physiological signs and BIS values were recorded, with changes of >10% being considered clinically relevant. RESULTS: A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (-2 [IQR: {-5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). CONCLUSIONS: The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures.

Dinamización de la clase magistral en medicina: diez ejemplos de minicasos utilizados en la docencia de la farmacología / Improving lectures in Medicine: ten examples of mini-cases to be used in the teaching of pharmacology

Las clases magistrales constituyen un método pedagógico muy utilizado en las facultades de medicina. Sin embargo, tiene diversas limitaciones entre las que se encuentran la pasividad y la pérdida de la atención de los alumnos. A fin de estimular la atención y revigorizar su empleo, se han empleado textos cortos que plantean preguntas que pueden resolverse con la información proporcionada en la clase magistral (minicasos). El presente artículo describe una experiencia de su uso en la docencia de la farmacología y ofrece diez ejemplos para ilustrar sobre su empleo. La mayoría de ellos están ambientados en el mundo real, permiten contextualizar los conocimientos básicos de farmacología y estimulan la comprensión de los conceptos claves (AU)

Lectures are the preferred method of teaching in many schools of Medicine. However, this method has several limitations, such as the passive role assumed by students and the loss of their attention. In order to improve the use of lectures, some authors have suggested the use of minicases. These are short texts that include several questions, which are related with the contents of the lecture and students are asked to answer them at its end. The present paper describes an experience of using minicases in the teaching of pharmacology. It offers ten examples to illustrate how they are built. Most of them are related with the real world, they permit to put knowledge of basic sciences in context of clinical problems and stimulate the understanding of key concepts of the discipline (AU)

Contacto precoz con la realidad asistencial: una experiencia piloto en medicina / Early contact with medical practice: a pilot experience in medical students

Introducción. Varios estudios han sugerido que el contacto precoz del estudiante de medicina con la realidad asistencial puede tener unos efectos beneficiosos sobre su motivación, el conocimiento de la relación médico-paciente y la aceptación de la importancia de las materias médicas básicas. En el nuevo grado conjunto de Medicina de la Universitat Autònoma de Barcelona y la Universitat Pompeu Fabra se ha incorporado una asignatura denominada ‘Prácticas de Grado’ que se imparte durante los tres primeros años, destinada a permitir el contacto de los estudiantes con la asistencia primaria, los equipos de enfermería y los centros sociosanitarios. El presente artículo describe la experiencia y la opinión de los estudiantes que la cursaron durante el primer año. Materiales y métodos. El artículo describe las características académicas de la asignatura. Se realizó una encuesta a los estudiantes al finalizar la asignatura para evaluar su grado de satisfacción y su percepción sobre el cumplimiento de los objetivos y las competencias que debían alcanzarse. Resultados. Existió una elevada satisfacción con la nueva actividad y una percepción entre los estudiantes de que las competencias preestablecidas se habían alcanzado en su mayor parte. Conclusión. El contacto precoz con la realidad asistencial es un elemento esencial para la comprensión de la actividad médica por los estudiantes de medicina de primer año (AU)

Introduction. Several studies have suggested that early contact of medical students with medical care may have beneficial effects on their motivation, knowledge of doctor-patient relationship and acceptance of the interest of biomedical sciences. In the new joint degree of Medicine of Autonomous University of Barcelona and Pompeu Fabra University we have incorporated the subject ‘Prácticas de Grado’ during the first three years. It is devoted to permit the early contact of medical students with primary care, nursing teams and chronic care facilities. The present paper describes its academic features as well as the opinion of students during the first year of the experience. Materials and methods. The characteristics of the subject are described in this section. A survey was performed in the students who completed the first year of the experience to get their degree of satisfaction and the perception with the achievement of pre-established competencies and educative objectives. Results. Students were highly satisfied with the new subject and they believed that planned competencies and objectives were fully achieved in most of cases. Conclusion. The early contact with health care is an important contribution to the understanding of the medical professions by medical students of first year (AU)

Tendiendo puentes: la utilidad de la historia de la ciencia para comprender el proceso de investigación y desarrollo de medicamentos / Filling the gap: the usefulness of history of science to understand the process of drug research and development

Introducción. Tradicionalmente, las ciencias sociales y las experimentales han seguido caminos distintos, lo que ha llevado a la creación de una separación artificial entre ellas. Uno de los ejemplos más evidentes que han intentado evitar tal situación es la creación de disciplinas como la historia de la ciencia, que contribuye a acercar unas y otras. No obstante, la percepción entre los científicos del interés de la historia no es óptima a pesar de las indudables virtudes que contiene. Materiales y métodos. En el presente artículo describimos la experiencia de utilizar episodios históricos para contribuir al aprendizaje de procesos complejos, como es el de la investigación y desarrollo de nuevos medicamentos. Se describe el empleo de dos casos que culminaron con éxito y fueron galardonados con el premio Nobel: la modificación de la estructura química de neurotransmisores para obtener nuevos medicamentos (hormonas emasculadas) por James Black y la aplicación del concepto de antimeta bolito para diseñar fármacos para el tratamiento de enfermedades infecciosas, neoplásicas y endocrinas. Conclusión. Tal aproximación docente es de notable éxito para hacer comprensible a los estudiantes las complejidades del proceso de investigación y desarrollo farmacéutico (AU)

Introduction. Traditionally, social and experimental science shave followed different paths, which have led to the creation of an artificial separation between them. One of the clearest examples that has tried to avoid this situation is the creation of disciplines such as the history of science, which helps to bring both closer together. However, the perception among scientists regarding the interest of history is not optimal, despite the undoubted virtues that the latter contains. Materials and methods. In this article the experience of using historical events to contribute to learning of complex processes, such as research and development of new drugs, is described. The use of two cases is outlined that were successfully completed and awarded the Nobel Prize: the modification of neurotransmitters’ structure to obtain new drugs (emasculated hormones) by James Black, and the application of the antimetabolite concept to design drugs for infectious, cancer and endocrine diseases. Conclusion. A teaching approach is remarkably successfulin helping students understand the complexities of research and drug development (AU)

La transversalidad en la enseñanza de la medicina: el ejemplo de la Oncología / Cross-sectional approach in medical education: the example of Oncology

El desarrollo de la medicina durante el siglo xix con llevó la aparición de las especialidades médicas y quirúrgicas, configurando un nuevo escenario asistencial con la fragmentación de los tradicionales servicios de medicina y cirugía. Estos cambios también acontecieron en el campo de la docencia de la medicina, originando algunos conflictos en la definición de competencias que aún persisten. La patología médica debería actuar como punto de encuentro y eje vertebrador del resto de las especialidades médicas, pero hasta hace relativamente poco tiempo ha existido un excesivo esfuerzo en delimitar el campo de cada disciplina, aspecto que no ha facilitado una comunicación fluida entre los diferentes especialistas. La atención a los pacientes con cáncer necesita de la implicación y colaboración de los diferentes profesionales que participan en el diagnóstico y tratamiento y, por ello, precisa de un diálogo fluido entre todos ellos. La oportunidad de poder desarrollar en el pregrado una formación multidisciplinar que englobe aspectos referentes a la integración de los diferentes especialistas en beneficio del paciente facilitará una mejora en la optimización de los recursos sanitarios. La enseñanza de la Oncología en el pregrado ha estado compartida con otras especialidades, pero hasta el momento actual no ha tenido la adecuada consideración. La Oncología constituye un claro ejemplo de que el trabajo en equipo permite mejorar la eficiencia y conducción de los procesos asistenciales. Es de esperar que en las futuras promociones de estudiantes existan menos resistencias para establecer puntos de encuentro y de sinergia y que ello redunde en la adquisición de una visión más amplia y posibilista, y que pueda aplicarse en beneficio de los futuros enfermos (AU)

The development of Medicine throughout the 19th century led to the appearance of medical and surgical specialties, which thus gave rise to a new health care scenario in which the traditional services of medicine and surgery became fragmented. These changes also came about within the field of the teaching of medicine and gave rise to a number of conflicts over the definition of competencies that still exist today. Medical pathology should act as a point of contact and backbone for the other medical specialities, but up until a relatively short time ago too much effort was being made to define the limits of each discipline, something that has not encouraged very fluent communication among the different specialists. Health care for cancer patients requires the commitment and collaboration of the different professionals who are involved in the diagnosis and treatment of the disease, and this in turn calls for fluent dialogue among all of them. The chance to be able to carry out multidisciplinary training for under-graduates that covers aspects related with the integration of the different specialists in order to benefit patients will make it easier to optimise healthcare resources. The teaching of Oncology at undergraduate level has been shared with other specialties, but up until now it has been paid too little attention. Oncology is a clear example of how teamwork makes it possible to improve the efficiency of health care processes and the way they are implemented. It is to be expected that in the future students will meet less resistance to establishing points of contact and synergy, and that this will result in their acquiring a broader and more positive vision, which they will be able to apply to help their patients (AU)

Mi tío de América, Henri Laborit y la ilustración de la teoría neurobiológica de la organización social / Mon oncle d’Amérique, Henri Laborit and the illustration of the neurobiological theory of the social organization

Los cambios recientes y venideros en la docencia universitaria condicionarán cada vez más el empleo de herramientas nuevas y más originales en la enseñanza. En el ámbito de las ciencias biomédicas en particular existen ya experiencias previas sobre el uso del cine comercial como una manera de favorecer el debate y la formación en áreas y asignaturas diferentes. Este artículo sugiere el empleo de la película Mi tío de América a través de la experiencia en estudiantes de Biología, como una forma de presentar las teorías de Henri Laborit sobre la neurobiología de la organización social. Se trata de una película realizada en 1980, dirigida por Alain Resnais y con guión de Jean Gruault. La trama discurre a lo largo de la vida de tres personajes que viven situaciones diversas que permiten reflejar algunas de las teorías de Laborit. En ellas, básicamente se justifica la conducta humana a través de la jerarquización de tres estructuras cerebrales y niveles, desde el más primitivo y primario –arquiencéfalo–, pasando por el paleoencéfalo, responsable de la memoria, hasta llegar a un nivel más sofisticado responsable de la conciencia, el neocórtex. La película pretende divulgar estas teorías y, para ello, emplea recursos diversos como imágenes de animales de experimentación en situaciones idénticas o similares a las vividas por los protagonistas. Si prestamos atención no sólo a las ventajas que puede ofrecer esta película para su empleo en la docencia sino también a algunas de las limitaciones propias de este filme, se podría concluir que Mi tío de América es altamente recomendable para la enseñanza en psiconeurobiología (AU)

The present and future changes in the teaching at the universities will advise for the use of new and more original methods. In the biomedical sciences there are some experiences regarding the use of popular movies to allow the discussion and interchange of points of view on some polemic topics. This review suggests the usefulness of the film Mononcle d’Amérique in the teaching of students of human Biology, as a way of introducing the neurobiological theories of Henri Laborit on social organization. This film was directed by Alain Resnais and written by Jean Gruault in 1980.It considers the life of three people who live several situations that are used to explain the Laborit theories. Basically, they justify the human behaviour by the hierarchical organization of the brain in three levels: the most primitive is the archiencephal, the intermediate is the paleoencephal (linked to memory) and the highest, the neocortex that is responsible of consciousness. The movie tries to introduce to these theories using several filmic resources such the viewing of laboratory animals in situations that mimic those lived by the three people. These comparisons allow Laborit himself to explain why people behave in specific ways when submitted to social conflicts. We conclude that Mon oncle d’Amérique is highly recommended for the teaching of some principles related to psychology, psycho neurobiology and psychiatry (AU)

Del escritorio a la tarima: una experiencia de formación en competencias transversales dentro de la licenciatura en biología / From the desk to the stand: a training experience in generic competences within the Biology Degree

Introducción. Se diseñó una asignatura de pregrado con el fin de desarrollar compentencias transversales en redacción científica y presentación oral. Materiales y métodos. Consistió en una asignatura de cuatro créditos en formato intensivo durante 2 semanas y al final se realizó una encuesta de evaluación de satisfacción, con una escala numérica (de 0 a 5, máxima satisfacción). Resultados. Los 20 alumnos dieron una puntuación de 4,4 a la asignatura en general, 4,5 a los contenidos teóricos y 4,8 a los prácticos sobre presentaciones orales. Consideraron que sus conocimientos y habilidades habían mejorado después de la asignatura. Conclusiones. El diseño de actividades dirigidas a la mejora de determinadas competencias transversales puede ser útil y es percibida satisfactoriamente por los estudiantes (AU)

Introduction. A new subject for undergraduates was desiged in order to develop generic competences on scientific writing and oral communication. Material and methods. It was organized as a 4 credit course in intensive format for 2 weeks. At the end of the course, an evaluation of the students´ satisfaction was carried out by means of a numerical scale ( from o= worst to 5 very good). Results. All twenty students scored the course in general as 4.4, 4.5 for lectures and 4.8 for the practical activities on oral presentations. Students felt that their abilities in scientific writing and oral communication have improved. Conclusions. The design of an education activity devoted to improve these cross-sectional competences could be useful and it is perceived positively by the students (AU)

Clinical characteristics and psychopathological profile of patients with vulvodynia: an observational and descriptive study.

BACKGROUND: Vulvodynia is a fairly common dermatological symptom that often interferes with the personal, social and working activities of affected women and results in a significant loss of their quality of life. It is a persistent and tedious clinical disorder which is often resistant to conventional treatments. OBJECTIVES: The aim of this study is to evaluate the main clinical signs, associated psychopathological disorders and outcome after antidepressant treatment of patients with vulvodynia. METHODS: Eighty patients were included. Clinical characteristics and psychopathological profiles were determined by appropriate instruments. The improvement of clinical symptoms after combined antidepressant drug therapy was also evaluated. RESULTS: Pain (70%), burning (63.7%), dyspareunia (57.5%) and stinging (56.2%) were the most commonly reported symptoms. Most patients (56.5%) showed anxiety, and 52.2% of them were reported as having a depression disorder. When evaluated by psychometric tools, 81.4% of patients scored >150 on the Life Event Scale, which means a risk >50% of suffering an illness in the near future, and patients' scores in the Dermatology Life Quality Index showed higher values than the mean of the Spanish validation group. After 6 months of combined treatment with escitalopram (10-20 mg/day), perfenazine (2-4 mg/day) and amytriptiline (10 mg/day), a complete remission of the clinical symptoms was achieved in 41% of patients. In contrast, only 12% of patients who did not follow drug treatment reported a complete resolution of the clinical symptoms. CONCLUSIONS: Our results seem to confirm that vulvodynia is associated with psychiatric co-morbidity such as stress and depression. The study highlights that the psychiatric treatment may be a useful option to improve clinical symptoms. Whether these patients should be evaluated for depression or be referred to a psychiatrist, remains to be investigated.

[Multicenter study of pain assessment in hospitals]. / Estudio multicéntrico de la evaluación del dolor en el medio hospitalario.

OBJECTIVE: To evaluate the recording of pain intensity in hospital charts. METHODS: A cross-sectional study was carried out in 15 hospitals in a sample of admitted patients with pain. Clinical data, including pain intensity, were gathered from the hospital records. Multiple analysis of variance was used to identify factors related to the intensity of pain recorded in the patients' charts. RESULTS: A total of 1038 patients with a mean (SD) age of 56.1 (18.9) years were included. Pain intensity was noted in the charts of 47.9% (95% confidence interval [CI], 44.9%-50.9%) of the patients. Pain intensity had been noted for 68.9% (95% CI, 61.4%-76.4%) of the patients with cancer, 43% (95% CI, 38.2%-47.8%) of postoperative patients, 38.2% (95% CI, 35%-41.4%) of trauma patients, and 26.6% (95% CI, 16.9%-36.3%) of postpartum women. There was great interhospital variability. Factors associated with the recording of pain intensity in medical charts were hospital characteristics (large hospitals, teaching hospitals, hospitals and internal medicine and surgical specialities) and type of patient (cancer and trauma cases and patients reporting pain to the staff). CONCLUSION: There is inadequate written recording of intensity of pain in hospitals, even though there is considerable interhospital variation. Pain intensity assessment and recording is an indicator of quality of health care and should become a routine practice in hospital health care.

Analgesic use and pain in the hospital settings.

AIM: The aim of this study was to assess the analgesic treatment and the prevalence of pain in patients treated with analgesics in hospitals. METHODS: Adult patients treated with analgesics were selected from a sample of 1,675 patients in a cross-sectional study carried out in 15 Catalonian hospitals (Spain). Patient characteristics, type of analgesics, treatment schedules, patients' pain intensity and clinical ward and hospital characteristics were assessed. Adherence to analgesic use guidelines was established according to the principles and recommendations of internationally recognised guidelines for pain management. Pain was determined by asking patients about pain intensity by means of a visual analogue scale (VAS). RESULTS: Analgesics were prescribed for 1,173 patients (70%; 95% CI: 67.4-72.6), in whom 57% (95% CI: 54.2-59.8) had pain and in whom 30.5% (95% CI: 27.9-33.1) pain intensity was greater than 30 mm. Adherence to analgesic treatment guidelines was judged appropriate in only 26.9% (95% CI: 24.4-29.4%) of all patients. The administered analgesic dose was in the recommended dose range in 42% (95% CI: 54-58) of all analgesics and in 28% (95% CI: 24-32) of opioid analgesics. A minority of patients was treated with a rescue schedule or patient-controlled analgesia (2%; 95% CI: 1.4-2.6). Pain prevalence was higher in those with analgesic treatment that did not adhere to guidelines (63.6%; 95% CI: 60.4-66.8) than in those considered as having appropriate adherence to guidelines (39.3%; 95% CI: 33.8-44.6) (p < 0.001). Adherence to analgesic treatment guidelines was higher in the large hospitals (21%; 95% CI: 18-24) than in medium and small hospitals (13%; 95% CI: 9-16) (p < 0.001). CONCLUSIONS: Although analgesic use is high in the hospital settings, adherence to the principles and recommendations of pain guidelines is low, and pain is usually common in patients treated with analgesics. These results once again emphasise the need to improve analgesic use and pain management in hospitals.

Estudio multicéntrico de la evaluación del dolor en el medio hospitalario / Multicenter study of pain assessment in hospitals

OBJETIVO: Evaluar el registro de la intensidad del dolor en los hospitales. MÉTODOS: Estudio transversal en 15 hospitales. Se seleccionó una muestra de los pacientes hospitalizados con dolor. Se recogió información clínica de los pacientes y del registro de la intensidad del dolor en las historias clínicas. Se realizó un análisis multivariante para identificar los factores relacionados con el registro de la intensidad del dolor en las historias clínicas. RESULTADOS: Fueron incluidos 1.038 pacientes con una edad media (DE) de 56,1 (18,9) años. Se registró la intensidad del dolor en las historias clínicas de un 47,9% (IC 95%: 44,9-50,9%) de los pacientes. Se anotó la intensidad del dolor en un 68,9% (IC 95%: 61,4-76,4%) de los pacientes neoplásicos, en un 43% (IC 95%: 38,2- 47,8%) de los postoperados, en un 38,2% (IC 95%: 35- 41,4%) de los traumáticos y en un 26,6% (IC 95%: 16,9- 36,3%) de las mujeres postparto. Se observó una amplia variabilidad entre los diferentes hospitales. Los factores relacionados con un mayor registro de la intensidad del dolor en las historias clínicas fueron las características hospitalarias (grandes hospitales, hospitales docentes y servicios de medicina y cirugía) y de los pacientes (neoplásicos, traumáticos y los que comunicaron el dolor al personal sanitario). CONCLUSIÓN: El registro de la intensidad del dolor de los pacientes en los hospitales es insuficiente aunque existe una amplia variabilidad entre los hospitales. El registro de la intensidad del dolor es un indicador de calidad asistencial y debería ser una actividad rutinaria en el proceso asistencial hospitalario

OBJECTIVE: To evaluate the recording of pain intensity in hospital charts. METHODS: A cross-sectional study was carried out in 15 hospitals in a sample of admitted patients with pain. Clinical data, including pain intensity, were gathered from the hospital records. Multiple analysis of variance was used to identify factors related to the intensity of pain recorded in the patients’ charts. RESULTS: A total of 1038 patients with a mean (SD) age of 56.1 (18.9) years were included. Pain intensity was noted in the charts of 47.9% (95% confidence interval [CI], 44.9%-50.9%) of the patients. Pain intensity had been noted for 68.9% (95% CI, 61.4%-76.4%) of the patients with cancer, 43% (95% CI, 38.2%-47.8%) of postoperative patients, 38.2% (95% CI, 35%-41.4%) of trauma patients, and 26.6% (95% CI, 16.9%-36.3%) of postpartum women. There was great interhospital variability. Factors associated with the recording of pain intensity in medical charts were hospital characteristics (large hospitals, teaching hospitals, hospitals and internal medicine and surgical specialities) and type of patient (cancer and trauma cases and patients reporting pain to the staff). CONCLUSION: There is inadequate written recording of intensity of pain in hospitals, even though there is considerable interhospital variation. Pain intensity assessment and recording is an indicator of quality of health care and should become a routine practice in hospital health care

La evaluación del dolor experimental en el laboratorio: los modelos de dolor neuropático en animales / Evaluation of experimental pain in the laboratory: models of neuropathic pain in animal´s

Pese a los avances realizados en los últimos años, el dolor neuropático constituye aún un serio problema asistencial. Los tratamientos disponibles sólo permiten aliviar adecuadamente un tercio de los pacientes. Los modelos experimentales pueden contribuir a conocer la fisiopatología de este cuadro clínico, así como a probar nuevos fármacos. Existen básicamente dos tipos de modelos, aquellos que realizan una lesión en el nervio periférico y los que causan alteraciones en el sistema nervioso central. A pesar de sus limitaciones, los modelos animales pueden contribuir a avanzar en el conocimiento de este síndrome y algunos de ellos pueden ayudar a predecir la utilidad terapéutica de nuevos medicamentos. Obviamente, sólo los ensayos clínicos bien diseñados permitirán conocer su eficacia real en el ámbito clínico (AU)

In spite of the advancement of pain research in the last decade, the therapy of neuropathic pain is still an unresolved issue. Available treatments only adequately improve only a third of patients. Experimental models may contribute to the knowledge of its pathophysiology, as well as to the development of new drugs. Basically, two types of animal models are available: those that cause a lesion in the peripheral nerves and those that injury the central nervous system. Beyond these limitations, animal models may help to improve the knowledge of neuropathic pain and some of them have predictive value on the usefulness of analgesic efficacy of new drugs. Obviously, only well-designed, controlled clinical trials will permit to establish their actual efficacy in the clinical setting (AU)