Inserción de la simulación clínica en el currículum de Anestesiología en un hospital universitario. Evaluación de la aceptabilidad de los participantes / Bringing clinical simulation into an Anesthesia residency training program in a university hospital. Participants’ acceptability assessment

Introducción. La simulación clínica actualmente forma parte integral del curriculum de la especialidad de Anestesiología en varios países. Nuestro objetivo es describir y evaluar la inclusión de la simulación en el programa de formación en Anestesiología de un hospital universitario. Métodos. Las actividades susceptibles de entrenamiento mediante simulación fueron clasificadas en 2 módulos: talleres de desarrollo de habilidades técnicas, realizados con residentes de primer año, y escenarios de alta fidelidad, realizados con residentes de segundo y tercer año. Al final de cada actividad, y usando una encuesta anónima, los residentes evaluaron el grado de satisfacción y cumplimiento de objetivos. Resultados. Se evaluaron 18 actividades: 6 talleres de habilidades y 12 escenarios de alta fidelidad. Se analizaron 206 encuestas, correspondientes a 41 residentes. El 96% de los encuestados está de acuerdo o totalmente de acuerdo con que los talleres cumplieron los objetivos planteados y que deberían ser obligatorios en el curriculum de anestesia; no obstante, el 11% afirmó que les produjo ansiedad y/o nerviosismo. El 97% consideró los talleres de alta fidelidad como realistas y acordes a los objetivos planteados. El 42% consideró que el taller le produjo ansiedad y/o nerviosismo. Conclusiones. La inserción de la simulación ha tenido buena aceptación por parte de los médicos residentes. Las actividades fueron calificadas como realistas y acotadas a los objetivos, puntos fundamentales en la educación del adulto, pues según el modelo de aprendizaje de Kolb, se asocia a conocimiento profundo, útil y duradero en el tiempo(AU)

Introduction. Clinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program. Methods. Activities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished. Results. A total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness. Conclusions. The inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge(AU)

[Bringing clinical simulation into an Anesthesia residency training program in a university hospital. Participants' acceptability assessment]. / Inserción de la simulación clínica en el currículum de Anestesiología en un hospital universitario. Evaluación de la aceptabilidad de los participantes.

INTRODUCTION: Clinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program. METHODS: Activities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished. RESULTS: A total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness. CONCLUSIONS: The inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.

Beneficial effect of ursodeoxycholic acid on alterations induced by cholestasis of pregnancy in bile acid transport across the human placenta.

BACKGROUND/AIMS: The existence of impairment in bile acid transport across the placenta during intrahepatic cholestasis of pregnancy and the effect of ursodeoxycholic acid treatment (1 g/day) were investigated. METHODS: Kinetic parameters were calculated from experiments carried out on membrane vesicles obtained from basal (TPMb, fetal-facing) and apical (TPMa, maternal-facing) trophoblast plasma membranes. Bile acid uptake was measured using varying concentrations of [14C]-glycocholate and a rapid filtration technique. RESULTS: The maximal velocity of transport (Vmax), the apparent affinity constant (Kt) and the efficiency (Ef) of transport (Vmax/Kt) of the anion:bile acid exchanger located at the TPMb were reduced in intrahepatic cholestasis of pregnancy. Ursodeoxycholic acid induced a reversal of Vmax, Kt and Ef to normal values. Owing to the 3-fold increase in Vmax, with no change in Kt, intrahepatic cholestasis of pregnancy induced an enhancement in Ef of ATP-independent bile acid transport across TPMa. Both Vmax and Ef were restored to normal values by ursodeoxycholic acid. Finally, in ATP-dependent bile acid transport across TPMa, a reduction in the Ef due to an increase in Vmax together with a more pronounced increase in Kt was found. This impairment was also reversed by ursodeoxycholic acid. CONCLUSIONS: These results suggest that placenta bile acid transport systems are impaired in intrahepatic cholestasis of pregnancy. Moreover, together with the confirmed beneficial effect for intrahepatic cholestasis of pregnancy patients, such as the relief of pruritus and the improvement in biochemical markers of cholestasis, ursodeoxycholic acid treatment restores the ability of the placenta to carry out vectorial bile acid transfer.

Dietary factors and prostatic cancer.

In order to learn about the influence of dietary factors and obesity on prostatic cancer in our environment, a case-control study was performed. The group of cases consisted of 90 men histologically diagnosed with prostatic cancer in the 'La Paz' hospital (Madrid) during the 4-year period of 1983-1987. The controls were 180 men selected to obtain a random sample of males from the same hospital, stratified according to age and date of admission as compared with the prostatic cancer patients. The results of the study revealed that a diet rich in animal fats as well as high in meat consumption increased the risk of prostatic cancer. Low ingestion of vitamin A or vitamin C and obesity were unassociated to the disease.

[Epidemiology of cancer of the prostate. Descriptive study]. / Epidemiología del cáncer de próstata. Estudio descriptivo.

Although the most frequent tumor of the male genitourinary system is cancer of the prostate, epidemiological studies on this tumor are uncommon in our setting. This study attempts to record the number of patients who were diagnosed as having prostatic cancer at La Paz Hospital (Madrid) during 1981-1987 and to determine the influence of pathological antecedents--personal and familial--in the development of the disease. The present study showed 90 patients had been diagnosed during this period. Most of the patients diagnosed as having this condition were aged 70-79 years. Most of the patients (85.6%) were living in urban areas. Only 2.2% were unmarried and without children. The mean patient age on diagnosis was lower in the group with a higher educational level. A previous history of benign hyperplasia of the prostate was present in 22.22%; tonsillectomy had been performed in 11.11%; only 5.55% had a previous history of rheumatic fever; 26.66% were obese; and 36.66% had a family history of cancer. A previous history of disease did not influence mean patient age at the time of diagnosis.

Occupational risk factors for cancer of the larynx in Spain.

Spain is one of the countries with the highest incidence of laryngeal cancer and, together with France, is the country with the lowest percentage of women with this disease. In order to identify the occupational risk factors associated with laryngeal cancer in this country a case-control study was performed. Cases included 85 patients with epidermoid carcinoma of the larynx diagnosed in "La Paz" Hospital, Madrid, between 1985 and 1987. A sample of 170 patients from the same hospital was used as control. The results of the study revealed that 56.5% of larynx cancer patients had a sedentary occupation working in the service sector. Exposure to insecticides or silica were strongest risk factors for laryngeal cancer. An association between laryngeal cancer and exposure to fumes, chemical products, mineral dust, or wood dust was not found.

Bladder cancer and asbestos in Spain.

The relationship between bladder cancer and occupational exposure to asbestos was investigated between 1978 and 1982 at La Paz Hospital in Madrid in a case-control study conducted among 353 male patients and 53 women with a diagnosis of urothelium carcinoma, and among an equal number of controls matched in age (decade of life), sex and date of admission to the hospital. The results showed that bladder cancer is associated with occupational exposure to asbestos.

Association between the occurrence of antibodies to simian vacuolating virus 40 and bladder cancer in male smokers.

An association between the occurrence of antibodies to simian vacuolating virus 40 and bladder cancer in male smokers was found in a case-control study conducted in 200 male patients with bladder cancer and 400 control men. The risk of bladder cancer increases with the years of cigarette smoking.

Bladder cancer and the consumption of alcoholic beverages in Spain.

The relationship between bladder cancer and alcohol consumption was investigated in a case-control study conducted in 506 patients (453 males and 53 females) with diagnoses of papillary urothelial carcinoma during 1978-1982 at "La Paz" hospital (Madrid), and an equal number of controls matched for age, sex and date of admission to the hospital. The results showed that the risk of bladder cancer does not increase with the intake of beer, wine and spirit beverages. However, a high risk of bladder cancer was associated with consumption of wine mixed with "gaseosa" (a refreshment beverage consisting of carbonated water plus artificial sweeteners).

Risk factors of bladder cancer in Spain.

A case-control study was performed on 406 (353 males and 53 females) bladder cancer patients and 406 controls matched in age, sex and date of admission to the hospital. The questionnaire included questions about socio-economic status, residence, personal and familial histories of diseases, professional occupations, and habits such as cigarette smoking and consumption of coffee, artificial sweeteners, alcoholic and nonalcoholic beverages, and water. Up to three different exposures to occupational risks were taken into account. Data were studied by a discriminant analysis technique. The results suggest a multifactorial etiology for this disease. The factors increasing the risk of bladder cancer, listed in order of importance, were: total number of cigarettes smoked, history of urologic disease, second exposure to an occupational risk, use of artificially sweetened beverages, low consumption of water, family history of cancer, third occupational exposure to a risk, use of artificial sweeteners, and years of coffee drinking.

Antibodies to simian vacuolating virus 40 in bladder cancer patients.

The occurrence of antibodies to herpes simplex virus type 2 (HSV-2) and simian vacuolating virus 40 (SV40) (two presumptive oncogenic viruses) was investigated by the technique of enzyme-linked immunosorbent assay in 233 patients with bladder cancer (200 males and 33 females) and in 466 controls (400 males and 66 females). The age of both the bladder cancer patients and controls varied from 55 to 65 years. A statistically significant association between bladder cancer and antibodies to SV40 was found in both males and females. No association between HSV-2 and bladder cancer was observed.

Testicular lymphangiectasis in Noonan's syndrome.

We describe a boy with testicular lymphangiectasis and Noonan's syndrome. Both testes showed seminiferous tubules with a reduced tubular diameter, containing few spermatogonia. The testicular interstitium exhibited a number of large, dilated lymphatic vessels forming irregular channels among the seminiferous tubules and surrounding them. Since there was no accompanying pathological condition to indicate an obstruction to the lymphatic flow at the level of the spermatic cord or in the regional lymph nodes, the abnormal development of testicular lymphatic vessels suggests a congenital malformation.

Leydig cell types in primary testicular disorders.

Ultrastructural study of testicular biopsy specimens from 67 adults with primary testicular disorders (Klinefelter's syndrome, XX male syndrome, Del Castillo's syndrome, and cryptorchidism) revealed the following four Leydig cell types: 1) normal or nearly normal Leydig cells with abundant smooth endoplasmic reticulum, mitochondria with tubular cristae, lipid droplets, and Reinke's crystals; 2) abnormally differentiated Leydig cells without either lipid droplets or Reinke's crystals but with altered mitochondria, concentric unfenestrated cisternae of smooth endoplasmic reticulum, and both paracrystalline and filamentous inclusions; 3) multivacuolated Leydig cells containing abundant lipid droplets; and 4) immature Leydig cells with scarce development of the smooth endoplasmic reticulum and mitochondria, and numerous cytoplasmic microfilaments. Abnormally differentiated Leydig cells might represent dysgenetic cells, whereas immature, normal, and vacuolated Leydig cells might represent three progressive stages in the Leydig cell cycle (undifferentiated, mature, and old involuting Leydig cells). An inverse correlation between the proportion of abnormal Leydig cells and testosterone levels was observed in each of these testicular disorders.

The formation of annulate lamellae in the human Sertoli cell.

The formation of annulate lamellae (AL) has been studied in human Sertoli cells. Sertoli cells of infants did not show AL. Sertoli cells of 9- to 11-year-old boys showed incompletely circumferentially arranged cisternae of endoplasmic reticulum (ER), alternating with rows of vesicles, 200-300 nm in diameter, with a weakly osmiophilic content. The ER cisternae displayed both pores and attached ribosomes at a few sites. These membranous structures were also observed beside true concentrically arranged AL in pubertal Sertoli cells (11-13 years of age). Both types of membranous formations were continuous with parallel, rough endoplasmic reticulum cisternae (RER) that interconnected them. Adult Sertoli cells showed only AL, not the other peculiar membranous formation. These features suggest that the RER plus associated vesicles originate the AL in human Sertoli cells.