Fecal immunochemical test for hemoglobin versus fecal calprotectin to monitor endoscopic activity in inflammatory bowel disease

Aim: endoscopy identifies inflammatory activity, however, it is an unpleasant test and is not always accessible. The aim of the study was to compare the usefulness of quantitative fecal immunochemical test (FIT) versus fecal calprotectin (FC) to determine endoscopic activity in patients with inflammatory bowel disease (IBD). Methods: cross-sectional prospective observational study. The stool samples were collected within three days before starting the preparation for the colonoscopy. We used the Mayo index for ulcerative colitis (UC) and the simplified endoscopic index for Crohn’s disease (CD). Mucosal healing (MH) was defined as the score 0 points in each of the endoscopic indices. Results: eighty-four patients were included, 40 (47.6 %) with UC. In patients with IBD, FIT and FC showed a significant correlation with the presence of inflammatory activity/MH on endoscopy, with no statistically significant differences between the two receiver-operating characteristic (ROC) curves. Both tests improved their diagnostic performance when assessing patients with UC; the Spearman correlations between FIT and FC and endoscopic inflammatory activity were r = 0.6 (p = 0.0001) and r = 0.7 (p = 0.0001), respectively. In Crohn’s disease, the diagnostic utility of both tests was lower. Conclusions: FIT is an alternative to monitor endoscopic activity among ulcerative colitis patients. In Crohn’s disease, more studies are needed to determine the role of fecal biomarkers. (AU)

Intestinal ultrasonography and fecal calprotectin for monitoring inflammation of ileal Crohn's disease: two complementary tests.

BACKGROUND/AIMS: Tight control of inflammation and adjustment of treatment if activity persists is the current strategy for the management of Crohn's disease (CD). The usefulness of fecal calprotectin (FC) in isolated involvement of the small intestine in CD is controversial. To assess the usefulness of FC to determine the inflammatory activity detected by intestinal ultrasonography (IUS) in ileal CD. METHODS: Patients with exclusively ileal involvement CD who underwent IUS and an FC were prospectively included. Simple ultrasound index was used to determine inflammatory activity. The usual statistical tests for comparison of diagnostic techniques were used. RESULTS: One hundred and five patients were included, IUS showed inflammatory activity in 59% of patients and complications in 18.1%. FC showed a significant correlation with IUS in the weak range (Spearman coefficient r=0.502; P<0.001); the area under the receiver operating characteristic curve was 0.79 (95% confidence interval, 0.70-0.88; P<0.001). The FC value that best reflected the activity in IUS was 100 µg/g with sensitivity, specificity, and positive and negative predictive values of 73.0%, 71.4%, 79.3% and 63.8%, respectively. There were no differences in FC concentration between patients with or without transmural complications. The addition of serum C-reactive protein to FC did not improve the ability to assess IUS activity. CONCLUSIONS: FC has a significant correlation with IUS to monitor ileal CD activity. This correlation is weak and it does not allow assessing the presence of CD complications. Both tests should be used in conjunction for tight control of ileal CD. More studies on noninvasive tests in this location are needed.

Virtual chromoendoscopy with iSCAN as an alternative method to dye-spray chromoendoscopy for dysplasia detection in long-standing colonic inflammatory bowel disease: a case-control study.

OBJECTIVE: Patients with long-standing colonic inflammatory bowel disease (cIBD) are at increased risk of developing colorectal cancer (CRC). Dye-spray chromoendoscopy (DCE) with targeted biopsies is the preferred technique for surveillance of dysplasia. Virtual chromoendoscopy (VCE) are arising to improve detection rates and adherence to surveillance guidelines, although its role is not yet well defined. The purpose of this study is to assess the effectiveness of VCE with iSCAN as an alternative method for dysplasia detection in cIBD. METHODS: Retrospective case-control study with 191 patients included, 98 in the DCE (Indigo carmine) group and 93 in the VCE (iSCAN, twin-mode 1-3) group. The dysplasia detection and the exploration time were analysed. A logistic regression analysis was performed to ascertain the factors related to colonic dysplasia. RESULTS: A total of 44 dysplastic lesions were detected in 21 (11%) patients. No differences were found in the per lesion and the per patient analysis (dysplastic versus non-dysplastic). Median withdrawal time was shorter in the VCE group than in the DCE group (9 min versus 14 min; p < .001). Location of lesions in the right colon was independently associated with an increased risk for colonic dysplasia (OR = 4.04, 95%CI 1.11-14.65; p = .034) after adjusting for age at inclusion, age at diagnosis, high risk for CRC and Kudo pit pattern. CONCLUSIONS: VCE with iSCAN presents a similar diagnostic performance to conventional DCE in the detection of colonic dysplasia in patients with long-standing cIBD. Furthermore, VCE with iSCAN is a less time-consuming surveillance alternative to DCE.

Treatment of abdominal fistulas in Crohn's disease and monitoring with abdominal ultrasonography.

OBJECTIVE: to assess the usefulness of medical treatment to achieve closure of internal fistulas detected on abdominal ultrasound in a series of patients with fistulizing Crohn's disease. MATERIAL AND METHODS: a retrospective analysis was performed of the medical records of patients with Crohn's disease with a fistula detected on abdominal ultrasound from 2010 to 2018. The study included patients who received medical treatment after the diagnosis of this complication and underwent ultrasonographic monitoring of the therapeutic response. The factors associated with the response to medical treatment or the need for surgery were investigated. RESULTS: forty-six patients were included in the study. Enteromesenteric (69.6 %) was the most common type of fistula and associated abscesses were found in 14 (30.4 %) patients. Fistulas were classified as complex in 20 patients. Treatment with immunosuppressants was started in 14 (30.4 %) cases and a biologic drug was added in 18 (39.1 %) patients. Complete closure of the abdominal fistula was observed with ultrasonography in 24 (52.2 %) of the 46 patients. The only factor related to fistula closure was the type of fistula and was more likely to occur in patients with an enteromesenteric fistula. Thirteen (28 %) of the 46 patients needed a surgical resection. The only factor with a significant correlation with a lower need for surgery was fistula closure after treatment (8.3 % vs 50 %, p = 0.002). CONCLUSION: medical treatment achieves internal fistula closure in more than half of cases and almost a third require surgical treatment. Abdominal ultrasound can detect abdominal fistulas at an earlier stage and allow prompt treatment changes.

Trastorno mental grave, sin hogar y creencias religiosas inusuales: a propósito de un caso / Serious mental illness, homeless and unusual religious beliefs: presentation of a case

OBJETIVO: El interés del caso es la documentación de las vicisitudes asistenciales de personas con TMG que se presentan con creencias religiosas inusuales (nuestra paciente era devota de Hare Krishna) y que además estén en una insólita situación de desaparición y necesidad de identificación policial. CASO CLÍNICO: Se trata de una mujer con diagnóstico de trastorno psicótico crónico, que fue ingresada en una Unidad de Hospitalización de Adultos de Psiquiatría por orden judicial. Transcurridas varias semanas de su ingreso, finalmente, fue identificada por la policía científica, donde constaba que se encontraba desaparecida desde hacía dos años en otra Comunidad Autónoma. RESULTADOS: Entre las personas sin hogar destaca una elevada prevalencia de trastorno mental, patología dual o ambos. En recientes estudios se encontraron las siguientes características sociodemográficas: mayor proporción de hombres, edad media, más sintomatología médica, bajo nivel de educación, mayor gravedad de síntomas psiquiátricos, con un deterioro funcional grave, periodos de más de 36 meses de estar sin hogar, y casi la mitad presentaban abuso de sustancias. Se encontró que el 78% de los pacientes tenían trastorno mental con psicosis. Además, en otro estudio, se objetivó que la mortalidad en mujeres indigentes de más de 45 años era más del doble de lo esperado. CONCLUSIONES: Sería conveniente mejorar las estructuras y procesos del trabajo comunitario, como se realiza en otros países de Europa, para poder atender a las personas sin hogar de una forma más adecuada, asegurando que reciben los servicios de salud que requieran

OBJECTIVE: The interest of this case is the documentation of the healthcare vicissitudes of people with Severe Mental Illness (SMI) who have unusual religious beliefs (our patient was a devotee of Hare Krishna), and who are also in an unusual situation of disappearance, and need of police identification. CLINICAL CASE: This is a woman diagnosed with chronic psychotic disorder, who was admitted to an Adult Psychiatric Ward by court order. After several weeks of admission, she was finally identified by the forensic police, stating that she had been missing for two years in another city. RESULTS: There is a high prevalence of mental disorder and/or dual disorder among the homeless. In recent studies the following sociodemographic characteristics were found: higher proportion of men, middle aged, more medical symptoms, low level of education, greater severity of psychiatric symptoms, with severe functional impairment, periods of more than 36 months of being homeless, and almost half had substance abuse. More than three-quarters (78%) of patients were found to have mental disorder with psychosis. Furthermore, in another study, it was found that mortality was more than double that expected in homeless women over 45 years old. CONCLUSIONS: It would be worthwhile to improve the structures and processes of community work, as has happened in other European countries, in order to be able to attend to the homeless in a more adequate way, ensuring that they receive the health services they deserve

Dietary Fat Patterns and Outcomes in Acute Pancreatitis in Spain.

Background/Objective: Evidence from basic and clinical studies suggests that unsaturated fatty acids (UFAs) might be relevant mediators of the development of complications in acute pancreatitis (AP). Objective: The aim of this study was to analyze outcomes in patients with AP from regions in Spain with different patterns of dietary fat intake. Materials and Methods: A retrospective analysis was performed with data from 1,655 patients with AP from a Spanish prospective cohort study and regional nutritional data from a Spanish cross-sectional study. Nutritional data considered in the study concern the total lipid consumption, detailing total saturated fatty acids, UFAs and monounsaturated fatty acids (MUFAs) consumption derived from regional data and not from the patient prospective cohort. Two multivariable analysis models were used: (1) a model with the Charlson comorbidity index, sex, alcoholic etiology, and recurrent AP; (2) a model that included these variables plus obesity. Results: In multivariable analysis, patients from regions with high UFA intake had a significantly increased frequency of local complications, persistent organ failure (POF), mortality, and moderate-to-severe disease in the model without obesity and a higher frequency of POF in the model with obesity. Patients from regions with high MUFA intake had significantly more local complications and moderate-to-severe disease; this significance remained for moderate-to-severe disease when obesity was added to the model. Conclusions: Differences in dietary fat patterns could be associated with different outcomes in AP, and dietary fat patterns may be a pre-morbid factor that determines the severity of AP. UFAs, and particulary MUFAs, may influence the pathogenesis of the severity of AP.

Do parents perceive the abnormal eating attitudes of their adolescent children with anorexia nervosa?

Parents are often the first to detect the initial signs of anorexia nervosa (AN) and take necessary measures to ensure that their children receive appropriate treatment. The evaluation of AN in adolescence is complicated by taking into account the tendency to minimize and deny the symptoms by adolescents, and the difficulty of parents in detecting the main symptoms. We compared the adolescent and parent scores on measures of disordered eating at initial presentation. The sample consisted of 62 adolescents diagnosed with AN, who attended an eating disorder children's unit. Adolescents completed the Eating Attitudes Test (EAT-40) and their parents the Anorectic Behavior Observation Scale (ABOS). The questionnaire data were collected as part of the routine clinical practice and were obtained from clinical notes. The findings indicate no significant correlations between the EAT-40 and ABOS scores, or between AN subtypes according to parent observation of symptoms. There were significant differences between parents, with mothers reporting higher scores than fathers. This study highlights the importance of psychoeducation for parents on the early signs of AN, in order to improve recognition and diagnosis at initial assessment of their adolescent children in the early phases.

Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn's Disease.

AIM: To assess the clinical benefits of transmural healing (TH) shown on intestinal ultrasound (IUS) after treatment with tumor necrosis factor-alpha antibodies (anti-TNF) in patients with Crohn's disease. MATERIALS AND METHODS: This prospective study included consecutively 36 patients who underwent IUS in the week prior to start anti-TNF treatment, at 12 weeks, and 1 year after starting treatment. The clinical response to treatment was assessed using the Crohn's disease activity index and C-reactive protein (CRP) values. TH was defined as the normalization of bowel wall thickness on IUS. Treated patients were considered to have a good outcome if none of the following situations presented: need to reintroduce corticosteroids or intensify maintenance therapy and/or need for surgery. RESULTS: After the induction regimen, 29 patients (80.6%) achieved clinical remission, and serum CRP values returned to normal in 20 patients (55.6%). In the IUS at 12 weeks, treatment induced a statistically significant reduction in the wall thickness (p < 0.001) and color Doppler grade (p < 0.001), as well as resolution of complications in 66.7% of patients (p < 0.03). IUS after 1 year of biological therapy showed TH in 14/33 patients (42.4%). During the follow-up (median 48.5 months), 23 of the 33 (69.7%) patients in remission or response after induction therapy presented a good outcome. Sonographic TH was significantly related with better outcomes, with only 1/14 patients having a poor outcome compared to 9/19 without TH (OR 11.7, 95% CI 1.2-108.2 p = 0.01, Chi-squared test). CONCLUSION: Patients who achieve TH on IUS with biological treatment have better clinical outcomes.

Reactivación de hepatitis B en paciente con hepatitis crónica C tratado con antivirales de acción directa / Hepatitis B reactivation in a patient with chronic hepatitis C treated with direct-acting antivirals

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Prevención y manejo de la hipotermia en el periodo perioperatorio / Prevention and management of hypothermia during the perioperative period

OBJETIVO: determinar la frecuencia de hipotermia durante el periodo perioperatorio en pacientes sometidos a cirugías programadas bajo anestesia general y conocer los factores personales y ambientales que influyen en la aparición de hipotermia durante el periodo quirúrgico. MÉTODO: se desarrolló un estudio piloto descriptivo longitudinal en el bloque quirúrgico del Hospital Clínico Universitario Lozano Blesa de Zaragoza, desde junio hasta octubre de 2015. La población del estudio fueron los pacientes intervenidos quirúrgicamente que cumpliesen con los criterios de inclusión. Se recopilaron variables sociodemográficas, variables ambientales (temperatura del quirófano, intervención y duración, tamaño de la herida quirúrgica, sueroterapia, gases anestésicos, sistemas de calentamiento) y variables térmicas (temperatura basal, pre y postinducción anestésica, y cada 20 minutos durante el periodo intraoperatorio y de recuperación anestésica hasta el alta de la Unidad de Recuperación Post Anestésica (URPA) con registro de aparición de hipotermia. Se realizó análisis descriptivo y bivariante. RESULTADOS: la muestra total fue de 25 individuos que presentaron un descenso medio intraoperatorio de 0,7 ºC con respecto a su temperatura inicial. El 40% de los individuos presentó hipotermia leve durante la intervención quirúrgica, dando lugar durante la primera hora en el 92% de los estos. El 24% de los sujetos padecieron hipotermia durante el postoperatorio, ya habiéndola desarrollado anteriormente la mitad de estos durante el tiempo intraoperatorio. CONCLUSIÓN: hay mayor frecuencia de hipotermia intraoperatoria que postoperatoria, registrada generalmente durante la primera hora quirúrgica y en los primeros 30 minutos de recuperación anestésica. Un mayor tiempo de intervención y del tamaño de incisión facilitan la aparición de hipotermia

OBJECTIVE: to determine the frequency of hypothermia during the perioperative period in patients undergoing scheduled surgery under general anaesthesia, and to understand the personal and environmental factors that have an impact on the development of hypothermia during the surgical period. METHOD: a longitudinal descriptive pilot study was conducted in the Surgical Unit of the Hospital Clínico Universitario Lozano Blesa of Zaragoza, from June to October, 2015. The study population was formed by those patients undergoing surgery who met the inclusion criteria. The study collected sociodemographical variables, environmental variables (Operating Room temperature, type of procedure and its duration, size of the surgical wound, saline therapy, anaesthetic gases, warming systems) and thermal variables (temperature at baseline, pre and post anaesthetic induction, and every 20 minutes during the perioperative period and the recovery from anesthesia, until discharge from the Post-anaesthetic Care Unit with recorded development of hypothermia. A descriptive and bivariate analysis was conducted. RESULTS: the total sample included 25 patients who presented a mean intraoperative reduction of 0.7 ºC from their initial temperature. Out of these patients, 40% presented mild hypothermia during the surgical procedure, which occurred during the first hour in 92% of cases. A 24% of patients suffered hypothermia during the post-operative period, and half of them had already developed it previously during the intraoperative period. CONCLUSION: there is a higher frequency of intraoperative vs. postoperative hypothermia, generally recorded during the first hour of surgery and within the first 30 minutes of recovery from anaesthesia. Longer surgery duration and a larger wound size will favour the development of hypothermia

Diferencias en el uso de servicios sanitarios en la población española adulta / Differencias in the use of health esrvices in the spanish adult population

Objetivo. Conocer las diferencias de utilización de servicios sanitarios según la modalidad de seguro sanitario, en la población española adulta. Métodos. Se realizó un estudio descriptivo transversal, empleando los datos de la Encuesta Nacional de Salud de España de 2011-2012, con entrevista a 21 007 personas. Entre los individuos que tenían alguna cobertura sanitaria, se han diferenciado los que tenían servicios sanitarios públicos, privados, o mixtos. Se realizó un estudio univariante y bivariante para conocer las diferencias de utilización de servicios según el tipo de cobertura. Resultados. El 83.5 % de la población manifiesta disponer exclusivamente de cobertura pública, el 2.5 % cuenta con seguro únicamente privado y el 14 % está afiliado a ambas modalidades. Los individuos con cobertura exclusivamente pública acuden más al facultativo general (81.9 %), mientras que las personas con seguro únicamente privado han sido quienes consultan en mayor proporción al especialista (65.6 %). Los sujetos con cobertura exclusivamente pública describen los mayores tiempos de espera, tanto para el ingreso programado como para recibir atención médica. En general, las personas con doble cobertura tuvieron una mayor participación en actividades preventivas. Conclusiones. La sanidad pública es la principal cobertura de la población española. Se evidencian perfiles diferentes de utilización de los recursos sanitarios distintos, según la cobertura asistencial correspondiente (AU)

Objective. To explore the use of health services in the Spanish population, according health insurance. Methods. A cross-sectional study using data from the Spanish National Health Survey 2011-2012 was conducted. 21 007 people were included. Among individuals with health coverage, three groups were differentiated: people with public, private and mixed insurance. Univariate and bivariate analyses were developed to know health services use differences by health insurance. Results. 83.5 % of the population reported only a public coverage, 2.5 % has only private insurance and 14 % was enrolled in both forms. Individuals with public coverage visited with higher frequency the general physician (81.9 %), while those with only private insurance visited a specialist in the highest proportion (65.6 %). Individuals with only public health coverage presented the longest waiting times, for both programmed hospitalization and medical attention. In general terms, people with double coverage showed the greatest participation in preventive activities. Conclusions. Public coverage is the most important coverage of the Spanish population. Different use of health resources were observed according to health insurance (AU)

Cobertura sanitaria en población española adulta: diferencias sociodemográficas y del estado de salud / Healthcare coverage in the adult spanish population: sociodemographical and health status differences

OBJETIVO: conocer las diferencias sociodemográficas y del estado de salud según la modalidad de seguro sanitario en población española adulta. MÉTODO: se realizó un estudio descriptivo transversal, empleándolos datos de la Encuesta Nacional de Salud española 2011-2012.Entre los individuos que tenían alguna cobertura sanitaria, se han diferenciado los que tenían servicios sanitarios públicos, privados o doble cobertura. Se desarrolló un estudio bivariante para conocer las diferencias sociodemográficas y de salud según el tipo de cobertura. Se aplicó un modelo de análisis multivariable de regresión logística para determinar el perfil del usuario con cobertura pública. RESULTADOS: el estudio se desarrolló a partir de una muestra de21.007 individuos residentes en el territorio español mayores de 15años. Tras eliminar a los sujetos que no contaban con ningún tipo de cobertura sanitaria (62 personas) y los que no contestaron (132 personas), se incluyeron 20.813 individuos en el análisis. Un 83,5% de la población dispone exclusivamente de cobertura pública, caracterizada por ser joven, con nivel de estudios bajo, desempleada, con peor estado de salud percibido, y sin padecer enfermedades crónicas. Un 14% de población cuenta además con cobertura privada. CONCLUSIONES: la sanidad pública es la principal cobertura de la población española. Los individuos más mayores, con una renta familia relevada, en situación de empleo, con un nivel académico más elevado, un buen estado de salud percibido y con alguna enfermedad crónica, son el perfil del usuario que opta por un aseguramiento privado

OBJECTIVE: to understand the sociodemographic and health status differences according to the healthcare insurance model in the adult Spanish population. METHOD: a transversal descriptive study was conducted, using data from the 2011-2012 Spanish National Healthcare Survey. Those individuals with some type of healthcare coverage were divided into those who had public healthcare insurance, private healthcare insurance, or double coverage. A bivariate study was conducted in order to understand the sociodemographical and health differences according to type of coverage. A multivariable logistic regression analysis model was applied in order to determine the profile of the user with public coverage. RESULTS: the study was conducted in a sample of 21,007 persons over 15 years of age residing in the Spanish territory. After removing those subjects who had no type of healthcare coverage (62 persons)and those who did not answer (132 persons), the analysis included20,813 individuals. A 83.5% of the population has public coverage exclusively; this group is mostly young, with a low level of education, unemployed, with a worse perception of their health status, and without any chronic diseases. A 14% of this population has also private coverage. CONCLUSIONS: public health is the main coverage for the Spanish population. Older individuals, with a high family income, who are working and have a higher academic level, a good perception of their health status, and some chronic disease, represent the profile of the user who chooses private insurance

[Differences in the use of health services in the Spanish adult populations].

Objective: To explore the use of health services in the Spanish population, according health insurance. Methods: A cross-sectional study using data from the Spanish National Health Survey 2011-2012 was conducted. 21 007 people were included. Among individuals with health coverage, three groups were differentiated: people with public, private and mixed insurance. Univariate and bivariate analyses were developed to know health services and bivariate analyses were developed to know health services use differences by health insurance. Results: 83.5 % of the population reported only a public coverage, 2.5 % has only private insurance and 14 % was enrolled in both forms. Individuals with public coverage visited with higher frequency the general physician (81.9 %), while those with only private insurance visited a specialist in the highest proportion (65.6 %). Individuals with only public health coverage presented the longest waiting times, for both programmed hospitalization and medical attention. In general terms, people with double coverage showed the greatest participation in preventive activities. Conclusions: Public coverage is the most important coverage of the Spanish population. Different use of health resources were observed according to health insurance.

Prevención de accidentes biológicos en los estudiantes de Enfermería / Prevention of Biological Accidents in Nursing Students

Objetivo: conocer la relación entre los conocimientos y actitudes adquiridos por los estudiantes de Enfermería y la siniestralidad accidental con material biológico. Método: se realizó un estudio descriptivo transversal de los alumnos matriculados en la Escuela Universitaria de Enfermería de Huesca, durante el curso académico 2011, matriculados en los cursos segundo, tercero y cuarto, y que habían cursado parcial o totalmente alguna de las asignaturas de Enfermería Clínica I, II o III. La recogida de datos se efectuó mediante el cuestionario de Merino de la Hoz, que contiene variables demográficas, de conocimiento sobre las precauciones universales, protocolo a seguir en caso de accidente biológico y medidas de bioseguridad, opinión de la formación recibida y la logística, actitudes de adopción de medidas de bioseguridad y características de los accidentes biológicos ocurridos. Resultados: respondieron el cuestionario 99 alumnos, de los que40 correspondían a segundo curso (40,4%), 28 a tercero (28,3%)y 31 a cuarto (31,3%). Más del 92% de los encuestados reconoce tener conocimientos sobre las precauciones estándares y sobre las medidas de bioseguridad, el conocimiento del protocolo de actuación en caso de accidente es significativamente mayor en los estudiantes de tercero. Los riesgos profesionales por exposición y la capacidad de seroconversión por cada virus fueron los aspectos menos conocidos. Se encontraron diferencias significativas entre cursos en la adopción de medidas de bioseguridad. El total de accidentes ocurridos fue 16, de los cuales 13 sucedieron en segundo curso, la mayoría originados por falta de precaución durante la administración de inyección y por el reencapuchado de aguja. Conclusiones: aunque los alumnos manifiestan conocimientos delas precauciones universales y de las medidas de bioseguridad, su cumplimiento es mejorable, especialmente durante las primeras prácticas clínicas. (AU)

Objective: to understand the relationship between the knowledge and attitudes acquired by Nursing students, and the rate of accidents with biologic material. Method: a transversal descriptive study was conducted on those students registered at the University School of Nursing in Huesca, during the 2011 academic term; students were registered in the second, third and fourth year, and they had taken partially or completely some of the subjects in Clinical Nursing I, II or III. Data collection was conducted through the Merino de la Hoz Questionnaire, which contains variables regarding demographic data, knowledge about global precautions, protocol to be followed in case of biological accident and biosafety measures, opinion of the training received and logistics, attitudes for adopting biosafety measures, and characteristics of biological accidents occurred. Results: the questionnaire was answered by 99 students, out of which 40 belonged to the second year (40.4%), 28 to the third year(28.3%) and 31 to the fourth year (31.3%). Over 92% of respondents stated that they had knowledge about standard precautions and biosafety measures; knowledge of the protocol of action in case of accident was significantly higher in third year students. Professional risks due to exposure and the ability of seroconversion by each virus were the least known aspects. Significant differences were found among courses in terms of adopting biosafety measures. The total number of accidents occurred was 16; 13 of these occurred in the second year, most of them caused by lack of precaution during the administration of an injection, and during needle recapping. Conclusions: even though students claim they have knowledge of global precautions and biosafety measures, their implementation could be improved, particularly during the initial clinical practices (AU)

Neonatal circumcisions performed by pediatric residents: implementation of a training program.

OBJECTIVE: To implement a pilot training program on neonatal circumcisions for pediatric residents in a residency training program, and to evaluate the effectiveness of the program in improving knowledge and skills in performing circumcisions. DESIGN: Educational curriculum. SETTING: The mother-baby unit of a tertiary care university medical center. PARTICIPANTS: Nineteen pediatric residents in training. INTERVENTION: A 1-month circumcision-training program. OUTCOME MEASURES: Successful completion of the training program, change in mean knowledge scores, and change in attitudes regarding circumcision. RESULTS: All 19 residents successfully completed the pilot program. Residents were enthusiastic about the opportunity to train in performing circumcisions. The mean test scores on the content items increased significantly from 5.0 (SD, 1.8) before training to 8.3 (SD, 1.0) after training (P <.003). After training, there were significant changes in residents' attitudes regarding giving anesthesia for the procedure and the medical indications for performing routine circumcisions. CONCLUSIONS: Given a structured curriculum, pediatric residents can be taught to safely and successfully perform neonatal circumcisions with adequate technical competency and pain relief skills. Training results in increased knowledge and increased level of comfort in performing this routine procedure.