Video-Based Guided Simulation without Peer or Expert Feedback is Not Enough: A Randomized Controlled Trial of Simulation-Based Training for Medical Students.

BACKGROUND: Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective. METHODS: A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores. RESULTS: No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores [(19.8 (18.5-21); 16.6 (15.5-17.5)) and (20.3 (19.88-21); 16.8 (16-17.5)) vs (15.7 (15-16); 13.3 (12.5-14)) (p < 0.05)], respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS [7 (4.5-9) and 7.4 (4.88-10) vs 3.5 (1.5-6) (p < 0.05)] and SRS scores [5.4 (3.5-7) and 6.3 (4-8.5) vs 3.1 (1.13-4.88) (p < 0.05)], respectively. CONCLUSION: The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education.

Prevención en la transmisión de Coronavirus-19: ¿qué tan preparado está el personal de salud en Chile?

Background: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. Aim: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. Material and Methods: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. Results: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. Conclusions: The adherence reported by health care workers was adequate in most of the evaluated recommendations.

[Adherence to COVID-19 trasmission prevention measures among health care workers]. / Prevención en la transmisión de Coronavirus-19: ¿qué tan preparado está el personal de salud en Chile?

BACKGROUND: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. AIM: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. MATERIAL AND METHODS: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. RESULTS: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. CONCLUSIONS: The adherence reported by health care workers was adequate in most of the evaluated recommendations.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development.

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time.

The 1994 International Conference on Population and Development established a basis for the advancement of adolescent sexual and reproductive health and rights (ASRHR) that endures today. Twenty-five years later, our vision for the future warrants reflection based on a clear understanding of the opportunities and challenges before us. Inclusion of adolescents on global, regional, and national agendas; increased investment in ASRHR policies and programs; renewed commitments to universal health coverage; increased school enrollment; and advances in technology are all critical opportunities we can and must leverage to catalyze progress for adolescents. At the same time, a range of significant challenges remain, have newly emerged, or can be seen on the horizon, including persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningfully engaging adolescents and young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. To achieve as much progress toward our vision for ASRHR as possible, the global ASRHR community must take strategic and specific steps in the next 10 years within five areas for action: (1) mobilize and make full use of political and social support for ASRHR policies and programs; (2) increase and make effective use of external and domestic funding for ASRHR; (3) develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR; (4) use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and (5) manage the implementation of ASRHR strategies at scale with quality and equity.

IMPACT OF A SIMULATED LAPAROSCOPIC TRAINING PROGRAM IN A THREE-YEAR GENERAL SURGERY RESIDENCY.

BACKGROUND: A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents' surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce. AIM: To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program. METHODS: A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described. RESULTS: Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05). CONCLUSIONS: The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.

Impact of a simulated laparoscopic training program in a three-year general surgery residency / Impacto de um programa de treinamento laparoscópico simulado em residência de cirurgia geral de três anos

ABSTRACT Background: A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents' surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.

RESUMO Racional: Residência em Cirurgia Geral pode durar entre 2-6 anos, dependendo do país. Residência mais curta deve otimizar a exposição dos residentes às cirurgias. Sabe-se que o treinamento cirúrgico simulado encurta as curvas de aprendizado, mas a informação relacionada à como isso afeta a residência em relação à exposição clínica é escassa. Objetivo: Analisar o efeito da introdução de um programa de treinamento laparoscópico simulado validado em procedimentos abdominais realizados por residentes em um programa de Residência em Cirurgia Geral de três anos. Métodos: Um estudo de coorte não simultâneo foi desenhado. Quatro gerações (2012-2015) de cirurgiões graduados foram incluídos. Apenas os procedimentos abdominais em que os cirurgiões graduados foram o cirurgião principal foram descritos e analisados. O grupo controle foi de cirurgiões graduados de 2012 sem programa de treinamento laparoscópico simulado. Procedimentos cirúrgicos por ano de programa, técnica cirúrgica, intervenção de emergência ou eletiva e local do hospital (hospitais principais/comunitários) foram descritos. Resultados: Intervenções de 28 cirurgiões graduados foram analisadas (controle=5; programa de treinamento simulado=23). Os cirurgiões graduados realizaram média de 372 procedimentos abdominais, com maior número médio de procedimentos de médio a complexo no grupo de programa de treinamento simulado (48 vs. 30, p=0,02). Cirurgiões graduados treinados com programa de treinamento simulado realizaram número maior de procedimentos abdominais totais (384 vs. 319, p=0,04) e procedimentos laparoscópicos (183 vs. 148, p<0,05). Conclusões: A introdução do programa de treinamento laparoscópico simulado pode aumentar o número e a complexidade dos procedimentos totais e laparoscópicos na Residência em Cirurgia Geral de três anos.

Diarrea poscolecistectomía: ¿un problema frecuente? / Postcholecystectomy diarrhea is a frequent problem?

Resumen Introducción: La colecistectomía laparoscópica es una de las intervenciones quirúrgicas más frecuentes en nuestro país. La diarrea poscolecistectomía es una entidad poco reconocida, con una prevalencia descrita entre el 0,9 y 35,6%, sin embargo, en Chile esto no ha sido claramente definido. Objetivo: Determinar la prevalencia y características de la diarrea poscolecistectomía laparoscópica electiva en una muestra de pacientes chilenos. Material y métodos: Se aplicó una encuesta telefónica estructurada sobre consistencia y frecuencia de deposiciones, entre 4 y 6 meses después de la intervención, a los pacientes adultos operados de colecistectomía laparoscópica electivamente entre diciembre de 2014 y marzo de 2015. Se definió como «diarrea poscolecistectomía¼ la presencia de deposiciones líquidas o inusualmente disgregadas que hubiesen comenzado posteriormente a la intervención y se estableció el término de «diarrea prolongada¼ como la duración de síntomas mayor de 4 semanas. Resultados: Se encuestó a 100 pacientes (73% de mujeres). La prevalencia global de diarrea poscolecistectomía fue del 35% (n = 35). La prevalencia de pacientes con diarrea prolongada fue del 15% (n = 15). En el grupo con diarrea prolongada, se observó resolución completa de esta en el 57% de los pacientes (n = 8) en un plazo medio de 99 ± 29 días. Conclusión: La diarrea poscolecistectomía es una entidad frecuente en nuestra población, con una alta prevalencia dentro de los primeros 28 días posteriores a la intervención. En la mayoría de los pacientes se resuelve en los primeros 6 meses.

Abstract Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months.

Allowing New Opportunities in Advanced Laparoscopy Training Using a Full High-Definition Training Box.

INTRODUCTION: Simulated laparoscopy training is limited by its low-quality image. A high-definition (HD) laparoscopic training box was developed under the present necessity of simulating advanced surgery. OBJECTIVE: To describe and test a new HD laparoscopic training box for advanced simulation training. METHODS: We describe the features and image quality of the new training box. The simulator was tested and then evaluated by a group of 76 expert surgeons using a 4-item questionnaire. To assess the effectiveness of training using this simulation box, 15 general surgery residents were trained to perform a laparoscopic jejuno-jejunostomy in a validated simulation program. They were assessed with objective rating scales before and after the training program, and their results were compared with that of experts. RESULTS: The training box was assembled using high-density fiberglass shaped as an insufflated abdomen. It has an adapted full-HD camera with a LED-based illumination system. A manually self-regulated monopod attached to the camera enables training without assistance. Of the expert surgeons who answered the questionnaire, 91% said that the simulation box had a high-quality image and that it was very similar to real laparoscopy. All residents trained improved their rating scores significantly when comparing their initial versus final assessment ( P < .001). Their performance after completing the training in the box was similar to that of experts ( P > .2). CONCLUSIONS: This novel laparoscopic training box presents a high-resolution image and allows training different types of advanced laparoscopic procedures. The simulator box was positively assessed by experts and demonstrated to be effective for laparoscopy training in resident surgeons.

Sclerotherapy with 6% polidocanol solution in patients with placenta accreta.

OBJECTIVE: Placenta accreta is one of the main obstetrical complications worldwide. The aim of this study was to report the experience of managing placenta accreta with a 6% polidocanol solution sclerotherapy. MATERIALS AND METHODS: We selected patients between 37 weeks of gestation and 38 weeks of gestation, diagnosed with placenta accreta, treated at the Maternal Perinatal Hospital "Monica Pretelini Sáenz", Toluca, Mexico, during the period from November 2013 to August 2014. The surgical technique has two steps: (1) fundic-arciform caesarean section followed by a 6% polidocanol sclerosing solution through a 6Fr neonatal feeding tube upon its reaching the placental bed; (2) total abdominal hysterectomy with internal hypogastric artery ligation. RESULTS: Data were collected from 11 patients with a mean age of 33.9 years (range, 26-42 years) and 2.8±0.6 days of hospitalization in the obstetrical intensive care unit. The majority of patients were classified as having pregnancies at an advanced age. All women were multigravidas. Bleeding volume exhibited a range between 2.5 L and 3 L without any case of neonatal death but one mother died because of coagulopathy. CONCLUSION: We conclude that the technique that we are reporting is feasible for implementation in obstetric hospitals, with technical and economic feasibility.

Uniportal video-assisted thoracic surgery lobectomy using a novel perfused ex vivo simulation model.

Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be reused many times changing the ex vivo tissue, so this model may help reduce the costs and animal use associated to this high complexity surgery.

Simulation of atmospheric dispersion of radionuclides using an Eulerian-Lagrangian modelling system.

In this paper we present an atmospheric dispersion scenario for a proposed nuclear power plant in Pakistan involving the hypothetical accidental release of radionuclides. For this, a concept involving a Lagrangian stochastic particle model (LSPM) coupled with an Eulerian regional atmospheric modelling system (RAMS) is used. The atmospheric turbulent dispersion of radionuclides (represented by non-buoyant particles/neutral traces) in the LSPM is modelled by applying non-homogeneous turbulence conditions. The mean wind velocities governed by the topography of the region and the surface fluxes of momentum and heat are calculated by the RAMS code. A moving least squares (MLS) technique is introduced to calculate the concentration of radionuclides at ground level. The numerically calculated vertical profiles of wind velocity and temperature are compared with observed data. The results obtained demonstrate that in regions of complex terrain it is not sufficient to model the atmospheric dispersion of particles using a straight-line Gaussian plume model, and that by utilising a Lagrangian stochastic particle model and regional atmospheric modelling system a much more realistic estimation of the dispersion in such a hypothetical scenario was ascertained. The particle dispersion results for a 12 h ground release show that a triangular area of about 400 km(2) situated in the north-west quadrant of release is under radiological threat. The particle distribution shows that the use of a Gaussian plume model (GPM) in such situations will yield quite misleading results.

Lack of extrapyramidal side effects predicts quality of life in outpatients treated with clozapine or with typical antipsychotics.

We compared symptom severity and quality of life (QOL) in schizophrenic patients adequately treated with typical antipsychotics (TAP) or clozapine (CZP). Groups did not differ in symptom severity or QOL. Clozapine caused fewer extrapyramidal symptoms. Negative and extrapyramidal symptoms predicted QOL. Similar outcome in both groups suggests a common ceiling to antipsychotic efficacy.

Técnica de enclavado endomedular acerrojado retrógrado de fracturas distales de fémur con asistencia artroscópica / Arthroscopic-assisted retrograde interlocked intramedullary fixation in distal femoral fractures

Las fracturas distales del femur son un desafio para la cirugia ortopedica. A traves del tiempo fueron surgiendo distintas tecnicas y materiales quirurgicos con sus ventajas y complicaciones. El clavo endomedular acerrojado retrogrado ha mejorado el aspecto biologico de la fractura al no abrir el foco, disminuyendo el sangrado, el indice de infeccion y de seudoartrosis. Aquí modificamos la técnica reemplazando el abordaje pararrotuliano convencional por un abordaje minimo con asistencia artroscopica, describimos la tecnica y sus ventajas funcionales, esteticas y de confort para el paciente, con minima agresion de tejidos. Se realiza ubicando al paciente sobre mesa ortopedica con el miembro a operar sobre soporta corva y rodilla en flexion de 90 grados. Con asistencia artroscopica se comienza el labrado del canal, opcionalmente se realiza el fresado del mismo o se coloca el clavo directamente, previa reduccion e introduccion del alambre guia y posteriormente se colocan los cerrojos. En el postoperatorio se indica movilidad a las 24 horas y deambulacion con muletas.

Direccion de agua y saneamiento Establecimiento Depurador Sudoeste

Diagramas con las caracteristicas de la planta y cuadros estadisticos sobre aspectos de su funcionamiento

Bajo peso al nacer y edad materna

Para conocer la posible relación entre edad materna y bajo peso al nacer se estudiaron 1 411 mujeres que parieron en los años de 1988 a 1989 en el área de salud del Policlínico Docente "Alcides Pino", de Holguín. Se tomaron los 114 casos que tuvieron niños de bajo peso al nacer como grupo de estudio y el resto como grupo control, y se utilizaron diferentes pruebas estadísticas para determinar la validez del estudio. Las madres adolescentes tuvieron niños con un peso promedio significativamente inferior a las madres mayores, pero éste fue superior a los 3 000 g. No se encontró relación entre edad materna y bajo peso al nacer

Bajo peso al nacer y edad materna

Para conocer la posible relación entre edad materna y bajo peso al nacer se estudiaron 1 411 mujeres que parieron en los años de 1988 a 1989 en el área de salud del Policlínico Docente "Alcides Pino", de Holguín. Se tomaron los 114 casos que tuvieron niños de bajo peso al nacer como grupo de estudio y el resto como grupo control, y se utilizaron diferentes pruebas estadísticas para determinar la validez del estudio. Las madres adolescentes tuvieron niños con un peso promedio significativamente inferior a las madres mayores, pero éste fue superior a los 3 000 g. No se encontró relación entre edad materna y bajo peso al nacer

Bajo peso al nacer y algunas entidades clínicas agregadas al embarazo / Infant low birth weight and some aggregated clinical entities with pregnacy

Se estudiaron 63 madres que tuvieron recién nacidos con bajo peso al nacer y 63 que tuvieron niños con peso normal en el área de salud del Policlínico Docente "Alcides Pino" de Holguín, en el período de julio de 1988 a diciembre de 1989, para analizar el efecto que sobre el bajo peso al nacer y sus componentes (pretérmino y crecimiento intrauterino retardado) tenían las siguientes entidades clínicas: toxemia gravídica, anemia, infección urinaria y modificaciones cervicales. Se notó influencia de la toxemia, la infección urinaria y las modificaciones cervicales, y no así de la anemia

Bajo peso al nacer y algunas entidades clínicas agregadas al embarazo / Infant low birth weight and some aggregated clinical entities with pregnacy

Se estudiaron 63 madres que tuvieron recién nacidos con bajo peso al nacer y 63 que tuvieron niños con peso normal en el área de salud del Policlínico Docente "Alcides Pino" de Holguín, en el período de julio de 1988 a diciembre de 1989, para analizar el efecto que sobre el bajo peso al nacer y sus componentes (pretérmino y crecimiento intrauterino retardado) tenían las siguientes entidades clínicas: toxemia gravídica, anemia, infección urinaria y modificaciones cervicales. Se notó influencia de la toxemia, la infección urinaria y las modificaciones cervicales, y no así de la anemia

Dosis letal media (LD50) y alteraciones ultraestructurales hepaticas inducidas por Eugenia uniflora, N.V. "Nängapiry" / Median lethal dose (LD50) and hepatic ultrastructural changes induced by Eugenia uniflora, N.V. \"Nängapiry\"

Se determinó la dosis letal media del extracto etanol: aguda 7:3 de hojas de Eugenia uniflora por vía intraperitoneal en ratones Balb-C, evaluando las alteraciones hepáticas por microscopía óptica y electrónica