Improvements in climate and satisfaction after implementing a quality management system in education.

The overall aim of this study is to evaluate the impact of applying ISO:9001 on the school climate and satisfaction in schools. This was done by using a Likert-type evaluation instrument consisting of 21 items with an excellent reliability score for the general scale (Cronbach α = 0.955) and specifically for the school climate dimension (α = 0.969) and school satisfaction (α = 0.927). The instrument was applied to a sample of 2189 subjects (1881 teachers and 308 members of the school management team) at 85 schools in Spain where ISO:9001 has been implemented for at least 3 years. The results show that implementation of this QMS has generally had a medium level impact on school climate and on satisfaction among the teachers, students, and families at the schools in the sample. Moreover, descriptive and differential analyses have been carried out to identify any significant differences in the impact of implementing the QMS on improvements in the two dimensions as a function of the position, gender, seniority at the school, ownership, and size of the school, and length of time with the QMS implemented there. In addition, other analyses were carried out using single-variant general linear models that revealed an effect of interaction between the variables of position and age. Furthermore, cluster analyses were also performed to identify three teacher and management profiles attending to the levels of improvement brought about from implanting the QMS on the dimensions under study.

Gastric plexiform fibromyxoma, an uncommon mesenchymal tumor.

Plexiform fibromyxoma (PF) is an uncommon primary tumor of the gastrointestinal tract, with a mesenchymal origin and a benign behavior. Herein, we report a case and provide a literature review. A 41-year-old male patient underwent surgery in our unit for a PF at the gastric antrum, after being admitted due to vomiting and weight loss. As illustrated by our case, the mean age at presentation is around 40 years, the antrum is the most common location and abdominal pain the most widely reported manifestation. None of the reviewed cases involved regional or distant spread.

[Surgical resident training program in minimally invasive surgery experimental laboratory (CENDOS)]. / Programa de formación del residente de cirugía en un laboratorio experimental de cirugía minimamente invasiva (CENDOS).

INTRODUCTION: The rapid development of laparoscopic surgery makes resident training programmes necessary. OBJECTIVE: To analyse the results of a structured programme of laparoscopic training in an experimental laboratory. MATERIAL AND METHOD: From 2003 until 2007, we trained 11 general surgery residents for 20 h every 3 months, for three years. The practice consisted of suture and anastomosis in Endo-Trainer with animal organs, as well as laparoscopic techniques in live animals. In the Endo-Trainer practice we evaluated the time and quality of anastomosis performance. In laparoscopic techniques (cholecystectomy and anti-reflux surgery) a task table was evaluated, from 0 (no errors) to 100 (severe lesion). RESULTS: In total, 314 anastomosis were performed by the 11 residents, with a median of 28.5 per resident (24-42). The mean time for the first gastro-jejunal anastomosis was 135 min (100-140) and 65 min (57.5-105) for the first jejunal-jejunal anastomosis. Maximum learning was achieved after 45 training hours. There were no appreciable differences between both types of anastomosis. There was inadequate anastomosis quality due to leakage in 17.1% during the learning period and 13.7% during the consolidation period. In the animal, 172 procedures were performed. In cholecystectomy and anti-reflux surgery the mean scores were 2.4 and 5.6 points, respectively. In the remaining procedures, subjectively evaluated by the monitors, the quality was adequate in 65%, deficient in 22% and highly deficient in 13%. CONCLUSIONS: This structured programme of laparoscopic skills based on intestinal anastomosis allows for quicker resident training.

Programa de formación del residente de cirugía en un laboratorio experimental de cirugía minimamente invasiva (CENDOS) / Surgical resident training program in minimally invasive surgery experimental laboratory (CENDOS)

Introducción: el rápido avance de la cirugía laparoscópica obliga a cambiar los métodos de enseñanza de residentes. Objetivo: analizar los resultados de un programa estructurado de formación laparoscópica en laboratorio experimental. Material y método: entre 2003 y 2007, entrenamos a 11 residentes de cirugía general 20h por trimestre durante 3 años. Incluimos habilidades en suturas y anastomosis en endotrainer con órganos animales y técnicas laparoscópicas en animales vivos. En la práctica en cajas, se registraron tiempo y calidad anastomótica. En la laparoscopia realizada al animal (colecistectomía y antirreflujo), se puntuó una tabla de tareas de 0 (ningún error) a 100 (lesión grave).Resultados: los 11 residentes realizaron 314 anastomosis, con una media de 28,5 (24-42) anastomosis/residente. La mediana de tiempo para la primera anastomosis gastroyeyunal fue 135 (100-140) min y para la yeyunoyeyunal, 65 (57,5-105) min. El máximo aprendizaje se produjo transcurridas 45h de entrenamiento. No se apreciaron diferencias en la ejecución de ambas anastomosis. Se registró deficiente calidad anastomótica, determinada por existencia de fuga, en el 17,1% durante el período de aprendizaje y el 13,7% durante el de consolidación. En el animal realizaron 172 procedimientos. En colecistectomía y antirreflujo hubo una media de 2,4 y 5,6 puntos. En el resto de procedimientos, valorados subjetivamente por el monitor, la calidad de la técnica fue correcta en el 65%, mejorable en el 22% y muy mejorable en el 13%.Conclusiones: este programa estructurado de habilidades laparoscópicas basado en la ejecución de anastomosis intestinales permite acelerar la formación de los residentes (AU)

Introduction: The rapid development of laparoscopic surgery makes resident training programmes necessary. Objective: To analyse the results of a structured programme of laparoscopic training in an experimental laboratory. Material and method: From 2003 until 2007, we trained 11 general surgery residents for 20h every 3 months, for three years. The practice consisted of suture and anastomosis in Endo-Trainer with animal organs, as well as laparoscopic techniques in live animals. In the Endo-Trainer practice we evaluated the time and quality of anastomosis performance. In laparoscopic techniques (cholecystectomy and anti-reflux surgery) a task table was evaluated, from 0 (no errors) to 100 (severe lesion).Results: In total, 314 anastomosis were performed by the 11 residents, with a median of 28.5 per resident (24–42). The mean time for the first gastro-jejunal anastomosis was 135min (100–140) and 65min (57.5–105) for the first jejunal-jejunal anastomosis. Maximum learning was achieved after 45 training hours. There were no appreciable differences between both types of anastomosis. There was inadequate anastomosis quality due to leakage in 17.1% during the learning period and 13.7% during the consolidation period. In the animal, 172 procedures were performed. In cholecystectomy and anti-reflux surgery the mean scores were 2.4 and 5.6 points, respectively. In the remaining procedures, subjectively evaluated by the monitors, the quality was adequate in 65%, deficient in 22% and highly deficient in 13%.Conclusions: This structured programme of laparoscopic skills based on intestinal anastomosis allows for quicker resident training (AU)

Complicaciones sépticas intraabdominales tras apendicectomía laparoscópica: descripción de una posible nueva complicación específica de la apendicectomía laparoscópica / Intraabdominal septic complications in laparoscopic appendectomy: description of a possible new intraabdominal septic complication specific to laparoscopic appendectomy

Introducción. Las controversias en torno a la apendicectomía laparoscópica (AL) se centran fundamentalmente en su índice de infecciones intraabdominales. Una complicación diferente y específica de la AL fue descrita por Serour et al en 2005 y denominada postlaparoscopic appendectomy complication (PLAC). Se trata de una infección intraabdominal, sin formación de absceso, tras una apendicectomía laparoscó-pica por apendicitis no complicada (simple, flegmonosa o con apéndice normal), desarrollada en pacientes dados de alta tras un postoperatorio sin incidencias. Revisamos nuestra casuística para conocer nuestra incidencia de infección intraabdominal e identificar casos similares a esta recientemente descrita complicación. Material y método. Revisamos retrospectivamente 651 historias clínicas de apendicectomía realizadas tanto por vía laparoscópica (AL) como abierta (AA). Los criterios para el diagnóstico de PLAC fueron: a) clínica: apendicectomía no complicada (AA o AL), alta hospitalaria estando asintomático, aparición de dolor en cuadrante inferior derecho tras el alta, fiebre y leucocitosis; b) anatomía patológica: apendicitis no complicada (se excluye las gangrenosas o perforadas), y c) ecografía: imágenes características. Resultados. Fueron revisadas 432 apendicectomías laparoscópicas y 219 abiertas. El índice de conversión fue del 11,1%. Las principales complicaciones fueron (análisis por intención de tratar): infección de herida, el 6,3% en AL y el 7,8% en AA; infección intraabdominal, el 4,2% en AL y el 2,3% en AA. Hubo 4 casos de 18 infecciones intraabdominales tras AL que cumplieron los criterios de PLAC: el 1% de todas las AL y el 22% de las infecciones intraabdominales tras AL. Conclusiones. La AL parece estar asociada a una mayor incidencia de infección intraabdominal. Nuestros resultados indican la posible existencia de una forma diferente de infección intraabdominal específica de la apendicectomía laparoscópica (AU)

Background. Controversies about laparoscopic appendectomy (LA) focus mainly on the high intraabdominal infection rate. In 2005, Serour et al described a distinct complication specific to LA, termed "postlaparoscopic appendectomy complication" (PLAC). This complication is an intraabdominal infection, without abscess formation, which develops after laparoscopic appendectomy for non-complicated appendicitis (simple, phlegmonous, or normal appendix) and is observed in patients discharged after an uneventful postoperative period. We reviewed our case series to establish our intraabdominal infection rate in appendectomy and to identify cases similar to this newly described complication. Material and method. We retrospectively reviewed 651 clinical records of appendectomy performed by the laparoscopic (LA) or open approach (OA) over an 11-year period in our hospital. The criteria for a diagnosis of PLAC were as follows: a) clinical criteria: uneventful appendectomy (OA or LA), asymptomatic status on hospital discharge, and onset of right lower quadrant pain, fever, and elevated white blood cell count after discharge; b) pathologic criteria: non-complicated appendicitis (gangrenous or perforated appendicitis were excluded), and c) ultrasound scan showing characteristic features. Results. A total of 432 LA and 219 OA were reviewed. The conversion rate was 11.1%. The main complications (intention-to-treat analysis) were wound infection (6.3% in LA versus 7.8% in OA) and intraabdominal infection (4.2% in LA versus 2.3% in OA). Four out of 18 cases of intraabdominal infection after LA fulfilled PLAC criteria, representing 1% of all LA and 22% of intraabdominal infections after LA. Conclusions. LA seems to be associated with an increased risk of intraabdominal infection. Our results suggest that a distinct form of intraabdominal infection specific to laparoscopic appendectomy may exist (AU)

[Intraabdominal septic complications in laparoscopic appendectomy: description of a possible new intraabdominal septic complication specific to laparoscopic appendectomy]. / Complicaciones sépticas intraabdominales tras apendicectomía laparoscópica: descripción de una posible nueva complicación específica de la apendicectomía laparoscópica.

BACKGROUND: Controversies about laparoscopic appendectomy (LA) focus mainly on the high intraabdominal infection rate. In 2005, Serour et al described a distinct complication specific to LA, termed "postlaparoscopic appendectomy complication" (PLAC). This complication is an intraabdominal infection, without abscess formation, which develops after laparoscopic appendectomy for non-complicated appendicitis (simple, phlegmonous, or normal appendix) and is observed in patients discharged after an uneventful postoperative period. We reviewed our case series to establish our intraabdominal infection rate in appendectomy and to identify cases similar to this newly described complication. MATERIAL AND METHOD: We retrospectively reviewed 651 clinical records of appendectomy performed by the laparoscopic (LA) or open approach (OA) over an 11-year period in our hospital. The criteria for a diagnosis of PLAC were as follows: a) clinical criteria: uneventful appendectomy (OA or LA), asymptomatic status on hospital discharge, and onset of right lower quadrant pain, fever, and elevated white blood cell count after discharge; b) pathologic criteria: non-complicated appendicitis (gangrenous or perforated appendicitis were excluded), and c) ultrasound scan showing characteristic features. RESULTS: A total of 432 LA and 219 OA were reviewed. The conversion rate was 11.1%. The main complications (intention-to-treat analysis) were wound infection (6.3% in LA versus 7.8% in OA) and intraabdominal infection (4.2% in LA versus 2.3% in OA). Four out of 18 cases of intraabdominal infection after LA fulfilled PLAC criteria, representing 1% of all LA and 22% of intraabdominal infections after LA. CONCLUSIONS: LA seems to be associated with an increased risk of intraabdominal infection. Our results suggest that a distinct form of intraabdominal infection specific to laparoscopic appendectomy may exist.

Mascarilla laríngea / Laryngeal mask

La mascarilla laríngea (ML) es un dispositivo muy útil tanto en el manejo de la vía aérea fácil como difícil. Se coloca en la faringe y permite la ventilación del paciente en distintas modalidades, espontánea o mecánica. Existen diferentes modelos, algunos incluso posibilitan la intubación endotraqueal a su través. Destacar que no asegura ni aísla la vía aérea. Como ventajas reseñar su fácil colocación, siendo una alternativa en la vía aérea difícil, por lo que es necesario su conocimiento y manejo por todos los profesionales que asistan la vía aérea (AU)

[Laryngeal mask]. / Mascarilla laríngea.

A laryngeal mask is a very useful instrument to use both in easy as well as difficult handling situations related to the air tract. This mask is placed in the pharynx and it permits a patient to breathe in different modes, either spontaneously or mechanically. Different models are available; some even facilitate the tracheal intubation through the mask. The authors highlight that this type of mask does not protect nor isolate the air tract. As advantages, the authors point out its easy installation; thus, it is an alternative when an air tract presents difficulties; therefore, it is necessary that all personnel who have to deal with the air tract be aware of this mask and know how to handle it.

Schwannoma benigno retroperitoneal / Benign retroperitoneal Schwannoma

Presentamos un caso clínico de un varón con una tumoración retroperitoneal, de hallazgo casual en el contexto de una salmonelosis, cuyos estudios radiológicos de imagen pusieron de manifiesto la masa retroperitoneal, aunque no se realizó punción-biopsia. El tratamiento fue quirúrgico, pudiendo resecarle totalmente, aunque se sacrificó el nervio periférico afectado (nervio femoral). El diagnóstico histológico fue de benignidad y la evolución ha sido favorable. (AU)