Genetic architecture of variation in Arabidopsis thaliana rosettes.

Rosette morphology across Arabidopsis accessions exhibits considerable variation. Here we report a high-throughput phenotyping approach based on automatic image analysis to quantify rosette shape and dissect the underlying genetic architecture. Shape measurements of the rosettes in a core set of Recombinant Inbred Lines from an advanced mapping population (Multiparent Advanced Generation Inter-Cross or MAGIC) derived from inter-crossing 19 natural accessions. Image acquisition and analysis was scaled to extract geometric descriptors from time stamped images of growing rosettes. Shape analyses revealed heritable morphological variation at early juvenile stages and QTL mapping resulted in over 116 chromosomal regions associated with trait variation within the population. Many QTL linked to variation in shape were located near genes related to hormonal signalling and signal transduction pathways while others are involved in shade avoidance and transition to flowering. Our results suggest rosette shape arises from modular integration of sub-organ morphologies and can be considered a functional trait subjected to selective pressures of subsequent morphological traits. On an applied aspect, QTLs found will be candidates for further research on plant architecture.

Cuidados para garantizar la seguridad del paciente con traumatismo craneoencefálico grave portador de drenaje ventricular externo / Care required to ensure safety in patients with severe traumatic brain injury with an external ventricular drain

Objetivo: analizar los cuidados enfermeros dirigidos a garantizar la seguridad del paciente neurocrítico portador de drenaje ventricular externo (DVE) tras haber sufrido un traumatismo craneoencefálico grave. Método: revisión narrativa mediante búsqueda bibliográfica en bases de datos de la Ciencias de la Salud: PubMed, CINAHL y la Biblioteca Cochrane, así como en los metabuscadores Dialnet Plus y Google Académico. Resultados: se seleccionaron 14 artículos por su idoneidad para abordar el objetivo principal del trabajo, analizando los cuidados generales de Enfermería que afectan a la presión intracraneal: cuidado bucal, aspiración de secreciones endotraqueales, elevación del cabecero de la cama, reposicionamiento y movilización temprana, administración de medicación sedativa y estimulación auditiva e interacción con el paciente. Conclusiones: la excelencia en el cuidado y la seguridad de los pacientes con traumatismo craneoencefálico radica en una indicación fundamentada para monitorizar la presión intracraneal y un equipo de enfermeras cuyas intervenciones se establezcan sobre la base de la evidencia científica. Para reducir la incidencia de complicaciones relacionadas con el drenaje intraventricular se han de protocolizar los cuidados. Como principales limitaciones de los estudios analizados están la heterogeneidad, el reducido tamaño muestral, la escasez de ensayos clínicos y estudios multicéntricos y la ausencia de protocolos y guías de práctica clínica para el manejo de estos pacientes

Objective: to analyze the nursing care required in order to ensure safety in neurocritical patients with an external ventricular drain after suffering a severe traumatic brain injury. Method: a narrative review through bibliographic search in Health Sciences databases: PubMed, CINAHL and the Cochrane Library, as well as the metasearch engines Dialnet Plus and Academic Google. Results: fourteen (14) articles were selected because they were adequate to address the primary objective of the study, analyzing the general Nursing care regarding intracranial pressure: mouth care, aspiration of endotracheal secretions, elevation of the head end of the bed, repositioning and early mobilization, administration of sedative medication, and auditory stimulation and interaction with the patient. Conclusions: excellence in care and safety of patients with traumatic brain injury lies in a well-founded indication to monitor intracranial pressure, and a team of nurses with specific interventions based on scientific evidence. In order to reduce the incidence of complications associated with intraventricular drain, there must be a protocol of care. The main limitations in the studies analyzed were: heterogeneity, reduced sample size, the limited number of clinical trials and multicenter studies, and the lack of protocols and clinical practice guidelines for the management of these patients

The role of the nurse at the end of the life of a critically ill patient. / Rol de la enfermera en el cuidado al final de la vida del paciente crítico.

OBJECTIVE: Analyze the role of the nurse at the end of the life of a critically ill patient. METHOD: Bibliographic review from a search of the health science databases such as PubMed, CINAHL, Cuiden, Scopus, Cochrane, as well as specialized platforms, general and thematic browsers. The limits were language (English or Spanish) and publication date (2005-2015). RESULTS: 180 articles met the inclusion criteria, and 16 of them were selected for analysis. The main results were grouped into three categories of analysis: direct patient care, family-focussed care and the nurse's role within the team. CONCLUSIONS: the described roles place the nurse as a key element in humanising death in the ICU and so nurses can and must lead change, playing an active role in creating strategies that really promote the integration of a palliative care approach in ICU.

La enfermera, clave en el cuidado de los pacientes con síndrome de intestino irritable / The key role of nurses in care for patients with irritable bowel syndrome

OBJETIVO: determinar el rol de la enfermera en el proceso asistencial de las personas con síndrome de intestino irritable. MÉTODO: revisión narrativa a partir de búsqueda bibliográfica en diferentes bases de datos de Ciencias de la Salud: PubMed, Cinhal y Web of Science (WOS). Se utilizaron los siguientes términos de lenguaje controlado (MeSH): "irritable bowel syndrome", "nursing", "patient education as topic", "selfcare, self-management", "quality of life", "adaptation, psychological", "attitude to health", "patient acceptance of health care" y "patient compliance". RESULTADOS: se seleccionaron 20 artículos considerados relevantes para dar respuesta al objetivo de la revisión, de cuyo análisis se generaron dos categorías: a) barreras que dificultanel afrontamiento y el autocuidado en personas con síndrome de intestino irritable y b) intervenciones enfermeras dirigidas a la mejora de su calidad de vida. Se destacaba que la atención recibida era en ocasiones poco empática, la escasez de información ofertada por los profesionales sobre la enfermedad y que las intervenciones han de estar centradas en la educación al paciente. CONCLUSIONES: la educación al paciente genera resultados muy favorecedores en la calidad de vida y el alivio de los síntomas, así como en la comprensión de la enfermedad y su manejo en la vida diaria. El rol de la enfermera en este proceso educativo se centra en una relación terapéutica eficaz para el afrontamiento de la enfermedad. Los profesionales de Enfermería han de tomar conciencia de su importancia en este proceso, adquiriendo un rol activo en el cuidado del paciente con síndrome de intestino irritable

OBJECTIVE: to determine the role of nurses in the process of care for persons with irritable bowel syndrome. METHOD: a narrative review based on the bibliographic search in different Health Sciences databases: PubMed, CINHAL and Web of Science (WOS). The following controlled vocabulary terms (MeSH) were used: "irritable bowel syndrome", "nursing", "patient education as topic", "selfcare, self-management", "quality of life", "adaptation, psychological", "attitude to health", "patient acceptance of health care" and "patient compliance". RESULTS: there was a selection of 20 articles considered relevant in order to give an answer to the objective of the review; two categories were generated from their analysis: a) barriers that impede coping and self-care in persons with irritable bowel syndrome, and b) Nursing interventions targeted to an improvement in their quality of life. It was pointed out that low empathy was occasionally present in the care received, that there was limited information offered by professionals about the disease, and that interventions must be focused on patient education. CONCLUSIONS: patient education generates very encouraging results in quality of life and symptom relief, as well as in terms of understanding the disease and its management in daily life. The role of the nurse in this education process must be focused on an effective therapeutic relationship in order to cope with the disease. Nursing professionals must be aware of their importance during this process, acquiring an active role in the care for patients with irritable bowel syndrome

Déficit de autocuidado en los pacientesde 75 años y más, a los dos mesesdel alta hospitalaria / Self-care deficit in patients aged 75 years and older, two months after hospital discharge

Objetivo: determinar la evolución del déficit de autocuidado en pacientesde 75 años y más, a los dos meses del alta en el Hospital Universitario“La Paz” de Madrid.Método: estudio descriptivo longitudinal. Las variables analizadas fueron:perfil de los pacientes, modificación del déficit en los requisitos de autocuidado,modificación en la prevalencia de diagnósticos enfermeros, cuidadosde transición y red de apoyo familiar y social. La información seobtuvo a través de una entrevista en el domicilio de los pacientes. El instrumentopara la recogida de la información ha sido un documento de valoraciónenfermera orientado según el modelo de autocuidado de D. Orem.Resultados: la muestra fue de 60 pacientes, con un 23% de pérdidas. Alos dos meses del alta los pacientes mantuvieron un déficit similar en losrequisitos de autocuidado, siendo los más afectados “mantenimiento delequilibrio entre la actividad y el descanso” y “prevención de peligrospara la vida el funcionamiento y el bienestar”. Se encontraron diferenciassignificativas en ambas fases entre los diagnósticos: “deterioro dela movilidad física”, “déficit de autocuidado: vestido/acicalamiento” y“déficit de autocuidado: uso de WC”. La capacidad funcional mejorórespecto al momento del alta. Todos los pacientes tuvieron seguimientoen Atención Primaria.Conclusiones: la mejora de la capacidad funcional, transcurridos dosmeses del alta, evidencia el impacto negativo de la hospitalización en laspersonas mayores y la necesidad de cuidados de transición y recursossociales de apoyo a los cuidadores (AU)

Objective: to determine the evolution of self-care deficit in patients aged75 years and older two months after hospital discharge at the “La Paz”University Hospital of Madrid.Method: longitudinal descriptive study. The following variables wereanalysed: patient profiles, deficit modification in the self-care requirements,modification in the prevalence of nursing diagnoses, transitionalcare and family and social support network. The information was obtainedby means of an interview conducted in the patients’ homes. The instrumentused for data collection has been a nursing assessment documentbased on D. Orem’s self-care model.Results: the sample consisted of 60 patients, with a 23% dropout rate.Two months after discharge the patients maintained a similar deficit inself-care requirements, the most affected ones being “maintenance ofbalance between activity and rest” and “prevention of hazards to life,functioning and wellbeing”. Significant differences were found in bothphases amongst the diagnoses: “physical mobility deterioration”, “selfcaredeficit: dressing/grooming” and “self-care deficit: toilet use”. Functionalcapacity improved with respect to what it was at the time of discharge.All patients underwent follow-up in primary care.Conclusions: the improvement of functional capacity, two months afterdischarge, evidences the negative impact of hospitalization in elderlypatients and the need for transitional care and social supportive resourcesfor caregivers (AU)

Requisitos de autocuidadode pacientes mayores de 75 añosal alta hospitalaria / Self-care requirements for patients over the age of 75 at hospital discharge

Objetivo: estimar el déficit de autocuidado de pacientes de 75y más años, después del alta hospitalaria.Método: estudio descriptivo transversal realizado en el HospitalUniversitario “La Paz” de Madrid, con 60 pacientes de75 y más años al alta hospitalaria. Las variables analizadashan sido los factores condicionantes básicos de la agencia deautocuidado, los factores que afectan a la regulación de losrequisitos de autocuidado y los diagnósticos enfermeros quedeterminan el déficit de autocuidado. Para la recogida de losdatos se ha utilizado un documento de valoración enfermeraelaborado por el equipo investigador, que tiene como referenteteórico el modelo de autocuidado de D. Orem.Resultados: los requisitos de autocuidado más afectados fueron“prevención de peligros para la vida, el funcionamiento yel bienestar” y “mantenimiento del equilibrio entre la actividady el descanso”, siendo el factor regulador más frecuenteel deterioro músculo-esquelético. Los diagnósticos de Enfermeríamás prevalentes fueron “deterioro de la movilidad física”y “déficit de autocuidado en baño, higiene y vestido”. Lamayor parte de los pacientes presentaban un nivel de dependenciaentre leve y moderada y como nuevos problemas desalud al alta destacaron la incontinencia urinaria y el dolor.Conclusiones: el impacto negativo de la hospitalización enlas personas mayores plantea la necesidad de garantizar unoscuidados de transición encaminados a proporcionar seguridad,ayudar en la movilidad y educar para la adquisición decomportamientos orientados a la salud. Para esto se precisaun informe enfermero al alta del paciente que recoja una valoraciónde su capacidad de autocuidado, así como de los recursosde que dispone para cubrir los distintos requisitos de autocuidado (AU)

Objective: to estimate the lack of self-care in patients aged 75and older, after hospital discharge.Method: cross-sectional descriptive study performed in the“La Paz” University Hospital of Madrid, with 60 patientsaged 75 years and older at hospital discharge. The variablesanalysed have been basic conditioning factors of the self-careagency, factors that affect the regulation of self-care requirementsand nursing diagnoses that determine a lack of selfcare.Data was gathered using a nursing assessment documentdeveloped by the research team, which employs D. Orem’sSelf-Care Model as a theory reference point.Results: the self-care requirements that were most impairedwere “prevention of dangers to life, functioning and wellbeing”and “maintenance of the activity-rest balance”, musculo-skeletal deterioration being the most frequent regulatingfactor. The most prevalent Nursing diagnoses were “deteriorationof physical mobility” and “deficit of self-care in bathing,hygiene and dressing”. Most patients presented a level of dependenceranging from mild to moderate and urinary incontinenceand pain stood out as new health problems at discharge.Conclusions: the negative impact of hospitalization on elderlypatients makes it necessary to guarantee certain transitioncare aimed at providing safety, helping with mobility and educatingfor the acquisition of health-oriented behaviours. Inorder to do this, a nursing report is needed at the moment ofdischarge that includes an assessment of the patient’s capacityto carry out self-care, as well the resources that are availableto this patient to cover the different requirements of self-care (AU)

[The portfolios as a tool for learning and competency assessment in nursing students]. / El portafolios como instrumento de aprendizaje y evaluación de competencias en los estudiantes de enfermería.

OBJECTIVES: To evaluate the utility of learning portfolios and to assess the generic and specific competencies of nursing students. To describe the advantages and difficulties of the use of portfolios. METHOD: We performed a descriptive longitudinal study in the Nursing School of La Paz (Universidad Autónoma de Madrid) in the academic years 2004-05, 2005-06 and 2006-07, with the participation of 211 students enrolled in the medical-surgical nursing course. The variables studied were the specific competence of comprehensive patient evaluation and other generic competencies to be acquired by the students. These competencies were evaluated on three occasions: at the beginning of the course, during the course and at the end of the course. The advantages and disadvantages perceived by the students concerning the use of portfolios were analyzed at the end of the course. Data contained in the evaluation reports of the portfolios and student opinion questionnaires were collected and analyzed. RESULTS: During the academic course, the students showed progress in the acquisition of all the competencies, although they experienced greater difficulties in acquiring the competence of information management. The main advantage emphasized by nursing students was that portfolios provided a complete evaluation, since this method requires tutors to constantly monitor learning. Among the disadvantages, the students stressed the initial insecurity generated by the program and the effort required to follow it. CONCLUSIONS: Through the use of portfolios, students progressively developed a way of perceiving patients that aided their understanding of patients' health status. The students' previous notions on the roles played by teachers and students were also modified, with teachers being viewed more as a guide to learning.

El portafolios como instrumento de aprendizaje y evaluación de competencias en los estudiantes de enfermería / The portfolios as a tool for learning and competency assessment in nursing students

Objetivos. Valorar la utilidad del portafolios para el aprendizaje y evaluación de competencias genéricas y específicas en los estudiantes de enfermería, y describir ventajas y dificultades de la utilización del portafolios. Método. Estudio longitudinal, prospectivo, descriptivo realizado en los cursos académicos 2004–2005, 2005–2006 y 2006–2007 en la Escuela Universitaria de Enfermería La Paz (Universidad Autónoma de Madrid). En total participaron 211 alumnos matriculados en la asignatura enfermería medicoquirúrgica. Las variables estudiadas fueron la competencia específica de valoración integral del paciente y otras competencias genéricas, medida en 3 ocasiones, al inicio, durante y al final del curso; también se estudiaron las ventajas e inconvenientes percibidos por los estudiantes en la utilización del portafolios al final del curso. Se realizó una recogida y análisis de los datos reflejados en los informes de evaluación de los portafolios y en los cuestionarios de opinión de los alumnos. Resultados. Los estudiantes progresaron, a lo largo del curso académico, en la adquisición de todas las competencias, aunque presentaron mayor dificultad en la competencia relacionada con la gestión de la información. Los alumnos consideran que el portafolios es un método de evaluación muy completo, ya que requiere un seguimiento continuo del aprendizaje por parte de los tutores. Entre los inconvenientes señalaron la inseguridad inicial y el esfuerzo que les generó su elaboración. Conclusiones. Con el portafolios los estudiantes construyeron, de manera progresiva, una forma de mirar a los pacientes que les facilitó la comprensión de su situación de salud y modificaron sus ideas previas acerca de los roles desempeñados por profesores y alumnos, considerando al profesor un guía en el aprendizaje (AU)

Objectives. To evaluate the utility of learning portfolios and to assess the generic and specific competencies of nursing students. To describe the advantages and difficulties of the use of portfolios. Method. We performed a descriptive longitudinal study in the Nursing School of La Paz (Universidad Autónoma de Madrid) in the academic years 2004–05, 2005–06 and 2006–07, with the participation of 211 students enrolled in the medical-surgical nursing course. The variables studied were the specific competence of comprehensive patient evaluation and other generic competencies to be acquired by the students. These competencies were evaluated on three occasions: at the beginning of the course, during the course and at the end of the course. The advantages and disadvantages perceived by the students concerning the use of portfolios were analyzed at the end of the course. Data contained in the evaluation reports of the portfolios and student opinion questionnaires were collected and analyzed. Results. During the academic course, the students showed progress in the acquisition of all the competencies, although they experienced greater difficulties in acquiring the competence of information management. The main advantage emphasized by nursing students was that portfolios provided a complete evaluation, since this method requires tutors to constantly monitor learning. Among the disadvantages, the students stressed the initial insecurity generated by the program and the effort required to follow it. Conclusions. Through the use of portfolios, students progressively developed a way of perceiving patients that aided their understanding of patients’ health status. The students’ previous notions on the roles played by teachers and students were also modified, with teachers being viewed more as a guide to learning (AU)

Acercamiento a la realidad de las familias depersonas con autismo / Approaching the children’ families with autism

Es un hecho universalmente aceptado que la presencia en las familias de un hijo conalgún tipo de minusvalía física o psíquica grave constituye un factor potencial que perturbala dinámica familiar. Esto es porque la convivencia con una persona con este tipo deproblemas puede provocar cambios importantes en la vida personal de los distintos miembros-fundamentalmente los padres- y de las relaciones entre ellos.Los datos muestran de manera indiscutible que muchas familias con hijos con autismopresentan niveles de estrés crónico, significativamente superiores a los que presentan lasfamilias con hijos con otras discapacidades. Esta diferenciación en cuanto al efecto causadopor el autismo en la familia, se inicia muchas veces a causa de las incertidumbres queplantea la evolución disarmónica de los niños y niñas con autismo, se mantiene posteriormenteante la ausencia de un diagnóstico y pronóstico claros y aumenta considerablementecomo consecuencia de los múltiples efectos negativos en el ámbito familiar. La convivenciaen el hogar de un niño o niña con autismo suele ser muy compleja y las familias se vensometidas desde el principio a modificaciones severas de su régimen de vida habitual conlimitaciones desmedidas de su independencia (AU)

It is a universally accepted fact that the presence in the families of a child with sometype of physical or psychic serious handicap constitutes a potential factor that disturbs thefamiliar dynamics. This is because the cohabitation with a person with this type of problemscan provoke important changes in the personal life of the different members - fundamentallythe parents - and of the relations between them.The information shows that many children families of with autism present levels ofstress, significantly higher to whom present the families with children with other disabilities.This differentiation on the effect caused by autism in the family begins often due tothe uncertainties on the not harmonic evolution of the children with autism, and is keptlater by the absence of a diagnosis and increases considerably as consequence of the multiplenegative effects in the familiar area. The coexistence at home with a child with autismis in the habit of being very complex and families are submitted from the beginning tosevere modifications of their habitual life with excessive limitations of their independence (AU)

Sarcoidosis subcutánea, lesiones nodulares que adoptan configuraciones cordonales o en bandas / Subcutaneous sarcoidosis, nodular lesions forming cords or bands

No disponible

Diagnóstico por la imagen de los malos tratos infantiles / Imaging diagnosis of non-accidental injury in children

El papel de la imagen en los casos de sospecha de malos tratos no es solo identificar el grado de lesiones físicas, sino también valorar todos los hallazgos de imagen que apunten hacia diagnósticos alternativos. Se hace preciso pruebas clarificadoras que nos lleve a un diagnóstico seguro y evite por un lado errores diagnósticos y por otro mantener una situación de riesgo de nuevos episodios de maltrato de consecuencias impredecibles. La actual oferta tecnológica del diagnóstico por imagen, exige al clínico que se enfrenta a un diagnóstico de sospecha de maltrato físico, conocer cuales son las lesiones más especificas de confirmación diagnóstica, así como cual es la técnica/as más indicada de acuerdo a la clínica y edad del paciente. Revisamos las recomendaciones actuales partiendo de nuestra experiencia

The image technology develops an important role in cases of abuse suspicion not only establishing the degree of physical harm, but also finding evidences that lead to different diagnosis. These verified evidences are required both to reach a certain diagnosis and to avoid mistakes which can perpetuate a risk situation and the arrival of new episodes of abuse with unpredictable consequences. The present situation in the image technology diagnosis demands from the physician the identification of the most specific lesions to confirm a suspicion of abuse as well as the most suitable technology according to the symptoms and age of the patient. We review the current recommendations from our experience

Estilos de aprendizaje en los estudiantes de enfermería / Learning styles in nursing students

Introducción: El objetivo de este trabajo es identificar el estilo de aprendizaje predominante en los estudiantes de enfermería de nuestro centro, como punto de partida para una reflexión sobre el proceso de aprendizaje-enseñanza que estamos llevando a cabo. Material y métodos: Se realizó un estudio observacional, exploratorio y transversal en la Escuela de Enfermería La Paz durante el curso académico2002-03 con una muestra de 180 estudiantes. Las variables seleccionadas fueron: estilo de aprendizaje, curso en el que estaban matriculados, vía de acceso a los estudios y experiencia laboral. El instrumento que se utilizó fue el cuestionario de estilos de aprendizaje Honey-Alonso (CHAEA).El análisis de los datos consistió en el contraste de las diferencias entre las puntuaciones obtenidas en los cuatro estilos de aprendizaje, mediante la prueba NOVA y el test de Kruskal-Wallis. Resultados: Se encontraron diferencias estadísticamente significativas en los estilos de aprendizaje reflexivo y teórico, en función del año de carrera que estaban cursando. No se encontraron diferencias estadísticamente significativas entre los cursos para los estilos de aprendizaje activo y pragmático. Discusión: El perfil de aprendizaje de los estudiantes de nuestro centro es diferente entre los alumnos de los tres cursos, existiendo una tendencia hacia un estilo más reflexivo y teórico, a medida que avanzan en su formación. Es necesario buscar alternativas para potenciar el desarrollo de los estilos activo y pragmático en la misma medida que los estilos reflexivo y teórico (AU)

Introduction: This paper aims to identify the prevalent learning style among nursing students at our teaching institution, as a starting point for an analysis of the current learning-teaching process. Methods and materials: An observational, exploratory and cross-sectional study was performed in the Nursing School of La Paz (Universidad Autónoma de Madrid),during the academic year 2002-2003, in a sample comprising 180 students. The variables selected were: learning style, academic year, form of access to nursing studies and previous work experience. The instrument used was the Honey-Alonso (CHAEA) learning style questionnaire. Data analysis was based on the contrasting of the differences between the scores in the four learning styles, through the ANOVA test and the Kruskal-Wallis test. Results: Statistically significant differences were found in the reflexive and theoretic learning styles, and no significant differences were found for the active and pragmatic learning styles, according to the students ‘academic year. Discussion: Learning styles in our teaching institution evolve as students progress through their studies. There is an increasing tendency towards the reflexive and theoretic styles at upper levels. Alternatives should be explored in order to develop the active and pragmatic learning styles (AU)

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model]. / El aprendizaje basado en problemas en la enseñanza de la urologia. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha.

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

[Based on the incidence of Creutzfeldt-Jakob disease in the Lanzarote healthcare area. Description of two definitive cases]. / A propósito de la incidencia de la enfermedad de Creutzfeldt-Jakob en el área de salud de Lanzarote. Descripción de dos casos definitivos.

We present two cases who have been diagnosed of definitive Creutzfeldt-Jakob disease in the health area of Lanzarote in the period January 2002 to January 2004. The two cases are presented with clinical description, complementary tests -- including electroencephalogram, 14-3-3 protein determination -- study of the prionic protein gene, and histopathologic findings. In this article, we try to show the importance of trying to reach a definitive diagnosis with the histopathologic study once there is clinical suspicion (a diagnosis that is probable or possible). In addition our cases show that communication between the clinical and the epidemiological coordinator of the regional community and the National Center of Epidemiology is very important. We refer to the clear growth in the incidence of the disease in the population of Lanzarote in the period above mentioned. Finally, we discuss whether this growth is or is not an isolated event.

A propósito de la incidencia de la enfermedad de Creutzfeldt-Jakob en el área de salud de Lanzarote: descripción de dos casos definitivos / Based on the incidence of Creutzfeldt-Jakob disease in the Lanzarote healthcare area: description of two definitive cases

Presentamos dos casos de enfermedad de Creutzfeldt-Jakob definitivo que han sido diagnosticados en el área de salud de Lanzarote durante el período de tiempo que comprende desde enero de 2002 a enero de 2004. Los dos casos se presentan con descripción clínica, de pruebas complementarias, incluido electroencefalografía, proteína 14-3-3 en líquido cefalorraquídeo, estudio del gen de la proteína priónica e histopatológico. En este artículo se intenta reflejar la importancia que tiene el hecho de, ante la sospecha clínica (diagnóstico posible y probable), poner los medios adecuados para intentar un diagnóstico definitivo mediante el estudio histopatológico. Se pone de manifiesto también la importancia de la comunicación con el coordinador clínico y epidemiológico de la comunidad autónoma, y de éstos con el Centro Nacional de Epidemiología. Se hace referencia al claro aumento de la incidencia de la enfermedad para la población de dicha área de salud en este período de tiempo. Al final planteamos una reflexión sobre si este aumento es o no un hecho aislado

We present two cases who have been diagnosed of definitive Creutzfeldt-Jakob disease in the health area of Lanzarote in the period January 2002 to January 2004. The two cases are presented with clinical description, complementary tests - including electroencephalogram, 14-3-3 protein determination - study of the prionic protein gene, and histopathologic findings. In this article, we try to show the importance of trying to reach a definitive diagnosis with the histopathologic study once there is clinical suspicion (a diagnosis that is probable or possible). In addition our cases show that communication between the clinical and the epidemiological coordinator of the regional community and the National Center of Epidemiology is very important. We refer to the clear growth in the incidence of the disease in the population of Lanzarote in the period above mentioned. Finally, we discuss whether this growth is or is not an isolated event

El aprendizaje basado en problemas en la enseñanza de la urología. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha / Problem-based learning in urology training. The faculty of medicine of the Universidad de Castilla-La Mancha model

Las nuevas necesidades derivadas de los actuales cambios sociales, económicos, tecnológicos, científicos, etc..., han hecho que distintos organismos hayan sugerido a los estamentos educativos la necesidad de desarrollar cambios en las estrategias educativas orientados al desarrollo de un profesional eficaz con competencias adaptadas a estas necesidades. Dentro de las estrategias “modernas” se encuentra la enseñanza basada en problemas o aprendizaje por problemas (PBL), mediante la cual el estudiante busca y selecciona la información, razona e integra los conocimientos previos y adquiridos, dando finalmente unas posibilidades diagnósticas y terapéuticas al problema planteado, tal y como se va a enfrentar en su actividad profesional. Los conocimientos previos y la actividad constituyen los pilares fundamentales del aprendizaje. El PBL incorpora algunos de los aspectos de la psicología cognitiva, modelo cuya parte principal determina la naturaleza de las estructuras del conocimiento que se encuentran en la memoria activa, en los procesos de almacenamiento y recuperación de la información y los diversos factores que lo activan. La urología en la Facultad de Medicina de la Universidad de Castilla-La Mancha forma parte de una asignatura troncal (Patología Médica y Quirúrgica II) que se imparte durante el quinto curso. La urología se desarrolla integrada con nefrología. El número de alumnos por curso es aproximadamente 75 divididos en 5 grupos. La “rotación” dura seis semanas durante las cuales los estudiantes tienen una media de 2 horas diarias de teoría (ya sean de nefrología y/o urología) y el resto son rotatorias por distintas actividades: tres semanas en nefrología y tres semanas en urología. Al finalizar la rotación los udiantes realizan un examen teórico conjunto con 100 preguntas de respuestas múltiple (50 de urología) y un examen práctico de las habilidades. A final de curso existe otra prueba práctica (OSCE: examen clínico objetivo y estructurado) con la utilización de pacientes estandarizados, debiendo el profesor evaluar de forma directa el nivel de competencias adquiridas ante un “caso real”

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These “modern” strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes.At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a “real” case