Autoevaluación de adquisición de competencias en estudiantes de grado de Medicina mediante simulación clínica / Self-assessment of skill acquisition in clinical simulations for medical undergraduate students

Introducción: La autopercepción que tienen los estudiantes para desarrollar su práctica clínica es la manera más acertada de evaluar cuán preparados se sienten y cuáles son sus habilidades. La universidad desarrolla un programa de simulación que permite a los alumnos potenciar su propio aprendizaje, con situaciones de feedback de los instructores de simulación.Sujetos y métodos.El estudio tuvo lugar en el curso académico 2019-2020. Los estudiantes de tercer año completaron tres escenarios de simulación; los de cuarto año, cuatro; y los de quinto año, tres. Antes y después de cada sesión de simulación, completaron un cuestionario electrónico de autopercepción de competencias técnicas y no técnicas.Resultados.De los 121 estudiantes de tercer curso, 79 (65,3%) contestaron a la encuesta inicial y 68 (61,2%) a la encuesta final. En cuarto curso participaron 111 alumnos, y contestaron la encuesta inicial 63 alumnos (56,8%) y 68 la final (61,2%). El quinto curso estuvo compuesto por 97 estudiantes, de los cuales 94 (96,9%) contestaron la encuesta inicial y 69 (71,1%) la final. Todos los ítems de la encuesta de autopercepción mejoraron de forma estadísticamente significativa (p < 0,001) en la encuesta final. Las puntuaciones iniciales medias en la dimensión no técnica fueron más altas que las puntuaciones medias en la dimensión técnica para todos los cursos de estudio.Conclusiones.Los resultados que obtuvimos mostraron una mejora en la autopercepción de las habilidades de los estudiantes y en su confianza para realizar las tareas de las simulaciones. Los alumnos de cursos superiores se sienten más seguros tanto en habilidades técnicas como en no técnicas, como la comunicación. (AU)

Introduction: The self-perception that students have to develop their clinical practice is the most accurate way to assess how prepared they feel and what their abilities are. The University develops an innovative and complete simulation program that allows students to enhance their own learning and that of their classmates, with feedback situations from the simulation instructors of the faculty itself.Subjects and methods.The study took place in the academic year 2019-2020. During the study period, 3rd-year students completed 3 simulation scenarios, 4th-year students 4 cases, and 5th-year students completed 3 scenarios. Before and after each simulation session, they anonymously and voluntarily completed an electronic questionnaire on self-perception of technical and non-technical skills.Results.Of the 121 third-year students, 79 (65.3%) answered the initial questionnaire and 68 (61.2%) the final questionnaire. In the fourth year, 111 students participated, and 63 students (56.8%) answered the initial questionnaire and 68 (61.2%) the final one. The fifth course was composed of 97 students, of which 94 (96.9%) answered the initial questionnaire and 69 (71.1%) the final one. All the items of the self-perception survey improved in a statistically significant way (p < 0.001) in the final survey. The mean baseline scores on the non-technical dimension were higher than the mean scores on the technical dimension for all study courses.Conclusions.The results we obtained showed an improvement in the self-perception of the students' abilities and in their confidence to perform the tasks of the simulations. Higher grade students feel more confident in both technical and non-technical skills, such as communication. (AU)

Resultados de las entrevistas familiares en donación en asistolia no controlada / Results of interviews with families of non-heart-beating donor candidates

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La enseñanza del manejo de la vía aérea en situaciones de emergencia / Teaching airway mangement skills for emergency situations

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Evolución del injerto hepático procendente de donante en asistolia / Evolution of the liver graft from a asystole donor

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Lung transplant of extrahospitalary donor after cardiac death.

Non-heart-beating donors (NHBDs) have to meet the predefined criteria for organ donation including death from irreversible cessation of the beating heart. The Maastricht conference defined 4 NHBD categories to differentiate their viability and ethical-legal support. In Spain, NHBDs who originate from an out-of-hospital setting correspond to type II donors. These are patients who have had a cardiac arrest outside hospital and, after failed CPR attempts, are transferred with hemodynamic support measures to the hospital for organ donation. The Hospital Clínico San Carlos also has a lung donation program in collaboration with the Hospital Puerta de Hierro in Madrid and the Hospital Marques de Valdecilla in Santander. The objective of this study is to describe the results of lung transplantation of after cardiac death program, specifically the section regarding lung extraction donation. Twenty potential lung donors were obtained during the study. Most patients were male (19 cases), with a mean age of 42 years (36.5-49.5 years). A total of 33 lungs were donated (18 right and 15 left lungs). Most extractions were multiorganic (19 cases). One liver, 19 kidneys, 2 pancreas, and 19 corneas were obtained from these donors; bone tissue was obtained from all donors. The transplantation was bipulmonary in 13 cases and unipulmonary in 7. Thirty days after transplantation, 2 recipients died, 1 died of stroke associated with bilateral pneumonia and 1 died of hypovolemic shock resulting from hemothorax. The remaining 18 patients were progressing well at 30 days. Our data suggest that lung transplantation from patients after extrahospitalary cardiac death is feasible.

Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review.

OBJECTIVE: The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL: A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS: A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION: This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.

Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca extrahospitalaria / Mechanical cardiopump use in organ donation after prehospital cardiac death

Objetivo: El Servicio de Urgencias Médicas de Madrid SUMMA112, en colaboración con dos hospitales de Madrid, está inmerso en un programa de donación de órganos de pacientes que han sufrido una parada cardiaca extrahospitalaria y no han respondido a las maniobras de resucitación. El objetivo de este estudio es valorar los resultados de la aplicación de cardiocompresores mecánicos. Metodología: Estudio descriptivo retrospectivo basado en la base de datos del SUMMA112 de donantes tras muerte cardiaca. El estudio se realizó durante el año 2008 y 2009, año este último en el que se generalizó el uso de estos cardiocompresores. Se usaron dos cardiocompresores, el LUCAS© de Physio-Control y el Autopulse© de Zoll. Se estudiaron como variables independientes la edad, el sexo, el uso de cardiocompresión mecánica (CCM) y el tipo de cardiocompresor, el tiempo de llegada a la escena y el tiempo desde la alerta a la llegada al hospital. Como variables dependientes se registraron si fueron donantes válidos, número de órganos y tipo de órganos. Se compararon los resultados de media por donantes en el año 2008 (periodo sin CCM) y 2009 (periodo con CCM). Resultados: Se registraron un total de 108 casos. El 87% del total de pacientes eran varones, y la mediana (RIQ) de la edad era 40 años (35-49,7). Se obtuvieron un total de 82 donantes válidos, lo que corresponde a 3,18 órganos por donante. La media de órganos en el periodo sin CCM fue de 3,4 y en el de CCM de 2,9 (p < 0,05). No encontramos diferencia significativa en la comparación entre los dos cardiocompresores. Conclusión: Según nuestra serie, el número de órganos extraídos y trasplantados por donante es menor con CCM. Se necesitan más estudios para demostrar que estos dispositivos mejoran el número o la calidad de los órganos extraídos (AU)

Objective: The SUMMA112 emergency health service of Madrid is working with area hospitals on a program to facilitate organ donation from persons who have suffered cardiac death outside the hospital and who have not responded to resuscitation maneuvers. The aim of this study was to assess the usefulness of mechanical cardiopumps. Methods: Retrospective, descriptive study based on SUMMA112 data available for organ donors after cardiac death. The data analyzed were from 2008, before cardiopumps, and 2009, the year when cardiopumps became widely used. Two models were available; one was the LUCAS pump, from Physio-Control, and the other was the Autopulse, from Zoll. Independent variables studied were age, sex, cardiopump use and model, time from arrival at the emergency site until notification of arrival at the hospital. Dependent variables were categorization as a valid donor, number of organs donated, and types of organs donated. We compared the mean number of organs donated in 2008 (period without mechanical cardiopumps) to the number donated in 2009 (with cardiopumps). Results: A total of 108 cases were on record. Eighty-seven percent of the patients were men. The median (interquartilerange) age was 40 (35-49.75) years. Overall, 82 cadavers were valid donors and a mean of 3.18 organs per donor were obtained. In the period without cardiopumps, the mean number of organs obtained was 3.4; with cardiopumps themean was 2.9 organs (P<0.05). There were no significant differences between the 2 cardiopumps. Conclusion: Fewer organs per donor were extracted and transplanted in the year the mechanical cardiopumps were used. Further studies are needed to demonstrate whether or not these devices can increase the number or quality ofextracted organs (AU)

Management of eclampsia in the prehospital setting.

Eclampsia is an uncommon and serious condition, particularly in the pre-hospital setting. Immediate treatment is required and should include airway control, administration of oxygen, anti-epileptics and magnesium, hypertension control, and urgent delivery of the baby.