[Obstructive sleep apnea syndrome and hypertension. Evidence of their relationship]. / Apnea obstructiva del sueño e hipertensión arterial. Las evidencias de su relación.

The purpose of this review is to analyze the relation between obstructive sleep apnea and hypertension. We present epidemiological data of the respiratory disorder and its association with high blood pressure, as well as physiopathological interactions between both conditions, the diagnostic methods, and the impact of treatment on pathophysiology and prognosis.

En esta revisión se analiza la relación entre la apnea obstructiva del sueño y la hipertensión arterial sistémica. Se exponen las evidencias epidemiológicas de la alteración respiratoria y de su asociación con la hipertensión arterial, las interacciones fisiopatológicas entre ambas condiciones, los métodos diagnósticos y el impacto del tratamiento sobre la fisiopatología y el pronóstico.

Apnea obstructiva del sueño y cardiopatía isquémica: Las evidencias de su relación / Obstructive sleep apnea syndrome and ischemic heart disease: Evidence of their relationship

El propósito de esta revisión es analizar la relación entre la apnea obstructiva del sueño y la enfermedad arterial coronaria. Se exponen las evidencias epidemiológicas del trastorno respiratorio y de su asociación con la cardiopatía isquémica, los factores comunes de riesgo cardiovascular, las interacciones fisiopatológicas entre ambos trastornos, la evolución clínica y el efecto del tratamiento sobre la fisiopatología y el pronóstico.

The purpose of this review is to analyse the relation between obstructive sleep apnea and coronary disease. We present epidemiological data on the respiratory disorder and its association with ischemic cardiopathy, as well as common cardiovascular risk factors, physiopathological interactions between both conditions, clinical evolution and impact of treatment on prognosis.

[Obstructive sleep apnea syndrome and ischemic heart disease. Evidence of their relationship]. / Apnea obstructiva del sueño y cardiopatía isquémica. Las evidencias de su relación.

The purpose of this review is to analyse the relation between obstructive sleep apnea and coronary disease. We present epidemiological data on the respiratory disorder and its association with ischemic cardiopathy, as well as common cardiovascular risk factors, physiopathological interactions between both conditions, clinical evolution and impact of treatment on prognosis.

What is the future of training in surgery? Needs assessment of national stakeholders.

BACKGROUND: The Curriculum Committee of the American College of Surgeons-Accredited Educational Institutes conducted a need assessment to (1) identify gaps between ideal and actual practices in areas of surgical care, (2) explore educational solutions for addressing these gaps, and (3) shape a vision to advance the future of training in surgery. METHODS: National stakeholders were recruited from the committee members' professional network and interviewed via telephone. Interview questions targeted areas for improving surgical patient care, optimal educational solutions for training in surgery including simulation roles, and entities that should primarily bear training costs. We performed an iterative, qualitative analysis including member checking to identify key themes. RESULTS: Twenty-two interviewees included state/national board representatives, risk managers, multispecialty faculty/program directors, nurses, trainees, an industry representative, and a patient. Surgeons' communication with patients, families, and team members was raised consistently by stakeholders as a way to establish clear expectations regarding pre-, peri-, and postoperative care. Other comments highlighted the surgeon's development and demonstration and maintenance of cognitive and technical skills, including surgical judgment. Stakeholders also reiterated the critical need for surgeons to engage in on-going self-assessment and professional development to identify and remediate recognized limitations. Recommended learning modalities for meeting surgeons' needs included active learning (deliberate practice, diverse patient experiences), experiential learning (simulation), and peer and mentored learning (preceptorship). CONCLUSION: This first formal needs assessment of education for surgeons points to opportunities for educational programs in patient-centered communication, learning models that match preferences of new generations of trainees, and training in interprofessional/interdisciplinary team communication and teamwork.

[Registry of myocardial infarction in a tertiary hospital of the Instituto Mexicano del Seguro Social]. / Registro de infarto del miocardio en un hospital del tercer nivel del Instituto Mexicano del Seguro Social.

BACKGROUND: Since the prognosis of myocardial infarction with ST elevation (STEMI) depends on its immediate handling and on secondary prevention measures, not following the recommendations could impede the improvement of the population affected by this disease. The aim was to describe the clinical-epidemiologic profile and the process of care of patients with STEMI in a tertiary hospital. METHODS: We analyzed the clinical information, the risk stratification, the revascularization therapy and the prescription trends at discharge of patients with STEMI attended in one year. RESULTS: 246 patients with a mean age of 61 years were included; 76 % were men. Most of the cases of STEMI (37.3 %) were patients from 60 to 69 years. The most prevalent risk factor was sedentarism. The TIMI score was low in 81.7 % of the cases. Residual ischemia/viability was detected in 35 %, and coronary obstructions were found in all the cases of catheterized patients. Percutaneous coronary intervention was carried out in 76 %, mainly with drug-eluting stents (77.5 %). At discharge, statins and antiplatelet agents were prescribed in more than 90 %; other drugs were prescribed to 64-82 % of the cases. CONCLUSION: STEMI predominates in sedentary men over 60 years. Using stents to stratify risk, to look for residual ischemia/viability, and to revascularize with drug-eluting are common practices, but the compliance of evidence-based guidelines, although better than in the past, is not optimal yet.

Introducción: dado que el pronóstico de infarto del miocardio con elevación del segmento ST (IMCEST) depende de su manejo inmediato y de las medidas de prevención secundaria, el no seguir las recomendaciones actuales impide mejorar las expectativas de la población afectada por este padecimiento. El objetivo es describir el perfil clínico-epidemiológico y el proceso de atención del IMCEST en un hospital de tercer nivel. Métodos: se analiza la información clínica, la estratificación de riesgo, la terapia de revascularización y los hábitos de prescripción al egreso de los casos con IMCEST atendidos en un año. Resultados: se incluyeron 246 pacientes con edad promedio de 61 años; el 76 % fueron varones. La mayoría (37.3 %) de IMCEST ocurrió entre los 60 y los 69 años. El sedentarismo fue el factor de riesgo predominante. El 81.7 % de los casos tuvo score TIMI de riesgo bajo. El 35 % tuvo isquemia/viabilidad y en todos los cateterizados se demostraron obstrucciones coronarias. El 76 % se revascularizó con stent, principalmente farmacológico (77.5 %). Al egreso más del 90 % de los casos recibió estatina y antiplaquetarios, mientras otras drogas se prescribieron al 64-82 % de los casos. Conclusiones: el IMCEST predomina en hombres sedentarios de la séptima década. Estratificar el riesgo, buscar isquemia/viabilidad residual y revascularizar con stent farmacológico son prácticas comunes; el cumplimiento de recomendaciones basadas en la evidencia es mejor que en el pasado, pero todavía no es óptimo.

Registro de síndromes coronarios agudos sin elevación del segmento ST en un centro hospitalario de tercer nivel de atención (estudio RESCATA-SEST) / Registry of non-ST elevation acute coronary syndromes in a tertiary hospital (RESCATA-SEST registry)

Objetivo: Describir el perfil clinicoepidemiológico y el proceso de atención del síndrome coronario agudo sin elevación del segmento ST en un hospital de tercer nivel. Método: Se analiza la información clínica, la estratificación de riesgo, la terapia de revascularización y los hábitos de prescripción al egreso de los casos con síndrome coronario agudo sin elevación del segmento ST atendidos en un año. Resultados: Se incluyeron 283 pacientes con una edad media de 58 años; el 63%, masculino. La mayoría (88.6%) de los casos ocurrió entre los 50 y 59 años. La hipertensión arterial fue el factor de riesgo predominante. El 82.5% de los sujetos tuvo índice TIMI de riesgo bajo-intermedio. En el 37% de los pacientes hubo isquemia residual y en 80 (70%) se demostraron obstrucciones coronarias. Setenta y dos pacientes (90%) fueron revascularizados con stent, principalmente farmacológico (87.5%). Más del 90% de los casos recibió estatina y antiplaquetarios al egreso; otros medicamentos se indicaron en poco más del 50%. Conclusiones: En la población estudiada, el síndrome coronario agudo sin elevación del ST predomina en hombres relativamente jóvenes e hipertensos. Estratificar el riesgo, buscar isquemia residual y revascularizar con stent farmacológico son prácticas comunes; el cumplimiento de las recomendaciones basadas en la evidencia es subóptimo.

Objective: To describe the clinical-epidemiologic profile and the process of care of the non-ST elevation acute coronary syndromes in a tertiary hospital. Method: We analyzed the clinical information, the risk stratification and diagnostic methods, the revascularization therapy and the prescription trends at discharge, of patients with non-ST elevation acute coronary syndromes cared for in one year. Results: Two hundred and eighty-three patients with mean age of 58 years were included (63% men). The largest number of non-ST elevation acute coronary syndromes (88.6%) was found between 50 to 59 years of age. The most common risk factor was hypertension; 82.5% of the patients had a low-intermediate TIMI score; residual ischemia was demonstrated in 37% and coronary obstructions were seen in 80 patients (70%). In 90%, a percutaneous coronary intervention was performed, mainly with drug-eluting Stents (87.5%). At discharge, even though antiplatelet agents and statins were prescribed in more than 90%, other drugs were indicated in a few more than 50% of patients. Conclusions: In this population, non-ST elevation acute coronary syndromes predominates in relatively young men, often with hypertension. To stratify risk, to look for residual ischemia and to revascularize with drug-eluting stents are common practices, but the evidence-based guidelines compliance is still suboptimal.

[Registry of non-ST elevation acute coronary syndromes in a tertiary hospital (RESCATA-SEST registry)]. / Registro de síndromes coronarios agudos sin elevación del segmento ST en un centro hospitalario de tercer nivel de atención (estudio RESCATA-SEST).

OBJECTIVE: To describe the clinical-epidemiologic profile and the process of care of the non-ST elevation acute coronary syndromes in a tertiary hospital. METHOD: We analyzed the clinical information, the risk stratification and diagnostic methods, the revascularization therapy and the prescription trends at discharge, of patients with non-ST elevation acute coronary syndromes cared for in one year. RESULTS: Two hundred and eighty-three patients with mean age of 58 years were included (63% men). The largest number of non-ST elevation acute coronary syndromes (88.6%) was found between 50 to 59 years of age. The most common risk factor was hypertension; 82.5% of the patients had a low-intermediate TIMI score; residual ischemia was demonstrated in 37% and coronary obstructions were seen in 80 patients (70%). In 90%, a percutaneous coronary intervention was performed, mainly with drug-eluting Stents (87.5%). At discharge, even though antiplatelet agents and statins were prescribed in more than 90%, other drugs were indicated in a few more than 50% of patients. CONCLUSIONS: In this population, non-ST elevation acute coronary syndromes predominates in relatively young men, often with hypertension. To stratify risk, to look for residual ischemia and to revascularize with drug-eluting stents are common practices, but the evidence-based guidelines compliance is still suboptimal.

Nurses' perceptions of simulation-based interprofessional training program for rapid response and code blue events.

Following completion of an interprofessional simulation program for rapid response and code blue events, we explored hospital unit nurses' perspectives of the training, through a mixed-methods analysis. The results of this study advocate for the use of simulation training in preparing nurses and promoting communication among team members, effective teamwork, and early recognition of clinically deteriorating patients. This study provides support for the implementation and continued use of simulation interprofessional programs in hospital settings.

OB/GYN boot cAMP using high-fidelity human simulators: enhancing residents' perceived competency, confidence in taking a leadership role, and stress hardiness.

OBJECTIVES: To evaluate the effectiveness of an obstetrical and gynecologic (Ob/Gyn) Boot Camp simulation training on perceived technical competency, confidence in a leadership role, and stress hardiness of resident training. METHODS: We conducted a prospective pilot study on the effectiveness of an Ob/Gyn Boot Camp on resident training. Residents participated in an intensive immersion in clinical simulation of common obstetrical emergencies including shoulder dystocia, neonatal resuscitation, postpartum hemorrhage, and ruptured ectopic pregnancy. After the training, residents completed a Web-based survey on their perceptions of how the Ob/Gyn Boot Camp affected their 1) technical competency in the assessment and management of their patients, 2) confidence in taking a leadership role, and 3) stress hardiness. Residents rated their perceptions on a Likert scale of 1 to 5, 1 = poor to 5 = excellent. RESULTS: Twenty-three (14 Ob/Gyn and 9 family medicine) residents participated in this pilot study. Eighteen (78%) residents completed the online survey; 4 Ob/Gyn and 1 family medicine resident did not complete the survey. The residents reported that the simulation training stimulated an interest in learning key skills for obstetrical and gynecologic emergencies. Ob/Gyn residents reported significant improvement in their perceived technical competence and stress hardiness after the Boot Camp. However both Ob/Gyn and family medicine residents reported no significant improvement of confidence in their leadership abilities during obstetrical emergencies after the Boot Camp. CONCLUSION: Boot Camp simulation training early in the curriculum has the potential for enhancing residents' self-assessments of confidence, competency, and stress hardiness in managing obstetrical emergencies.

2007 simulation education summit.

The Society for Simulation in Healthcare convened the second Simulation Education Summit meeting in October 2007 in Chicago, Illinois. The purpose of the Summit was to bring together leaders of public, private, and government organizations, associations, and agencies involved in healthcare education for a focused discussion of standards for simulation-based applications. Sixty-eight participants representing 36 organizations discussed in structured small and large groups the criteria needed for various training and assessment applications using simulation. Although consensus was reached for many topics, there were also areas that required further thought and dialogue. This article is a summary of the results of these discussions along with a preliminary draft of a guideline for simulation-based education.

Using simulation to orient code blue teams to a new hospital facility.

OBJECTIVES: Prompt and successful cardiopulmonary resuscitation during a sudden cardiac arrest can be hindered by multiple variables, ie, ineffective communication, stress, lack of training, and an unfamiliar environment, such as a new hospital facility. The main objective of the study was to use high-fidelity simulations to orient Code Blue Teams (CBTs) to critical events in a new hospital facility. A secondary objective was to elucidate factors that may have contributed to responses by debriefing teams. METHODS: Mock Code Blue exercises using high-fidelity simulation were implemented in real workplace settings to orient CBTs to critical events. We measured arrival time of first responder, crash cart to code site, first six CBT responders, first chest compression, and first electrical shock. After each mock code, participants were debriefed to assess any barriers to effective response and decision making. RESULTS: Twelve mock codes were conducted at different locations of the new facility. Sixty-nine percent of the participants reported that the training was beneficial. The median time of arrival of the first responders was 42 seconds and the first CBT member was 66 seconds. The median time to initiation of chest compressions was 80 seconds, crash cart arrival was 68 seconds, and first electrical shock was 341 seconds. An additional outcome of the study was the identification of facility and systems issues that had the potential to impact patient safety. CONCLUSIONS: Clinical simulation can be effectively used to orient CBTs and identify critical safety issues in a newly constructed healthcare facility.

[Triggering of acute coronary syndromes. Pathophysiologic relationships]. / Desencadenantes de síndromes coronarios agudos. Relaciones fisiopatológicas.

In this review, the relationship of external triggers with the development of acute coronary syndromes is described. Based on current evidence, the pathophysiological mechanisms that probably result in the rupture of vulnerable coronary plaques are revised and preventive measures to stop the functional and lethal consequences of its occurrence are proposed.

La onda P en la hipertensión arterial sistémica: correlación con el ecocardiograma y apexcardiograma / The P wave in systemic arterial hypertension: relationship with echocardiogram and apexcardiogram

En múltiples reportes se ha informado la presencia de una onda P electrocardiográfica anormal (OPA) en sujetos hipertensos y la interpretación de este signo es aún controversial. Para demostrar si las alteraciones de esta deflexión se relacionan con una sobrecarga de presión o de volumen auricular izquierda, se estudiaron 34 casos con hipertensión arterial sistémica (HAS) sin insuficiencia cardíaca u otras complicaciones. La población se dividió en dos grupos: grupo A, formado por 13 casos con onda P de duración > de duración > 0.10 seg. en la derivación D2 y grupo B, integrado por 21 casos con onda P < 0.10 seg. En todos se efectuó estudio fono-ecocardiográfico y se estudiaron: índice "a" (Ia), diámetro auricular izquierdo (DAI), espesor septal y de la pared posterior del ventrículo izquierdo (PPVI, índice de Sokolow (IS), presión arterial sistólica (PAS) y diastólica (PAD). No hubo diferencias estadiscamente significativas entre ambos grupos, inclucyendo la PAS y la PAD (no señalados en la tabla). Se correlacionaron el DAI y el Ia con las variables electrocardiográficas y tampoco se observó significancia. La OPA en el HAS no resulta de una sobrecarga de presión o volumétrica auricular izquierda

La onda P en la hipertensión arterial sistémica / P wave in systemic arterial hypertension

La onda Pelectrocardiográfica anormal (OPA) de la hipertensión arterial sistémica (HAS) ha sido interpretada en varias formas: indicativa de insuficiencia cardíaca, hipertrofia de aurícula izquierda o hipertrofia ventricular izquierda (HVI). Para precisar el significado clínico de este signo se estudiaron 47 casos de HAS sin IC o coronariopatía oclusiva. La población se dividió en 2 grupos: grupo A, formado por 22 casos con onda P de duración > 0.11 seg en la derivación D2 y grupo B constituido por 25 casos con onda P de duración menor a esta cifra. En todos los casos se efectuó cineventriculografía izquierda y se estudiaron los siguientes datos: fracción de expulsión (FE), fracción de llenado ventricular en telediástole (FLLTD), índice electrocardiográfico de Sokolow (IS), presión diastólica final del ventrículo izquierdo (PDFVI) y presión arterial sistólica (PAS). Los resultados obtenidos fueron: GA (n=22); FE 70.1 (12.2); FLLTD (%) 32.5 (10.3); IS(mm) 33.2 (41.5); PAS(mmHg) l85.0 (27); GB (n=25) 61.7(12.5); 29.5(13.8); 29.3(9.3); 177.2(34). Entre los grupos ningún valor fue estadísticamente significativo (incluyendo la PDFVI no señalada en la tabla). Los coeficientes de correlación entre la duración de la onda P (DOP) y el resto de las variables estudiadas no tuvieron significancia (hubo una relación débil entre DOP y la FLLTD = 0.217). La OPA en la HAS no está relacionada a un grado determinado de HVI o de disfunción de este ventrículo, ni de sobrecarga de presión de la aurícula izquierda. La cardiopatia hipertensiva no debe clasificarse en base a una onda P electrocardiográfica anormal