Curso de ecografía abdominal. Introducción a la técnica ecográfica. Principios físicos. Lenguaje ecográfico / Abdominal ultrasound course an introduction to the ultrasound technique. Physical basis. Ultrasound language

La ecografía es una técnica diagnóstica no invasiva, asequible y versátil que emplea el ultrasonido para definir los órganos del cuerpo humano, sin radiaciones ionizantes, en tiempo real y con capacidad de visualizar varios planos. La gran rentabilidad diagnóstica de la técnica, unida a su facilidad de realización, y a las características antes mencionadas, la han colocado en la actualidad como un método de rutina en la práctica médica diaria. Es por esto por lo que, día tras día, se refuerza el carácter multidisciplinario de la técnica. Para una adecuada realización de la técnica se requiere tener conocimientos de los principios físicos del ultrasonido, del método e instrumental y de la anatomía humana, para así conseguir recopilar la máxima información posible y evitar errores de diagnóstico por mala interpretación u omisión de información (AU)

Ultrasound is a non-invasive, accessible, and versatile diagnostic technique that uses high frequency ultrasound waves to define outline the organs of the human body, with no ionising radiation, in real time and with the capacity to visual several planes. The high diagnostic yield of the technique, together with its ease of uses plus the previously mentioned characteristics, has currently made it a routine method in daily medical practice. It is for this reason that the multidisciplinary character of this technique is being strengthened every day. To be able to perform the technique correctly requires knowledge of the physical basis of ultrasound, the method and the equipment, as well as of the human anatomy, in order to have the maximum information possible to avoid diagnostic errors due to poor interpretation or lack of information (AU)

[Abdominal ultrasound course an introduction to the ultrasound technique. Physical basis. Ultrasound language]. / Curso de ecografía abdominal. Introducción a la técnica ecográfica. Principios físicos. Lenguaje ecográfico.

Ultrasound is a non-invasive, accessible, and versatile diagnostic technique that uses high frequency ultrasound waves to define outline the organs of the human body, with no ionising radiation, in real time and with the capacity to visual several planes. The high diagnostic yield of the technique, together with its ease of uses plus the previously mentioned characteristics, has currently made it a routine method in daily medical practice. It is for this reason that the multidisciplinary character of this technique is being strengthened every day. To be able to perform the technique correctly requires knowledge of the physical basis of ultrasound, the method and the equipment, as well as of the human anatomy, in order to have the maximum information possible to avoid diagnostic errors due to poor interpretation or lack of information.

Migración de dispositivo para cierre percutáneo de comunicación interauricular a cavidades izquierdas / Migration to the left cavities of an interatrial communication closure device

No disponible

[Analysis of the training and teaching situation of anaesthesiology and resuscitation tutors in Spain: a proposal for improvement]. / Análisis de la situación formativa y docente de los tutores españoles de Anestesiología y Reanimación. Propuestas de mejora.

OBJECTIVES: To determine the current situation of the tutors in our specialty as regards resident/tutor ratios, times they have available to develop their work, the training that they have received to perform their function, and whether this is recognised by official bodies, other than by their own hospital. Furthermore, to determine the teaching and research work taught to the residents through the sessions, as well as their participation in publications per year. To find out their opinion of the tutors as regards unifying training contents, whether or not they have objective tests on finishing their residency, and their willingness to take part in the project promoted by the Teaching Section of SEDAR to carry out a common minimum theoretical-practical programme throughout the whole of Spain. MATERIAL AND METHODS: A questionnaire with the aforementioned questions was sent to Anaesthesiology Teach Units through the different regional coordinators, during the years 2008-2010. RESULTS: A total of 77/106 (72.6%) Teaching Units responded. The mean ratio of residents per tutor was 5.6±3.3. More than 60% of the tutors had not attended any training course or even how to join one in the two years of the study; 62.3% did not have specific time available to develop their role as tutors, and in 18.2%, their work was only recognised by health institutions. The number of teaching sessions for residents per year was 5.0±4.0 and the number of publications was 1.6±1.4. Almost all of them (98.7%) believe it was necessary to produce a programme that would ensure similar minimum theoretical-practical training plans and that on their own initiative had been carried out in 70% of Teaching Units, but without uniform criteria. Almost three-quarters (74%) had not presented any resident to the European Examination of Anaesthesia in the last few years, and 87% considered the system of evaluating residents as inadequate, with 79% in favour of having a final exam or test. CONCLUSIONS: The tutor/resident ratio should according to that stipulated. Time needs to be set aside for teaching, separate from care work, and our tutors, in general, lack specific training courses, and these are very disparate. There is a general demand to have a training programme of common minimum theoretical-practical skills. It is considered that the current evaluation system is inadequate, but there is no unanimity in whether or not to have an exam at the end of the residency, although the European Examination could be the model to consider in this regard.

La simulación clínica y nuestra nueva realidad. La necesidad de aunar esfuerzos / Clinical simulation and our new reality. The need for a combined effort

No disponible

Análisis de la situación formativa y docente de los tutores españoles de Anestesiología y Reanimación. Propuestas de mejora / Analysis of the training and teaching situation of anaesthesiology and resuscitation tutors in Spain: a proposal for improvement

Objetivos: Conocer la situación actual de los tutores de nuestra especialidad en cuanto a proporciones residentes/tutor, tiempos de que disponen para desarrollar su labor, la formación que han recibido para realizar su función y si esta es reconocida por los organismos oficiales, más allá de su propio hospital. Asimismo conocer la labor docente e investigadora de los residentes a través de las sesiones que realizaban y las publicaciones anuales en que eran partícipes. Conocer la opinión de los tutores respecto a la unificación de contenidos formativos, que se realicen o no pruebas objetivas al concluir la residencia y su disposición a colaborar en el proyecto, promovido desde la Sección de Docencia de la SEDAR, de colaborar en la aplicación de un programa de mínimos teóricoprácticos común a todo el territorio nacional. Material y métodos: Se envió a los tutores de las unidades docentes de Anestesiología, a través de diferentes coordinadores territoriales, una encuesta con las cuestiones anteriores, durante los años 2008-2010. Resultados: Contestaron 77/106 unidades docentes (72,6%). La razón media de residentes por tutor era 5,6 ± 3,3. Más de un 60% de los tutores no habían recibido ningún curso de formación o a lo sumo uno en 2 años, el 62,3% no disponía de tiempos específicos para desarrollar su función de tutores y su labor sólo era reconocida por las instituciones sanitarias en un 18,2%. El número de sesiones impartidas por los residentes al año era 5,0 ± 4,0 y el número de publicaciones, 1,6 ± 1,4. El 98,7% creía necesaria la elaboración de un programa que garantice unos mismos planes formativos teórico-prácticos mínimos y que, a título individual, habían realizado en un 70% de las unidades docentes, pero sin criterios uniformes. El 74% de los hospitales no habían presentado a ningún residente al Examen Europeo de Anestesia en los últimos 2 años, no se consideraba adecuado el sistema de evaluación de los residentes en un 87%, y un 79% era partidario de realizar un examen o prueba final. Conclusiones: Debe adecuarse la razón residentes/tutor según lo estipulado. Es necesario disponer de un tiempo para la docencia, separado del asistencial y nuestros tutores carecen, en general, de cursos específicos de formación, y estos son muy dispares. Existe una demanda generalizada de realizar un programa formativo común de competencias y mínimos teórico-prácticos. Se considera que el actual sistema de evaluación no es el adecuado, pero no hay unanimidad en si realizar o no un examen al final de la residencia, aunque el modelo del examen europeo podría ser una prueba que considerar a este respecto(AU)

Objectives: To determine the current situation of the tutors in our specialty as regards resident/tutor ratios, times they have available to develop their work, the training that they have received to perform their function, and whether this is recognised by official bodies, other than by their own hospital. Furthermore, to determine the teaching and research work taught to the residents through the sessions, as well as their participation in publications per year. To find out their opinion of the tutors as regards unifying training contents, whether or not they have objective tests on finishing their residency, and their willingness to take part in the project promoted by the Teaching Section of SEDAR to carry out a common minimum theoretical-practical programme throughout the whole of Spain. Material and methods: A questionnaire with the aforementioned questions was sent to Anaesthesiology Teach Units through the different regional coordinators, during the years 2008-2010. Results: A total of 77/106 (72.6%) Teaching Units responded. The mean ratio of residents per tutor was 5.6±3.3. More than 60% of the tutors had not attended any training course or even how to join one in the two years of the study; 62.3% did not have specific time available to develop their role as tutors, and in 18.2%, their work was only recognised by health institutions. The number of teaching sessions for residents per year was 5.0±4.0 and the number of publications was 1.6±1.4. Almost all of them (98.7%) believe it was necessary to produce a programme that would ensure similar minimum theoretical-practical training plans and that on their own initiative had been carried out in 70% of Teaching Units, but without uniform criteria. Almost three-quarters (74%) had not presented any resident to the European Examination of Anaesthesia in the last few years, and 87% considered the system of evaluating residents as inadequate, with 79% in favour of having a final exam or test. Conclusions: The tutor/resident ratio should according to that stipulated. Time needs to be set aside for teaching, separate from care work, and our tutors, in general, lack specific training courses, and these are very disparate. There is a general demand to have a training programme of common minimum theoretical-practical skills. It is considered that the current evaluation system is inadequate, but there is no unanimity in whether or not to have an exam at the end of the residency, although the European Examination could be the model to consider in this regard(AU)

[Reflections on residency training under the current recommendations of the European Union of Medical specialists and the European Board of Anaesthesia (UEMS/EBA guidelines)]. / Consideraciones formativas ante el actual escenario europeo programa formativo postgraduado. UEMS/EBA guidelines.

The recent publication of guidelines for postgraduate training in anesthesiology, pain, and intensive care issued by the European Board of Anaesthesia (EBA) and the European Union of Medical Specialists (UEMS) (http://www.sedar.es/revistasedar/uems.pdf) specifies directions we must take with our residents. The training section of the Sociedad Española de Anestesiología y Reanimación (SEDAR) has decided to make the guidelines available on the association's website so that the UEMS/EBA proposals can be compared to the training program drafted by the Spanish national board for our specialty. Our aim is to identify points of convergence between the two proposals and to target gaps where improvements can be made so that Spanish residency training in this specialty is in harmony with the European framework.

I Jornadas de formación continuada de tutores organizadas por la sección de docencia y formación de la Sociedad Española de Anestesiología y Reanimación / No disponible

No disponible

Docencia y Formación. Un camino de futuro en el desarrollo de la Anestesiología y Reanimación del siglo XXI / No disponible

No disponible

Creación y desarrollo de la sección de docencia y formaciónde la Sociedad Española de Anestesiología, Reanimacióny Terapéutica del Dolor / No disponible

No disponible

Hipofosfatemia en nutrición parenteral: prevención y factores de riesgo asociados / Hypophosphatemia in parenteral nutrition: prevention and associated risks factors

Objetivo: Determinar la incidencia de hipofosfatemia en pacientes con nutrición parenteral, la cantidad de fosfato necesaria para prevenir esta complicación y los factores de riesgo asociados. Ámbito: Estudio observacional no controlado en un hospital de nivel III. Pacientes: pacientes ingresados con nutrición parenteral a los que se les ha realizado como mínimo una analitica completa. Intervención: Se registran durante un año, los días de nutrición parenteral, el fosfato administrado y los niveles plasmáticos de calcio ionizado, -glutamiltranspeptidasa, glucosa, fosfato, prealbúmina, urea y leucocitos. Para el análisis se aplica una regresión múltiple stepwise y una regresión logistica. Resultados: Se incluyeron en el estudio 827 determinaciones correspondientes a 401 pacientes. Las variables significativas (p < 0,05) fueron: fosfato administrado y los niveles séricos de calcio ionizado, glucosa, prealbúmina y urea; los coeficientes de regresión fueron 0,004 (95 por ciento IC: 0,002-0,006), -0,156 (95 por ciento IC: -0,270-0,037), 0,014 (95 por ciento IC: -0,022-0,009), 0,005 (95 por ciento CI: 0,0020,009) y 0,019 (95 por ciento IC: 0,016-0,022) respectivamente; la constante fue 1,0735 (95 por ciento IC: 0,939-1,2079). El riesgo de desarrollar hipofosfatemia disminuyó de 0,65 (95 por ciento IC: 0,33-1,26) a 0,16 (95 por ciento IC: 0,078-0.35) cuando el fosfato administrado variaba deL rango 7,5-17,5 mmol a valores superiores a 27,5 mmol. Conclusiones: es necesario suplementar rutinariamente las nutriciones con fosfato debido a que su contenido en las emulsiones lipídicas comercializadas no es suficiente para evitar la hipofosfatemia en la mayoría de pacientes con nutrición parenteral. El aporte de fosfato debe ser suficiente para restaurar el déficit de fosfato intracelular y compensar la caída de fosfato plasmático, con especial cuidado para los pacientes desnutridos, hiperglucémicos o con insuficiencia renal. Aportes de fosfato entre 27-37 mmol, disminuyen drásticamente la incidencia de hipofosfatemia en los pacientes estudiados, no registrándose ningún caso de hipofosfatemia severa (AU)

Aim: To determine the incidence of hypophosphatemia in parenterally fed patients, the phosphate amount necessary to prevent this complication and associated risks factors. Setting: Observational study, not controlled, in a third level hospital. Patients: In-patients with parenteral nutrition with at least a complete laboratory work-up. Intervention: For a complete year, days on parenteral nutrition, administered phosphate and plasmatic ionised calcium levels, γ-glutamiltranspeptidase, glucose, phosphate, pre-albumin, urea, and leukocytes were recorded. A multiple stepwise regression analysis and logistic regression are used for data analysis. Results: Eight hundred and twenty seven determinations, corresponding to 401 patients, were included. Significant variables (p < 0.05) were: administered phosphate and ionised calcium serum levels, glucose, pre-albumin, and urea; regression coefficients were 0.004 (95%CI: 0.002 to 0.006), -0.156 (95%CI: -0.270 to 0.037), -0.014 (95%IC: -0.022 to 0.009), 0.005 (95%CI: 0.002 to 0.009) and 0.019 (95%CI: 0.016 to 0.022), respectively; the constant was 1.0735 (95%CI: 0.939 to 1.2079). The risk for developing hypophosphatemia decreased from 0.65 (95%CI: 0.33 to 1.26) to 0.16 (95%CI: 0.078 to 0.35) when administered phosphate varied from the span 7.5-17.5 mmol to values higher than 27.5 mmol. Conclusions: It is necessary to routinely supplement nutrition with phosphate since its content in commercially available lipidic emulsions is not sufficient to prevent hypophosphatemia in the majority of patients with parenteral nutrition. Phosphate intake must be sufficient to restore the intracellular phosphate deficit and to compensate for the plasmatic phosphate fall, with special attention to poorly nourished, hyperglycaemic or with renal failure patients. Phosphate intakes around 27-37 mmol dramatically decrease the incidence of hypophosphatemia in studied patients, with no recorded cases of severe hypophosphatemia (AU)