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1.
Resuscitation ; 134: 127-132, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30428308

RESUMO

BACKGROUND: The use of online teaching methodology for basic life support (BLS) courses is progressively increasing. OBJECTIVE: The objective of this study was to verify whether the blended-learning methodology (virtual course with a short face-to-face complement) was more efficient than a course that followed the classical or face-to-face methodology in our university. MATERIALS AND METHODS: A cost minimization analysis was performed for two BLS and automatic external defibrillation (AED) courses, one of which was conducted face-to-face (Control Group) and the second of which was conducted via blended-learning (Experimental Group). The courses had the same duration and content according to the European Resuscitation Council (ERC) recommendations. In the face-to-face course, direct costs were considered those generated by the faculty and derived from the academic activity. Other costs were those generated by the use of classrooms and the amortization of manikins and AED training. The perspective of the analysis was that of the provider, the academic, and a time horizon of six months. The costs are expressed in € 2017. RESULTS: The savings of a course in BLS-AED based on the blended-learning methodology calculated for a total of 160 university nursing and medical students were € 2328.8 for the first year of its implementation and € 9048.8 for its second edition compared with the same course using a face-to-face methodology. CONCLUSIONS: The blended-learning methodology supposes a cost savings for BLS-AED courses, mainly due to the reduction of expenses of the teaching staff. The blended-learning methodology seems to be more efficient than the face-to-face methodology.

2.
Nurse Educ Today ; 65: 232-238, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29605787

RESUMO

AIM OF THE STUDY: The objective of this study was to compare the immediate and 6-month efficacy of basic life support (BLS) and automatic external defibrillation (AED) training using standard or blended methods. METHODS: First-year students of medicine and nursing (n = 129) were randomly assigned to a control group (face-to-face training based on the European Resuscitation Council [ERC] Guidelines) or to an experimental group that trained with a self-training video, a new website, a Moodle platform, an intelligent manikin, and 45 min of instructor presence. Both groups were homogeneous and were evaluated identically. Theoretical knowledge was evaluated using a multi-choice questionnaire (MCQ). Skill performance was evaluated by the instructor's rubric and on a high-fidelity Resusci Anne QCPR manikin. RESULTS: Immediately after the course, there were no statistically significant differences in knowledge between the two groups. The median score of practical evaluation assessed by the instructor was significantly better in the experimental group (8.15, SD 0.93 vs 7.7, SD 1.18; P = 0.02). No differences between groups were found when using a high-fidelity manikin to evaluate chest compressions and lung inflations. At six months, the scores in knowledge and skill performance were significantly lower compared to the evaluations at the end of the instruction, but they remained still higher compared to baseline. The experimental group had higher scores in practical skills evaluated by the instructor than the control group (7.44, SD 1.85 vs 6.10, SD 2.6; P = 0.01). CONCLUSIONS: The blended method provides the same or even higher levels of knowledge and skills than standard instruction both immediately after the course and six months later.


Assuntos
Reanimação Cardiopulmonar/educação , Competência Clínica/normas , Desfibriladores/psicologia , Estudantes/psicologia , Ensino/normas , Reanimação Cardiopulmonar/métodos , Avaliação Educacional/métodos , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Estatísticas não Paramétricas , Adulto Jovem
3.
Medicine (Baltimore) ; 96(15): e6624, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28403113

RESUMO

Studies designed to assess persistent postoperative pain (PPP) incidence after hepatectomies are lacking. Our aim was to assess PPP incidence 6 months after hepatectomies with intravenous (IV) or epidural (EPI) analgesia containing ketamine.Prospective observational comparative study between 2 cohorts of patients submitted to hepatectomy. Patients received 1 of 2 analgesic regimes containing ketamine: EPI group or IV group. Visual analog scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), and quantitative sensorial testing (QST: to determine area of hyperalgesia/allodynia) were assessed preoperatively and postoperatively at 2 h, 24 h, 7 days, 1 month, and 6 months. VAS ≥ 1 at 1 and 6 months was considered indicative of PPP and VAS > 3 was considered as not controlled pain. Side effects and complications were registered.Forty-four patients were included: 23 in EPI group and 21 in IV group. Patients in IV group were older and had more comorbidities. No patient presented VAS > 3 at 1 or 6 months. VAS ≥ 1 at 1 and 6 months was 36.4% and 22.7%, respectively. No differences in VAS, NPSI, or PCS were found between groups. Allodynia/hyperalgesia area did not differ between groups and was infrequent and slight. Pain pressure threshold in the wound vertical component was significantly higher in EPI group after 7 days. IV group showed more cognitive side effects.Incidence of PPP at 6 months after open hepatectomies with EPI or IV analgesia containing ketamine was lower than previously reported for other abdominal surgeries.Ketamine influence on low PPP incidence and hyperalgesia cannot be discarded.


Assuntos
Analgésicos/administração & dosagem , Hepatectomia/efeitos adversos , Hiperalgesia/epidemiologia , Ketamina/administração & dosagem , Dor Pós-Operatória/epidemiologia , Idoso , Feminino , Hepatectomia/métodos , Humanos , Hiperalgesia/etiologia , Hiperalgesia/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Assistência Perioperatória/métodos , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Clin J Pain ; 30(6): 490-500, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24281290

RESUMO

OBJECTIVES: Persistent postsurgical pain (PPP) after thoracotomy effect 50% to 80%. Nerve damage and central sensitization involving NDMDAr activation may play an important role. This study evaluates the efficacy of adding intravenous (IV) or epidural ketamine to thoracic epidural analgesia (TEA) after thoracotomy. MATERIALS AND METHODS: Double-blind randomized study on patients undergoing thoracotomy allocated to one of the following: group Kiv (IV racemic ketamine 0.5 mg/kg preincisional +0.25 mg/kg/h for 48 h), group Kep (epidural racemic ketamine 0.5 mg/kg preincisional +0.25 mg/kg/h for 48 h), or group S (saline). Postoperative analgesia was ensured by TEA with ropivacaine and fentanyl. Pain visual analog scales (VAS), Neuropathic Pain Symptom Inventory, Catastrophizing Scale, and Quantitative Sensory Testing, measuring both the peri-incisional and distant hyperalgesia area, were conducted preoperatively and postoperatively until 6 months. Plasma ketamine levels and stability of the analgesic solutions were analyzed. RESULTS: A total of 104 patients were included. PPP incidence was 20% at 6 months. Pain scores on coughing were significantly lower in Kiv and Kep than in S at 24 and 72 hours, but there were no differences afterwards. There were no significant differences in pain at rest, Neuropathic Pain Symptom Inventory, and Catastrophizing Scale, or in the area of mechanical allodynia at any time. Adverse effects were mild. Plasma ketamine levels did not differ significantly between groups. Analgesic solutions were stable. CONCLUSIONS: Adding epidural or IV racemic ketamine to TEA after thoracotomy did not lead to any reduction in PPP or allodynia. Epidural administration produced similar plasma ketamine levels to the IV route.


Assuntos
Analgesia Epidural , Analgésicos/uso terapêutico , Dor Crônica/tratamento farmacológico , Ketamina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Toracotomia/efeitos adversos , Doença Aguda , Administração Intravenosa/efeitos adversos , Adulto , Analgesia Epidural/efeitos adversos , Analgésicos/efeitos adversos , Analgésicos/sangue , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Tosse/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Hiperalgesia/tratamento farmacológico , Hiperalgesia/epidemiologia , Hiperalgesia/etiologia , Hiperalgesia/fisiopatologia , Incidência , Ketamina/efeitos adversos , Ketamina/sangue , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Tórax , Resultado do Tratamento
6.
Med. clín (Ed. impr.) ; 139(supl.2): 46-50, oct. 2012. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-141310

RESUMO

Las características de los anticoagulantes orales de acción directa (ACOD), la ausencia de antídoto para revertir completamente sus efectos anticoagulantes, la falta de sistematización en la monitorización de sus efectos y la experiencia limitada de su empleo, hacen necesarias unas recomendaciones específicas para su uso en el periodo perioperatorio o ante situaciones de urgencia. En cirugía programada, en pacientes con función renal normal y riesgos hemorrágico/trombótico bajos, se recomienda suspender el ACOD 2 días antes de la cirugía; en situaciones de mayor riesgo hemorrágico/trombótico se propone como alternativa una terapia puente con una heparina de bajo peso molecular desde 5 días antes de la cirugía. Ante cirugía urgente no se recomienda la administración sistemática de hemostáticos de forma profiláctica. En caso de hemorragia aguda relacionada con la toma de un ACOD, se debe valorar la administración de concentrados de complejo protrombínico, plasma fresco o factor VIIa, implementando las medidas generales de control de la hemorragia (AU)


Because of the characteristics of direct oral anticoagulants (DOA), the lack of an antidote to completely reverse their anticoagulant effects, the absence of standardization in monitoring of their effects, and limited experience of their use, specific recommendations for their management in the perioperative period or in emergencies are required. In elective surgery, in patients with normal renal function and low hemorrhagic/ thrombotic risk, DOA should be withdrawn 2 days before the intervention; when the hemorrhagic/ thrombotic risk is higher, bridge therapy with a low molecular weight hepatin beginning 5 days before the intervention is proposed as an alternative. In emergency surgery, systematic administration of hemostatic drugs as prophylaxis is not recommended. In DOA-related acute hemorrhage, administration of prothrombin complex concentrate, fresh plasma or factor VIIa should be evaluated, and general measures to control bleeding should be implemented (AU)


Assuntos
Humanos , Anticoagulantes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Suspensão de Tratamento , beta-Alanina/análogos & derivados , beta-Alanina/efeitos adversos , beta-Alanina/uso terapêutico , Administração Oral , Anticoagulantes/uso terapêutico , Hemorragia Pós-Operatória/induzido quimicamente , Tiofenos/efeitos adversos , Tiofenos/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Morfolinas/efeitos adversos , Morfolinas/uso terapêutico , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico
7.
Med Clin (Barc) ; 139 Suppl 2: 46-50, 2012 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-23498073

RESUMO

Because of the characteristics of direct oral anticoagulants (DOA), the lack of an antidote to completely reverse their anticoagulant effects, the absence of standardization in monitoring of their effects, and limited experience of their use, specific recommendations for their management in the perioperative period or in emergencies are required. In elective surgery, in patients with normal renal function and low hemorrhagic/ thrombotic risk, DOA should be withdrawn 2 days before the intervention; when the hemorrhagic/ thrombotic risk is higher, bridge therapy with a low molecular weight hepatin beginning 5 days before the intervention is proposed as an alternative. In emergency surgery, systematic administration of hemostatic drugs as prophylaxis is not recommended. In DOA-related acute hemorrhage, administration of prothrombin complex concentrate, fresh plasma or factor VIIa should be evaluated, and general measures to control bleeding should be implemented.


Assuntos
Anticoagulantes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Suspensão de Tratamento , Administração Oral , Anticoagulantes/uso terapêutico , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico , Dabigatrana , Humanos , Morfolinas/efeitos adversos , Morfolinas/uso terapêutico , Hemorragia Pós-Operatória/induzido quimicamente , Guias de Prática Clínica como Assunto , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Rivaroxabana , Tiofenos/efeitos adversos , Tiofenos/uso terapêutico , beta-Alanina/efeitos adversos , beta-Alanina/análogos & derivados , beta-Alanina/uso terapêutico
8.
Clin J Pain ; 28(4): 318-23, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22001670

RESUMO

OBJECTIVES: Von Frey monofilaments (VFM) and Electronic von Frey are used as quantitative sensory testing to explore mechanical hyperalgesia. The aim of the study was to determine VFM and Electronic von Frey reproducibility and the time required for testing undamaged areas in volunteers and surgical in-hospital patients. METHODS: Prospective study in 2 groups of individuals without neurological disorders and not receiving treatments that alter sensorial response. Group 1 was formed by 30 healthy volunteers and group 2 by 28 patients after knee arthroplasty who received unilateral femoral block as postoperative analgesia. Testing was performed by 2 trained investigators in the forearm and abdominal wall and repeated 24 hours later. Pain threshold was determined as the VMF or the pressure rate applied with the Electronic von Frey referred to as unpleasant. The time used in each test was measured. Intraobserver and interobserver reproducibility were analyzed by means of Kappa and Lin coefficients. RESULTS: Intraobserver and interobserver reproducibility for VFM was only fair or moderate in both groups (Kappa<0.6). Intraobserver reproducibility for Electronic von Frey was good in Group 1 (Lin 0.61 to 0.8) and almost perfect in Group 2 (Lin>0.8). No differences were found between the 2 tested areas. Time used was 6.03 and 3.16 minutes for VFM and Electronic von Frey, respectively. DISCUSSION: Exploration of mechanical allodynia in postoperative patients requires rapid and reliable quantitative sensory testing. Electronic von Frey was more reliable and rapid than VFM in exploring mechanical pain thresholds in undamaged areas in volunteers and patients. Further studies are required to confirm whether these results can be extrapolated to areas affected by surgery.


Assuntos
Eletrônica , Hiperalgesia/fisiopatologia , Medição da Dor/métodos , Limiar da Dor/fisiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Hiperalgesia/diagnóstico , Masculino , Estimulação Física , Estudos Prospectivos , Reprodutibilidade dos Testes
9.
Anesthesiology ; 113(6): 1338-50, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21045639

RESUMO

BACKGROUND: Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures. Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical population. METHODS: Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study. The main outcome was the development of at least one of the following: respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis. The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample. A PPC predictive index was constructed. RESULTS: Of 2,464 patients studied, 252 events were observed in 123 (5%). Thirty-day mortality was higher in patients with a PPC (19.5%; 95% [CI], 12.5-26.5%) than in those without a PPC (0.5%; 95% CI, 0.2-0.8%). Regression modeling identified seven independent risk factors: low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration of at least 2 h, and emergency surgery. The area under the receiver operating characteristic curve was 90% (95% CI, 85-94%) for the development subsample and 88% (95% CI, 84-93%) for the validation subsample. CONCLUSION: The risk index based on seven objective, easily assessed factors has excellent discriminative ability. The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care.


Assuntos
Pneumopatias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia , Estudos de Coortes , Coleta de Dados/normas , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Pneumopatias/epidemiologia , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , População , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Tamanho da Amostra , Estações do Ano , Espanha/epidemiologia , Resultado do Tratamento
10.
Anesthesiology ; 112(5): 1164-74, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20418697

RESUMO

BACKGROUND: Health-related quality of life is usually reported for specific rather than heterogeneous populations such as those treated in routine anesthesia practice. The 8-item short-form generic health-related quality-of-life questionnaire (SF-8) is a candidate instrument for this setting. The authors evaluated the feasibility, reliability, validity, and responsiveness to change of the Spanish version of SF-8 in a population-based surgical cohort. METHODS: Recruiting patients from a large population-based study of risk factors for pulmonary complications, before surgery, the authors administered the 1-week recall SF-8 to 2,991 patients undergoing nonobstetric elective or emergency surgery in 59 hospitals, each of which collected data on seven randomly assigned days in 2006. The SF-8 was administered again 3 months later. Reliability was evaluated using the Cronbach alpha coefficient and validity by comparing physical and mental component summary SF-8 scores with clinical variables. Responsiveness after surgery was evaluated using the standardized response mean. RESULTS: Cronbach alpha for the overall test was 0.92. Physical and mental component summary scores and all individual scores were lower (worse quality of life) in women (P < 0. 01) and decreased with age (P < 0.01). Preoperative scores were lower for those in worse clinical condition (higher body mass index, American Society of Anesthesiologists physical status class, or surgical risk scores), with preoperative respiratory symptoms, and in emergency situations (P < 0.01). The standardized response mean ranged from 0.1 to 0.5. CONCLUSIONS: The SF-8 is a feasible, reliable, valid, and responsive instrument for assessing health-related quality of life in a broad-spectrum surgical population.


Assuntos
Nível de Saúde , Inquéritos Epidemiológicos , Multilinguismo , Qualidade de Vida , Procedimentos Cirúrgicos Operatórios , Inquéritos e Questionários/normas , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia , Espanha , Procedimentos Cirúrgicos Operatórios/psicologia
11.
J Clin Anesth ; 21(1): 30-7, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19232938

RESUMO

STUDY OBJECTIVE: To describe the characteristics of anesthetic and postoperative care applied in urologic surgery. DESIGN: Prospective, cross-sectional survey. SETTING: 131 authorized public and private hospitals in Catalonia, Spain. MEASUREMENTS: Data were collected from a representative sample of 23,136 patients and all questionnaires related to urologic surgery were analyzed. MAIN RESULTS: Data included patient characteristics, anesthetic techniques, and type of procedure. Eighty-five hospitals performed urologic surgery and 75.4% of activity took place in public hospitals. The median age of patients was 61 years and 87.3% were men. Preoperative physical status was poorer than in the rest of the surgical population. Surgery was elective in 93.2% of the cases, and the most frequent procedure was transurethral resection of bladder tissue (25.6%). The median duration of anesthesia was 60 minutes, and 9.7% of patients required postoperative admission to an intensive care unit. Regional anesthesia, especially subarachnoid block, was the most frequently used anesthetic technique. CONCLUSIONS: The older age and poor physical status of urology patients make high demands on anesthetic resources and must be considered in the organization of services and training programs.


Assuntos
Anestesia/métodos , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestesia/estatística & dados numéricos , Anestesia por Condução/métodos , Anestesia por Condução/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha/epidemiologia , Inquéritos e Questionários , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto Jovem
12.
Med Teach ; 31(5): e189-95, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19241215

RESUMO

BACKGROUND: There is no evidence on the best method for teaching Basic Life Support (BLS). AIMS: To compare two methods for teaching BLS, assessing the level of cognitive skills. METHODS: Randomized, prospective study including 68 medical students. BLS algorithms were taught for 60 minutes using either a multimedia presentation (Group I, n=34) or case based discussion (Group II, n=34). Assessments included a scenario-based quiz test and an error-pinpointing video, which the students completed before (T1) and after (T2) teaching. Comparisons between both groups were made on scores of the assessments, actual increases in scores (final value - initial value) and score gains (actual increase/potential increase). RESULTS: No significant differences were found between the groups in any of the recorded scores. Both groups improved their T2 scores (p values <0.001). The actual increases in scores and the score gains were similar in both groups. Test scores improved in 55.9% of students in Group I and 58.8% in Group II; video scores improved in 85.3% of Group I and in 82.3% of Group II. CONCLUSIONS: BLS teaching by either multimedia presentations or case based discussion equally improves the level of cognitive skills among medical students.


Assuntos
Algoritmos , Cognição , Educação de Graduação em Medicina , Cuidados para Prolongar a Vida , Multimídia , Estudantes de Medicina/psicologia , Ensino/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto Jovem
13.
Med Teach ; 30(7): 693-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18608952

RESUMO

BACKGROUND: In 2001, in order to improve the curriculum, the medical school of the University of Barcelona began discussions aimed at defining specific learning outcomes for its medical graduates and, subsequently, evaluating the acquisition of these competencies. AIM: To report the views of our medical students regarding the extent to which they have acquired the learning outcomes previously defined by the faculty. METHOD: A questionnaire was administered to seventy final year students, who had finished all the course clerkships and they were asked to indicate on a Likert scale their perceived level of acquisition of each learning outcome. RESULTS: Overall, the students report an adequate level of competency and consider themselves able to meet skills targets under supervision in eight of the eleven domains investigated. In three of the domains (patient management, medical information search skills, and decision-making skills and clinical reasoning and judgment) students regarded themselves as only partially competent. These results agree with the global course score of the students, according to the medical school assessment system. CONCLUSIONS: The results will allow us to make curricular and methodological changes in order to implement a new outcome-based curriculum.


Assuntos
Competência Clínica , Avaliação Educacional/métodos , Faculdades de Medicina , Estudantes de Medicina/psicologia , Coleta de Dados , Feminino , Humanos , Espanha
14.
Reg Anesth Pain Med ; 33(3): 211-6, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18433671

RESUMO

BACKGROUND AND OBJECTIVES: Damage to peripheral nerves provokes chronic neuropathic pain that lasts beyond the duration of the nerve injury. The presence of pain signs have been reported in areas other than those attributed to the injured nerve, i.e., in contralateral regions. We evaluated the presence, magnitude, and chronology of mechanical and cold allodynia in the contralateral paw of rats undergoing unilateral ligation of the L5 and L6 spinal nerves. METHODS: Twenty-three male Sprague-Dawley rats underwent spinal nerve ligation of the left L5 and L6 spinal nerves (SNL group) and 7 rats received a sham surgery without nerve ligation (sham group). Signs of mechanical allodynia as assessed with von Frey filaments, and cold allodynia as assessed with the acetone drop test, were studied before surgery and throughout 21 postoperative days. Responses of ipsilateral and contralateral paws of the SNL group were compared between themselves and with those in the sham group. RESULTS: Rats in the SNL group developed mechanical and cold allodynia responses in the ipsilateral paw, and also in the contralateral paw. Allodynia in the contralateral paw appeared later, becoming statistically significant on day 10 after surgery for mechanical allodynia and on day 21 for cold allodynia as compared with the sham group. Contralateral pain was of a lower intensity than on the ipsilateral side. CONCLUSIONS: After L5 and L6 spinal nerve ligation, rats developed mechanical and cold allodynia in the contralateral paw, suggesting extraterritorial development of neuropathic signs. This finding has implications for future study design and therapeutic approaches.


Assuntos
Neuralgia/fisiopatologia , Nervos Espinhais/fisiopatologia , Animais , Temperatura Baixa , Modelos Animais de Doenças , Ligadura , Masculino , Estimulação Física , Ratos , Ratos Sprague-Dawley , Nervos Espinhais/lesões , Fatores de Tempo
15.
Med Clin (Barc) ; 127 Suppl 1: 3-20, 2006 Jul 18.
Artigo em Espanhol | MEDLINE | ID: mdl-17020674

RESUMO

The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, "C", "D", or "E", thus indicating the need for further controlled studies.


Assuntos
Hemorragia/terapia , Ácido Aminocaproico/administração & dosagem , Ácido Aminocaproico/efeitos adversos , Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Antifibrinolíticos/uso terapêutico , Aprotinina/administração & dosagem , Aprotinina/efeitos adversos , Aprotinina/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Substitutos Sanguíneos/administração & dosagem , Substitutos Sanguíneos/efeitos adversos , Substitutos Sanguíneos/uso terapêutico , Transfusão de Sangue Autóloga , Coloides/administração & dosagem , Coloides/efeitos adversos , Coloides/uso terapêutico , Soluções Cristaloides , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/efeitos adversos , Desamino Arginina Vasopressina/uso terapêutico , Medicina Baseada em Evidências , Fator VIIa/administração & dosagem , Fator VIIa/efeitos adversos , Fator VIIa/uso terapêutico , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Hematínicos/uso terapêutico , Hemodiluição , Hemorragia/tratamento farmacológico , Hemostáticos/administração & dosagem , Hemostáticos/efeitos adversos , Hemostáticos/uso terapêutico , Humanos , Ferro/administração & dosagem , Ferro/efeitos adversos , Ferro/uso terapêutico , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/efeitos adversos , Soluções Isotônicas/uso terapêutico , Recuperação de Sangue Operatório , Hemorragia Pós-Operatória/tratamento farmacológico , Pré-Medicação , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/efeitos adversos , Ácido Tranexâmico/uso terapêutico
16.
Reg Anesth Pain Med ; 31(5): 438-44, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16952816

RESUMO

BACKGROUND: The safety of ketamine when administered by the spinal route must be confirmed in various animal species before it is approved for use in humans. This study evaluates the ultrastructure of canine meninges after repeated doses of epidural S(+)-ketamine. METHODS: Five dogs received S(+)-ketamine 5%, 1 mg/kg, twice a day for 10 days through an epidural catheter with its tip located at the L5 level. One dog received the same volume of normal saline at the same times. The spinal cord and meninges were processed for histopathological and ultrastructural studies. Clinical effects were assessed after each injection. RESULTS: Motor and sensory block appeared after each injection of S(+)-ketamine, but not in the dog receiving saline. No signs of clinical or neurologic alterations were observed. Using light microscopy, no meningeal layer showed alterations except focal infiltration at the catheter tip level by macrophages, lymphocytes, and a few mast cells. The cells of different layers were studied by electron microscopy and interpreted according to data from human and other animal species because no ultrastructural description of the canine meninges is currently available. There were no cellular signs of inflammation, phagocytosis, or degeneration in meningeal layers and no signs of atrophy, compression, or demyelinization in the areas of dorsal root ganglia and spinal cord around the arachnoid. These findings were common for dogs receiving S(+)-ketamine and the dog receiving saline. CONCLUSION: Repeated doses of epidural S(+)-ketamine 5%, 1 mg/kg, twice a day for 10 days was not associated to cellular alterations in canine meninges.


Assuntos
Injeções Epidurais , Ketamina/administração & dosagem , Ketamina/toxicidade , Meninges/efeitos dos fármacos , Animais , Cães , Feminino , Meninges/ultraestrutura , Estereoisomerismo
17.
Med. clín (Ed. impr.) ; 127(supl.1): 3-20, jul. 2006. tab
Artigo em Espanhol | IBECS | ID: ibc-142063

RESUMO

El Documento de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica (ATSA) ha sido elaborado por un panel de expertos pertenecientes a 5 sociedades científicas. Han participado y patrocinado las sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) y Trombosis y Hemostasia (SETH). Las alternativas a la transfusión se han clasificado en farmacológicas y no farmacológicas, con un total de 4 módulos y 12 tópicos. La disminución de las transfusiones de sangre alogénica y/o el número de pacientes transfundidos fue la principal variable objetivo. El grado de cumplimiento de este objetivo, para cada ATSA, se llevó a cabo siguiendo la metodología Delphi, que clasifica el grado de recomendación desde «A» (apoyado por estudios controlados) hasta «E» (estudios no controlados y opinión de expertos). Los expertos concluyeron que la mayor parte de las indicaciones de las ATSA se sustentan en grados de recomendación medios y bajos, «C», «D» o «E», precisándose nuevos estudios controlados (AU)


The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, «C», «D», or «E», thus indicating the need for further controlled studies (AU)


Assuntos
Humanos , Hemorragia/tratamento farmacológico , Hemorragia/terapia , Ácido Aminocaproico/administração & dosagem , Ácido Aminocaproico/efeitos adversos , Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Hemodiluição , Aprotinina/administração & dosagem , Aprotinina/efeitos adversos , Aprotinina/uso terapêutico , Substitutos Sanguíneos , Transfusão de Sangue Autóloga , Coloides , Proteínas Recombinantes , Soluções Isotônicas
18.
Med Clin (Barc) ; 126 Suppl 2: 19-26, 2006 May 24.
Artigo em Espanhol | MEDLINE | ID: mdl-16759601

RESUMO

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT 2003 study was to describe the temporal distribution and types of anesthesia used in Catalonia, Spain, in 2003, along with the associated human resources used. PATIENTS AND METHOD: Data were used from a survey of 23,136 anesthetic procedures collected on 14 randomly selected days in 2003 and an individual questionnaire was completed by 765 anesthesiologists working in Catalonia. RESULTS: Anesthesia practice was divided into that associated with surgery (78.4%), obstetrics (11.3%), and other nonsurgical procedures (10.4%). Of all anesthetic procedures performed, 84.3% took place in operating theaters and 7.0% in obstetric areas. Emergency procedures accounted for 20.3% of the total. Most procedures (71.2%) were undertaken within 08:00 and 16:00 h, and the lowest number of procedures performed on workdays took place on Fridays. The median duration of anesthesia was 60 minutes. The most common technique was regional anesthesia (41.4%), with spinal block being the most widely used. There were an estimated 12.5 anesthesiologists per 100,000 inhabitants, with a median (10th-90th percentile) age of 45 (34-57) years; women made up 47.2% of that group. The mean number of standard working hours was 46 hours per week and 65% of anesthesiologists also undertook on duty shifts. Anesthesiologists spent 77% of their time performing anesthesia and the remainder in postoperative recovery and critical care units and pain clinics. CONCLUSIONS: Emergency anesthesia represents 20% of the total workload and obstetrics and nonsurgical procedures another 20%. The use of regional anesthesia was very widespread. The population density of anesthesiologists is comparable to that of other European countries, but with a higher proportion of women.


Assuntos
Anestesia/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Adulto , Idoso , Anestesia/métodos , Anestesia Obstétrica/métodos , Anestesia Obstétrica/normas , Anestesia Obstétrica/estatística & dados numéricos , Agendamento de Consultas , Sedação Consciente/estatística & dados numéricos , Estudos Transversais , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Amostragem , Espanha , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricos
19.
Med Clin (Barc) ; 126 Suppl 2: 3-12, 2006 May 24.
Artigo em Espanhol | MEDLINE | ID: mdl-16759599

RESUMO

BACKGROUND AND OBJECTIVE: The increasing workload in anesthesiology together with the shortage of anesthetists has led to worldwide concern within the specialty. In 2003, the Catalan Society of Anesthesiology, Critical Care and Pain Therapy undertook the ANESCAT survey to determine the anesthesia practice workload in Catalonia, Spain. PATIENTS AND METHOD: A set of 3 questionnaires was used to quantify anesthesia practice and resources. A sample size of 12,228 events was estimated to be necessary to be representative of the number of anesthetic procedures carried out in Catalonia annually. A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. Each hospital designated a coordinator responsible for ensuring that a questionnaire was filled in for each anesthetic procedure, to provide information about patient characteristics, anesthetic technique, and the intervention for which anesthesia was needed. RESULTS: All 131 public and private hospitals in which anesthetic procedures were carried out participated. The geographic distribution was as follows: Barcelona city, 54 (41.2%); rest of the province of Barcelona, 39 (29.8%); Tarragona, 15 (11.5%); Girona, 14 (10.7%), and Lleida, 9 (6.9%). A total of 23,136 questionnaires about anesthesia procedures were received; the number of questionnaires returned on the selected workdays varied by 1.85% and the percentage of incomplete returns was less than 5%. The number of individual anesthetists returning questionnaires for processing was 765. CONCLUSIONS: This large-scale study was possible thanks to a simple design and the strong motivation of a community of anesthesiologists. The results have provided an accurate picture of anesthesia practice within a specific geographical area. Such studies are necessary for introducing organizational changes and applying for additional resources.


Assuntos
Anestesia/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Padrões de Prática Médica/estatística & dados numéricos , Distribuição por Idade , Anestesia/métodos , Anestesiologia/tendências , Estudos Transversais , Demografia , Grupos Diagnósticos Relacionados , Pesquisas sobre Serviços de Saúde/métodos , Hospitais/estatística & dados numéricos , Humanos , Enfermeiras Anestesistas/estatística & dados numéricos , Estudos Prospectivos , Reprodutibilidade dos Testes , Amostragem , Distribuição por Sexo , Sociedades Médicas , Espanha , Inquéritos e Questionários , Recursos Humanos , Carga de Trabalho
20.
Med Clin (Barc) ; 126 Suppl 2: 40-5, 2006 May 24.
Artigo em Espanhol | MEDLINE | ID: mdl-16759604

RESUMO

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT 2003 study was to describe obstetric anesthesia and analgesia practice in Catalonia, Spain. PATIENTS AND METHOD: Using information obtained from a survey of anesthesia performed in Catalonia in 2003, data was identified on anesthesia for obstetric procedures: labor, cesarean section, and others unrelated to childbirth. Patient characteristics were analyzed along with anesthetic techniques and the rates at which they are used in the population. RESULTS: Obstetric procedures were performed in 71 hospitals (54% of the hospitals surveyed). Obstetric anesthesia represented 11.3% of total anesthesia practice, corresponding to an estimated 67,864 anesthetic procedures per year. Of those procedures, 87.7% were associated with labor and childbirth. An estimated 82% of the 71,851 births in Catalonia were assisted by an anesthesiologist. Cesarean sections accounted for 25.1% of births and the rate increased with age. Regional anesthesia for labor and cesarean section was used in 98.7% and 96.2% of cases, respectively. Epidural anesthesia was used in 96.9% of vaginal births. In elective and emergency cesarean sections, spinal block was used in 75.5% and 44.8% of cases, respectively, while epidural anesthesia was used in 23.3% and 53.3%, respectively. CONCLUSIONS: The anesthesia coverage for labor in Catalonia is the highest published. The use of regional anesthetic techniques in Catalonia is also the highest recorded. Although continuous epidural anesthesia is the most widely used technique, spinal block is also increasingly employed.


Assuntos
Analgesia Obstétrica/estatística & dados numéricos , Anestesia Obstétrica/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Analgesia Epidural/estatística & dados numéricos , Analgesia Obstétrica/métodos , Anestesia Epidural/estatística & dados numéricos , Anestesia Obstétrica/métodos , Raquianestesia/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Feminino , Humanos , Gravidez , Estudos Prospectivos , Amostragem , Espanha , Inquéritos e Questionários , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
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