RESUMO
We present a case of a healthy 64-year-old man whose endoscopy showed an irregular subepithelial lesion in the gastric antrum. This lesion was covered by normal mucosa. Biopsies were taken by a bite-on-bite technique. After biopsies, the patient developed arterial bleeding, which was controlled. The anatomopathological study showed a tortuous artery in the submucosa, with a marked hyperplasia of the intima and the internal elastic lamina. These findings were consistent with a gastric arteriovenous malformation versus a Dieulafoy's lesion. This case demonstrates the risk of the bite-on-bite biopsy technique. In our country we have endoscopic ultrasound to assess these lesions, however its availability is low.
Assuntos
Gastropatias , Doenças Vasculares , Malformações Vasculares , Masculino , Humanos , Pessoa de Meia-Idade , Endoscopia Gastrointestinal , Hemorragia , Biópsia , Hemorragia GastrointestinalRESUMO
INTRODUCTION: Helicobacter pylori infection affects approximately 70% of the Chilean population. It is a public health problem whose eradication treatment is part of the explicit health guarantees in Chile. OBJECTIVES: Characterize the most widely used H. pylori first-line eradication therapies in our environment and evaluate their efficacy. METHODS: A retrospective observational study was carried out where, in patients with certified H. pylori infection, the eradication therapy indicated by the treating physician, its efficacy, adherence and adverse effects, in addition to the eradication certification method used, were evaluated. RESULTS: 242 patients and 4 main therapies were analyzed: standard triple therapy, dual therapy, concomitant therapy, and bismuth quadruple therapy. Eradication rates of 81.9% (95% CI 74.44-87.63), 88.5% (95% CI 73.13-95.67), 93.7% (95% CI 78.07-98.44) and 97.6% (95% CI 84.81-99.67) were observed respectively, with concomitant therapy (RR: 1.14; 95% CI 1.01-1.29; p=.028) and quadruple therapy with bismuth (RR: 1.19; 95% CI 1.09-1.31; p<.001) being significantly more effective than standard triple therapy. Regarding the rate of reported adverse effects, it was 58.5% (95% CI 50.66-65.92), 35.4% (95% CI 24.6-48.11), 22.9% (95% CI 81-37.14) and 63.4% (95% CI 47.8-76.64), having the dual and concomitant therapy significantly fewer adverse effects compared with standard therapy. CONCLUSIONS: Quadruple therapies are superior to standard triple therapy and should be considered as first-line treatment in Chile. Dual therapy is promising. More studies will be required to determine which therapies are most cost-effective.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/efeitos adversos , Bismuto/uso terapêutico , Chile , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Humanos , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
OBJECTIVES: To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2. METHODS: We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using Kaplan-Meier curves. RESULTS: We included 32 patients; mean age was 43.7±17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients had detectable viral RNA in stools. The median clearance time in stools of the cohort was 11[10-15] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studies were performed in children and 55% were male. The pooled prevalence of viral detection in stools was 34.6% (twenty-four studies, 1393 patients; 95%CI:25.4-45.1); heterogeneity was high (I2:91.2%, Q:208.6; p≤0.001). A meta-regression demonstrates an association between female-gender and lower presence in stools (p=0.004). The median clearance time in stools was 22 days (nineteen studies, 140 patients; 95%CI:19-25). After 34 days, 19.9% (95%CI:11.3-29.7) of patients have a persistent detection in stools. CONCLUSIONS: Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions.
Assuntos
COVID-19 , SARS-CoV-2 , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , RNA Viral , Eliminação de Partículas ViraisRESUMO
BACKGROUND: The risk of neoplasia in gallbladder polyps seems to be low, but the evidence from populations at high-risk of gallbladder cancer is limited. We aimed to estimate the risk and to identify the factors associated with neoplastic polyps in a high-risk Hispanic population. METHODS: A retrospective cohort was recruited between January 2010 and December 2019 at a Chilean university center. Multivariate survival analyses were conducted. Fine-Gray models were fitted to account for competing risks. Covariate adjustment was conducted using propensity scores. The main outcome was the development of gallbladder adenomas or adenocarcinoma. RESULTS: Overall, 748 patients were included, 59.6% underwent cholecystectomy. The median follow-up of patients not subjected to cholecystectomy was 54.7 months (12-128.6 months). Seventeen patients (2.27%) developed the outcome. After adjustment by age, sex, intralesional blood flow, lithiasis and gallbladder wall thickening, only polyp size (≥10 mm, adjusted-HR: 15.01, 95%CI: 5.4-48.2) and number of polyps (≥3 polyps, adjusted-HR: 0.11, 95%CI: 0.01-0.55) were associated with neoplasia. CONCLUSION: In a Hispanic population at high-risk for gallbladder cancer, gallbladder polyps seem to have a low risk of neoplasia. Polyp size was the main risk factor, while having multiple polyps was associated with an underlying benign condition.
Assuntos
Carcinoma in Situ , Doenças da Vesícula Biliar , Neoplasias da Vesícula Biliar , Pólipos , Carcinoma in Situ/patologia , Estudos de Coortes , Seguimentos , Vesícula Biliar/patologia , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pólipos/epidemiologia , Pólipos/patologia , Pólipos/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Análise de SobrevidaRESUMO
BACKGROUND AND AIMS: Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students. METHODS: A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop. RESULTS: 247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5. CONCLUSIONS: Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment.
Assuntos
Educação de Graduação em Medicina/métodos , Paracentese/educação , Treinamento por Simulação , Competência Clínica , Educação/organização & administração , Feminino , Humanos , Masculino , Modelos Anatômicos , Adulto JovemRESUMO
Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.
Assuntos
Doença Antimembrana Basal Glomerular/patologia , Autoanticorpos/análise , Antibacterianos/uso terapêutico , Doença Antimembrana Basal Glomerular/diagnóstico por imagem , Doença Antimembrana Basal Glomerular/tratamento farmacológico , Biópsia , Ciclofosfamida/uso terapêutico , Imunofluorescência , Humanos , Nefropatias/patologia , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Recidiva , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
BACKGROUND: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. AIM: To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. MATERIAL AND METHODS: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. RESULTS: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. CONCLUSIONS: The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.
Assuntos
Competência Clínica/normas , Educação de Graduação em Medicina/métodos , Percepção , Treinamento por Simulação/métodos , Estudantes de Medicina/psicologia , Inquéritos e Questionários/normas , Técnica Delphi , Análise Fatorial , Feedback Formativo , Humanos , Padrões de Referência , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/psicologiaAssuntos
Neoplasias Pancreáticas/secundário , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Humanos , Excisão de Linfonodo , Metástase Linfática , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Resultado do TratamentoRESUMO
Background: The effectiveness of dietary therapy to induce remission of eosinophilic esophagitis (EoE) has been evaluated over the last decades and summarized in meta-analyses. Choosing the dietary modality, identifying the most suitable patients, and implementing specific prerequisites are essential to ensure long-term success. Summary: Impractical exclusive elemental diets provided the highest remission rates in EoE; however, they are not recommended due to their numerous disadvantages and detrimental effects on patient quality of life. Allergy testing-guided diets for EoE are limited; their insufficient effectiveness and low reproducibility are due to poor accuracy of skin or serum test results in identifying EoE food triggers. Initial experiences with a six-food elimination diet have provided evidence of high and predictive effectiveness rates and paved the way for less restrictive and more efficient step-up approaches, including four-food, two-food, and most recently, milk elimination diets. Dietary treatment for EoE is challenging for patients and families and requires certain skills to ensure success in the short and long term. Key Messages: The selection of appropriate patients is essential to ensure the success of and long-term adherence to dietary treatment of EoE. As normal triggers for EoE are commonly found in the staple diet, it is important to ensure adequate nutritional substitutes to avoid nutrient deficiency risks when long-lasting feeding difficulties or extensive restrictions are present. Specialized facilities in dietary therapy should adopt patient-centered and personalized approaches in order to provide timely monitoring and support for complex cases.
RESUMO
BACKGROUND: Oesophageal disorders and chronic liver disease are common worldwide and significantly impact quality of life. The intricate link between these conditions, including how oesophageal disorders like GERD, Barrett's oesophagus and oesophageal cancer affect and are affected by chronic liver disease, remains poorly understood. AIMS: To review the relationship between oesophageal disorders and chronic liver disease, evaluating epidemiology, pathophysiology and therapeutic factors. METHODS: We reviewed the literature on the relationship between oesophageal disorders and chronic liver disease, including cirrhosis, using the PubMed database RESULTS: Oesophageal disorders such as gastroesophageal reflux disease, Barrett's oesophagus, oesophageal cancer, oesophageal motor disorders and oesophageal candidiasis are prevalent among individuals with cirrhosis, exacerbating the burden of liver disease. These diseases have a multifaceted symptomatology and pathogenic basis, posing a significant challenge in cirrhotic patients that necessitates careful diagnosis and management. Additionally, therapies frequently used for these diseases, such as proton pump inhibitors, require careful consideration in cirrhotic patients due to potential adverse effects and altered pharmacokinetics. Managing oesophageal disorders in cirrhotic patients requires a cautious approach due to possible interactions with medications and the risk of adverse effects. Furthermore, symptoms associated with these conditions are often exacerbated by common interventions in patients with cirrhosis, such as band ligation for oesophageal varices. CONCLUSIONS: Oesophageal disorders are common in cirrhosis and increase the disease burden. These conditions require careful management due to complex symptoms and treatment risks. Proton pump inhibitors and other therapies must be used cautiously, as cirrhosis interventions can worsen symptoms.
Assuntos
Doenças do Esôfago , Hepatopatias , Humanos , Doenças do Esôfago/fisiopatologia , Doenças do Esôfago/etiologia , Doenças do Esôfago/complicações , Hepatopatias/complicações , Hepatopatias/fisiopatologia , Doença Crônica , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Qualidade de Vida , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
Pancreatic metastases of papillary thyroid carcinoma (PTC) are exceptional. We report a 80-year-old man consulting for obstructive jaundice and dysphonia. Abdominal ultrasonography showed biliary dilation and abdominal magnetic resonance imaging (MRI) showed a pancreatic head mass of 36 mm. A left vocal cord paralysis was confirmed and cervical computed tomography (CT) showed multiple thyroid nodules of up to 35 mm associated with bilateral cervical lymph nodes (LN). Positron emission tomography ( 18 F-FDG PET/CT) evidenced hyper-metabolic activity in bilateral cervical LN, lungs, pancreas and left intercostal soft tissue, as well as left gluteus. Thyroid biopsy reported a tall-cell variant of PTC, and endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic mass confirmed PTC metastasis. The molecular study was positive for BRAFV600E. Pancreatic metastasis from PTC can be accurately diagnosed with 18 F-FDG PET/CT and EUS-FNA, which is consistent with a predominant expression of BRAFV600E mutation and, thus, an aggressive presentation with poor short-term survival.
Assuntos
Humanos , Neoplasias Pancreáticas/secundário , Neoplasias da Glândula Tireoide/patologia , Câncer Papilífero da Tireoide/patologia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Tireoidectomia , Neoplasias da Glândula Tireoide/cirurgia , Resultado do Tratamento , Câncer Papilífero da Tireoide/cirurgia , Excisão de Linfonodo , Metástase LinfáticaRESUMO
Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Autoanticorpos/análise , Doença Antimembrana Basal Glomerular/patologia , Recidiva , Biópsia , Prednisona/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Imunofluorescência , Doença Antimembrana Basal Glomerular/tratamento farmacológico , Doença Antimembrana Basal Glomerular/diagnóstico por imagem , Ciclofosfamida/uso terapêutico , Nefropatias/patologia , Glomérulos Renais/patologia , Antibacterianos/uso terapêuticoRESUMO
Background: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. Aim: To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. Material and Methods: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. Results: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. Conclusions: The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.
Assuntos
Humanos , Percepção , Estudantes de Medicina/psicologia , Inquéritos e Questionários/normas , Competência Clínica/normas , Educação de Graduação em Medicina/métodos , Treinamento por Simulação/métodos , Padrões de Referência , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/psicologia , Reprodutibilidade dos Testes , Análise Fatorial , Técnica Delphi , Feedback FormativoRESUMO
Objectives: To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2. Methods: We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using KaplanMeier curves. Results: We included 32 patients; mean age was 43.7±17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients had detectable viral RNA in stools. The median clearance time in stools of the cohort was 11[1015] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studies were performed in children and 55% were male. The pooled prevalence of viral detection in stools was 34.6% (twenty-four studies, 1393 patients; 95%CI:25.445.1); heterogeneity was high (I2:91.2%, Q:208.6; p≤0.001). A meta-regression demonstrates an association between female-gender and lower presence in stools (p=0.004). The median clearance time in stools was 22 days (nineteen studies, 140 patients; 95%CI:1925). After 34 days, 19.9% (95%CI:11.329.7) of patients have a persistent detection in stools. Conclusions: Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions.(AU)
Objetivos: 1. Evaluar la detección de ARN viral en deposiciones y su tiempo de excreción en una cohorte de pacientes con SARS-CoV-2; 2. Realizar una revisión sistemática para evaluar el tiempo de excreción en deposiciones del SARS-CoV-2. Métodos: Estudio de cohorte prospectiva en dos centros entre marzo-mayo del 2020. Incluimos pacientes infectados con SARS-CoV-2 de cualquier edad y gravedad. Recolectamos secreciones nasofaríngeas y deposiciones en forma seriada para detectar SARS-CoV-2. También realizamos una revisión sistemática de la prevalencia y excreción del SARS-CoV-2 en deposiciones (PROSPERO-ID: CRD42020192490). Estimamos la prevalencia usando un modelo de efectos aleatorios. Evaluamos el tiempo de excreción usando curvas Kaplan-Meier. Resultados: Incluimos 32 pacientes; edad media 43 ± 17,7 años, 43,8% eran mujeres y 40,6% reportaron síntomas gastrointestinales. Veinticinco por ciento (8/32) tenían ARN viral detectable en deposiciones. La mediana de excreción en deposiciones fue 11 [10-15] días. La revisión sistemática incluyó 30 estudios (1.392 pacientes) con muestras en deposiciones. Seis estudios fueron realizados en niños y 55% eran hombres. La prevalencia estimada de detección viral en deposiciones fue de 34,6% (24 estudios, 1.393 pacientes; IC 95%: 25,4-45,1); la heterogeneidad fue elevada (I2: 91,2%; Q: 208,6; p ≤ 0,001). Una metarregresión demostró una asociación entre el género femenino y menor prevalencia en deposiciones (p = 0,004). La mediana de tiempo de excreción fueron 22 días (19 estudios, 140 pacientes; IC 95%: 19-25). Tras 34 días, 19,9% (IC 95%: 11,3-29,7) de los pacientes tenían detección persistente en deposiciones. Conclusiones: La detección de SARS-CoV-2 en deposiciones es un hallazgo frecuente. La excreción del SARS-CoV-2 en deposiciones es prolongada y es más tardía que en secreciones nasofaríngeas.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Infecções por Coronavirus , Diarreia , Disenteria , RNA Viral , Manejo de Espécimes , Gastroenterologia , Hepatopatias , Estudos de Coortes , Estudos Prospectivos , 28599RESUMO
Resumen: El aprendizaje de los estudiantes de Medicina de Pregrado en ambiente simulado constituye una alternativa en la obtención de competencias técnicas y no técnicas. Objetivo: Desarrollar un fantoma e implementar un taller modular de entrenamiento de paracentesis abdominal en ambiente simulado para estudiantes de Medicina. Métodos: Se diseñaron y desarrollaron modelos para la realización de paracentesis abdominal en la Escuela de Diseño de la Pontificia Universidad Católica de Chile (PUC) y se implementó un taller para alumnos de 4to año de Medicina de la PUC, utilizando un enfoque constructivista, sesiones de entrenamiento simulado con debriefing basadas en el modelo plus-delta y evaluación pre y post-procedimiento siguiendo los principios de evaluación para el aprendizaje. Resultados: Se desarrollaron 3 prototipos hasta llegar a un modelo definitivo de alta fidelidad basado en la percepción de 20 expertos. 237 alumnos asistieron a un taller de paracentesis abdominal en el Centro de Cirugía Experimental y Simulación Universidad Católica (UC). Este consistió en una actividad práctica grupal (7-8 alumnos por sesión) que incluyó: una evaluación pre-sesión, un vídeo instruccional, una demostración en tiempo real en el fantoma por parte de un docente, la realización guiada del procedimiento por parte de los alumnos, debriefing y cierre de la sesión. Conclusiones: Un modelo de enseñanza en ambiente simulado es posible de ser diseñado e implementado exitosamente en un centro educacional para estudiantes de Medicina de Pregrado. Este taller de paracentesis permite entrenar a los alumnos en la realización de paracentesis abdominal en un ambiente seguro para los alumnos y pacientes y puede ser implementado a bajo costo en otros centros o instituciones. (AU)
Abstract: Simulated environments are an option in the learning process of undergraduate medical students in order to obtain technical and non-technical. Aim: To develop a mannequin for abdominal paracentesis and the implementation of a training workshop to perform abdominal paracentesis in a simulated environment for undergraduate medical students. Methods: The prototypes were designed and developed to perform abdominal paracentesis at the School of Design at the Pontificia Universidad Católica de Chile (PUC) and a workshop was implemented in a course with 4-year medical students at the PUC, using a constructivist approach and simulated training sessions and providing debriefing (based on plus-delta model) and pre-post training assessment following the principles of Assessment for Learning. Results: Three prototypes were developed until the final high-fidelity-mannequin was achieved. The abdominal paracentesis workshop was attended by 237 students at the Universidad Católica (UC) Experimental Surgery and Simulation Center. This was a hands-on group activity (7-8 students per session) including pre-session assessment, instructional video-tape, real-time demonstration of abdominal paracentesis procedure by the clinical teacher, followed by abdominal paracentesis performed by the students, debriefing and closing session. Conclusions: A teaching model in a simulated environment is feasible to be successfully designed and implemented in an educational center for undergraduate medical students. This workshop allows students training process to perform abdominal paracentesis in a safe environment for students and patients and it can be implemented in other centers or institutions with low cost.(AU)
Assuntos
Humanos , Masculino , Feminino , Ensaios Clínicos Adaptados como Assunto , Estudantes de Medicina , Paracentese , Educação Médica , AbdomeRESUMO
Background and aims: Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students. Methods: A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop. Results: 247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5. Conclusions: Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment
Antecedentes: La paracentesis abdominal es una competencia que todo médico general debe conocer, y el modelo de aprendizaje actual no es seguro para los pacientes. La simulación permite a los estudiantes desarrollar habilidades antes del enfrentamiento clínico minimizando riesgos. Los objetivos de este estudio han sido diseñar y evaluar un taller de simulación de paracentesis para estudiantes de pregrado. Métodos: Se implementó un taller de paracentesis abdominal, utilizando un fantoma especialmente diseñado y validado. La enseñanza de la técnica consideró el reconocimiento de materiales, equipo del operador, asepsia, anestesia, punción y obtención de líquido, recolección de muestras para análisis, extracción del material y oclusión. Para la evaluación se usó una pauta de observación directa (24 puntos). Dos estudiantes por grupo fueron evaluados al comienzo del taller y todos los alumnos se evaluaron al final. Al término del taller se aplicó una encuesta de percepción a los asistentes. Resultados: Se incluyeron 247 estudiantes en un taller que involucraba 8 alumnos por sesión. Los estudiantes mejoraron significativamente sus habilidades al comparar los resultados de la pre-evaluación versus la postevaluación (13,36±4,46 [55,7%] vs. 22,3±1,83 [92,9%], respectivamente [n=69]; p<0,001]. El cuestionario de percepción de los estudiantes (n=38) demostró que las sesiones de entrenamiento fueron valoradas positivamente, con un promedio de 4,8±0,38 en la escala de Likert de 1-5. Conclusiones: El entrenamiento simulado en paracentesis es un muy buen método de enseñanza. Esta metodología debe ser altamente recomendada como estrategia educacional en medicina, ya que podría acelerar la adquisición de habilidades clínicas en un ambiente de aprendizaje seguro