Patterns of recovery in extant and extirpated seabirds after the world's largest multipredator eradication.

Eradicating invasive predators from islands can result in substantial recovery of seabirds, but the mechanisms that drive population changes remain poorly understood. Meta-analyses have recently revealed that immigration is surprisingly important to the recovery of philopatric seabirds, but it is not known whether dispersal and philopatry interact predictably to determine rates of population growth and changes of distribution. We used whole-island surveys and long-term monitoring plots to study the abundance, distribution, and trends of 4 burrowing seabird species on Macquarie Island, Australia, to examine the legacy impacts of invasive species and ongoing responses to the world's largest eradication of multiple species of vertebrates. Wekas (Gallirallus australis) were eradicated in 1988; cats (Felis catus) in 2001; and rabbits (Oryctolagus cuniculus), black rats (Rattus rattus), and mice (Mus mus) in 2011-2014. We compared surveys from 1976-1979 and 2017-2018 and monitoring from the 1990s and 2000s onward. Antarctic prions (Pachyptila desolata) and white-headed petrels (Pterodroma lessonii) increased ∼1% per year. Blue petrels (Halobaena caerulea) and gray petrels (Procellaria cinerea) recolonized following extirpation from the main island in the 1900s but remained spatially and numerically rare in 2018. However, they increased rapidly at 14% and 10% per year, respectively, since cat eradication in 2001. Blue and gray petrel recolonization occurred on steep, dry, west-facing slopes close to ridgelines at low elevation (i.e., high-quality petrel habitat). They overlapped <5% with the distribution of Antarctic prion and white-headed petrels which occurred in suboptimal shallow, wet, east-facing slopes at high elevation. We inferred that the speed of population growth of recolonizing species was related to their numerically smaller starting size compared with the established species and was driven by immigration and selection of ideal habitat.

Patrones de recuperación en aves marinas existentes y extirpadas después de la mayor erradicación mundial de multidepredadores Resumen La erradicación de depredadores invasores en las islas puede derivar en la recuperación sustancial de aves marinas, aunque entendemos muy poco los mecanismos que causan los cambios poblacionales. Los metaanálisis recientes han revelado que la inmigración es de gran importancia para la recuperación de aves marinas filopátricas, aunque no sabemos si la dispersión y la filopatría interactúan de forma predecible para poder determinar las tasas de crecimiento poblacional y los cambios en la distribución. Aplicamos censos de isla completa y parcelas de monitoreo a largo plazo para estudiar la abundancia, distribución y tendencias de cuatro especies de aves marinas cavadoras en la Isla Macquarie, Australia, para analizar los impactos heredados de las especies invasoras y la respuesta continua a la mayor erradicación mundial de varias especies de vertebrados. El rascón weka (Gallirallus australis) se erradicó en 1988; los gatos (Felis catus) en 2001; y los conejos (Oryctolagus cuniculus), ratas (Rattus rattus) y ratones (Mus mus) entre 2011 y 2014. Comparamos los censos de 1976­1979 y 2017­2018 y el monitoreo realizado en los 90s y del año 2000 en adelante. El pato petrel antártico (Pachyptila desolata) y el petrel cabeciblanco (Pterodroma lessonii) incrementaron ∼1% por año. El petrel azulado (Halobaena caerulea) y la pardela gris (Procellaria cinerea) recolonizaron la isla después de su extirpación en la década de 1900, pero todavía eran especies raras espacial y numéricamente en 2018. Sin embargo, esta especie incrementó rápidamente en un 14% y 10% por año respectivamente desde que se erradicaron los gatos en 2001. La recolonización ocurrió desde las laderas empinadas, secas y con orientación al oeste en los sistemas montañosos de baja elevación (es decir, hábitats de gran calidad para los petreles). La distribución del petrel azulado y la pardela gris ocurrió en laderas someras subóptimas y húmedas con orientación al este a altas elevaciones. Esta distribución se traslapó menos del 5% con la del pato petrel antártico y la del petrel cabeciblanco. Inferimos que la velocidad del crecimiento poblacional de las especies que recolonizaron estuvo relacionada con el menor tamaño inicial en comparación con las especies establecidas y fue causada por la inmigración y la selección del hábitat ideal.

Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing.

OBJECTIVE: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. DESIGN: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. SETTING: PC of the Andalusian Health Service. PARTICIPANTS: The study was completed by 80 healthcare professionals from 31 PC centers. INTERVENTIONS: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. MAIN MEASUREMENTS: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. RESULTS: Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. CONCLUSIONS: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.

[Family and community medicine: The most chosen specialty in the MIR]. / Medicina familiar y comunitaria: la especialidad más elegida en el MIR.

Family and Community Medicine is the most offered and chosen specialty in the MIR (Spanish medical residency examination), however, every year its attractiveness is questioned due to not all offered positions being filled and a certain number of resident doctors deciding not to continue in this specialty once started. In this context, some of the proposals to address the problem focus on increasing the supply when the facts show that the challenge lies in addressing the demand by making the specialty and its professional scope more attractive. The problem and its determinants are analyzed in this context by focusing on four elements that may be influencing it: the vocational aspects of medical graduates who pursue specialization, the characteristics of the specialty program and the teaching units where training is carried out, the presence of family medicine in the university as a key element for knowledge and affinity to this specialty from undergraduate studies, and finally, the situation of primary care as the space where training is materialized and the priority setting for the professional practice of future specialists.

Health sciences graduates: perception of their professional training and job placement.

BACKGROUND: The follow-up of health sciences graduates is relevant due to the commitment of universities to train professionals who contribute to solve the country's health problems. The National Autonomous University of Mexico (UNAM) has health sciences graduates who join the workforce every year. OBJECTIVE: To identify the perception of health sciences graduates regarding the curriculum and their incorporation into the labor market from 1994 to 2015, and compare it according to the degree program and campus. MATERIAL AND METHODS: Observational, cross-sectional, comparative, quantitative study. The sample of 26,866 graduates was obtained from information of three decades of the institutional questionnaire for graduates applied by the General Directorate of Planning of the UNAM. RESULTS: Most graduates were females (68.4%), with admission to the degree course at between 19 and 20 years of age (65.4%). At least 47% had a job; incorporation into the labor market depended on not having an income, a higher grade point average, not having presented extraordinary exams, or failed subjects, among others. CONCLUSIONS: Adequate job insertion is associated with starting the degree course at age 18, having financial support, having an average of 8.1 or higher and perceiving low academic and teaching training.

ANTECEDENTES: El seguimiento de egresados en ciencias de la salud es de relevancia debido al compromiso de las universidades de formar profesionales que contribuyan a resolver los problemas de salud del país. La Universidad Nacional Autónoma de Mexico (UNAM) cuenta con egresados en ciencias de la salud que cada año se incorporan al campo laboral. OBJETIVO: Identificar la percepción de los egresados de ciencias de la salud de 1994 a 2015 respecto su formación académica y su incorporación laboral, y compararla según licenciatura y plantel. MATERIAL Y MÉTODOS: Estudio observacional, transversal, comparativo y cuantitativo. La muestra de 26 866 graduados se obtuvo de la información de tres décadas del cuestionario institucional para egresados de la Dirección General de Planeación de la UNAM. RESULTADOS: La mayoría de los egresados fue del sexo femenino (68.4 %), con ingreso a la licenciatura entre los 19 y 20 años (65.4 %). Al menos 47 % trabajaba; la incorporación laboral dependió de no contar con ingresos, mayor promedio, no haber presentado exámenes extraordinarios ni recursado materias, entre otros. CONCLUSIONES: La inserción laboral adecuada se asocia a iniciar la licenciatura a los 18 años, contar con apoyo económico, tener promedio de 8.1 o más y percibir la formación académica y docente baja.

[Assessment of basic training needs in palliative care in primary healthcare nurses in Spain]. / Valoración de necesidades formativas de nivel básico en cuidados paliativos en enfermeras de atención primaria en España.

AIM: Asses training, perception of readiness and training needs in palliative care (PC) theoretical and practical of primary care nurses in Spain, through descriptive cross-sectional study. DESIGN: Descriptive cross-sectional study. SETTING: Primary care nurses in Spain with online access. PARTICIPANTS: Primary care nurses in Spain, January and February 2021. 344 responses, 339 met the inclusion criteria. MAIN NEASUREMENTS: Sociodemographic variables, PC training, training needs were analyzed. Through Google Forms online questionnaire and INCUE Instrument. Descriptive analyses were performed and the results were compared using the exact symmetry test and the Mann-Whitney test. RESULTS: 82,6% women, with an average age of 45.5years. 86.1% of the nurses had training in PC, been basic in the 45.4%. Only 40.5% feel quite or very prepared to take care for palliative patients. Nurses demanded more training in psycho-emotional and grief and coping with losses. 83.76% passed the theoretical block compared to 43.36% of the practical, detecting higher training needs in the last (P<.001). The passed rates varied depending on the educational level. CONCLUSIONS: Nursing training in PC in primary care continues to be deficient, especially in practical application. Targeted training is necessary to have an impact on the care of people with palliative needs and their families.

[Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia]. / Impacto de la formación y aspectos legales en la aplicación de la gestión enfermera de la demanda por parte de las enfermeras de atención primaria de Cataluña.

OBJECTIVE: To evaluate the experience of primary care nurses in the application of nurse demand management (NDM). DESIGN: Observational, cross-sectional descriptive study. LOCATION: Primary care in Catalonia. PARTICIPANTS: Nurses in the field of primary care in Catalonia. A sample of 394 responses was estimated and 405 were finally obtained. Data collection was from October 2021 to January 2022. MAIN MEASUREMENTS: An ad hoc questionnaire was developed which explored aspects related to the experience of applying NDM: definition and management of the program, training, and legal concerns of the program. RESULTS: Nurses understand NDM as triage. In addition, they consider that the implementation of nurse prescription would not improve the application of NDM. They express a lack of training, especially among the younger nurses. They consider that the ideal training in NDM, should include physiopathology and practical cases. Seven out of ten nurses are unaware of the legal framework that protects NDM and feel insecure about not knowing it. Six out of ten nurses have stopped being resolutive due to fear of legal repercussions. Nurses who are aware of the legal framework are those who have stopped resolving in the lowest proportion. CONCLUSIONS: There is a need for general training in NDM and in the legal aspects that cover the program, especially for younger nurses with less experience in primary care. This will improve the application and acceptance of the autonomous nursing role in the management of acute minor illnesses.

[Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)]. / Impacto de la formación en entrevista motivacional para médicos: diseño y evaluación de un Programa Formativo (MOTIVA).

AIM: To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. STUDY DESIGN: Multicenter, double blind and randomized clinical essay, with 2arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. LOCATION: 32 Primary Healthcare Centers. SAMPLE DESCRIPTION: 54 physicians (CG=28, EG=26). INTERVENTIONS: Training Program MOTIVA in ME with an initial presential course (16h), followed by online activities during 12months, and presential meetings (Problem BasedInterviewing with expert feedback). MAIN MEASUREMENTS: Communicative skills in MI were assessed based on video-recordings (VR) with the EVEM 2.0 scale by peer reviewers. 236 VR with standardized patients and 96 VR with real patients. RESULTS: Average results in EVEM scale (up to 56 points) at the beginning of the study were EG=21.27 (CI 95% 15.8-26.7) and CG=20.23 (CI95% 16.4-23.9) with no differences between both groups (P=.79). After the training, EG punctuation increased by 13.89 points (P<.001), average 35.16 (CI 95% 29.8-40.6). Real patients' VR in EG over a 12 month period keep their MI skills with an average of 36.9 points (CI 95% 30.3-43.6) versus CG 15.9 points (CI 95% 9.8-22.0). Once ended the MOTIVA Training Program, the EG maintains the acquired skills: final average EG=37.6 (CI 95% 33.2-41.1) versus CG=24.3 (CI95% 19.0-29.2) (P<.001). CONCLUSIONS: The MOTIVA Training Program improves Motivational Interviewing skills, significatively improving after a presential course and sequential keep-alive activities. The effectiveness of the Program has been proven in the Third and Fourth steps of Miller's Pyramid.

[Patient safety training and a safe teaching in primary care]. / La formación en seguridad del paciente y una docencia segura en atención primaria.

This narrative review manuscript aims to raise the difficulties and opportunities for patient safety in specialised healthcare training considering undergraduate, postgraduate, specialist and continuing education, even during the COVID-19 pandemic. It also suggests some proposals for carrying it out. It very briefly discusses this specific training and its current situation in primary care. Highlighting that patient safety is a need, an area of competence and a training opportunity for residents. It establishes the general framework of patient safety in primary care in the document "7 steps for Patient Safety in Primary Care", stating the need for a systemic approach. It highlights the elaboration and presentation of cases on clinical errors as the most frequent training strategy. The real-life clinical scenarios relate to difficult patients, critical incidents and bioethics issues in professional practice. These scenarios have as common characteristics, the fact to produce difficulties and suffering for all the actors involved. Several instruments for training in patient safety are also included. The medium-term goal is to consolidate clinical safety in specialised healthcare training. Finally, an analysis is made of the impact of the pandemic on patient safety training, particularly on specialised healthcare training and some proposals are recommended on how to carry out safe teaching in the times of the COVID-19 pandemic.

[Patient participation in its own safety]. / La participación del paciente en su seguridad.

Patient-centered approach to care and regulatory advances developed in recent years have promoted patient involvement in decision-making about diagnostic tests and treatments. In other aspects, such as participating in their own safety, there is still a lot to do. Until recently, the patient has been considered as a simple health services receiver, not as an active part of the system, much less as a safety barrier against failures and errors that occur in health care. Some patients have been activated thanks to their experiences. However, many others do not. That is why it is necessary to proactively sensitize, inform and train patients to participate in their own safety. It is not about holding them responsible, but about facilitating and promoting their participation by reinforcing their safety during the care process. The health system must be committed, and the patient informed and trained. We provide tools and online resources to apply in primary care.

Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study.

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees' participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees' experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees' development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.

Este estudio exploratorio cualitativo analiza las experiencias y los significados asociados con la participación de practicantes de terapia familiar en la práctica narrativa con grupos de testigos externos (OWG; White, 2007). En el Barcai Institute de Tel Aviv, incorporamos grupos de testigos externos en nuestros cursos de supervisión clínica en vivo. En algunas sesiones, ofrecemos a las familias que están en terapia la oportunidad de escuchar las reflexiones del grupo de practicantes con respecto a lo que observaron durante la sesión. Veintinueve practicantes de terapia familiar participaron en el estudio en cinco entrevistas de grupos focales. Los análisis de las entrevistas arrojaron cuatro temas principales relativos a las experiencias de los practicantes: (a) el análisis de la postura del terapeuta; (b) el arte de escuchar; (c) la reflexión sobre la jerarquía y la fijación de límites; y (d) la negociación de la autorrevelación. Los resultados indican que los practicantes de terapia familiar salen ganando considerablemente en su recorrido, desarrollo y crecimiento profesional como consecuencia de la integración de las prácticas de grupos de testigos externos en su formación. Los grupos de testigos externos fomentan el desarrollo de la reflexividad crítica en los practicantes, incluida la deconstrucción de los supuestos comunes y dados por sentado. También promueven las prácticas relacionadas con la terapia familiar, y quizá también con la terapia en general. Los resultados también sugieren que formar parte de los grupos de testigos externos durante la formación puede contribuir al desarrollo de la reflexividad crítica de los practicantes de terapia familiar como forma de incorporar un enfoque más crítico y político de la terapia y desarrollar sus propias historias preferidas como terapeutas.

Consensus document for the training of residents in cardiovascular risk. / Documento de consenso para la formación de residentes en riesgo vascular.

Vascular disease is currently a major health problem, not only for its high prevalence but also for the considerable morbidity, mortality and disability that it entails. Medical internists play a central role in diagnosing and treating vascular disease and controlling the cardiovascular risk factors (CRFs) that cause it. In fact, the clinical care of patients in cardiovascular risk units is a specific characteristic of an internist's field of action. This article contains the consensus document for the training of residents in CRFs. This proposal by the Cardiovascular Risk Workgroup of the Spanish Society of Internal Medicine emerged as a response by our Society to the specific need for training in CRFs. Implementing this proposal would provide an important benefit, not only for medical internists in training but also for society as a whole.

Validity of thoracic ultrasonography to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure. / Validez de la ecografía torácica para descartar neumotórax iatrogénico realizada por neumólogos sin experiencia en este procedimiento.

INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of thoracic ultrasonography to rule out pneumothorax after invasive procedures, conducted by pulmonologists without experience in this procedure. MATERIAL AND METHODS: Our observational prospective study consecutively included patients who underwent transbronchial biopsy (TBB), evacuating thoracentesis (ECT) and/or transparietal pleural biopsies (TPB) who were indicated subsequent chest radiography to rule out complications. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the «barcode¼ sign. RESULTS: We included 275 procedures (149 TBBs, 36 TPBs, 90 ECTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and a positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Thoracic ultrasonography performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.

State of endoscopic ultrasonography in Spain in 2017. / Estado de la ecoendoscopia en España en 2017.

AIM: To understand the current state of endoscopic ultrasonography (EUS) in Spain. METHODS: Descriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists. RESULTS: Sixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7,446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2-8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6months (0.5-36). CONCLUSIONS: EUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training program since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.

Biofilm-forming capacity of blood-borne Candida albicans strains and effects of antifungal agents.

Infections related to Candida albicans biofilms and subsequent antifungal resistance have become more common with the increased use of indwelling medical devices. Regimens for preventing fungal biofilm formation are needed, particularly in high-risk patients. In this study, we investigated the biofilm formation rate of multiple strains of Candida albicans (n=162 clinical isolates), their antifungal susceptibility patterns, and the efficacy of certain antifungals for preventing biofilm formation. Biofilm formation was graded using a modified Christensen's 96-well plate method. We further analyzed 30 randomly chosen intense biofilm-forming isolates using the XTT method. Minimum biofilm inhibition concentrations (MBIC) of caspofungin, micafungin, anidulafungin, fluconazole, voriconazole, posaconazole, itraconazole, and amphotericin B were determined using the modified Calgary biofilm method. In addition, the inhibitory effects of antifungal agents on biofilm formation were investigated. Our study showed weak, moderate, and extensive biofilm formation in 29% (n=47), 38% (n=61), and 23% (n=37) of the isolates, respectively. We found that echinocandins had the lowest MBIC values and that itraconazole inhibited biofilm formation in more isolates (26/32; 81.3%) than other tested agents. In conclusion, echinocandins were most effective against formed biofilms, while itraconazole was most effective for preventing biofilm formation. Standardized methods are needed for biofilm antifungal sensitivity tests when determining the treatment and prophylaxis of C. albicans infections.

[Promoting directives of the Quality Law of the Spanish National Health System: Computer-interpretable clinical practice guidelines]. / Impulsando las directrices de la Ley de Calidad del SNS: modelos computacionales de guías de práctica clínica.

The Cohesion and Quality Act of the National Health System promotes the use of new technologies to make it possible for health professionals put the scientific evidence into practice. In order to do this, there are technological tools, known as of computer-interpretable guidelines, which can help achieve this goal from an innovation perspective. They can be adopted using an iterative process, having a great initial potential as an educational tool, of quality and safety of the patient, in the decision making and, optionally, can be integrated with the electronic medical history, once they are rigorously validated. This article presents updates on these tools, reviews international projects, and personal experiences in which they have demonstrated their value, and highlights the advantages, risks, and limitations they present from a clinical point of view.

Criteria for training and accreditation in Interventional Neuroradiology-Neurointervention, approved by the Spanish Group of Interventional Neuroradiology (GENI), the Spanish Society of Neuroradiology (SENR), the Spanish Group of Cerebrovascular Diseases (GEECV), the Spanish Society of Neurology (SEN), and the vascular disease specialists in the Spanish Society of Neurosurgery (SENEC). Requirements for accreditation in Interventional Neuroradiology-Neurointervention for institutions and specialists. / Criterios para la formación y capacitación en Neurorradiología Intervencionista-Neurointervencionismo, acordados por el Grupo Español de Neurorradiología Intervencionista (GENI), la Sociedad Española de Neurorradiología (SENR), el Grupo de Estudio de Enfermedades Cerebrovasculares (GEECV) de la Sociedad Española de Neurología (SEN) y el grupo experto en enfermedades vasculares de la Sociedad Española de Neurocirugía (SENEC). Bases para la obtención de una Acreditación de Centros y Especialistas en Neurorradiología Intervencionista-Neurointervencionismo.

BACKGROUND: The development of endovascular techniques has put Interventional Neuroradiology (INR) as the first-option treatment in the majority of vascular diseases of the central nervous system. Scientific societies in developed countries have created standard procedures for training and accreditation for a safe practice in these procedures. DISCUSSION: In Spain, we are waiting for the development of the legislation on the accreditation for specialists which will establish the official formative model to achieve an accreditation in INR. Until this moment comes, it is necessary to establish standards that define desirable minimums for the formative period in INR. Radiology specialists as well as neurologists and neurosurgeons will have access to INR accreditation. Specific requirements for the hospitals that wish to offer this technique and training should also be defined. CONCLUSION: The Spanish Group of Interventional Neuroradiology (GENI), the Spanish Society of Neuroradiology (SENR), the Spanish Group of Cerebrovascular Diseases (GEECV), the Spanish Society of Neurology (SEN) and the Spanish Society of Neurosurgery (SENEC) have approved the content of this document and will create a committee in order to put into practice the accreditation of formative centres and INR specialists.

Pediatric and neonatal transport in Spain, Portugal and Latin America. / Transporte pediátrico y neonatal en España, Portugal y Latinoamérica.

OBJECTIVE: To study the organization of inter-hospital transport of pediatric and neonatal patients in Spain, Portugal and Latin America. DESIGN: An observational study was performed. An on-line survey was sent by email including questions about characteristics of national, regional and local health transport systems, vehicles, material, and composition of the transport team and their training. SETTING: Hospital pediatric healthcare professionals treating children in Spain, Portugal and Latin America RESULTS: A total of 117 surveys from 15 countries were analyzed. Of them, 55 (47%) come from 15 regions of Spain and the rest from Portugal and 13 Latin American countries. The inter-hospital transport of pediatric patients is unified only in the Spanish regions of Baleares and Cataluña and in Portugal. Chile has a mixed unified transport system for pediatric and adult patients. Only 51.4% of responders have an educational program for the transport personnel, and only in 36.4% of them the educational program is specific for pediatric patients. In Spain and Portugal the transport is executed mostly by public entities, while in Latin America public and private systems coexist. Specific pediatric equipment is more frequent in the transport teams in the Iberian Peninsula than in Latin American teams. The specific pediatric transport training is less frequent for teams in Latin America than on Spain and Portugal. CONCLUSIONS: There is a great variation in the organization of children transport in each country and region. Most of countries and cities do not have unified and specific teams of pediatric transport, with pediatric qualified personnel and specific material.

Management of pancreatic trauma: a literature review. / Orientación terapéutica del traumatismo pancreático: revisión de la literatura.

The European Union of Medical Specialists, founded in 1958, is the largest and oldest european medical organization. It includes 39 member states (of the European Union and others), and represents a total of 1.600.000 medical specialists. The main objective of the UEMS is to influence european healthcare politics by promoting the interests of the european medical specialists, establishing high standards in practice and training, as well as continuing medical education and professional development, and guaranteeing quality in specialist practice. The UEMS is developing several projects to face current and future challenges related to surgical training, education, acreditation, revalidation and professional development: i.- First, the UEMS is developing homogeneous requisites for European Training (ETRs), ii.- To manage the quality control process of the ETRs and evaluation of the organization, the UEMS has created the Council of european specialized medial evaluations (CESMA), iii.- The UEMS has been greatly involved in the acreditation process of training centres in all of Europe, iv.- in relation to continuing medical education, the European Accreditation Council for Continuing Medical Education (EACCME) is the main project of the UEMS for the accreditation of educational events and v.- the UEMS has established the Network of Accredited Clinical Skills Centres of Europe (UEMS-NASCE), that facilitates the accreditation and cooperation of training centres in Europe. In conclusion, with the great support of National Surgical Societies of the UEMS and the Surgery Section a series of solid projects have been established to support the professional development of the collective in Europe. This process constitutes a continuous effort that is very gratifying, with the aim to set the standards for a brilliant future for surgery students and specialized surgeons.

Choice of the specialty of diagnostic radiology by results of the competitive examination to assign residency positions from 2006 to 2015. / Análisis de la elección de la especialidad de radiodiagnóstico en el examen MIR desde el año 2006 hasta 2015.

OBJECTIVE: To analyze the profile of residency candidates choosing the specialty of diagnostic radiology in function of variables related to the positions available in different years. MATERIAL AND METHODS: We compiled the data published on the Spanish Ministry of Health's website during the acts celebrated to allow residency candidates to choose positions based on the results of the competitive examinations held from 2006 to 2015, comparing the specialty of diagnostic radiology with the other specialties available in terms of positions available, net questions, sex, nationality, and order of choice of the position. RESULTS: The specialty of diagnostic radiology occupied the 16th position in the ranking of specialties according to the median number of order in the choice for each of the positions offered in the years studied. The first diagnostic radiology residency position was usually assigned after 75 candidates had chosen other specialties, and the last position was usually assigned after 3700 to 4100 candidates had chosen their positions. During the period studied, of those who chose diagnostic radiology 58% were women and 76% were Spanish nationality. Candidates preferred hospitals in the Autonomous Community of Madrid, and the hospital chosen with the lowest median position (highest score on the competitive examination) was the Hospital Clínic de Barcelona. CONCLUSIONS: Diagnostic radiology is chosen by candidates with good positioning in the ranking according to official examination results, is less likely than other specialties to be chosen by women, and is chosen mostly by Spanish physicians. Candidates prefer large hospitals in provincial capitals.