Actively changing the narrative: An exploration of culturally grounded parenting and social skills.

Recognizing culturally salient aspects of socialization practices and understanding how these practices support culturally valued aspects of development is an integral component in conducting anti-racist research and validating the lived experiences of minoritized families. With this aim, we explored how Active Direction, an observational rating of an African American approach to parenting measured during mother-child interactions at age 2.5 (n = 172), supported social skills and emotion regulation for children living in a Southwestern metropolitan area of the United States concurrently, in kindergarten (n = 109), and in 1st grade (n = 108). Descriptive findings indicated few significant associations between Active Direction and socials skills or emotion regulation. Exploratory analyses, which included traditional parenting behavior measures of Sensitivity and Intrusiveness, also indicated limited significant relations between any measure of parenting and child skills. However, moderation analyses indicated that high levels of Active Direction attenuated the effects of sensitivity on aspects of child social skills. The lack of significant findings across the current study highlight how extant measures-of child social skills and parentings behaviors-are not performing as expected within these African American families.

Reconocer aspectos culturalmente salientes de las prácticas de socialización y comprender cómo estas prácticas apoyan aspectos del desarrollo culturalmente valorados, es un componente integral para llevar a cabo la investigación antiracista y darle validez a las experiencias vividas de familias vistas como minorías. Con este propósito, exploramos cómo Activa Direccción, una evaluación de observación de un acercamiento afroamericano a la crianza medido durante las interacciones madre­niño a la edad de 2.5 (n = 172), apoyaba las habilidades sociales y la regulación de la emoción para niños que vivían en un área metropolitana de los Estados Unidos, de manera concurrente, en el kinder (n = 109) y en el primer grado (n = 108). Los resultados descriptivos señalaron pocas asociaciones significativas entre Activa Direccción y las habilidades sociales o la regulación de la emoción. Los análisis exploratorios, los cuales incluyen medidas de Sensibilidad y de Entremetimiento en cuanto al comportamiento de crianza tradicional, también señalaron limitadas relaciones significativas entre cualquier medida de crianza y las habilidades sociales. Sin embargo, los análisis de moderación señalaron que altos niveles de Activa Dirección atenúan los efectos de la Sensibilidad sobre los aspectos de las habilidades sociales del niño. La falta de resultados significativos, a lo largo del presente estudio, subraya hasta qué punto las medidas ­de habilidades sociales del niño y de comportamientos de crianza­ no están actuando de la manera esperada dentro de estas familias afroamericanas.

[Teleconsultation: finding its place in primary care]. / Teleconsulta: encontrando su lugar en Atención Primaria.

Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation. This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change. To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential. Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.

The ethics of infant and early childhood mental health practice.

Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision-making when there is a sense of moral conflict or ambiguity about the "right" course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress' four principles framework (respect for autonomy, beneficence, non-maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent workforce, caring for caregivers, and the problem of multiple patients. Finally, the role of infant rights is briefly explored, noting the significant interest and debate that has been generated by the publication of the World Association of Infant Mental Health's Position Paper on the Rights of Infants.

A la ética le concierne la base para los juicios morales de lo que está 'bien' y lo que está 'mal' y es esencial para la labor clínica. Muchos profesionales clínicos incorporan estimaciones éticas en su trabajo sin mucha percepción consciente. Sin embargo, el uso explícito de principios y marcos de trabajo éticos puede ayudar a guiar las tomas de decisiones clínicas cuando se trata de un sentido de conflicto o ambigüedad moral acerca del curso de acción 'correcto.' Este artículo se propone subrayar los conceptos y principios claves en la ética clínica tal como ellos se aplican a la práctica de IECMH y estimular una mayor conversación en la profesión sobre cómo apoyarse mutuamente para mantener altos estándares éticos al trabajar con niños pequeños y sus familias. Específicamente, los autores consideran la relevancia del marco de trabajo de los cuatro principios de Beauchamp y Childress (respeto a la autonomía, el beneficiar y no perjudicar, y la justicia), y abordan algunos de los retos éticos particulares en el campo, tales como la vulnerabilidad del infante, la necesidad de una fuerza laboral competente, el cuidar de quienes prestan el cuidado, así como los problemas de quienes usan los servicios múltiples. Finalmente, se explora brevemente el papel de los derechos del infante, notando el significativo interés y debate que ha generado la publicación del Informe de Situación sobre los Derechos del Infante por parte de la Asociación Mundial de Salud Mental Infantil.

Le parentage attentif (aussi connu en tant que réactivité) est un échange dynamique et bidirectionnel entre la dyade parent-enfant, et lié au développement social et cognitif de l'enfant. Les interactions optimales exigent une sensibilité et la compréhension des signaux qu'envoie l'enfant, une réaction au besoin de l'enfant, et une modification du comportement du parent afin de répondre à ce besoin. Cette étude qualitative a exploré l'impact d'un programme de visite à domicile sur les perceptions que se font les mère sur leur réactivité à leurs enfants. Cette étude fait partie d'une plus ample recherche appelée right@home, un programme de visite à domicile en Australie qui promeut l'apprentissage et le développement des enfants. Les programmes de prévention comme le right@home privilégient des groupes de population qui font face à une adversité socioéconomique et psychosociale. Ils offrent des opportunités de promouvoir le développement des enfants au travers de la valorisation des compétences de parentage et d'un accroissement du parentage attentif. Des entretiens semi-structuré ont été fait avec 12 mères, fournissant des informations sur leurs perceptions du parentage attentif. Quatre thèmes ont été extraits des données en utilisant une analyse thématique inductive. Ceux-ci ont indiqué que (1) la préparation au parentage perçue des mères, (2) la reconnaissance des besoins de la mère et de l'enfant, (3) la réponse aux besoins de la mère et de l'enfant, et (4) la motivation à parenter avec réactivité sont toutes estimées être importantes. Ces recherches soulignent l'importance d'interventions qui mettent l'accent sur la relation parent-enfant en augmentant les capacités de parentage et en promouvant le parentage attentif.

Simulated training program in abdominal paracentesis for undergraduate medical students.

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.

[Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care]. / Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria.

OBJECTIVE: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. DESIGN: Quasi-experimental before-after study. SETTING: A School of Medicine. PARTICIPANTS: All students in their 4th year (n=110). INTERVENTIONS: Experiential training course on communicative strategies for HPCRB. MEASUREMENTS: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. RESULTS: After the course, students (n=103) changed their ideas about motivation as an 'internal' (15, 13%) to 'internal-external' factor (71, 61%) (P=.003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P=.008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P=.001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P<.001). CONCLUSIONS: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy.

A view of the global conservation job market and how to succeed in it.

The high demand for conservation work is creating a need for conservation-focused training of scientists. Although many people with postsecondary degrees in biology are finding careers outside academia, many programs and mentors continue to prepare students to follow-in-the-footsteps of their professors. Unfortunately, information regarding how to prepare for today's conservation-based job market is limited in detail and scope. This problem is complicated by the differing needs of conservation organizations in both economically developed and developing regions worldwide. To help scientists identify the tools needed for conservation positions worldwide, we reviewed the current global conservation job market and identified skills required for success in careers in academia, government, nonprofit, and for-profit organizations. We also interviewed conservation professionals across all conservation sectors. Positions in nonprofit organizations were the most abundant, whereas academic jobs were only 10% of the current job market. The most common skills required across sectors were a strong disciplinary background, followed by analytical and technical skills. Academic positions differed the most from other types of positions in that they emphasized teaching as a top skill. Nonacademic jobs emphasized the need for excellent written and oral communication, as well as project-management experience. Furthermore, we found distinct differences across job locations. Positions in developing countries emphasized language and interpersonal skills, whereas positions in countries with advanced economies focused on publication history and technical skills. Our results were corroborated by the conservation professionals we interviewed. Based on our results, we compiled a nondefinitive list of conservation-based training programs that are likely to provide training for the current job market. Using the results of this study, scientists may be better able to tailor their training to maximize success in the conservation job market. Similarly, institutions can apply this information to create educational programs that produce graduates primed for long-term success.

Executive functions and language in children with different subtypes of specific language impairment. / Funciones ejecutivas y lenguaje en subtipos de niños con trastorno específico del lenguaje.

INTRODUCTION: The marked heterogeneity among children diagnosed with specific language impairment (SLI) highlights the importance of studying and describing cases based on the distinction between the expressive and receptive-expressive SLI subtypes. The main objective of this study was to examine neuropsychological, linguistic, and narrative behaviours in children with different SLI subtypes. METHOD: A comprehensive battery of language and neuropsychological tests was administered to a total of 58 children (29 with SLI and 29 normal controls) between 5.60 and 11.20 years old. RESULTS: Both SLI subtypes performed more poorly than the control group in language skills, narrative, and executive function. Furthermore, the expressive SLI group demonstrated substantial ungrammaticality, as well as problems with verbal fluency and both verbal and spatial working memory, while the receptive-expressive SLI subtype displayed poorer neuropsychological performance in general. CONCLUSIONS: Our findings showed that children with either SLI subtype displayed executive dysfunctions that were not limited to verbal tasks but rather extended to nonverbal measures. This could reflect a global cognitive difficulty which, along with declining linguistic and narrative skills, illustrates the complex profile of this impairment.

Communication skills in ICU and adult hospitalisation unit nursing staff. / Habilidades de comunicación en enfermeras de UCI y de hospitalización de adultos.

OBJECTIVES: In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: Intensive Care Units, ICU, and Hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). METHOD: The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n=29) and those from Hospitalisation units (n=40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. RESULTS: The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5,6 (A+), 5,2 (C-), 6,2 (O+), 5,1 (H-), 5,3 (Q1-), and emotional control: 6,1 (B+), 5,9 (N+). Meanwhile the data doesn't adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. CONCLUSIONS: The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills.

Impairment of visuospatial/visuoconstructional skills in multiple sclerosis patients: the correlation with regional lesion load and subcortical atrophy.

INTRODUCTION: About 20% to 26% of patients with multiple sclerosis (MS) show alterations in visuospatial/visuoconstructive (VS-VC) skills even though temporo-parieto-occipital impairment is a frequent finding in magnetic resonance imaging. No studies have specifically analysed the relationship between these functions and lesion volume (LV) in these specific brain areas. OBJECTIVE: To evaluate the relationship between VS-VC impairment and magnetic resonance imaging temporo-parieto-occipital LV with subcortical atrophy in patients with MS. METHODOLOGY: Of 100 MS patients undergoing a routine neuropsychological evaluation, 21 were selected because they displayed VS-VC impairments in the following tests: Incomplete picture, Block design (WAIS-III), and Rey-Osterrieth complex figure test. We also selected 13 MS patients without cognitive impairment (control group). Regional LV was measured in FLAIR and T1-weighted images using a semiautomated method; subcortical atrophy was measured by bicaudate ratio and third ventricle width. Partial correlations (controlling for age and years of school) and linear regression analysis were employed to analyse correlations between magnetic resonance imaging parameters and cognitive performance. RESULTS: All measures of LV and brain atrophy were significantly higher in patients with cognitive impairment. Regional LV, bicaudate ratio, and third ventricle width are significantly and inversely correlated with cognitive performance; the strongest correlation was between third ventricle width and VC performance (Block design: P=.001; Rey-Osterrieth complex figure: P<.000). In the multivariate analysis, third ventricle width only had a significant effect on performance of VC tasks (Block design: P=.000; Rey-Osterrieth complex figure: P=.000), and regional FLAIR VL was linked to the VS task (Incomplete picture; P=.002). CONCLUSIONS: Measures of subcortical atrophy explain the variations in performance on visuocostructive tasks, and regional FLAIR VL measures are linked to VS tasks.

Validation of a model of intensive training in digestive laparoscopic surgery.

INTRODUCTION: Our objective was to assess a laparoscopic training model for general surgery residents. METHODS: Twelve general surgery residents carried out a training program, consisting of a theoretical session (one hour) and a hands-on session on simulator (7 h) and on animal model (13 h). For the first and last repetitions of simulator tasks and the Nissen fundoplication technique, time and scores from the global rating scale objective structured assessment of technical skills (OSATS) were registered. Before and after the course, participants performed 4 tasks on the virtual reality simulator LAPMentor™: 1) hand-eye coordination, 2) hand-hand coordination, 3) transference of objects and 4) cholecystectomy task, registering time and movement metrics. Moreover, the residents completed a questionnaire related to the training components on a 5-point rating scale. RESULTS: The last repetition of the tasks and the Nissen fundoplication technique were performed faster and with a higher OSATS score. After the course, the participants performed all LAPMentor™ tasks faster, increasing the speed of movements in all tasks. Number of movements decreased in tasks 2, 3 and 4; as well as path length in tasks 2 and 4. Training components were positively rated by residents, being the suture task the aspect best rated (4.90 ± 0.32). CONCLUSIONS: This training model in digestive laparoscopic surgery has demonstrated to be valid for the improvement of basic and advanced skills of general surgery residents. Intracorporeal suturing and the animal model were the best rated training elements.

[Communication skills in the curriculum of Medical students from Spain (1990-2014): From the Primary Health Care to the Bologna Plan. A descriptive study]. / Competencia en comunicación en el currículo del estudiante de Medicina de España (1990-2014): de la Atención Primaria al Plan Bolonia. Un estudio descriptivo.

OBJECTIVES: Analyse the currently situation of teaching in communication skills in the Spanish Medical Schools (MS) and the grade of implementation from the recommended by the National Agency of Evaluation of the Quality and Accreditation. DESIGN: Descriptive-comparative, transversal and quantitative-qualitative study. SITUATION: University teaching field. SAMPLE: The whole population of MS in Spain. INCLUSION CRITERIA: teaching during the academic year 2013-2014 the Degree in Medicine homologated by the National Agency of Evaluation of the Quality and Accreditation and offering information of their educational plans and teaching guides (online, telephonic or e-mail). VARIABLES: 1) Existence of courses about communication skills; 2) type of teaching; 3) format of the course; 4) credits; 5) length, and 6) grade. They were analysed with descriptive parameters and the Cohen's coefficient (d). RESULTS: Forty-two MS: 10 privates and 32 publics. Thirty MS (71.43%) presented at least one course of communication skills. The 78.12% of the public MS contained this kind of teaching as an entire course versus the 50.00% of the private MS. The national average by MS was 2.77 (σ=2.41), lower than the 5.0 credits recommended by the the National Agency of Evaluation of the Quality and Accreditation (relevant difference: d=1.63>>0,8). The 63.63% contained this teaching over the second cycle (mode: second degree). CONCLUSIONS: The course loads in terms of credits destined to this skills has increased considerably from 1990 to 2014 (d= 1,43>>0,8). However, it has not been completely established yet the recommendations about this aspect in most of the Spanish MS. The public universities seem to be more aware of this teaching. Furthermore, it would be interesting strengthen this skills in the sixth grade.

Communication between the obese patient and bariatric surgeon.

Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important.

Usefulness of an optical tracking system in laparoscopic surgery for motor skills assessment.

INTRODUCTION: The objective of this study is to assess the usefulness of an evaluation system of surgical skills based on motion analysis of laparoscopic instruments. METHOD: This system consists of a physical laparoscopic simulator and a tracking and assessment system of technical skills in laparoscopy. Six surgeons with intermediate experience (between 1 and 50 laparoscopic surgeries) and 5 experienced surgeons (more than 50 laparoscopic surgeries) took part in this study. All participants were right-handed. The subjects performed 3 repetitions of a cutting task on synthetic tissue with the right hand, dissection of a gastric serous layer, and a suturing task in the dissection previously done. Objective metrics such as time, path length, speed of movements, acceleration and motion smoothness were analyzed for the instruments of each hand. RESULTS: In the cutting task, experienced surgeons show less acceleration (P=.014) and a smoother motion (P=.023) using the scissors. Regarding the dissection activity, experienced surgeons need less time (P=.006) and less length with both instruments (P=.006 for dissector and P=.01 for scissors). In the suturing task, experienced surgeons require less time (P=.037) and distance travelled (P=.041) by the dissector. CONCLUSIONS: This study shows the usefulness of the evaluation system for the cutting, dissecting, and suturing tasks. It represents a significant step in the development of advanced systems for training and assessment of surgical skills in laparoscopic surgery.

The human factor and ergonomics in Patient Safety.

The human condition is linked to error in any activity that is performed, and the healthcare world is no exception. The origin of human error does not lie within the perversity of human nature, instead, it has its origins in latent failures in the healthcare environment and is a consequence of the processes and procedures applied. The science of the Human Factor deals with the application of knowledge to people (capabilities, characteristics and limitations), with the design and the management of the equipment they use and with the environments in which they work and the activities they carry out. Part of the Human Factor are the non-technical skills. These skills greatly influence people's behavior and, therefore, their performance and the quality of healthcare in a very complex socio-technical system.

Assessment of high fidelity simulation with actors in palliative care in nursing students: a mixed methods study.

OBJECTIVE: The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals: in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. METHOD: Over three years, the study was conducted in a Faculty of Nursing of the south of Spain with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: (1) Quasi-experimental study in a single group (n = 12) before and after attending the palliative care course with Clinical Simulation with actors to assess the communication skills (CICAA scale), (2) Qualitative study with phenomenological perspective after Clinical Simulation (174 reflective students' narratives), (3) Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). RESULTS: Students who interacted with actors in Clinical Simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the Clinical Simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. CONCLUSIONS: Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.

El sentido de coherencia y las habilidades para la vida como factores protectores en personas con prediabetes.

OBJETIVO: analizar el sentido de coherencia y las habilidades para la vida y su relación con el cumplimiento del estilo de vida saludable. MÉTODO: estudio observacional transversal en personas con prediabetes atendidas en atención primaria, quienes respondieron a un cuestionario con variables sociodemográficas y hábitos saludables y a los cuestionarios de sentido de coherencia y habilidades para la vida. Se realizó un análisis descriptivo, bivariante y un modelo de regresión múltiple. RESULTADOS: los y las participantes con mayor sentido de coherencia son quienes presentan mayores habilidades para la vida (Pearson = 0.470; p ⩽ 0.001) y mantienen un estilo de vida más saludable (B:1.24; p = 0.001). Una mayor puntuación de las habilidades de la vida se relaciona con un estilo de vida saludable (Pearson = 0.355, p < 0.001). El sentido de coherencia predice el estilo de vida saludable (BB = 0.21, p = 0.001). CONCLUSIÓN: las personas con prediabetes con un mayor sentido de coherencia y más habilidades para la vida realizan conductas más saludables con relación a la dieta, al ejercicio físico y al hábito tabáquico. Las personas con mayor sentido de coherencia tienen mayor probabilidad de seguir el estilo de vida saludable.

The objective structured clinical examination (OSCE): Main aspects and the role of imaging.

The objective structured clinical examination (OSCE) is a format of examination that enables students to be evaluated in a uniform, standardized, reliable, and objective way. It is carried out in different clinical stations that simulate real clinical situations and scenarios. Numerous universities in Spain and other countries employ this approach for the final examination for medical school students. This update describes the organization, design, and fundamentals for the OSCE, proposing that radiology should form part of multidisciplinary OSCEs to the extent that it forms part of clinical practice. Moreover, it is interesting and opportune to introduce the OSCE in undergraduate and postgraduate training in radiology. Online platforms enable bidimensional OSCEs that are cost-effective in terms of staff, resources, and physical space, although this approach has certain limitations. Virtual world technologies make it possible to reproduce OSCE stations in three-dimensional scenarios; recent experiences in radiology have shown that this approach interests and motivates students and is widely accepted by them.

The utility of intraoperative endoscopy in esophagogastric surgery.

Flexible endoscopy (FE) plays a major role in the diagnosis and treatment of gastrointestinal disease. Although its intraoperative use has spread over the years, its use by surgeons is still limited in our setting. FE training opportunities are different among many institutions, specialties, and countries. Intraoperative endoscopy (IOE) presents peculiarities that increase its complexity compared to standard FE. IOE has a positive impact on surgical results, due to increased safety and quality, as well as a reduction in the complications. Due to its innumerable advantages, its intraoperative use by surgeons is currently a current project in many countries and is part of the near future in others because of the creation of better structured training projects. This manuscript reviews and updates the indications and uses of intraoperative upper gastrointestinal endoscopy in esophagogastric surgery.

Improving mental health following multiple disasters in Australia: a randomized controlled trial of the Skills for Life Adjustment and Resilience (SOLAR) programme.

Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..

We tested the efficacy of a brief, skills-based psychosocial programme under randomised controlled conditions following compound disasters.The SOLAR programme was associated with improvements in anxiety, depression and posttraumatic stress symptoms across time.The SOLAR programme may benefit from booster sessions especially where there are ongoing impacts of disaster.

Sleep deprivation among surgical residents: Does it affect performance while practising a laparoscopic intestinal anastomosis?

INTRODUCTION: To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis. METHODS: A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the FATIGUE group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the REST group(R), being those who slept at home for more than 7 h. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches. RESULTS: 402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33.5% anastomoses, as opposed to 19.4% in the rest group (P < .01). El rest group performed the anastomosis in 56.75 min and the fatigue group in 61,49 min (P = .006). There were no significant differences in the others parameters. CONCLUSIONS: Fatigue increases the risk of leakage and the time to do the exercise.