vgaraujov/thesis-chile huggingface dataset:
Bringing clinical simulation into an Anesthesia residency training program in a university hospital. Participants' acceptability assessment

Introduction Clinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program. Methods Activities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished. Results A total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness. Conclusions The inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.Introduction Clinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program. Methods Activities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished. Results A total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness. Conclusions The inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.
Catastrophic respiratory failure from tuberculosis pneumonia: Survival after prolonged extracorporeal membrane oxygenation support

Tuberculosis (TB) is an uncommon cause of severe respiratory failure, even in highly endemic regions. Mortality in cases requiring mechanical ventilation (MV) varies between 60 and 90%. The use of extracorporeal membrane oxygenation (ECMO) is not frequently needed in TB. We report the case of a 24 year old woman diagnosed with bilateral pneumonia that required MV and intensive care, patient was managed with prone ventilation for 48 h, but persisted in refractory hypoxemia. Etiological study was only positive for mycobacterium tuberculosis. As a rescue therapy arterio-venous extracorporeal CO2 removal was started and lased for 4 days, but fails to support the patient due to greater impairment of oxygenation. Veno-venous ECMO was then initiated, thus normalizes gas exchanged and allows lungs to rest. ECMO was maintained for 36 days, with two episodes of serious complication treated successfully. Given the absence of clinical improvement and the lack of nosocomial infection, at 42-day of ICU stay methylprednisolone 250 mg daily for 4 days was started, since secondary organizing pneumonia associated with TB was suspected. Thereafter progressive improvement in pulmonary mechanics and reduction of pulmonary opacities was observed, allowing the final withdrawal of ECMO. Percutaneous tracheostomy was performed and the patient remained connected until her transfer to her base hospital at day 59 of admission to our unit. The tracheostomy was removed prior to hospital discharge, and the patient is today at home. Prolonged ECMO support is a useful and potentially successful tool in catastrophic respiratory failure caused by TB.
Descended mouth corner: an ignored but needed feature of facial rejuvenation

For years, the gold standard in facial rejuvenation has been the face lift. However, exploring new, less complex procedures for achieving the same goal is currently drawing interest. Rejuvenation of the perioral area is a difficult task for plastic surgeons because of the minimal effect that face lift procedures have over this region and the lack of published material on the subject. In this article, the descended mouth corner anguloplasty technique is presented. It is a 20-minutes lift technique that can correct this typical feature of the ageing mouth. The authors have treated 71 patients using the technique with consistently good results, with just one requiring revision. They conclude that this procedure by itself and in combination with other small operations or even a full face lift can rejuvenate the ageing face.
Employment precariousness and poor mental health: evidence from Spain on a new social determinant of health

Background. Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale. Methods. Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent’s sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men. Results. Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95–3.31) for women and 2.23 (95% CI: 1.86–2.68) for men. Conclusion. The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.
Factors associated with avascular necrosis of the femoral head and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation

Introduction: Few studies have evaluated treatment of displaced femoral neck fractures in patients younger than 65 years, and risk factors for AVN or nonunion have not been clearly delineated within this age range. METHOD: To determine factors associated with avascular necrosis of the femoral head (AVN) and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation, we conducted a retrospective study of 29 displaced femoral neck fractures in 29 consecutive patients treated at a single institution. The influence of age, trauma energy, open reduction, and time from fracture to treatment on development of AVN and nonunion was evaluated. RESULTS: Patients who developed AVN were significantly older and suffered lower energy trauma than cases without AVN. No recorded variables were associated with nonunion. Logistic regression determined that only age was independently associated with AVN. Age was a good predictor for developing AVN, with a C statistics of 0.861, and a best cutoff determined at 53.5 years. CONCLUSION: Patients between 53.5 and 65 years presented a higher risk of AVN. A primary arthroplasty should be considered in this subgroup.Introduction: Few studies have evaluated treatment of displaced femoral neck fractures in patients younger than 65 years, and risk factors for AVN or nonunion have not been clearly delineated within this age range. METHOD: To determine factors associated with avascular necrosis of the femoral head (AVN) and nonunion in patients younger than 65 years with displaced femoral neck fractures treated with reduction and internal fixation, we conducted a retrospective study of 29 displaced femoral neck fractures in 29 consecutive patients treated at a single institution. The influence of age, trauma energy, open reduction, and time from fracture to treatment on development of AVN and nonunion was evaluated. RESULTS: Patients who developed AVN were significantly older and suffered lower energy trauma than cases without AVN. No recorded variables were associated with nonunion. Logistic regression determined that only age was independently associated with AVN. Age was a good predictor for developing AVN, with a C statistics of 0.861, and a best cutoff determined at 53.5 years. CONCLUSION: Patients between 53.5 and 65 years presented a higher risk of AVN. A primary arthroplasty should be considered in this subgroup.
IL28B Polymorphisms Among Latin American HCV Patients

Latin America is a diverse region with more than 500 million people and approximately 8 million HCV infected individuals. The recent description of genetic polymorphisms associated to the interleukin 28B gene that predicts the response to treatment in these patients has impacted the clinical algorithms of management. In this review we examine the studies of prevalence of the IL28B genotypes in the general population and in HCV infected patients in the region and its relationship with treatment response to peginterferon and ribavirin. We show that the prevalence in the different studies in the region show a CC genotype of the rs12979860 between 18 to 35 %. This particular SNP is more consistently associated with treatment response than rs8099917 in Latin America, as well as around the world.
Melanoma amelanótico en una paciente con enfermedad de Parkinson

El melanoma amelanótico es un subtipo de melanoma maligno cutáneo primario que carece de pigmento a la observación clínica, por lo que la anamnesis y la dermatoscopia son de gran importancia para su sospecha diagnóstica. Se comunica el caso de una paciente de 68 años de edad con enfermedad de Parkinson que tenía un melanoma amelanótico en la pierna derecha. Se realiza una breve revisión de la bibliografía sobre este melanoma y su relación con la enfermedad de Parkinson.
Progesterone-releasing vaginal ring for luteal phase support after superovulation and intrauterine insemination cycles, a pilot study

Objective: The main objective of this pilot study was to determine whether a progesterone-releasing vaginal ring is a good alternative for luteal phase support for patients undergoing intrauterine insemination after ovulation induction with sc gonadotrophins. Material and methods: We performed a multi-center study involving three different reproductive medicine units. Patients included were diagnosed with unexplained infertility and this was their first IUI cycle after ovulation induction with rFSH (Puregon ®) and ovulation induction with urinary HCG (Pregnyl ®). The day of insemination patients were randomized to receive luteal phase supplementation with progesterone vaginal ring (Fertiring ®) or no supplementation. Results: One hundred patients were invited to participate, and completed the study. Forty seven received luteal phase support with Fertiring ®. Overall the pregnancy rate was 15%. It was higher, although without reaching statistical significance, in the group receiving luteal phase support Fertirng ® (19.1%) than in the group without supplementation(11.3%). Conclusions: In this study, patients undergoing ovulation induction with Puregon ® and received luteal phase support with Fertiring ® showed a higher pregnancy rate than those who received no luteal phase support, although statistical significance was not achieved.
Prophylaxis and treatment of arterial hypotension during caesarean with spinal anaesthesia

Resumen La cesárea es uno de los procedimientos quirúrgicos más frecuentes a nivel mundial. La hipotensión arterial es el efecto adverso más prevalente tras una anestesia subaracnoidea. Se han utilizado diversos métodos para prevenirla o tratarla, para lograr un óptimo equilibrio hemodinámico. Al no hallar ninguno que sea 100% efectivo por sí solo, es necesario el tratamiento multimodal para lograr el objetivo deseado. Las estrategias para evitar este efecto colateral se analizaron a la luz de la mejor evidencia disponible hasta ahora, resumidas como factores mecánicos, anestésicos, líquidos y vasopresores. Resumen Tras anestesia subaracnoidea para la cesárea, la mejor estrategia disponible hoy para prevención de hipotensión arterial parece ser el uso de carga de cristaloides conjuntamente con un vasopresor alfa agonista tipo 1.
Rational use of topical corticosteroids

Many dermatological conditions will respond to a topical corticosteroid. The clinical outcome will depend on making a correct clinical diagnosis and applying the right molecule in the most appropriate vehicle for the correct duration. Topical corticosteroids are classified by their strength, but the same molecule will have different effects depending on the vehicle. The patient's age and the affected area of skin are other important factors. If used correctly the adverse effects of topical corticosteroids are usually minimal. Systemic effects can occur with high doses.
Simulación en Anestesiología

Training in anaesthesia relies on the duration and quality of clinical experience. It involves exposure to a range of interventions. This works well in routine cases, but when an uncommon and life-threatening event occurs, the anaesthetist needs to carry out multiple tasks simultaneously. Aviation has remarkable similarities with the practice of anaesthesia. Over the years, the aviation industry has used simulation to train and assess individuals very effectively. Anaesthetists face rapidly evolving clinical situations. This needs appropriate decision-making and communication with others in the theatre team. Simulation, using current technology, offers innovative and reproducible training experience. It enables standardised scenario building and reflective learning. Various non-technical aspects of an anaesthetist's day-to-day work could also be addressed to during such training. The technology could be used very effectively for the assessment of competence too. Simulation has been used for technology development and appraisal over the years.
Social cognition in schizophrenia: from social stimuli processing to social engagement

Social cognition consists of several skills which allow us to interact with other humans. These skills include social stimuli processing, drawing inferences about others’ mental states, and engaging in social interactions. In recent years, there has been growing evidence of social cognitive impairments in patients with schizophrenia. Apparently, these impairments are separable from general neurocognitive impairments, such as attention, memory, and executive functioning. Moreover, social cognition seems to be a main determinant of functional outcome and could be used as a guide to elaborate new pharmacological and psychological treatments. However, most of these studies focus on individual mechanisms and observational perspectives; only few of them study schizophrenic patients during interactive situations. We first review evidences of social cognitive impairments both in social stimuli processing and in mental state attribution. We focus on the relationship between these functions and both general cognitive impairments and functional outcome. We next review recent game theory approaches to the study of how social engagement occurs in schizophrenic patients. The advantage of using game theory is that game-oriented tasks can assess social decision making in an interactive everyday situation model. Finally, we review proposed theoretical models used to explain social alterations and their underlying biological mechanisms. Based on interactive studies, we propose a framework which takes into account the dynamic nature of social processes. Thus, understanding social skills as a result of dynamical systems could facilitate the development of both basic research and clinical applications oriented to psychiatric populations.
Tranverse colon volvulus

The volvulus of the colon is a relatively common cause of colonic obstruction, mainly in the sigmoid colon, less frequent in the caecum, and rarely in the transverse colon. Multidetector tomography (MDCT) is able to establish the diagnosis showing dilated loops of proximal right and transverse colon, which depend on the time scale of evolution, with an abrupt transition site at the splenic flexure and a secondary torsion of the transverse colon mesentery. Volvulus of the transverse requires surgical detorsion in adults. Among the therapeutic options, simple detorsion or detorsion associated with a colopexy are included, but both have high rates of recurrence compared to resection techniques. Surgical resection of the involved segment is required prior to gangrene and perforation. Resection with or without primary anastomosis is the treatment of choice and prevents recurrence. The transverse colon volvulus is a disease of very low frequency and clinical diagnosis may be difficult. The management remains controversial. We stress that although many surgeons will never see a case of transverse colon volvulus, it should be considered as a differential diagnosis of intermittent abdominal pain or acute intestinal obstruction.
A conjoint analysis framework for evaluating user preferences in machine translation

Despite much research on machine translation (MT) evaluation, there is surprisingly little work that directly measures users' intuitive or emotional preferences regarding different types of MT errors. However, the elicitation and modeling of user preferences is an important prerequisite for research on user adaptation and customization of MT engines. In this paper we explore the use of conjoint analysis as a formal quantitative framework to assess users' relative preferences for different types of translation errors. We apply our approach to the analysis of MT output from translating public health documents from English into Spanish. Our results indicate that word order errors are clearly the most dispreferred error type, followed by word sense, morphological, and function word errors. The conjoint analysis-based model is able to predict user preferences more accurately than a baseline model that chooses the translation with the fewest errors overall. Additionally we analyze the effect of using a crowd-sourced respondent population versus a sample of domain experts and observe that main preference effects are remarkably stable across the two samples
A program to support family worker-caregivers: An emerging social phenomenon

A new role has emerged within the current demographic context of an aging population; namely, that of the worker-caregiver. The person who works and also cares for a disabled family member has personal and work-related problems and is less committed to their own self-care. Improving the perception of social support can be an effective intervention in this respect. The article describes an interdisciplinary program initiated in 2009 to support family workers-caregivers. Its purpose is to promote health and prevent disease risk factors by strengthening self-care skills and the development of institutional policies that facilitate efficient and healthy compliance with both roles. Some of the health promotion strategies that have been used include education for self-care, strengthening family and social support networks, professional counseling and a community of peers. Sixty workers took part in the last three annual cohorts: 83.4% were women, with an average age of fifty. The program has successfully met its proposed objectives by increasing the perception of social support expressed by the participants themselves.
Adaptation and validation of the Maternal Welfare Scale in childbirth situations: Second version for integral assistance scenarios

Antecedentes: La literatura actual ha mostrado escasa información respecto del bienestar materno durante el proceso de parto. Objetivo: Mejorar la exigencia de la Escala Bienestar materno en Situación de Parto (BMSP1), para ser utilizada en modalidades integrales de asistencia, se adapta la versión inicial y se valida estadísticamente. Método: Se utiliza una muestra no probabilística de 223 puérperas de bajo riesgo, que participan como grupo control, previo a la implementación del Centro de Asistencia Integral del Parto en un hospital público de Santiago. A la escala BMSP1 se agregan 10 afirmaciones alineadas con las políticas de parto integral y, posteriormente, se le aplica dos pruebas psicométricas que permiten evaluar su consistencia interna y reagrupar los ítems en nuevas dimensiones-subescalas. Resultados: Se obtiene un instrumento válido y fiable, apto para recoger la percepción de bienestar en modalidades de asistencia integral del parto. Se compone de 7 dimensiones que agrupan a 47 afirmaciones de bienestar o malestar. La primera, referida al cuidado relacional de calidad, concentra la mayor cantidad de afirmaciones. El resto de las dimensiones agrupan, cada una, a lo menos 4 ítems de bienestar o malestar, y se refieren a las condiciones ambientales, a la percepción de contacto precoz con el hijo, al acompañamiento familiar, a las medidas de autocuidado y confort, al cuidado oportuno y respetuoso; asimismo, la que tiene relación con la despersonalización del cuidado. Conclusión: La escala BMSP2 es aplicable para evaluar bienestar materno en escenarios de parto con las exigencias de un proceso integral, de calidad y seguridad.
Adherence to vitamin D supplementation and determinant factors during the first year of life

Introducción: Los lactantes menores de un año alimentados con leche materna poseen múltiples factores que impiden una adecuada adquisición de vitamina D, haciendo la suplementación necesaria. La adherencia a esta política de salud no ha sido evaluada en Chile. Objetivo: Evaluar la adherencia a la suplementación con vitamina D en niños menores de un año y conocer los factores determinantes que intervienen en ella. Pacientes y Método: Estudio transversal en tres Centros de Salud pertenecientes a Red de Salud Universidad Católica. Se reclutaron lactantes menores de 1 año que recibían lactancia materna y se realizó una encuesta a sus tutores indagando sobre adherencia a la suplementación y factores determinantes de ésta. Resultados: Se reclutaron 170 lactantes. Recibían suplementación 164 de ellos, reportando buena adherencia en un 68,9%. La principal causa para no adherir fue el olvido materno. El factor de riesgo identificado para mala adherencia fue el número de hijos maternos. Conclusiones: La suplementación con vitamina D en Chile alcanza niveles altos, pero la adherencia a ésta es deficiente. Se necesita de mayor educación a los padres al respecto, reforzando maneras de evitar el olvido e identificando los factores de riesgo en todas las consultas médicas.