Training in ambulatory surgery. A pending subject in our country

The implementation and generalized use of Ambulatory Surgery worldwide is currently a clear reality. Its progressive growth is expected in the short term, but this globalization can also negatively affect the education and training of future doctors, as well as those who are being trained now, if it is not standardized and regulated, since a significant part of the management of the most common pathology that could be performed in Ambulatory Surgery is completed outside the training circuits of hospitals where resident doctors are trained.

[Prevalence of dermatological diseases in Primary Care]

OBJECTIVE

To guide the training of Primary Care physicians in the most prevalent and relevant skin pathologies, it is necessary to study their prevalence in the Primary Care consultation and describe their characteristics.

MATERIALS AND METHODS

Observational cross-sectional study. It took place at the Porriño Health Center (Pontevedra, Spain). A total of 305 patients of the same quota participated, recruited in consultation during 41days between September 2018 and February 2019, selected by systematic sampling coinciding with those mentioned at the hour between 9 and 13hours and, failing that, we selected the next of those mentioned. The variables were analyzed: age, sex, educational and economic level, diagnostic means, previous diagnosis of dermatological disease, treatment, follow-up and relationship with systemic diseases. The statistical analysis performed was descriptive and bivariate by sex with chi-square and Fisher's exact tests.

RESULTS

161 women and 144 men participated, age and number of consultations being non-parametric. Median age was 59years (IQR: 42-69), with no significant differences between sexes. 69.83% (95%CI: 64.46-74.71) present between 1 and 5 types of skin lesions grouped in 33 different diagnoses. The 15 most frequent pathologies account for 77.35% (95%CI: 75.80-84.48) of diagnoses. As the most relevant pathologies, we observed two basal cell carcinomas and one squamous cell carcinoma (0.98%; 95%CI: 0.34-2.85).

CONCLUSIONS

Dermatological diseases have a high prevalence in Primary Care.

Doctoral theses: a survival guide for radiologists

Nowadays, there are, surprisingly, many opportunities for research in the field of radiology, and these are accessible at any level. Thanks to radiological information systems and picture archiving and communication systems (PACS), a huge number of images and cases are available. Nevertheless, the daily workload and the lack of resources sometimes limit the advance of radiologic research. One of the routes of access is doctoral programs. The Bologna process has resulted in significant changes in the organization and in the prerequisites for doctoral theses. The new situation can be confusing for those who are further removed from the university. Given that many radiologists undertake their doctoral theses once their careers are well established, unfamiliarity with the new system can represent an added difficulty. This article aims to review the basic regulations that govern doctoral programs nowadays and to provide some useful advice for potential doctoral students.

Analysis of referrals after a synergic work between Primary Care and Urology. Impact of joint protocol implementation and a continuing education program in our healthcare area

OBJECTIVE

To analyse the evolution and adequacy of referrals from Primary Care to Urology, after the implementation of referral protocols on the most frequent urological diseases and the establishment of a continuing education program.

MATERIAL AND METHODS

A Primary Care-Urology work group was created in 2011. Initially, performance and clinical practice protocols in prostatic pathology (BPH and PSA) were established. These were supported by training sessions for primary care physicians. After analysing the effect of the mentioned joint work, 3more (scrotal pathology, urinary tract infections and urinary incontinence) were included. We analysed and compared the referrals and their adequacy before and after the establishment of the protocols.

RESULTS

The most common referral causes were symptoms of the lower urinary tract due to BPH, which initially represented 22.8% of the total, and decreased to 16.9%. After the introduction of the new algorithms, we observed a decrease in referrals for scrotal pathology (13-14% to 7.8%), an increase in urinary incontinence referrals (3% al 10.3%) and those related to urinary tract infections remained stable. The adequacy to the protocols improved progressively: LUTS from 46% to 65.3%; PSA from 55% to 84.4% and urinary incontinence from 66.2% to 73.1%. Adequacy in scrotal pathology decreased (de 67.1% a 63.3%), while in UTI it stayed much the same (around 76%).

CONCLUSIONS

The joint work between Urology and Primary Care achieves an improvement in referrals adequacy regarding the most frequent urological pathologies.

Simulation as a learning tool for continuing education on cardiorespiratory arrest

OBJECTIVE

To evaluate the level of knowledge and the degree of satisfaction obtained through continuous training in simulation-debriefing methods as a learning tool in the care of cardiopulmonary arrest (CPA).

METHOD

A quasi-experimental study. Evaluation by ad hoc questionnaire (pre and post, and reassessment at 4 months) to all professionals (physicians and nurses) who passed any of the 6 editions of the course: 'Simulation of situations of cardiopulmonary arrest or peri-arrest in hospitalisation units'. Descriptive and inferential statistics.

RESULTS

133 participants, 16 physicians, and 117 nurses. Before the course started, the level of knowledge was 78.5%, at the end of training it was 94.6% (P<.001), and after 4 months, it was 88% (P<.05). The satisfaction achieved was 91.8% at the end of the course, and subsequently 88.4%; this was significant (P<.05) among the younger professionals, with less experience and with a temporary contract. Eighty one point two percent of the participants expressed that they changed the way they acted during a cardiopulmonary arrest.

CONCLUSIONS

Continuous education in CPA, performed through simulation-debriefing, is consolidated in our field as an effective tool to acquire a suitable level of knowledge that lasts over time. The level of satisfaction achieved was high since this method of learning meets the expectations of the professionals and resembles real care practice.

[Need of cardiopulmonary resuscitation training in the sport of soccer]

OBJECTIVE

In Spain there are around 25,000 cardiac arrests, many of them in the presence of non-medical personnel. In less than 25% of the cardio-respiratory arrests witnessed, witnesses began cardiopulmonary resuscitation. Soccer is a contact sport with multiple physical characteristics and requirements which pushes your body to the limit, thus leading to a higher chance of developing multiple lesions, including cardio-respiratory arrest. Therefore, our goal was to know the actual situation on training in basic life support in soccer.

METHOD

A literature review was performed on different databases both national (IME, CUIDEN, ENCUENTR@, ENFERMERÍA AL DÍA, ISOC) and international (PUBMED, SCOPUS, CINAHL), with different MESH descriptors related to the topic.

RESULTS

A total of 395 references were identified. 17 studies were selected; 8 of them had like main theme cardiopulmonary resuscitation and the remaining 9 spoke on the use of semi-automatic defibrillators.

CONCLUSIONS

There is a lack of research on this topic in soccer. This strikes our attention because in this area there could be situations requiring immediate rescue action. Therefore, we emphasize the importance of early cardio-respiratory resuscitation because training in basic life support and semi-automatic defibrillators in soccer are fundamental.

[Update of breast cancer in primary care (I/V)]

Breast cancer is a prevalent disease affecting all areas of the patients' lives. Therefore, family physicians should have a thorough knowledge of this disease in order to optimize the health care services for these patients, and making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The first article reviews the epidemiology, risk factors, and protective factors in this disease This summary report aims to provide a current and practical review on breast cancer, providing answers to family doctors and helping them to support the patients for their benefit throughout their illness.

[Update of breast cancer in Primary Care (II/V)]

Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family doctors need to thoroughly understand this disease in order to optimize the health care services for these patients, making the best use of available resources. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. The second one deals with population screening and its controversies, screening in high-risk women, and the current recommendations. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors, and helping them to be able to care for their patients for their benefit throughout their illness.

[The referral of infectious diseases is a key activity for infectious diseases departments and units, as well as for the hospital]

Infectious diseases referrals (IDR) is a core activity of infectious diseases departments, and is certainly the one with the greatest potential impact on the hospital due to their cross-sectional nature, and with the emergence of a bacterial resistance and antimicrobial crisis. However, there is no standard model for IDR, no official training, and evaluation is merely descriptive. Paradoxically IDR are at risk in a health system that demands more quality and efficiency. The aim of this review is to assess what is known about IDR, its definition, key features, objectives, method, and the evaluation of results, and to suggest improvements to this key activity for the infectious diseases departments and the hospital.