E-Learning en la educación continua de profesionales de la salud de establecimientos del tercer nivel de atención en Lima, Perú / E-Learning and continuing education in tertiary health facilities in Lima, Peru

RESUMEN Objetivos. Identificar el grado de utilización del e-learning por los profesionales de la salud y la relación que existe entre los factores organizacionales y los factores individuales del e-learning, en establecimientos de salud públicos y privados de tercer nivel de atención. Métodos. Investigación no experimental, descriptiva, de correlación, con una muestra de 134 profesionales de la salud de dos hospitales públicos y un hospital privado de Lima, Perú. Resultados. Más del 94 % de los encuestados contaban con una computadora ó laptop, celular y acceso a internet. El 74,63% había realizado un curso en línea; 79,10% ha estado presente en video conferencias. Más del 80% manifestaron satisfacción por los cursos virtuales y desearían que estos se incrementen. Conclusiones. El uso del e-learning es alto, con un promedio de 105 minutos diarios de acceso a contenidos de capacitación, y que sus modalidades principales fueron las videoconferencias y los cursos online; existió una relación directa entre la utilización de recursos de e-learning para la educación profesional continua y los siguientes factores individuales: dominio del idioma inglés, dominio de redes sociales, y acceso a internet. Por otro lado, no se demuestra una relación entre el empleo de recursos de e-learning para la educación profesional continua y los siguientes factores institucionales explorados: políticas de recertificación profesional, políticas de acreditación institucional, e incentivos para la capacitación.

ABSTRACT Objective. To identify the relationship between organizational factors and individual factors of e-learning, with the use of it for the purposes of continued education of health professionals, in public and private hospitals. Methods. A non-experimental research has been developed, with a correlational scope, with a sample of 134 health professionals of one private and two public hospitals in Lima, Peru. Results. The use of e-learning for continued education is high (over 70%), with an average of 105 daily minutes of access to training content, and that its main modalities are video conferences and online courses. Our results suggest that individual factors are more important than organizational factors as determinants of e-learning for continued education purposes. Conclusions. There is a direct relationship between the use of e-learning resources for continuing professional education and the following individual factors: proficiency in the English language, domain of social networks, internet access. On the other hand, we explored possible relationship between the use of e-learning resources for continuing professional education and the following institutional factors: professional recertification policies, institutional accreditation policies, and incentives for continuous education, concluding there is no evidence of such relationship.

Superiority of wall motion score index over left ventricle ejection fraction in predicting cardiovascular events after an acute myocardial infarction.

BACKGROUND:: There are few data on the prognostic significance of the wall motion score index compared with left ventricle ejection fraction after an acute myocardial infarction. Our objective was to compare them after the hyperacute phase. METHODS:: Transthoracic echocardiograms were performed in 352 consecutive patients with myocardial infarction, after the first 48 hours of admission and before hospital discharge (median 56.3 hours (48.2-83.1)). We evaluated the ability of the wall motion score index and left ventricular ejection fraction to predict the combined endpoint (mortality and rehospitalization for heart failure) as a primary objective and the independent events of the combined endpoint as a secondary objective. RESULTS:: In 80.7% of patients, the wall motion score index was high despite having an ejection fraction >40%. No patient had an ejection fraction <55% with a normal index. After a follow-up of 30.5 months (24.2-49.5), both variables were predictors of the composite endpoint and all-cause mortality ( p<0.0001), although only the wall motion score index was a predictor of readmission for heart failure ( p=0.007). By multivariate analysis, a wall motion score index >1.8 proved to be the most powerful predictor of the composite endpoint (hazard ratio: 8.5; 95% confidence interval 3.7-18.8; p<0.0001). The superiority of the wall motion score index over ejection fraction was especially significant in patients with less myocardial damage (non-ST elevation myocardial infarction, or left ventricle ejection fraction >40%). CONCLUSIONS:: Both variables provide important prognostic information after a myocardial infarction. Beyond the hyperacute phase, wall motion score index is a more powerful prognostic predictor, especially in subgroups with less myocardial damage.

Management of primary pulmonary artery sarcoma: experience of a single center.

Primary sarcoma of the pulmonary artery (PSPA) is extremely rare. Many cases are misdiagnosed as pulmonary arterial hypertension (PAH) because of chronic thromboembolic disease (CTD). Four cases of PSPA with the initial misdiagnosis are reported. The presence of a unique mass in the main pulmonary artery or proximal branches, rapidly progressive dyspnea, and constitutional symptoms should raise the suspicion of PSPA. The pathological diagnosis is usually confirmed during surgery, which is done along with adjuvant chemotherapy, the treatment of choice.

Efficacy of sildenafil as a rescue therapy for patients with severe pulmonary arterial hypertension and given long-term treatment with prostanoids: 2-year experience.

BACKGROUND: Both prostanoids and sildenafil are effective treatments for severe pulmonary arterial hypertension (PAH). The combined use of these drugs to maximize the clinical benefit is an emerging treatment option. This study describes a 2-year experience with adjunct sildenafil as a rescue therapy for patients with severe PAH treated long term with prostanoids and who showed clinical deterioration or onset of heart failure. METHODS: Twenty patients (11 men, 9 women; mean age 42 +/- 11 years) with severe PAH, who showed clinical or functional worsening despite ongoing treatment with prostanoids (8 subcutaneous, 7 intravenous, 5 inhaled), were started on adjunct oral sildenafil. New York Heart Association (NYHA) functional class, 6-minute walking test, signs of right ventricular failure and echocardiography were assessed before and after 1 and 2 years of combined therapy. RESULTS: There was a significant improvement of NYHA functional class and signs of right heart failure after 1- and 2-year follow-up. Patients showed a mean increase in 6-minute walking distance of 79 m and 105 m after 1 and 2 years of adjunct sildenafil, respectively. Two patients died during follow-up. The echocardiographic parameters showed a significant reduction of right ventricular end-diastolic diameter and left ventricular diastolic eccentricity index. No serious side effects related to sildenafil were observed. CONCLUSIONS: Adjunct sildenafil to long-term prostacyclin therapy in patients with severe PAH provided sustained clinical stabilization and an improved clinical situation, exercise capacity and echocardiographic parameters of right ventricular function. The beneficial effects were strong and lasted >24 months.