Anesthesia training: Are we doing enough in three years? Cross-sectional study

Introduction: The mínimum number of procedures required to be performed during anesthesia training has not been officially defined in Colombia. Although a number is no guarantee of acquired competencies, it does indicate the level of opportunity offered by the different programs. This study describes the practical training afforded to residents in a graduate anesthesia program in Colombia, and compares its results with international standards. Objective: Describe exposure to procedures performed by residents enrolled in a three-year anesthesia specialization program in Colombia between 2015 and 2020, and compare with the standards proposed by ASCOFAME and ACGME. Methods: Descriptive, cross-sectional study which included residents who did their specialization in a Colombian anesthesia program between 2015 and 2020. Complexity, anesthesia techniques, invasive monitoring and airway approach were described. Finally a descriptive comparison was made with the published references of the Colombian Association of Medical Schools (ASCOFAME) and the Accreditation Council for Graduate Medical Education (ACGME). Results: The results for 10 residents were included. Each resident had a median of 978 cases (IQR 942-1120), corresponding to 25 surgical specialties, the most frequent being general surgery (18%), orthopedics (16%), pediatric surgery (19%), and obstetrics (10.8%). According to the American Society of Anesthesiology (ASA) classification, the majority of patients were ASA II (39.63%) and ASA III (28.4%). Adequate exposure was achieved in 11 of the 15 categories proposed by ACGME and in 6 of the 15 proposed by ASCOFAME. Conclusions: A detailed description of the practice component acquired by the residents during their three years of training was obtained. This baseline provides insight into the national landscape and allows to describe the relationship with international standards.

Introducción: En Colombia no se encuentra oficialmente definido el número mínimo de procedimientos que se deben realizar durante el entrenamiento en anestesiología. Aunque el número no garantiza la adquisición de competencias de la especialidad, sí es un indicador de la oportunidad ofertada por parte de los programas. Este estudio describe el entrenamiento práctico que tienen los médicos residentes en un programa de posgrado de anestesiología en Colombia y compara sus resultados con estándares internacionales. Objetivo: Describir la exposición a procedimientos realizados por los médicos residentes de un programa de especialización en anestesiología de tres años en Colombia, entre 2015 y 2020, y compararlo con los estándares propuestos por ASCOFAME y el ACGME. Métodos: Estudio descriptivo de corte transversal; se incluyeron los residentes que cursaron su programa de especialidad en un programa colombiano de anestesiología entre 2015 y 2020. Se describieron la complejidad, técnicas anestésicas, monitoría invasiva y abordaje de la vía aérea. Finalmente, se compararon los resultados de manera descriptiva con lo referenciado por la Asociación Colombiana de Facultades de Medicina y el Accreditation Council for Graduate Medical Education (ACGME). Resultados: Se incluyeron los resultados de 10 médicos residentes. El número de casos por residente tuvo una mediana de 978 casos (RIQ942-1120), correspondientes a 25 especialidades quirúrgicas; cirugía general (18 %), ortopedia (16 %), cirugía pediátrica (19 %) y obstetricia (10,8 %) fueron las más frecuentes. Según la clasificación de la Sociedad Americana de Anestesiología (ASA), la mayoría de los pacientes tenían ASA 2 (39,63 %), ASA 3 (28,4 %). Se alcanzó una exposición adecuada en 11 de las 15 categorías propuestas por el ACGME y en 6 de las 15 propuestas por la Asociación Colombiana de Facultades de Medicina. Conclusiones: Se obtuvo una descripción detallada del aspecto práctico de los residentes de anestesiología durante sus tres años de formación. Esta línea de base permite ampliar el panorama a escala nacional y describir la relación con estándares internacionales.

Current trends and prospects in quinoa research: An approach for strategic knowledge areas.

Currently, the demand for healthy consumption and the use of alternatives to dairy proteins for the development of foods with good nutritional value are growing. Quinoa has received much attention because it contains a high content of proteins, essential amino acids, essential fatty acids, minerals, vitamins, dietary fibers, and bioactive compounds. Nevertheless, this content and the bioavailability of specific compounds of interest are related to the genotype, the agri-environmental conditions, and management practices where quinoa is grown and postharvest management. This article aimed to analyze the research trends for three knowledge areas: quinoa plant breeding for nutraceutical properties, plant-soil relations focused on abiotic stresses, and postharvest and value-added transformation activities. To this end, a specific methodological design based on bibliometrics and scientometrics methods was used. Through these analyses based on publications' keywords, titles, abstracts, and conclusions sections, for each knowledge area, the key research trends (scope and main topics), the classification of trends based on their development and relevance degree, and the core of knowledge were established. The trends comprise the current state of research. Finally, analyzing the conclusions, recommendations, and future research sections of key publications, a strong correlation among plant breeding research to obtain varieties with tolerance to biotic and abiotic stresses, nutritional and functional compounds of interest for food safety, and the development of products with higher added value established interest in further research on the potential bioactivity of quinoa and the verification of health benefits to humans.

Activities used by evidence networks to promote evidence-informed decision-making in the health sector- a rapid evidence review.

BACKGROUND: Evidence networks facilitate the exchange of information and foster international relationships among researchers and stakeholders. These networks are instrumental in enabling the integration of scientific evidence into decision-making processes. While there is a global emphasis on evidence-based decision-making at policy and organisational levels, there exists a significant gap in our understanding of the most effective activities to exchange scientific knowledge and use it in practice. The objective of this rapid review was to explore the strategies employed by evidence networks to facilitate the translation of evidence into decision-making processes. This review makes a contribution to global health policymaking by mapping the landscape of knowledge translation in this context and identifying the evidence translation activities that evidence networks have found effective. METHODS: The review was guided by standardised techniques for conducting rapid evidence reviews. Document searching was based on a phased approach, commencing with a comprehensive initial search strategy and progressively refining it with each subsequent search iterations. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. RESULTS: The review identified 143 articles, after screening 1135 articles. Out of these, 35 articles were included in the review. The studies encompassed a diverse range of countries, with the majority originating from the United States (n = 14), followed by Canada (n = 5), Sweden (n = 2), and various other single locations (n = 14). These studies presented a varied set of implementation strategies such as research-related activities, the creation of teams/task forces/partnerships, meetings/consultations, mobilising/working with communities, influencing policy, activity evaluation, training, trust-building, and regular meetings, as well as community-academic-policymaker engagement. CONCLUSIONS: Evidence networks play a crucial role in developing, sharing, and implementing high-quality research for policy. These networks face challenges like coordinating diverse stakeholders, international collaboration, language barriers, research consistency, knowledge dissemination, capacity building, evaluation, and funding. To enhance their impact, sharing network efforts with wider audiences, including local, national, and international agencies, is essential for evidence-based decision-making to shape evidence-informed policies and programmes effectively.

Mental health services implementation in Colombia-A systematic review.

Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).

ECPR for prolonged Pediatric Cardiac Arrest, an outcome without major neurological compromise.

Pediatric in-hospital cardiac arrest (IHCA) has been reported in 1-3% of pediatric intensive care unit (ICU) admissions and up to 6% of children admissions to the cardiac ICU. In the last 25 years, the survival to hospital discharge after pediatric IHCA has improved from 9% to 13.7% up to 35%. The improvement in outcomes was attributed in part to the application of ECMO as a rescue strategy when prolonged conventional CPR cannot restore spontaneous circulation. We report a case of a 4-month-old patient with a history of ventricular and septal defects, with left to right shunt and enlargement of left heart chambers that underwent surgery for the closure of the atrial and septal defects, and experienced complications that led to the use of ECMO in response to a prolonged cardiac arrest.

Long Term Veno-Pulmonary Arterial Extracorporeal Membrane Oxygenation as Bridge To Lung Transplantation And Its Challenges: A Case Report.

We present a case of a patient with acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus 2 infection who underwent an extracorporeal membrane oxygenation (ECMO) run of 8 months with various configuration changes, including off-label use of cannulas. The patient eventually underwent successful double lung transplantation after a follow-up of 17 months, demonstrating the successful application of a hybrid approach and careful monitoring in the face of supply shortages during the pandemic. This case highlights the challenges faced by ECMO and transplantation centers during the pandemic and the importance of careful communication and planning to optimize patient outcomes.

Sustainable Development in Rural Territories within the Last Decade: A Review of the State of the Art.

Rural territories play an important role when progress is made toward a balanced regional development; thus, an analysis is required of the components and/or factors which have contributed to sustainable development. Therefore, the main subdimensions and variables identified represent the ecological, social and economic dimensions in rural areas. Rural area development is characterised by complex social phenomena, such as the lack of job opportunities, conditions of poverty, unequal development and health services coverage and quality, among others. Consequently, the dynamics and realities of rural territories pose great challenges to sustainable development, arising the following question: What components and/or factors represent sustainable development in rural territories? Therefore, this study aims to use SLR to identify a set of variables relevant to sustainable development in rural territories under the economic, social, and ecological dimensions of sustainability. Based on the foregoing discussion, the systematic literature review (SLR) method is applied. This procces consists of four phases: approach, search and selection, extraction, and information analysis. Then, five subdimensions and 59 variables are established in the Economic Dimension, seven subdimensions and 63 variables in the Social Dimension and five subdimensions and 42 variables in the Ecological Dimension. The results contribute to the comprehensive analysis of the object of study, the main subdimensions in which the ecological, social, and economic dimensions of sustainable development in rural territories are found. Likewise, it is intended to relate all these components found with some of the objectives of sustainable development so that, having a positive impact on these variables, the fulfilment of these objectives is reached to improve the well-being of rural regions.

Riesgo de accidente cerebrovascular en pacientes con aterosclerosis carotídea asintomática: ¿se debe tratar médicamente o quirúrgicamente?

Los desórdenes cerebrovasculares siguen siendo la primera causa de morbilidad y mortalidad neurológica en el mundo, representando una de las entidades patológicas que genera mayor carga de enfermedad a nivel global. La aterosclerosis, o estenosis carotídea, es un potencial factor de riesgo para el ictus isquémico. La identificación y seguimiento estricto de esta condición son esenciales en la prevención secundaria de complicaciones a través de la atención primaria y el manejo especializado del riesgo cardiometabólico. No obstante, dependiendo de este riesgo y/o la presencia de sintomatología, es necesario realizar un manejo definitivo. Actualmente, existe controversia sobre si es mejor tratar la estenosis carotídea asintomática, ya sea médica o quirúrgicamente. Teniendo en cuenta la relevancia de esta entidad, el objetivo de esta revisión consiste en analizar la evidencia reciente sobre el riesgo de ictus isquémico en la aterosclerosis carotídea asintomática en adultos, y el potencial beneficio del manejo quirúrgico vs. farmacológico de esta condición. Para esto, se llevó a cabo una búsqueda bibliográfica en las bases de datos PubMed, ScienceDirect, Web of Science y MEDLINE, hasta el año 2023. Se evidenció que el riesgo de ictus asociado a estenosis carotídea asintomática es significativo (>10 %, aproximadamente), incluso en aquellos con terapia antiplaquetaria e hipolipemiante activa. En aquellos con manejo médico, la supervivencia a cinco años es alrededor del 80 %. Sin embargo, la progresión de la estenosis sucede en promedio en más del 60 % de los casos, y es significativa. Por el contrario, el stent carotídeo y la endarterectomía son intervenciones resolutivas. Pero existe un riesgo mayor comparado con la terapia médica, el cual se atribuye al periodo periy posoperatorio, así como a 30 días de aparición o recurrencia del ictus, infarto agudo de miocardio o muerte por cualquier causa; aunque el uso de la endarterectomía ha demostrado beneficios superiores a largo plazo en cuanto a estos mismos desenlaces. Entonces, la evidencia es heterogénea en cuanto a la superioridad del tratamiento quirúrgico comparado con la terapia farmacológica en el manejo de la aterosclerosis o estenosis carotídea asintomática. Sin embargo, parece ser que el manejo quirúrgico, específicamente la endarterectomía, podría impactar significativamente sobre la aparición o recurrencia del ictus ipsilateral y muerte a largo plazo, pero con resultados controversiales periy postoperatorios.

Cerebrovascular disorders remain the leading cause of neurological morbidity and mortality in the world, representing one of the pathological entities responsible for the greatest burden of disease worldwide. Carotid atherosclerosis or stenosis is a potential risk factor for ischemic stroke. The identification and strict follow-up of this condition are essential in the secondary prevention of complications through primary care and the specialized treatment of cardiometabolic risk. However, depending on this risk and/or presence of symptoms, definitive treatment is necessary. Currently, there is controversy as to whether asymptomatic carotid stenosis is better to be treated medically or surgically. Considering the significance of such entity, this review aims to analyze recent evidence on the risk of ischemic stroke in the case of asymptomatic carotid atherosclerosis among adults, as well as the potential benefit of the surgical vs. pharmacological treatment for this condition. For this purpose, a literature search for publications up to 2023 was carried out in PubMed, ScienceDirect, Web of Science and MEDLINE databases. It was shown that there is a significant risk of stroke associated with asymptomatic carotid stenosis (> 10 % approximately), even in patients with active antiplatelet and lipid-lowering therapy. Out of all those who receive medical treatment, around 80 % had a five-year survival rate. However, stenosis progression occurs on average in more than 60 % of the cases and is significant. On the other hand, carotid stenting and endarterectomy are curative interventions. Nevertheless, these procedures involve a higher risk compared to the medical therapy during the periand postoperative period, as well as 30 days afterwards, due to the occurrence or recurrence of stroke, acute myocardial infarction or death from any cause. Despite this, the use of endarterectomy has shown superior long-term benefits concerning these same outcomes. Thus, evidence regarding the superiority of surgical treatment compared to pharmacological treatment for asymptomatic carotid atherosclerosis or stenosis is heterogeneous. However, it seems that surgical treatment, specifically endarterectomy, could have a significant impact on the occurrence or recurrence of ipsilateral stroke and death in the long term but with controversial periand postoperative outcomes.

Acción colectiva, movilización social y defensa territorial en colombia: análisis de la producción académica en las primeras dos décadas del siglo xxi

Este artículo analiza la producción académica relacionada con la acción colectiva, movilización social y defensa territorial en Colombia durante las últimas dos décadas (2000-2020). Para esto, se parte de un contexto de conflicto social, político y económico, comenzando con la Política de Defensa y Seguridad Democrática y finalizado con la implementación de los acuerdos de paz con las Fuerzas Armadas Revolucionarias de Colombia (FARC). Se soporta en referentes teóricos propios del estudio de la acción colectiva, los movimientos sociales y la defensa territorial tanto de la escuela anglosajona clásica como en la escuela latinoamericana contemporánea. La metodología implementada es documental, relacional y espacial, incluso trabajos doctorales hechos en Colombia y artículos en revistas académicas a escala global. Lo anterior evidencia el crecimiento en la cantidad de este tipo de trabajos, sus principales temas y vacíos, así como la distribución espacial de los casos de estudio abordados.

This article analyzes the academic production related to the processes of collective action, social mobilization and territorial defense in Colombia during the last two decades (2000-2020). A context of social, political, and economic conflict is taken as a starting point. Beginning with the Democratic Security policy and ending with the implementation of the peace agreements with the FARC. This work is supported by theoretical references typical of the study of collective action, social movements, and territorial defense, both from the classical Anglo-Saxon tradition, as well as the contemporary Latin American one. The analysis is based on a documentary, relational and spatial methodology, which includes the review of doctoral works done in Colombia, and articles in academic journals on a global scale. The above evidences the growth in the amount of this type of work, its main themes as well as its gray areas, also the spatial distribution of the case studies addressed.

The implementation of large-scale genomic screening or diagnostic programmes: A rapid evidence review.

Genomic healthcare programmes, both in a research and clinical context, have demonstrated a pivotal opportunity to prevent, diagnose, and treat rare diseases. However, implementation factors could increase overall costs and affect uptake. As well, uncertainties remain regarding effective training, guidelines and legislation. The purpose of this rapid evidence review was to draw together the available global evidence on the implementation of genomic testing programmes, particularly on population-based screening and diagnostic programmes implemented at the national level, to understand the range of factors influencing implementation. This review involved a search of terms related to genomics, implementation and health care. The search was limited to peer-reviewed articles published between 2017-2022 and found in five databases. The review included thirty articles drawing on sixteen countries. A wide range of factors was cited as critical to the successful implementation of genomics programmes. These included having policy frameworks, regulations, guidelines; clinical decision support tools; access to genetic counselling; and education and training for healthcare staff. The high costs of implementing and integrating genomics into healthcare were also often barriers to stakeholders. National genomics programmes are complex and require the generation of evidence and addressing implementation challenges. The findings from this review highlight that there is a strong emphasis on addressing genomic education and engagement among varied stakeholders, including the general public, policymakers, and governments. Articles also emphasised the development of appropriate policies and regulatory frameworks to govern genomic healthcare, with a focus on legislation that regulates the collection, storage, and sharing of personal genomic data.