RESUMO
Antecedentes y objetivos La pandemia de la COVID-19 ha obligado a completar los estudios universitarios online. La Conferencia Nacional de Decanos de Facultades de Medicina coordina una prueba de evaluación de competencias clínicas objetiva y estructurada (ECOE) de 20 estaciones presenciales a los estudiantes de sexto del grado. Como consecuencia de la pandemia se ha diseñado una ECOE sustitutoria con casos-clínicos computarizados simulados (ECOE-CCS). El objetivo del artículo es describir la elaboración, la ejecución y el desarrollo de la prueba. Materiales y métodos Estudio descriptivo de la ECOE-CCS conjunta desde su gestación en abril 2020 hasta su ejecución en junio 2020. Resultados La ECOE-CCS evaluó las competencias de anamnesis, exploración, juicio clínico, aspectos éticos, relaciones interprofesionales, prevención y promoción de la salud. No se evaluaron habilidades técnicas ni de comunicación. La ECOE-CCS consistió en 10 estaciones de 12 minutos de duración, con un número de preguntas de seis a 21 (media: 1,1 minutos/pregunta). En la ECOE-CCS se utilizó la plataforma virtual del campus de cada una de las 16 facultades de Medicina que participaron, con un total de 2.829 estudiantes de sexto curso. Se realizó de una forma conjunta en dos fechas de junio del 2020. Conclusiones La experiencia de la ECOE-CCS permitió llevar a cabo una integración y el trabajo interdisciplinar de las diferentes facultades de Medicina. La ECOE-CCS realizada podría asemejarse al Step 3 CCS de la United States Medical Licensing Examination (AU)
Background and objectives The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. Materials and methods This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. Results The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. Conclusions The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination (AU)
Assuntos
Humanos , Competência Clínica/normas , Simulação por Computador , Avaliação Educacional/métodos , Faculdades de Medicina , EspanhaRESUMO
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-min time limit and ranged from six to 21 questions (mean: 1.1â¯min/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.
Assuntos
COVID-19 , Competência Clínica/normas , Simulação por Computador , Avaliação Educacional/métodos , Faculdades de Medicina , Humanos , EspanhaRESUMO
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.
RESUMO
Patients with Alzheimer's disease (AD) show high incidence of behavioral and psychological symptoms (BPS).The occurrence of BPS has a great impact on the patients and caregiver's quality of life, increases caregiver's burden, and in many cases precipitates admission of the patients to a geriatric center. On the other hand, the importance of the BPS is increasing because most of them are susceptible to being treated effectively, mainly thanks to the use of drug measures and behaviour modification techniques. This study describes the pathophysiological mechanisms of BPS in AD and its relationship with cognitive and functional impairment of patient and caregiver's burden and current therapies.
Assuntos
Doença de Alzheimer/diagnóstico , Doença de Alzheimer/complicações , Doença de Alzheimer/terapia , Encefalopatias/etiologia , Humanos , Transtornos Mentais/etiologiaRESUMO
Los síntomas conductuales y psicológicos están presentes en la mayoría de los pacientes con enfermedad de Alzheimer y contribuyen de manera muy significativa al aumento de los costes asistenciales, a la pérdida de calidad de vida tanto del paciente como del cuidador y al incremento en éste de los niveles de carga y sufrimiento, a la vez que se constituyen como los principales predictores de institucionalización prematura del enfermo. Su importancia se ve incrementada porque la mayoría de ellos son susceptibles de ser tratados de manera eficaz gracias al empleo de medidas farmacológicas y de técnicas de modificación de conducta. En el presente trabajo se discuten sus posibles causas fisiopatológicas, así como su relación con el deterioro cognitivo y funcional del paciente, su influencia en la carga del cuidador y las opciones terapéuticas disponibles actualmente (AU)
Patients with Alzheimer´s disease (AD) show high incidence of behavioral and psychological symptoms (BPS).The occurrence of BPS have a great impact on the patients and caregiver´s quality of life, increase caregiver´s burden, and in many cases precipitates admission of the patients to a geriatric center. On the other hand, the importance of the BPS is increasing because most of them are susceptible to being treated effectively, mainly thanks to the use of drug measures and behaviour modification techniques. This study to describe the mechanisms pathophysiological of BPS in AD and its relationship with cognitive and functional impairment of patient and caregiver´s burden and current therapies (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Transtornos Mentais/epidemiologia , Doença de Alzheimer/complicações , Transtornos Cognitivos/epidemiologia , Carga de Trabalho , Cuidadores/psicologia , InstitucionalizaçãoRESUMO
Objetivo: Describir las características sociodemográficas,perfil cognitivo, estado funcional y síntomas conductualesy psicológicos (SCP) en 125 pacientes conenfermedad de Alzheimer (EA), así como la carga desus cuidadores.Material y métodos: Se recogieron datos sociodemográficosy clínicos y se evaluaron: estadio de la demencia(Global Deterioration Scale), cognición (Mini Mental StateExamination/MMSE, Fluencia Verbal Semántica yFonológica, Rey Auditory Verbal Learning Test y TrailMaking Test), estado funcional (Bayer Activities of DailyLiving/B-ADL), SCP (Neuropsychiatric Inventory) y cargadel cuidador (atención a las actividades básicas de la vidadiaria/ABVD, Hamilton Depression Rating Scale/HDRS,State-Trait Inventory/STAI y subescala de sufrimiento delNeuropsychiatric Inventory).Resultados: El 70%de los pacientes eran mujeres (edadmedia: 76 años), con un tiempo de evolución de la demenciade 62 meses. Sufrían un deterioro cognitivo moderado(MMSE: 14,46 ± 4,81), un deterioro funcional moderado/grave (B-ADL: 8,92 ± 1,31). El 98% presentaron SCP.El 79% de los cuidadores fueron mujeres (edad media: 61años), dedicaban 2,34 ± 1,61 horas diarias a la atención deABVD. Presentaban niveles elevados de ansiedad (STAI:35,59 ± 7,05) y depresión (HDRS: 14,28 ± 6,66).Conclusiones: Nuestros resultados indican que lospacientes con EA atendidos en centros de día psicogeriátricosson mayoritariamente mujeres, con un deteriorocognitivo y funcional moderadamente graves y conuna elevada frecuencia de SCP. Sus cuidadores principalespresentan síntomas de ansiedad y depresión
Objective: The objective of this study is to describethe socio-demographic data, cognitive profile, functionalstatus and behavioral and psychological symptoms(BPS) in a group of 125 patients diagnosed withAlzheimers disease (AD), as also the burden and distressof their caregivers.Material and methods:We collected socio-demographicand clinical data and assessment: stage of dementia(Global Deterioration Scale), cognitive functions (MiniMental State Examination/MMSE, Semantic and PhonemicVerbal Fluency, Rey Auditory Verbal Learning Testand Trail Making Test), activities of daily living (BayerActivities of Daily Living/B-ADL), BPS (NeuropsychiatricInventory) and caregivers burden (number of hoursof attention given to the basic activities of dailyliving/BADL, Hamilton Depression Rating Scale/HDRS,State-Trait Inventory /STAI and NPI-distress Scale).Results: 70% of patients were women (mean age: 76years old), with a mean time of dementia of 62 months.They had a moderate cognitive impairment (MMSE:14.46 ± 4.81) and a severe functional deterioration (BADL:8.92 ± 1.31). A total of 122 patients (98%)showed BPS. 79% of caregiver were women (mean age:61 years old), dedicating an average of 2.34 hours toattend to the BADL, with a high level of anxiety (STAIE:35.59 ± 7.05) and depression (HDRS: 14.28 ± 6.66).Conclusions: The AD patients who attend the psychogeriatricday centers are mainly women, with moderatelysevere cognitive and functional impairment andwith high frequency of BPS. Their main caregiversshow symptoms of anxiety and depression
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Doença de Alzheimer/epidemiologia , Psiquiatria Geriátrica , Psiquiatria Geriátrica/métodos , Testes Neuropsicológicos/estatística & dados numéricos , Testes Neuropsicológicos/normas , Transtornos da Memória/diagnóstico , Transtornos da Memória/patologia , Transtornos da Memória/psicologia , Ansiedade/patologia , Ansiedade/terapia , Espanha/epidemiologiaRESUMO
In anaesthetized rats, extracellular and intracellular recordings were taken from 106 respiratory neurones in the intermediate region of the nucleus ambiguus. We observed unprovoked shortening of expiratory time accompanied, in all classes of respiratory neurone, by the elimination of the changes in membrane potential that were characteristic of stage II expiration. The demonstration of the elimination of stage II expiration in both the rat and cat strongly supports the functional division of expiration into stage I expiration (post-inspiration) and stage II expiration. In order to identify the neurones in the rat that receive inputs from vagal afferents and modulate the central respiratory rhythm, we examined whether any respiratory neurones responded to stimulation of the vagus nerve. Some post-inspiratory and stage II expiratory neurones responded. The short latency (< 2 ms) of four of the responses indicates that some vagal afferents act on post-inspiratory neurones via a disynaptic pathway. While repetitive stimulation of the vagus nerve could inhibit the phrenic rhythm, it appears that most inspiratory neurones in the intermediate region of the nucleus ambiguous complex are not directly involved in integrating the information from vagal afferents with the central respiratory rhythm.
