La virtualización en programas de postgrado: experiencia del CIES UNAN MANAGUA 2010-2017 / Virtualization in postgraduate programs: experience of CIES UNAN MANAGUA 2010-2017

El CIES-UNAN Managua ha desarrollado una tendencia hacia la virtualización de los Programas de Estudios de Postgrado en Salud Pública (5 programas de Maestría -Salud Pública, Administración de la Salud, Epidemiología, Salud Ocupacional, Economía de la Salud- y uno de Doctorado en Ciencias de la Salud) en el último decenio de sus 35 años de servicio. Motivado en las necesidades de sus usuarios (Profesionales de la Salud de la Región Meso Americana, especialmente de Nicaragua, Honduras y El Salvador), surgidas de factores que impulsan un cambio permanente en sus necesidades, ha ido incorporando la Tecnología y la Metodología necesaria para que esta evolución sea siempre en función de las necesidades de los usuarios. Esto ha sido mediado a través de Modalidades mixtas. Los avances evidenciados en este estudio parten del diagnóstico sobre el uso de la tecnología de los estudiantes activos en los programas académicos de Postgrado, llegando a una valoración de los espacios virtuales de aprendizaje a partir de criterios presentes en la literatura existente sobre el tema. Se evidencia la satisfacción de los Estudiantes específicamente en los elementos de virtualización que han sido implementados. El conocimiento previo de la tecnología por su parte permite una mejor utilización de las Plataformas. También es notoria la Evolución satisfactoria de los hábitos de búsqueda de Información de los Estudiantes en Internet, acompañado con el desarrollo de competencias con el aprovechamiento de la Tecnología, lo que les ha permitido emigrar hacia Plataformas y Sitios más reconocidos y más confiables

The CIES-UNAN Managua has developed a trend towards the virtualization of the Postgraduate Studies Programs in Public Health (5 Master's programs - Public Health, Health Administration, Epidemiology, Occupational Health, Health Economics - and one Doctorate in Health Sciences) in the last decade of his 35 years of service. Motivated in the needs of its users (Health Professionals of the Meso-American Region, especially in Nicaragua, Honduras and El Salvador), arising from factors that drive a permanent change in their needs, it has incorporated the Technology and Methodology necessary to that this evolution is always based on the needs of users. This has been mediated through mixed Modalities. The advances evidenced in this study are based on the diagnosis of the use of technology by active students in postgraduate academic programs, reaching an assessment of virtual learning spaces based on criteria present in the existing literature on the subject. The satisfaction of the Students is evidenced specifically in the elements of virtualization that have been implemented. The prior knowledge of the technology allows a better use of the Platforms. It is also notorious the satisfactory evolution of student's information search habits on Internet, accompanied by the development of skills on the use of technology, which has allowed them to migrate to more recognized and reliable platforms and sites.

Management of impacted third molars based on telemedicine: a pilot study.

PURPOSE: The incorporation of new technologies into clinical daily practice is nowadays a fact in the field of medicine. Within these new technologies, telemedicine is turning out to be a working tool that is used with increasing frequency in medical centers. The systems of telemedicine have still not reached the same development in oral and maxillofacial surgery that they have reached in other medical specialties. This study describes the preliminary results of a store-and-forward telemedicine system (SFTMS) aimed at the presurgical management of impacted third molar pathology. MATERIALS AND METHODS: A multicenter, longitudinal, descriptive, evaluative pilot study of an SFTMS aimed at the presurgical management of patients with impacted third molar pathology was conducted at the Oral and Maxillofacial Surgery Unit of Virgen Macarena University Hospital (Seville, Spain) and 4 primary care areas located between 15 and 95 km from the hospital. The study was carried out between January and December 2009. RESULTS: Over a period of 12 months, 97 patients were enrolled in the study, from 102 teleconsultations received and evaluated within the same period. Patients managed through telemedicine were included on the surgical wait list on within a mean interval of 3.33 days (95% confidence interval [CI], 2-4.65 days) since the visit to the primary care dentist, with only 1 visit to the hospital that was on the day of surgery. The mean waiting interval of patients managed through the conventional referral system was 28 days (95% CI, 24.51-29.6 days), with at least 2 visits to the hospital before the final intervention. The on-the-day surgery cancellation rate of the series was 7.8% (95% CI, 3.8%-10.5%) because 8 patients did not have surgery on the scheduled day. The cancellation rate in the sample of patients managed through the conventional system was 8.85% (95% CI, 5.62%-11.81%; P < .005). CONCLUSIONS: The SFTMS was effective and accurate as a preoperative tool for impacted third molar pathology. It avoids unnecessary visits to the hospital and shortens waiting intervals. Further randomized studies are needed, however, to establish real advantages, in clinical and economic terms, against the conventional presurgical management systems.

Manejo del SAHS mediante dispositivos de avance mandibular. Estudio preliminar / Sleep apnea-hypopnea syndrome management using a mandibular advancement device. Preliminary study

El tratamiento que ha demostrado mayor eficacia en los pacientes con síndrome de apneas-hipopneas del sueño (SAHS) es la presión positiva continua de la vía aérea (CPAP). Los mayores inconvenientes son la incomodidad y la sensación de claustrofobia, que en algunos pacientes provoca rechazo o intolerancia. Una alternativa son los dispositivos de avance mandibular (DAM), que insertados en las arcadas dentarias producen el avance de la mandíbula y de la lengua, aumentando el volumen de la vía aérea. Objetivo: Presentar nuestra experiencia en el tratamiento del SAHS mediante dispositivos de avance mandibular tipo Herbst. Metodologia: Estudio de seguimiento prospectivo desde junio de 2006 hasta enero de 2009 de 7 pacientes del Área Hospitalaria Virgen Macarena con SAHS que rechazan el tratamiento con CPAP y a los que se ofrece tratamiento con DAM. Las variables analizadas son: índice de apneas-hipopneas por hora, índice de desaturaciones por hora, intensidad subjetiva del ronquido y el test de somnolencia de Epworth, antes del tratamiento y al menos 6 meses después desde el inicio de su uso. Utilizamos el test de Wilcoxon para detectar diferencias estadísticas significativas (p<0,05). Resultados: Se observó una reducción estadísticamente significativa del índice de apneahipopneas por hora (p<0,018) y del índice de desaturaciones por hora (p<0,018), así como una reducción no significativa del ronquido y de la somnolencia. Conclusiones: El uso de DAM tipo Herbst en pacientes afectos de SAHS que rechazan el uso de la CPAP podría ser útil, mejorando clínica y funcionalmente su situación(AU)

The most effective treatment in patients with sleep apnea-hypopnea syndrome (SAHS) is CPAP (continuous positive airway pressure). The main drawback of CPAP is the discomfort and claustrophobic sensation that it causes, which elicits rejection or intolerance by some patients. A non-surgical alternative to CPAP is the mandibular advancement device (MAD), which consists of a plastic splint inserted between the dental arches to shift the jaw and tongue forward and thus increase airway volume. Objective: Report our experience with the treatment of SAHS using the Herbst mandibular advancement device. Material and method: A prospective follow-up study was carried out from June 2006 until January 2009 at the Virgen Macarena University Hospital with 7 patients with SAHS who refused treatment with CPAP and were treated with the mandibular advancement device. The outcome variables analyzed were: apnea-hypopnea disruptions per hour index, desaturations per hour index, subjective intensity of snoring, and the Epworth Sleepiness Scale. Variables were evaluated pre-treatment and at least once 6 months after initiation MAD use. The Wilcoxon test for paired samples was used to detect statistically significant differences (p<0.05). Results: A statistically significant reduction in the hourly indices of apnea-hypopnea disruptions (p<0.018) and desaturations (p<0.018) was observed, as well as a statistically nonsignificant reduction in snoring and sleepiness. Conclusions: Use of the Herbst mandibular advancement device in patients with obstructive sleep apnea syndrome who refuse CPAP may be helpful as it improves the clinical and functional parameters of the condition(AU)