Dissimilar Planes and Approaches with Common Neural Targets - A Cadaveric Evaluation of Three Different Ultrasound-guided Fascial Plane Blocks for Lumbar Plexus Nerves.

Background: The lumbar plexus (LP) is a group of nerves located at the fourth lumbar vertebra level, between the anterior two-thirds and posterior one-thirds of the psoas muscle. In this study, the researchers aimed to investigate the spread of latex in injections of LP, suprainguinal fascia iliaca, and circum-psoas planes to assess the different regional techniques for blocking LP nerves (LPNs). Methods: The study involved performing ultrasound-guided injections of three different colored latexes in six cadavers. The researchers observed and compared the spread of latex in each plane by taking cross sections at the levels of L4, anterior superior iliac spine (ASIS), and sacral foramina (SF). The spread of latex and LPN staining was documented and analyzed through photography. Results: The results showed that the latex spread within the psoas muscle and fascia iliaca plane (FIP) during LP injections, whereas suprainguinal fascia iliaca injections showed latex dissemination in the FIP at both ASIS and SF levels. On the other hand, circum-psoas injections spread beneath the iliopsoas fascia at both levels and medially toward the external iliac vessels. Despite this spread, there was no communication between the three planes, and there was no mixing of latex from the different injections at any level. Conclusion: There are distinct fascial planes, for the three approaches, with no communication between them. While latex diffused from LP plane to FIP, no mixing of dye was observed and also the reverse could not be achieved. These findings suggest that different regional techniques for blocking LPNs have their unique planes of action.

Movements of the pelvic bones of expectant mothers during vaginal delivery.

Subtle but demonstrable movements in the expectant mother's pelvis occur during vaginal delivery in all the pelvic joints and anatomical planes of the body (sagittal, frontal, and transverse). The purpose of these movements is to gradually expand the space in the lesser pelvis via widening of the individual pelvic planes so that the newborn's head can enter the pelvic inlet, safely pass through the narrow planes of the pelvis, and through the pelvic outlet. From the point of view of biomechanics, these movements are described in literature as counternutation and nutation of the sacrum and iliac bone. The counternutation of the sacrum helps to expand the plane of the pelvic inlet. The nutation of the sacrum assists in expanding the plane of the pelvic width, height, and outlet. These physiological movements are affected by the body constitution, the state of the myofascial and skeletal systems of the mother, and furthermore, by hormonal disjunction of the connections in the expectant mother's pelvis together with the progress of the delivery mechanism itself. The main factor that determines the range of movement in the individual joints, and therefore adequate expansion of the individual pelvic planes, is the position of the mother during delivery. Engagement of active movements of the mother together with application of passive stretching of the soft tissues in the lower lumbar area and in the hip joints are both needed for maximum expansion of the individual pelvic planes and utilization of the maximum useful capacity of the mother's pelvis during delivery. These movements help invoke the abduction forces on muscles, tendons, and ligaments in the pelvis that lead to the optimum setting of the joints during which delivery movements happen. The specific movements in the pelvic joints predetermine whether nutation or counternutation is possible, and therefore if the newborn's head can progress to the pelvic inlet or pass through the narrow and wide pelvic planes, and the pelvic outlet. The knowledge of these biomechanical principles and movements in the pelvis during delivery enables obstetricians and midwives to understand how the movements in the hip joints of the expectant mother can positively impact the spatial ratios in the lesser pelvis, and how to support further progress in the event of non-progressive labour.

Determination of α lamellae orientation in a ß-Ti alloy using electron backscatter diffraction.

The spatial orientation of α lamellae in a metastable ß-Ti matrix of Timetal LCB (Ti-6.8 Mo-4.5 Fe-1.5 Al in wt%) was examined and the orientation of the hexagonal close-packed α lattice in the α lamella was determined. For this purpose, a combination of methods of small-angle X-ray scattering, scanning electron microscopy and electron backscatter diffraction was used. The habit planes of α laths are close to {111}ß, which corresponds to (1320)α in the hexagonal coordinate system of the α phase. The longest α lamella direction lies approximately along one of the 〈110ã€‰ß directions which are parallel to the specific habit plane. Taking into account the average lattice parameters of the ß and α phases in aged conditions in Timetal LCB, it was possible to index all main axes and faces of an α lath not only in the cubic coordinate system of the parent ß phase but also in the hexagonal system of the α phase.

Pneumomastia following subdermal upper arm helium contouring treatment.

A case is presented of extensive pneumomastia seen on a screening mammogram of an asymptomatic patient who had helium plasma treatment 2 weeks earlier for flabby upper arms. Contribution: Rare complications of subcutaneous emphysema, following helium plasma treatment, have been discussed to highlight that such emphysema is usually self-limiting.

Evaluation of Mesiodistal Angulation of Maxillary Anterior Teeth in Incisal View Using Manual and Digital Methods: An In Vivo Study.

AIM: The aim of the present research was to assess the mesiodistal angulation of the maxillary anterior teeth utilizing Image J computer software, a Profile projector, and a Custom-made jig. MATERIALS AND METHODS: A total of 34 subjects (17 males and 17 females) were chosen from a group of 18-30 years old with bilateral Angle Class I molars and canine relationships. One manual approach (Custom-made jig) and two digital methods (J computer software, a Profile projector) were used to record the mesiodistal angulation in incisal view. The individuals had alginate impressions made, and a facebow was used to capture the maxilla's spatial relationship with the cranium. The articulated cast with the help of mounting ring moved to the specially customized jig, then the angulations was measured in the incisal view after the casts were placed in a semi-adjustable articulator. Data were recorded and statistically analyzed. RESULTS: The mesiodistal angulation in the incisal view via three methods between the 17 males and 17 females has statistically significant different. Although the mesiodistal angulation for maxillary lateral incisor and canine did not show any statistically significant difference, the maximum and minimum values obtained were always greater in males in comparison with the females. This indicates that the positions of six maxillary anterior teeth in the males resulted in the creation of upward sweep of incisal edges of central and lateral incisors which was also referred to as "smiling line" producing masculine surface anatomy more squared and vigorous while feminine surface anatomy being more rounded, soft, and pleasant. There was no statistically significant difference between the right and left sides, indicating bilateral arch symmetry and the symmetrical place of the right teeth compared with the left side's corresponding teeth. CONCLUSION: On conclusion, according to the current study's findings, all three approaches can measure the mesiodistal angulations of maxillary anterior teeth in incisal view with clinically acceptable accuracy. The digital methods, which included using the Image J computer software and the profile projector, achieved more accurate results than the manual method. CLINICAL SIGNIFICANCE: The outcomes of this study's mesiodistal angulations can be used as a reference for placing teeth in both fully and partially edentulous conditions. This study contributes to a better understanding of the importance of achieving the ideal occlusion in the Indian population by placing the maxillary anterior teeth at the proper mesiodistal angulation. How to cite this article: Shadaksharappa SH, Lahiri B, Kamath AG, et al. Evaluation of Mesiodistal Angulation of Maxillary Anterior Teeth in Incisal View Using Manual and Digital Methods: An In Vivo Study. J Contemp Dent Pract 2024;25(4):320-325.

First-trimester 3D fetal neurosonography: five standardised views.

BACKGROUND: There are several international guidelines for foetal anomalies scanning at 11-14 weeks' gestation. The aim of this study is to present our first-trimester specialist neurosonography protocol with examples of pathology in order to develop a systematic approach to evaluating the first-trimester foetal brain. METHODS: Women undergoing a first-trimester foetal medicine ultrasound scan between 2010 and 2020 for multiple indications underwent neurosonography according to a set protocol. 3D transvaginal brain examination was performed in all cases (2000 pregnancies scanned). We retrospectively reviewed all imaging to develop this protocol. RESULTS: We propose that the following five axial-plane parallel views should be obtained when performing neurosonography in the first trimester, moving from cranial to caudal: 1. Lateral ventricles; 2. Third ventricle; 3. Thalamus and mesencephalon; 4. Cerebellum; 5. Fourth ventricle. Examples of these images and abnormalities that can be seen in each plane are given. CONCLUSIONS: We have presented a specialist protocol for systematically assessing the foetal brain in the first trimester and given examples of pathology which may be seen in each plane. Further work is needed to prospectively assess detection rates of major abnormalities using this protocol and assess the reproducibility and learning curve of this technique.

This article suggests a way in which specialists scanning babies at 11­14 weeks of pregnancy can check the brain in a structured way. This involves looking at the brain at five levels or planes to view the developing structures. The suggested scan protocol is similar to images produced of the brain and heart at the second trimester (20 week) scan. We hope that specialists will find it useful to check the brain in this way if there are concerns raised at the dating (12 week) scan, and that this will lead to earlier detection of brain abnormalities or differences.

Plan de monitoreo y evaluación del PENM VIH e ITS de El Salvador 2022-2026 / Monitoring and evaluation plan of the PENM HIV and STIs of El Salvador 2022-2026

Este documento prioriza 32 indicadores del Plan Estratégico Nacional Multisectorial de VIH e ITS 2022-2026, a los cuales se dará vigilancia y evaluación durante el período. El Salvador ha priorizado sus acciones enfocadas en poblaciones clave, personas con VIH, para este quinquenio, se ha enfocado en estrategias de prevención, diagnóstico, atención profundizando el enfoque en el alcance de las metas

This document prioritizes 32 indicators of the National Multisector Strategic Plan for HIV and STIs 2022-2026, which will be monitored and evaluated during the period. El Salvador has prioritized its actions focused on key populations, people with HIV, for this five-year period, it has focused on prevention, diagnosis, and care strategies, deepening the focus on achieving the goals

Aplicación de la clasificación de Robson como método útil para estandarizar el manejo del parto. Un ejercicio que reduce la tasa de cesáreas / Application of Robson's Ten Group Classification System to standardize patient management. A useful way to reduce cesarean rates

Introducción: La tasa de cesárea es un motivo de controversia y la clasificación de Robson es un método de estandarización que evalúa las causas de esta. En nuestro trabajo analizamos si las medidas de mejora de manejo prenatal e intraparto implementadas tras la revisión de Robson suponen un descenso de índice de cesáreas sin incrementar los de morbimortalidad neonatal y materna. Material y método: Estudio cuasi experimental antes-después, entre 2019 y 2020, con un total de 2.181 pacientes con parto en el Hospital Universitario de Valme (1.027 en el grupo 2019 y 1.154 en el de 2020). Resultados: Observamos que se produjo una disminución estadísticamente significativa de la tasa de cesárea entre 2019 y 2020 (21 vs. 15,8%; p = 0,001) sin ser relevante la reducción en ningún subgrupo de estudio. Hubo un menor índice de parto inducido (29,3 vs. 24,6%; p = 0.01), un aumento en la tasa de parto vaginal (79 vs. 84,2%; p = 0,001) tanto de eutócicos como instrumentales (57,9 vs. 60,3%; 21 vs. 23,9%; p = 0.005) y una baja estadísticamente significativa de la de cesáreas por fallo de inducción o no progresión del parto (NPP) (34,7 vs. 20,9%; p = 0,008). En las inducciones mediante balón de Cook observamos una disminución del índice de cesárea (45,3 vs. 22,2% p = 0,001). Hallamos que redujo el porcentaje de ingreso en la Unidad de Cuidados Intensivos Neonatales (UCIN) (10,5 vs. 7.6%; p = 0,016) y la morbilidad neonatal global (11,4 vs. 8,2%; p = 0,013) sin encontrar diferencia en los resultados maternos. Conclusiones: La aplicación de la clasificación de Robson puede ser un método útil para identificar grupos que requieran de medidas específicas destinadas a estandarizar el manejo de las pacientes, con lo que se permite reducir la tasa de cesáreas.(AU)

Background: Cesarean section rate is controversial and the Robson classification is a method for standardizing the evaluation of the causes of cesarean section. The aim of this study was to evaluate whether the measures to improve prenatal and intrapartum management implemented after the Robson classification evaluation lead to a decrease in the rate of cesarean sections without increasing the rates of neonatal and maternal morbidity and mortality. Material and method: Quasi-experimental study before-after,between-2019 and 2020, including a total of 2181 patients with delivery at Hospital-Universitario-Valme(1027 patients in Group-2019, and 1154 patients in group-2020).Results: We observed that there was a statistically significant decrease in the cesarean section rate between 2019 and 2020 (21.0% vs 15.8%; p = 0.001) without the decrease being significant in any study subgroup. There was a lower rate of induced labor(29.3% vs 24.6%; p = 0.01), an increased rate of vaginal delivery (79.0% vs 84.2%; p = 0.001), both eutocic and instrumental deliveries (57.9% vs 60.3%; 21% vs 23.9%; p = 0.005) and a statistically significant decrease in the rate of cesarean sections due to failure of induction or non-progression of labor(34.7% vs 20.9%;p = 0.008). In inductions using the balloon-Cook we observed a decrease in the rate of cesarean section (45.3% versus 22.2% p = 0.001). We found a decrease in the percentage of admission to the Neonatal ICU (10.5% vs 7.6%; p = 0.016) and global neonatal morbidity(11.4% vs 8.2%; p = 0.013) without observing a difference in maternal outcomes. Conclusions: The application of the Robson classification can be a useful method to identify groups that require the application of specific measures aimed at standardizing the management of these patients, thus allowing to reduce the rate of cesarean sections.(AU)

Evaluating Urine Cytology Slide Digitization Efficiency: A Comparative Study Using an Artificial Intelligence-Based Heuristic Scanning Simulation and Multiple Z-Plane Scanning.

INTRODUCTION: Digitizing cytology slides presents challenges because of their three-dimensional features and uneven cell distribution. While multi-Z-plane scan is a prevalent solution, its adoption in clinical digital cytopathology is hindered by prolonged scanning times, increased image file sizes, and the requirement for cytopathologists to review multiple Z-plane images. METHODS: This study presents heuristic scan as a novel solution, using an artificial intelligence (AI)-based approach specifically designed for cytology slide scanning as an alternative to the multi-Z-plane scan. Both the 21 Z-plane scan and the heuristic scan simulation methods were used on 52 urine cytology slides from three distinct cytopreparations (Cytospin, ThinPrep, and BD CytoRich™ [SurePath]), generating whole-slide images (WSIs) via the Leica Aperio AT2 digital scanner. The AI algorithm inferred the WSI from 21 Z-planes to quantitate the total number of suspicious for high-grade urothelial carcinoma or more severe cells (SHGUC+) cells. The heuristic scan simulation calculated the total number of SHGUC+ cells from the 21 Z-plane scan data. Performance metrics including SHGUC+ cell coverage rates (calculated by dividing the number of SHGUC+ cells identified in multiple Z-planes or heuristic scan simulation by the total SHGUC+ cells in the 21 Z-planes for each WSI), scanning time, and file size were analyzed to compare the performance of each scanning method. The heuristic scan's metrics were linearly estimated from the 21 Z-plane scan data. Additionally, AI-aided interpretations of WSIs with scant SHGUC+ cells followed The Paris System guidelines and were compared with original diagnoses. RESULTS: The heuristic scan achieved median SHGUC+ cell coverage rates similar to 5 Z-plane scans across three cytopreparations (0.78-0.91 vs. 0.75-0.88, p = 0.451-0.578). Notably, it substantially reduced both scanning time (137.2-635.0 s vs. 332.6-1,278.8 s, p < 0.05) and image file size (0.51-2.10 GB vs. 1.16-3.10 GB, p < 0.05). Importantly, the heuristic scan yielded higher rates of accurate AI-aided interpretations compared to the single Z-plane scan (62.5% vs. 37.5%). CONCLUSION: We demonstrated that the heuristic scan offers a cost-effective alternative to the conventional multi-Z-plane scan in digital cytopathology. It achieves comparable SHGUC+ cell capture rates while reducing both scanning time and image file size, promising to aid digital urine cytology interpretations with a higher accuracy rate compared to the conventional single (optimal) plane scan. Further studies are needed to assess the integration of this new technology into compatible digital scanners for practical cytology slide scanning.

Ações contra monkeypox em unidade de urgência e emergência: relato de experiência / Actions against monkeypox in a urgency and emergency unit: experience report / Acciones contra la viruela del mono en una unidad de urgencias y emergencias: reporte de experiencia

A monkeypox, ou mpox, consiste em uma nova problemática em saúde pública, que exige ações imediatas para seu controle. Diante disso, este relato de experiência visou relatar as fragilidades nas ações de controle da monkeypox em unidades de urgência e emergência em Fortaleza, Brasil, de 10 de agosto a 20 de novembro de 2022. Utilizou-se a análise temática para organização das categorias nos resultados e o referencial teórico da racionalidade limitada de Herbert Simon para discussão. Duas categorias surgiram: capacitação para identificação e manejo de monkeypox pelos profissionais de saúde; e desafios nas ações contra monkeypox em unidades de pronto atendimento. Apesar de ações iniciais significativas para contenção da doença, ainda há fragilidades na capacitação de recursos humanos, na vigilância em saúde e na qualidade da detecção de casos, que podem impactar o controle da doença e aumentar sua infectividade, morbidade e mortalidade futura.

Monkeypox or mpox configures a new public health problem that requires immediate action to control it. Thus, this experience report aimed to describe weaknesses in control actions against monkeypox in urgency and emergency units in Fortaleza, Brazil, from August 10 to November 20, 2022. Thematic analysis was used to organize the categories in results and in the theoretical framework of Herbert Simon's Limited Rationality for discussion. Overall, two categories emerged: Training so healthcare providers can identify and manage monkeypox and Challenges in actions against the disease in emergency care units. Despite significant initial actions to contain the disease, weaknesses remain in the training of human resources, health surveillance, and the quality of case detection, which can impact disease control and increase its future infectivity, morbidity, and mortality.

La viruela del mono es un nuevo problema de salud pública que requiere acciones inmediatas para controlarla. Ante esto, este reporte de experiencia tuvo como objetivo reportar debilidades en las acciones de control contra la viruela del mono en las unidades de urgencias y emergencias en Fortaleza, Brasil, en el período del 10 de agosto al 20 de noviembre de 2022. Se utilizaron el análisis temático para organizar las categorías en los resultados y el marco teórico de la racionalidad limitada de Herbert Simon para la discusión. Surgieron dos categorías: Capacitación para la identificación y manejo de la viruela del mono por parte de profesionales de la salud; y desafíos en las acciones contra la enfermedad en las unidades de urgencias. A pesar de las importantes acciones iniciales para contener la enfermedad, aún existen debilidades en la capacitación de los recursos humanos, la vigilancia de la salud y la calidad de la detección de casos, que pueden impactar el control de la enfermedad y aumentar su infectividad, morbilidad y mortalidad futura.

Beyond the Jump: A Scoping Review of External Training Load Metrics in Volleyball.

CONTEXT: Volleyball is a complex sport involving multifaceted movements and high-velocity actions, leading to diverse external training loads (ETLs) that have profound implications for player performance and injury risk. OBJECTIVE: To provide a comprehensive overview of the measurement of ETL in volleyball, identify gaps in current understanding, and offer valuable insights for stakeholders in the field. DATA SOURCES: The literature search was conducted across the following electronic databases: PubMed/Medline, Scopus, Web of Science, and SPORTDiscus. STUDY SELECTION: Studies were selected based on their relevance to the measurement of ETL in volleyball. STUDY DESIGN: A scoping review methodology was chosen to map and summarize the broad body of literature related to ETL measurement in volleyball. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data related to ETL measurements in volleyball were extracted and analyzed from the selected studies, focusing on metrics utilized, player positions examined, and technologies employed. RESULTS: A total of 18 studies related to ETL in volleyball were identified and examined for this review. Despite the importance of sagittal plane movements in volleyball, the review identified a substantial research gap regarding ETL measurements beyond this plane, as well as a lack of focus on the unique demands of different player positions like the liberos. The use of technologies such as inertial measurement units was prevalent, but more comprehensive measurement methods are needed. CONCLUSION: There is a critical need for diversified ETL metrics in volleyball, extending beyond the conventional sagittal plane measurements. The findings highlight a substantial research gap in addressing the unique demands of different player positions, notably the liberos. This study underscores the importance of incorporating multiplanar movement data, player-specific roles, and advanced measurement technologies to develop more tailored training programs and injury prevention strategies.

Trasplante renal con ureterostomía cutánea / Renal Transplant with Cutaneous Ureterostomy: A Case Report

Introducción: El trasplante renal precisa de un tratamiento inmunosupresor para evitar el rechazo del injerto, pero éste aumenta el riesgo de contraer una infección. Este riesgo se agrava, aún más, cuando el paciente es portador de una ureterostomía cutánea por la manipulación de las sondas. Descripción Caso Clínico: Varón que ingresa para realización de primer trasplante renal y ureterostomía cutánea. Como antecedentes personales encontramos nefrectomía derecha en 2014 y nefrectomía izquierda y cistectomía radical en 2019, momento en el que comienza en programa de hemodiálisis. Descripción del plan de cuidados: Se realizó valoración inicial y cada 7 días según patrones funcionales de Marjory Gordon. De los diagnósticos identificados a los 15 días se establecieron como prioritarios: Disposición para mejorar los conocimientos, Complicación potencial la infección y Disposición para mejorar el afrontamiento. Evaluación del plan de cuidados: Semanalmente, se revisó el plan de cuidados, cerrando aquellos diagnósticos resueltos. Al alta, tras 33 días ingresado, se alcanzaron los objetivos establecidos, aunque la gran mayoría de ellos se continuaron reevaluando en la Consulta de Enfermería post-trasplante, como fue el diagnóstico de Disposición para mejorar los conocimientos. Conclusiones: Una correcta educación para la salud y la intervención de un equipo interdisciplinar permite un adecua-do aprendizaje de los cuidados fomentando la adherencia terapéutica y una buena prevención y detección precoz de las complicaciones que pueda conllevar la derivación en un paciente trasplantado. Además, ayudar al paciente y a su familia a aceptar esta nueva etapa que conlleva cambios a nivel físico, emocional y social. (AU)

Introduction: Renal transplant requires immunosuppressive treatment to prevent graft rejection, but this increases the risk of infection. This risk is further exacerbated when the patient has a cutaneous ureterostomy due to catheter manipulation. Clinical case description: A male patient was admitted for his first renal transplant and cutaneous ureterostomy. Past medical history includes a right nephrectomy in 2014, a left nephrectomy, and a radical cystectomy in 2019, which led to the initiation of hemodialysis. Nursing care plan description: Initial assessment was conducted, with subsequent evaluations every seven days based on Marjory Gordon’s functional patterns. At the 15-day mark, the following diagnoses were prioritized: Readiness for Enhanced Knowledge, Potential Infection Complication, and Readiness for Enhanced Coping. Evaluation of care plan: The care plan was reviewed weekly, closing out resolved diagnoses. Upon discharge after 33 days of hospitalization, established goals were achieved, with an ongoing revaluation of most of them in the post-transplant Nursing Consultation, particularly the Readiness for Enhanced Knowledge diagnosis. Conclusions: Proper health education and involvement of an interdisciplinary team enable effective learning of care practices, promoting therapeutic adherence and facilitating early prevention and detection of complications that may arise in transplant patients. Additionally, assisting the patient and family in accepting this new phase, which entails physical, emotional, and social changes, is crucial.

[Pay for performance in public directly managed healthcare centers. Part 1: General framework. SESPAS Report 2024]. / Evaluación del rendimiento y compensación en centros sanitarios de gestión directa. Parte 1: marco general. Informe SESPAS 2024.

Assessing and compensating performance in professional organizations is extremely difficult in direct public management settings of health services. Performance assessment is technically complex and, more so, with multiplicity of principals influencing goal setting. Incentives are a lever to generate directionality and motivation, both structural (for attracting and retaining workers) and specific ones (rewarding performance and directing behavior towards institutional goals). Incentives influence the behavior of workers in various ways, and their effectiveness seams weak and controversial in publicly run health services. To overcome the problems of deciding and evaluating performance, both good governance models and the revitalization of contractual management are required. To improve the effectiveness of incentive models, it is convenient to: 1) widen the conceptual framework of incentives, to incorporate the structural aspects of employment contract and payment; 2) improve the designs from a greater understanding of the determinants of motivation; and 3) broaden the lens to survey the extra-mural factors that alter the behavior of workers, trying to counter them.

[Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System. SESPAS Report 2024]. / Evaluación del rendimiento y compensación en centros sanitarios de gestión directa. Parte 2: el Sistema Nacional de Salud. Informe SESPAS 2024.

In Spain, the compensation model for statutory health personnel is complex, heterogeneous, and more oriented to rewarding complementary functions and activities, than to paying for the actual performance in the position of employee. The various attempts to incorporate incentives have been distorted by a civil service egalitarianist culture, and weak systemic governance. External attractors (private practice, etc.) for healthcare professionals are becoming more important and neutralize many intramural incentives. There are few prospects of relevant or general changes, since the main actors involved are reforms-averse; but some environmental factors can lead to incremental improvements in employment contracts, in the information available to improve benchmarking, and in the creation of islands of good clinical governance and management. The economic scenario, increasingly concerned about inflationary trends and sustainability risks, may have a revitalizing effect of some governance and management reforms.

Transformando la educación médica del siglo xxi: El rol de la educación médica basada en competencias / Transforming medical education in the 21st century: The role of competency-based medical education

RESUMEN Introducción: Con el panorama cambiante de la educación médica, es crucial examinar críticamente los enfoques y marcos existentes. La educación médica basada en competencias (EMBC) surge como un prometedor cambio de paradigma, que prioriza el desarrollo de habilidades, conocimientos y actitudes explícitas centrado en el alumno y orientado a los resultados. Objetivo: Identificar los ajustes estructurales y procedimentales esenciales necesarios para una implementación eficaz de la EMBC. Se subraya la importancia de reorganizar las instituciones educativas, adaptar las técnicas de instrucción y evaluación y fomentar la adopción de la EMBC en el aula. Resultados: Para impartir con eficacia la EMBC, es imperativo reestructurar las instituciones educativas para que se centren en planes de estudios basados en competencias y en la enseñanza personalizada. Asimismo, es necesario modificar las estrategias de enseñanza y evaluación para facilitar la evaluación continua y el aprendizaje activo. Conclusiones: Adoptar los principios de EMBC puede permitir que la educación médica produzca profesionales equipados con las habilidades necesarias para satisfacer las demandas dinámicas de la medicina moderna.

ABSTRACT Introduction: With the changing landscape of medical education, it is crucial to critically examine existing approaches and frameworks. competency-based medical education (CBME) emerges as a promising paradigm shift, which prioritizes learner-centered, outcome-oriented development of skills, knowledge, and attitudes. Objective: To identify the essential structural and procedural adjustments needed for effective implementation of CBME. It underscores the importance of reorganizing educational institutions, adapting instructional and assessment techniques, and fostering acceptance of CBME in the classroom. Results: To effectively deliver CBME, it is imperative to restructure educational institutions to focus on competency-based curricula and personalized instruction. Also, there is a need to modify teaching and assessment strategies to facilitate continuous assessment and active learning. Conclusions: Adopting CBME principles can enable medical education to produce professionals equipped with the skills necessary to meet the dynamic demands of modern medicine.

Proceso de enseñanza-aprendizaje de la Ginecobstetricia en situaciones de contingencia

Introducción: Los actores del ámbito educativo deben gestionar procesos adecuados y coherentes con la movilidad social que acontece en la sociedad. Objetivo: Exponer los resultados del diagnóstico del estado inicial de la gestión didáctica de los docentes de la asignatura Ginecología y Obstetricia en situaciones de contingencia. Métodos: Se realizó un estudio cualitativo en el Hospital Universitario Ginecobstétrico Provincial Ana Betancourt de Mora durante el año 2022. Se tuvieron en cuenta las siguientes dimensiones: cognitiva, instrumental y actitudinal con sus respectivos indicadores e índices a medir en el diagnóstico de necesidades. El diagnóstico efectuado se aplicó a 17 docentes de dicha asignatura que laboran en la mencionada institución. Resultados: La dimensión cognitiva fue evaluada de regular, aunque la mayoría de los docentes conocían lo relativo al programa vigente de la asignatura Ginecología y Obstetricia, la mayor cantidad de ellos desconocían los reajustes realizados en situaciones de contingencia. La dimensión instrumental fue evaluada de mal porque los dos indicadores que la componen fueron evaluados de igual modo; mientras que la dimensión actitudinal fue evaluada de regular. Conclusiones: La determinación de la situación inicial de la gestión didáctica de los docentes de la asignatura Ginecología y Obstetricia en situaciones de contingencia, confirmó la presencia de insuficiencias en la gestión didáctica de dicha asignatura en las condiciones señaladas. Ello refleja la necesidad de instrumentar vías para su perfeccionamiento.

Introduction: The actors in the educational field must manage adequate and coherent processes with the social mobility that occurs in society. Objective: To present the results of the diagnosis of the initial state of the didactic management of the teachers of the subject Gynecology and Obstetrics in contingency situations. Methods: A qualitative study was carried out at the Ana Betancourt de Mora Provincial Gynecobstetric University Hospital during the year 2022. The following dimensions were taken into account: cognitive, instrumental and attitudinal with their respective indicators and indices to be measured in the diagnosis of needs. The diagnosis made was applied to 17 teachers of the said subject who work in the aforementioned institution. Results: The cognitive dimension was evaluated as regular, although most of the teachers knew about the current program of the Gynecology and Obstetrics subject, most of them were unaware of the readjustments made in contingency situations. The instrumental dimension was evaluated poorly because the two indicators that comprise it were evaluated in the same way; while the attitudinal dimension was evaluated as regular. Conclusions: The determination of the initial situation of the didactic management of the teachers of the Gynecology and Obstetrics subject in contingency situations, confirmed the presence of insufficiencies in the didactic management of said subject under the indicated conditions. This reflects the need to implement ways for its improvement.

Reflexos do pagamento por desempenho na atuação do(a)s profissionais da Atenção Primária à Saúde, Paraíba, Brasil / Effects of pay-for-performance on the work of primary health care professionals in the state of Paraíba, Brazil / Reflejos del pago por desempeño en la actuación de los y las profesionales de la atención primaria de la salud, Paraíba, Brasil

O estudo buscou compreender a influência da estratégia do Pay for Performance (P4P), por meio do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB), na atuação do(a)s trabalhadore(a)s. Trata-se de um estudo de caso qualitativo realizado com o(a)s trabalhadore(a)s das Estratégias de Saúde da Família. A análise foi realizada mediante a técnica de construção de narrativas. Constatou-se que o P4P contribuiu para qualificação do processo de trabalho, ao mesmo tempo que estimulou competição e conflito entre as equipes, aflorando sentimentos de culpa e injustiça e, devido à precarização do trabalho, o estímulo financeiro se descaracteriza, tornando-se complemento salarial. Problemas macroestruturais afetam as condições de trabalho e a motivação do(a)s trabalhadore(a)s, de modo que modelos de incentivo financeiro, isoladamente, não são suficientes para reverter tal cenário.(AU)

This study sought to understand the influence of pay-for-performance (P4P) on worker performance using data from the National Program for Improving Primary Care Access and Quality (PMAQ-AB). We conducted a qualitative case study with professionals working in family health strategy teams. The data were analyzed using the narrative construction technique. The findings show that P4P contributed to the improvement of work processes, while at the same time stimulating competition and conflict between the teams, causing feelings of guilt and injustice. However, the original purpose of the financial incentive is defeated due to poor working terms and conditions, becoming akin to a salary supplement. Macrostructural problems affect working conditions and worker motivation, showing that financial incentive models alone are not sufficient to reverse this situation.(AU)

El estudio buscó comprender la influencia de la estrategia Pay for Performance (P4P), por medio del Programa de Mejora del Acceso y Calidad de la Atención Básica (Pmaq-AB), en la actuación de los trabajadores y las trabajadoras. Se trata de un estudio de caso, cualitativo, realizado con los trabajadores y las trabajadoras de las Estrategias de Salud de la Familia. El análisis se realizó mediante la construcción de narrativas. Se constató que el P4P contribuyó para la calificación del proceso de trabajo, al mismo tiempo que incentivó competencia y conflicto entre los equipos, haciendo aflorar los sentimientos de culpa e injusticia y, debido a la precarización del trabajo, el incentivo financiero se descaracteriza pasando a ser complemento salarial. Problemas macroestructurales afectan las condiciones de trabajo y la motivación de los trabajadores y de las trabajadoras, de modo que los modelos de incentivo económico, aisladamente, no son suficientes para revertir ese escenario.(AU)

Effect of egocentric and allocentric reference frames on spatial-numerical associations.

From an embodied view of cognition, sensorimotor mechanisms are strongly involved in abstract processing, such as Arabic number meanings. For example, spatial cognition can influence number processing. These spatial-numerical associations (SNAs) have been deeply explored since the seminal SNAs of response code (SNARC) effect (i.e., faster left/right sided responses to small/large magnitude numbers, respectively). Although these SNAs along the transverse plane (left-to-right axis) have been extensively studied in cognitive sciences, no systematic assessment of other planes of the tridimensional space has been afforded. Moreover, there is no evidence of how SNAs organise themselves throughout the changes in spatial body-reference frames (egocentric and allocentric). Hence, this study aimed to explore how SNAs organise themselves along the transverse and sagittal planes when egocentric and allocentric changes are processed during body displacements in the environment. In the first experiment, the results revealed that, when the participants used an egocentric reference, SNAs were observed only along the sagittal plane. In a second experiment that used an allocentric reference, the reversed pattern of results was observed: SNAs were present only along the transverse plane of the body. Overall, these findings suggest that, depending on the spatial reference frames of the body, SNAs are strongly flexible.

Effectiveness of the contingency plan for social and health care during the COVID-19 pandemic in a health district in northwestern Spain / Efectividad del plan de contingencia sociosanitario durante la pandemia de la COVID-19 en un distrito sanitario del noroeste de España

Introduction During the COVID-19 pandemic, healthcare facilities have implemented contingency plans to minimize the consequences of this pathology however, the deployment and results of these contingency plans are scarcely shared. Objectives To describe the implementation of the contingency plan in the social and health care in the COVID-19 pandemic in the Public Hospital of Monforte (Lugo, Spain) and to evaluate the effectiveness of the measures included in this plan. Method Phenomenological sampling conducted between March 10 and May 15, 2020. Evaluation qualitative assessment by an external quality improvement team of the Galician Health Service (SERGAS), based on the Practicum Direct rapid structured checklist in risk management, organizational management, and evaluation of decision making. As outcome indicators, we assessed the number of hospital admissions, number of PCRs performed, telephone attention to social and health social-healthcare patients, number of hospitalizations avoided and estimation of their direct cost. Results After assessing and managing the risks, an information security plan was developed and solutions to minimize complications in our patients derived from this pandemic. An emergency decision making team was created, as well as an employee communication mechanism for employees through standardized documents and documentation channels. Conclusions The adaptation of the Practicum Direct rapid model to the healthcare setting is a useful and easy-to-apply tool that allows us to identify weak points and areas for improvement in our Service and thus to strengthen patient care in all clinical areas, improving the quality of care (AU)

Introducción Durante la pandemia de la COVID-19 los centros sanitarios han puesto en marcha planes de contingencia para minimizar las consecuencias de esta enfermedad. Sin embargo, el despliegue y los resultados de estos planes de contingencia son escasamente compartidos. Objetivos Describir la implantación del plan de contingencia en la atención sociosanitaria en la pandemia de la COVID-19 en el Hospital Público de Monforte (Lugo, España) y evaluar la efectividad de las medidas incluidas en dicho plan. Método Muestreo fenomenológico realizado entre el 10 de marzo y el 15 de mayo de 2020. Evaluación cualitativa por un equipo externo de mejora de la calidad del Servicio Gallego de Salud, basada en la lista de verificación rápida estructurada Practicum Direct en gestión de riesgos, gestión organizativa y evaluación de la toma de decisiones. Como indicadores de resultado se valoraron el número de ingresos hospitalarios, el número de PCR realizadas, la atención telefónica a pacientes sociosanitarios, el número de hospitalizaciones evitadas y la estimación de su coste directo. Resultados Tras evaluar y gestionar los riesgos se elaboró un plan de seguridad de la información y soluciones para minimizar las complicaciones en nuestros pacientes derivadas de esta pandemia. Se creó un equipo de toma de decisiones de emergencia, así como un mecanismo de comunicación para los empleados a través de documentos y canales de documentación estandarizados. Conclusiones La adaptación del modelo Practicum Direct rapid al ámbito sanitario es una herramienta útil y de fácil aplicación que nos permite identificar puntos débiles y áreas de mejora en nuestro servicio, y así reforzar la atención al paciente en todas las áreas clínicas, mejorando la calidad asistencial (AU)

Plan de acción para el fortalecimiento de las funciones esenciales de salud pública (FESP) en El Salvador / Plan of Action for the Strengthening of Essential Public Health Functions (FESP) in El Salvador

Actualmente, las Funciones Esenciales de Salud Pública (FESP) se conceptualizan en todos los niveles institucionales, junto con la sociedad civil, para fortalecer los sistemas de salud y garantizar un ejercicio pleno de la salud pública, actuando sobre los factores y determinantes sociales que tienen un efecto en la salud de la población En ese sentido, la propuesta «renovada¼ de las FESP orienta el desarrollo de políticas de salud pública mediante cuatro etapas: evaluación, desarrollo de políticas, asignación de recursos y acceso; y tiene como objetivo general que los países de las Américas efectúen un diagnóstico de las capacidades necesarias para el ejercicio de las FESP, establezcan una línea base para futuras evaluaciones y fortalezcan aquellas áreas que pudieran requerir mejoras. El presente Plan de Acción contempla las principales propuestas de actividades que se delinearon, con la participación de una amplia gama de instituciones gubernamentales, durante las 3 fases del ejercicio de evaluación y fortalecimiento de las FESP conducido por el Ministerio de Salud, en su calidad de ente rector, con el propósito de abordar las brechas identificadas en cada una de las capacidades priorizadas por cada una de las once funciones esenciales de salud pública, a fin de fortalecer las competencias de la Autoridad Sanitaria Nacional en el ámbito de la Salud Pública

Currently, the Essential Functions of Public Health. (EPHF) are conceptualized at all institutional levels, together with civil society, to strengthen health systems and guarantee the full exercise of public health, acting on the social factors and determinants that have an effect on the health of the population. In this sense, the "renewed" FESP proposal guides the development of public health policies through four stages: evaluation, policy development, resource allocation and access; and its general objective is for the countries of the Americas to carry out a diagnosis of the capacities necessary for the exercise of the FESP, establish a baseline for future evaluations and strengthen those areas that may require improvements. This Action Plan contemplates the main proposals for activities that were outlined, with the participation of a wide range of government institutions, during the 3 phases of the evaluation and strengthening exercise of the FESP conducted by the Ministry of Health, in its capacity as governing body, with the purpose of addressing the gaps identified in each of the capacities prioritized by each of the eleven essential public health functions, in order to strengthen the competencies of the National Health Authority in the field of Public Health