¿Qué preguntar,cómo explorar y qué escalas usar en el paciente con cefalea? Recomendaciones del Grupo de Estudio de Cefalea de la Sociedad Española de Neurología

IntroductionHeadache is the most common neurological complaint at the different levels of the healthcare system, and clinical history and physical examination are essential in the diagnosis and treatment of these patients. With the objective of unifying the care given to patients with headache, the Spanish Society of Neurology's Headache Study Group (GECSEN) has decided to establish a series of consensus recommendations to improve and guarantee adequate care in primary care, emergency services, and neurology departments.MethodsWith the aim of creating a practical document, the recommendations follow the dynamics of a medical consultation: clinical history, physical examination, and scales quantifying headache impact and disability. In addition, we provide recommendations for follow-up and managing patients’ expectations of the treatment.ConclusionsWith this tool, we aim to improve the care given to patients with headache in order to guarantee adequate, homogeneous care across Spain.     

Teaching,Learning and Bion's Model of Digestion

In this paper the author is using Bion's model of the digestive process, among other models, in order to think about how teaching of theory can be approached as a task and undertaken in practice. Beginning with the ideas of Plato, she discusses how new ideas may be best conveyed, and how psychoanalytic theory teachers (using the teaching of Melanie Klein's ideas here to make her points) may make what they teach acceptable and ‘digestible’ to students. She uses some material from a theory group as well as a baby observation group, and concludes that in group teaching the responsibility for the taking on and elaboration of ideas – a process of digestion – is shared by the teacher and by the group. As psychoanalytic workers need to be able to ‘manage uncertainty’ in daily practice, this state of mind can usefully also be held by the theory teacher. The process of digestion will vary according to the composition of any group, drawing out different facets of understanding in both ‘teachers’ and ‘learners’, and may well draw on other vertices beyond that of psychoanalysis. These links will aid the process of digesting ideas, and will also be evident in the author style, structure and content of this paper.     

Diseño y evaluación de un modelo de simulación de fractura de pene

ObjectiveTo design and assess a novel penile fracture simulation model for teaching penile fracture repair.MethodsWe used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit (“simulated fracture”) was created on one part of the first half of the foreskin (mimicking “tunica”) and was applied over the penile model. A red jelly tablet (“clot”) was placed underneath the cut. A second full-length of foreskin was applied over it to cover the defect. The model was assessed by participants and expert faculty at the Urology Simulation Boot Camp. Evaluation was performed using a 5-point Likert Scale questionnaire. Data was analysed using Microsoft Excel and IBM SPSS Statistics V25. The intra-class correlation was calculated using a “One-way random model”.ResultsTwenty-two urology trainees and four experts participated in the evaluation. The majority of trainees strongly agreed (59%, n = 13) the model is useful for training with experts similarly agreeing in 75% of cases. The appearance of penile fracture was considered good by both trainees (68%, n = 14) and faculty (75%). Overall, the ability of the model to represent a realistic simulation of the task was considered excellent by 23% of participants and good by 64%. Personal confidence after simulation in managing a similar situation was considered high among trainees. The main difficulties reported were related to fascial planes and urethra.ConclusionThis is the first simulation model for penile fracture repair and has demonstrated face validity at a national urology bootcamp.     

Assessment of neuropsychological impairments in regular cannabis users

BackgroundCannabis is the most widely used illicit drug in the world. It is responsible for cognitive dysfunction of memory, speed of information processing, attention, and executive functions. Cognitive performance depends on the level of study, tolerance, and duration of abstinence from cannabis use. This study analyses cognitive function in a large population of regular cannabis consumers taking into account level of education.MethodsA battery of neuropsychological tests using the Cambridge Neuropsychological Test Automated Battery was performed on a population of 58 cannabis users categorized into two groups according to their level of education with a threshold of 12 years of study, and 25 non-users.ResultsIn Attention Switching Task percent correct trials, significant differences were found between the group of cannabis smokers with less than 12 years of study and the non-smoker group (P = 0.022), and between the cannabis users with more than 12 years of study and the non-smoker group (P = 0.008). A significantly lower performance in the Rapid Visual Information Processing (Mean latency, Probability of hit, Total hits, Total misses, Correct rejections) was found in the cannabis users with less than 12 years of study compared with the non-user group.ConclusionIn our population, chronic cannabis users presented divided and sustained attention and working memory disorders. Rapid Visual Information Processing performance may be influenced by education level in cannabis smokers.     

Apheresis education in Canadian residency programs: A needs assessment

Indications for therapeutic and donor apheresis continue to increase and expand into new domains of therapy. The level and amount of apheresis education in residency programs remains heterogeneous, which may translate into varying degrees of clinical confidence in providing care. The purpose of this study was to assess Canadian clinicians' perceptions of their apheresis training in order to help demonstrate a need for a concrete apheresis education in residency curricula. A 22-question survey was distributed to Canadian graduates who recently completed training (2013–2017) in the following specialties: hematology, nephrology, transfusion medicine, and hematologic pathology. Questions regarding clinician perception of their training were asked using a Likert scale. Fifty-seven survey responses (32% response rate) were obtained from recent graduates from hematology (29/57, 51%), nephrology (21/57, 37%), hematologic pathology (4/57, 7%) and transfusion medicine (3/57, 5%). Although most respondents (68%) received some form of apheresis exposure during residency, only 23% reported a formal apheresis rotation. Only 40% felt that the amount of time devoted to apheresis education was sufficient, and only four respondents (7%) felt confident providing independent apheresis care at the end of training. Overall, these findings suggest that a common, dedicated apheresis curriculum in these training programs could possibly increase knowledge and competence of trainees, and provide a more solid foundation in apheresis for future practice.