Inserción de la simulación clínica en el currículum de Anestesiología en un hospital universitario. Evaluación de la aceptabilidad de los participantes

IntroductionClinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program.MethodsActivities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished.ResultsA total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness.ConclusionsThe inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.     

Epidemiology of cervical cancer in Colombia

Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV exposures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.     

Prediction of early (4-week) mortality in acute myeloid leukemia with intensive chemotherapy

The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m² during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality.     

Generalized empirical likelihood testing in semiparametric conditional moment restrictions models

Summary This paper shows how generalized empirical likelihood can be used to obtain specification tests in semiparametric conditional moment restrictions models. The resulting test statistics are similar in spirit to classical Kolmogorov–Smirnov and Cramer von Mises goodness‐of‐fit statistics and are based on an integrated version of the original moment restrictions. The results are applied to test the correct specification of an instrumental variable smooth varying coefficient model and of a censored non‐linear quantile regression model. Monte Carlo results suggest that the proposed tests have competitive finite sample properties.