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Purpose The purpose of this study was to classify elements of patients' discomfort in the resuscitation room after open or laparoscopic abdominal surgery as per health care professionals’ perceptions. Design A prospective cross-sectional study at a tertiary hospital in Spain. Methods Resuscitation room nurses administered the Postoperative Discomfort Inventory to physicians and nurses with >1 year experience working closely with patients who had undergone abdominal surgery, asking them to score nine items related to patients' discomfort in the first 8 hours after surgery on an 11-point scale (0 = absent to 10 = very severe). Interobserver agreement among proxy reporters was measured with the Spearman's ρ; correlations >0.35 was considered adequate agreement. Findings Of 125 eligible professionals, 116 (93%) participated (63 [54%] nurses and 53 [46%] physicians; mean age, 38 ± 12 years; 86 [74%] women). Professionals' perception of discomfort differed significantly between patients undergoing open surgery and those undergoing laparoscopic surgery; after open surgery, the most common types were pain (7.1 ± 1.8), movement restriction (7 ± 1.75), and dry mouth (6.6 ± 2.6), whereas after laparoscopic surgery, the most common types were dry mouth (5.85 ± 2.8), abdominal bloating (5.3 ± 2.5), and pain (5 ± 2.2). The Spearman's ρ correlations were inadequate for all items except for dry mouth in open surgery (r = 0.40). Conclusions Pain, movement restriction, abdominal bloating, and dry mouth were the main causes of discomfort. Our findings highlight the need to be vigilant for all manifestations of discomfort after abdominal surgery to enable timely treatment. more...

El año 2020 será recordado, probablemente, como “el año del coronavirus”. La pandemia SARS-CoV-2 que azota desde diciembre de 2019 a todo el mundo marcará un antes y un después en la vida cotidiana de muchas personas. Para evitar la propagación del virus, se han impuesto restricciones rigurosas de circulación, cuarentenas y confinamientos como nunca había sucedido. Frente a esta realidad inédita y disruptiva, acudimos a una fuente privilegiada para analizar y aprender sobre las epidemias: el cine y las series. En particular, las series médicas permiten que los espectadores se adentren en el mundo hospitalario y conozcan distintas representaciones de los profesionales de la salud. En este artículo presentamos la descripción y el análisis de seis episodios de series médicas donde se retrata una epidemia como tema central: Urgencias, Anatomía de Grey, Doctor House, The Good Doctor, New Amsterdam y The Resident. La representación de la enfermedad y la epidemia suele ser misteriosa y peligrosa y se representa a los profesionales como héroes dispuestos a sacrificar su propia salud en pos de sus pacientes. Los temas bioéticos se relacionan con el consentimiento informado y la influencia de temas personales de los profesionales en el tratamiento de sus pacientes. more...

espanolEl uso de peliculas comerciales en la educacion medica es un recurso pedagogico cada vez mas extendido, y particularmente el metodo de Cinema-educacion proporciona tanto una base teorica como antecedentes documentados sobre esta forma de innovacion pedagogica. En esta ocasion, proponemos la utilizacion de una pelicula comercial para la ensenanza de la farmacologia, particularmente de la farmacovigilancia y los efectos indeseabless de los medicamentos, temas que suelen ser muy complejos para estudiantes de Medicina. Se detalla el metodo riguroso de seleccion del film y sus escenas, asi como la secuencia metodologica de su utilizacion en clase. La pelicula elegida, La doctora de Brest (2016) de Emmanuelle Bercot, se basa en la historia real de Irene Frachon, una medica francesa que comienza a detectar casos de cardiotoxicidad asociados al consumo de un medicamento y libra una batalla judicial contra la compania farmaceutica que lo produce y comercializa. El film revela en detalle el estudio epidemiologico llevado a cabo en el Hospital de Brest y tambien el papel de las agencias de seguridad, farmacovigilancia y salud publica en una trama compleja que permite debatir con los estudiantes de Medicina aspectos clave de la farmacovigilancia. EnglishThe use of commercial films in medical education is an increasingly widespread pedagogical resource, and particularly the Cinemeducation method provides a theoretical basis as well as documented background on this pedagogical innovation. In this paper, we propose the use of a commercial film for teaching pharmacology, particularly pharmacovigilance and adverse effects of drugs, topics that are usually very complex for medical students. The rigorous method followed in the choice of the film and its scenes is detailed, as well as the methodological sequence of its use in class. The selected film, La fille de Brest by Emmanuelle Bercot, is based on the true story of Irene Frachon, a French doctor who begins to detect cases of cardiotoxicity associated with the consumption of a drug and undertakes a legal battle against the pharmaceutical company that produces and distributes it. The film reveals in detail the epidemiological study carried out at Brest Hospital and also the role of safety, pharmacovigilance and public health agencies in a complex plot that allows key aspects of pharmacovigilance to be discussed with medical students. more...

El avance tecnocientífico en el siglo XX ha exacerbado la sensación de que las humanidades son inútiles para la formación de profesionales de la salud. El desarrollo de la medicina científica y los avances terapéuticos en los últimos dos siglos modificaron el foco de atención de muchos profesionales y Universidades, pasando de centrarse en los pacientes hacia privilegiar el foco de atención en las enfermedades, su diagnóstico y tratamiento. En las últimas décadas, el éxito de la medicina basada en evidencia y la creciente disponibilidad de la tecnología han exacerbado esta situación. Sin embargo, es evidente que cada vez más se necesita volver a las humanidades en las ciencias de la salud. Tradiciones disciplinares como las “humanidades médicas” implican volver a incorporar elementos de historia, literatura, arte, cine, para un mejor entendimiento de los pacientes y sus sentimientos. En este ensayo relevamos los aportes de las humanidades en la enseñanza de las ciencias de la salud, señalando que no son simplemente un complemento prescindible en la formación universitaria, y recomendamos incluirlos en los currículos para garantizar que haya profesionales más empáticos que traten a los pacientes y las enfermedades. more...

Background and purpose Mu and delta opioid receptors(MOP, DOP) contribution to the manifestations of pathological pain is not understood. We used genetic approaches to investigate the opioid mechanisms modulating neuropathic pain and its comorbid manifestations. Experimental approach We generated conditional knockout mice with MOP or DOP deletion in sensoryNav1.8-positive neurons (Nav1.8), in GABAergic forebrain neurons (DLX5/6) orconstitutively (CMV). Mutant mice and wild-type littermates were subjected topartial sciatic nerve ligation (PSNL) or sham surgery and their nociception wascompared. Anxiety-, depressivelike behaviour and cognitive performance were also measured. Opioid receptor mRNA expression, microgliosis and astrocytosis were assessed in the dorsalroot ganglia (DRG) and/or the spinal cord (SC). Key results Constitutive CMV-MOP knockouts after PSNL displayed reduced mechanical allodynia and enhanced heat hyperalgesia. This phenotype was accompanied by increased DOP expression in DRG and SC, and reduced microgliosis and astrocytosis in deep dorsal horn laminae. Conditional MOP knockouts and control mice developed similar hypersensitivity after PSNL, except for anenhanced heat hyperalgesia by DLX5/6-MOP male mice. Neuropathic pain-induced anxiety was aggravated in CMV-MOP and DLX5/6-MOP knockouts. Nerve-injured CMV-DOP mice showed increased mechanical allodynia, whereas Nav1.8-DOP and DLX5/8-DOP mice had partial nociceptive enhancement. CMV-DOP and DLX5/6-DOP mutants showed increased depressive-like behaviour after PSNL. Conclusions and implications MOP activity after nerve injury increased anxiety-like responses involving forebrain GABAergic neurons and enhanced mechanical pain sensitivity along with repression of DOP expression and spinal cord gliosis. In contrast, DOP shows a protective function limiting nociceptive and affective manifestations of neuropathic pain. more...

Background/Aims: The term vulvodynia refers to vulvar pain of unknown origin lasting at least 3 months. Psychiatric comorbidities are a common feature and, along with pain, may severely affect patients’ wellbeing. We aimed to determine the characteristics of pain in vulvodynia, to correlate characteristics with symptoms of anxiety and depression, and to analyse the impact of these factors on patients’ quality of life. Methods: This cross-sectional observational study analysed pain, anxiety, and depression and the effects of these factors on quality of life. Pain, anxiety, and depression were assessed using validated tools in 110 women. Results: Statistical analyses found correlations between pain and anxiety and between anxiety and worsened quality of life. Patients often reported stinging, burning, pain, itching, and dyspareunia, pointing to the importance of temporal, localisation, punctate pressure, thermal, tactile sensitivity, and emotional tension characteristics. Most patients had severe pain related to psychiatric comorbidities and decreased quality of life. Conclusion: Using descriptors of pain quality and assessing anxiety and depression might help to define subgroups of patients that may benefit from different therapeutic approaches and thus enable treatments to be tailored to individual patients. more...

Introduction: Television medical dramas enjoy great popularity among the general public and university students. These dramas have been used to illustrate important aspects of medical training (doctor–patient relationships, professionalism, ethical conflicts), but their usefulness for discussing the use of drugs in medical care remains unexplored. We analyzed pharmacological issues in House, M.D. to determine their potential usefulness in teaching clinical pharmacology. Material and methods: Two investigators, blind to each other's responses, reviewed each of the 22 episodes of the first season of House, M.D., recording the main and secondary topics dealt with as well as the drugs portrayed and rating the episode's interest for teaching clinical pharmacology (High/Medium/Low). Discordant ratings were settled by a third (or fourth, if necessary) investigator. Results: Most episodes included information on drugs; in six, pharmacologic issues were the main topics. The episodes dealt with 115 drugs, mainly anti-infective (16.5%), cardiovascular (12.2%), CNS-acting (12.2%), and analgesic or anti-inflammatory (12.2%) drugs. Five episodes were considered very useful for teaching clinical pharmacology. Discussion: The episodes of the first season of House, M.D. contained frequent references to drug treatment and pharmacological issues; in a few episodes, the main topic was related with clinical pharmacology. Before medical dramas are recommended as a regular teaching tool, their pedagogical efficacy should be tested empirically. Resumen: Introducción: Las series médicas de televisión disfrutan de gran popularidad entre los estudiantes universitarios, y se han empleado para ilustrar aspectos importantes de la educación médica (relación médico-paciente, profesionalismo, conflictos éticos). Su utilidad para debatir el empleo de medicamentos en la práctica médica no se ha evaluado. En el presente estudio analizamos los temas farmacológicos presentes en House, M.D. para establecer su interés potencial en la docencia de la farmacología clínica. Material y métodos: Dos investigadores, desconocedores de las respuestas mutuas, revisaron los 22 episodios de la primera temporada de House, M.D., y registraron los temas principales y secundarios de cada episodio, así como los fármacos empleados. Asimismo, puntuaron su interés para la docencia de la farmacología clínica (alto/medio/bajo). Cuando existía discordancia, un tercer evaluador (y un cuarto, si era necesario) establecía la decisión final. Resultados: La mayoría de los capítulos contenían información de medicamentos; en 6 los temas farmacológicos constituían el principal elemento argumental. Los episodios refirieron 115 fármacos, principalmente antiinfecciosos (16,5%), cardiovasculares (12,2%), neuropsicofármacos (12,2%) y analgésicos o antiinflamatorios (12,2%). Se consideró que 5 episodios podrían tener utilidad docente alta. Discusión: Los episodios de la primera temporada de House, M.D. contenían referencias frecuentes a medicamentos y a temas farmacológicos. En un número reducido de episodios, el argumento principal se vinculaba a la farmacología clínica. Antes de que pueda recomendarse su empleo en docencia, debe evaluarse empíricamente su eficacia pedagógica. Keywords: Medical TV series, Medical curricula, Clinical pharmacology, Undergraduate Teaching, Palabras clave: Series médicas de televisión, Estudios médicos, Farmacología clínica, Docencia de grado more...

Background Medical dramas have been popular since their inception, especially among medical students. We hypothesized that the recent increase in the availability of TV medical series through online streaming platforms has probably changed health science students’ viewing habits as well as the representation of bioethical conflicts and health professionals. Methods We invited undergraduate students of medicine, nursing, and human biology to complete a self-administered questionnaire about their viewing habits and perceptions of the depictions of bioethical issues and professionalism in TV medical series. Results Of the 355 respondents, 98.6 % had watched TV in the last year, 93.5 % watched TV series, and 49.6 % watched medical dramas more than once a week. The most-viewed medical dramas were The Good Doctor, House MD, and Grey’s Anatomy. The most-remembered bioethical topics were medical errors, inappropriate professional behaviors, and death. Most students considered that ideals of professionalism were depicted positively and professionals were portrayed as intelligent, professionally qualified, and competent. Conclusions Medical dramas are very popular with health science students and are potentially useful as teaching tools for discussing issues related to bioethics and professionalism. more...

BackgroundAdvances in biomedicine can substantially change human life. However, progress is not always followed by ethical reflection on its consequences or scientists’ responsibility for their creations. The humanities can help health sciences students learn to critically analyse these issues; in particular, literature can aid discussions about ethical principles in biomedical research. Mary Shelley’sFrankenstein; or, the modern Prometheus(1818) is an example of a classic novel presenting complex scenarios that could be used to stimulate discussion.Main textWithin the framework of the 200th anniversary of the novel, we searched PubMed to identify works that explore and discuss its value in teaching health sciences. Our search yielded 56 articles, but only two of these reported empirical findings. Our analysis of these articles identified three main approaches to usingFrankensteinin teaching health sciences: discussing the relationship between literature and science, analysing ethical issues in biomedical research, and examining the importance of empathy and compassion in healthcare and research. After a critical discussion of the articles, we propose usingFrankensteinas a teaching tool to prompt students to critically analyse ethical aspects of scientific and technological progress, the need for compassion and empathy in medical research, and scientists’ responsibility for their discoveries.ConclusionFrankensteincan help students reflect on the personal and social limits of science, the connection between curiosity and scientific progress, and scientists’ responsibilities. Its potential usefulness in teaching derives from the interconnectedness of science, ethics, and compassion.Frankensteincan be a useful tool for analysing bioethical issues related to scientific and technological advances, such as artificial intelligence, genetic engineering, and cloning. Empirical studies measuring learning outcomes are necessary to confirm the usefulness of this approach. more...

Feature films are increasingly being used in teaching health sciences. However, few publications address the effectiveness of this approach. We hypothesized that using feature films could help students learn. We aimed to assess the effectiveness of using a feature film to teach students about adverse drug reactions and pharmacovigilance. The study population comprised third-, fifth-, and sixth-year undergraduate students of medicine, third-year undergraduate students of human biology, and graduate students in a master’s degree program about the pharmaceutical and biotechnology industry. Students watched clips from the film 150 Miligrams (La fille de Brest) and discussed them afterward. To measure learning, we administered a 10-question multiple-choice test about pharmacovigilance concepts. We assessed students’ satisfaction with the activity through a questionnaire. An exploratory comparative analysis was performed. A total of 237 students participated. Postintervention assessment scores were significantly higher than preintervention scores for the entire population and for all subgroups. The mean number of correct answers was 4.41 on the preintervention assessment and 5.78 on the postintervention assessment (mean gain: 1.37; 95% CI: 1.10–1.65). Similar results were found when analyzing groups of students from each group. Student satisfaction with this teaching activity was high in all groups. Cinemeducation is a useful tool for teaching about adverse drug reactions and pharmacovigilance processes. Most students were highly satisfied. more...

The medical drama The Good Doctor / El buen doctor (TV) (2017) of David Shore (United States) is helpful to analyze various important issues to health sciences. On the one hand, as a medical drama, it allows to examine the fiction of doctors and patients, the bioethical dilemmas raised in each of the cases, and the implications of the professional actions in the lives of patients. On the other hand, the peculiar qualities of the protagonist (characterized with a diagnosis of autism and savant syndrome, which makes him both extremely intelligent and not very skilled in social relations) are the key of access for the analysis of representations about people with autism, both in the cinema and on television. In this article we will focus especially on the representation of autism and the fact that the guest is the first autistic doctor to appear in a medical drama. What are their characteristics? How is the guest of The Good Doctor characterized? Its usefulness for students of health sciences is multiplied and allows to return to bioethical questions as well as aspects linked to doctor-patient communication and the limits and possibilities of the medical practice. more...

Oliver Sacks (1933-2015) has been one for the most prominent authors in scientific popularizing of neurology. His works stimulated the interest of public in this field, but Sacks’s contribution in the relationship between neurology and ophthalmology is not so well known. In this paper, we analyze his works regarding achromatopsia, a disorder of retinal cones that produces a black and white vision. Sacks analyzed several types, as transient achromatopsia, which appears in migraine aura, but the most interesting were those linked to congenital and acquired achromatopsia. The first was studied in the population of Pingelap, an island in Micronesia, and explained in The island of the colorblind (1996), whereas the second was reported in The case of colorblind painter (1995). In both works, Sacks described not only the pure medical aspects of the disorder, but considered in full its psychological and anthropological consequences. Reading these tales allows us to understand how chromatically limited vision affected, or not, their personal and social life. more...

José Luis Sampedro (1917-2013) was a Spanish economist who wrote literary works since his youth, although the public success did not reach him until his maturity. His father was physician and Sampedro himself was interested in becoming medical doctor during a time. Many of his literary works contain references to medicine and physiology, especially two of them, La sonrisa etrusca (1985) and Monte Sinaí (1995). In the first, Sampedro analyzed the effects of a severe disease in an elderly man, and how his illness experience is modulated by his grandson. In the second, he described his stay in the Mount Sinai Hospital after a severe endocarditis that threatened his life. The narrative shows the emotions associated with the vital threaten and how the human contact relieved them. This paper analyzes these two literary works but also some of the other novels and autobiographical works. more...

Background Problem-based learning (PBL) provides an encouraging learning environment to develop generic, research, and creative thinking skills, which have been identified as essential for facing 21 st century challenges. However, how PBL is implemented into a curriculum can be critical for achieving these outcomes. This study explores the effects of shifting the implementation of PBL from a PBL-module integrated into traditional subjects to full interdisciplinary PBL-courses in undergraduate health sciences students. Methods This study involved 651 participants, with 364 taking the PBL-module and 287 taking the PBL-courses. Students’ and tutors’ perceptions about the acquisition of the skill set as well as their satisfaction with the learning experience were collected through surveys and compared in both models. Results Results showed that in interdisciplinary PBL-courses, both students and teachers had the perception that both skills improvement and PBL usefulness were better, and overall were more satisfied with the course. A strong correlation was observed between the acquisition of generic and research skills and the perception of PBL usefulness and overall satisfaction with the experience. The study also showed how creative skills are developed during the different PBL phases. Conclusions This study provides new evidence on PBL characteristics that favour the development of these skills. more...

RESUMEN Introducción y objetivos: Felipe Trigo (1864-1916) fue uno de los médicos escritores más importantes de la época de la Restauración borbónica. Fue médico rural y médico militar pero fue especialmente conocido por su obra literaria y periodística. Material y métodos: Entre sus obras más importantes figuran El médico rural (1912) y Jarrapellejos (1914), donde realiza una profunda crítica de la sociedad española de la época. Trigo fue conocido por sus obras de literatura erótica por las que fue atacado en su tiempo, lo que contribuyó a su olvido después de su muerte. El médico rural contiene numerosos elementos autobiográficos del tiempo que ejerció como la medicina en pueblos extremeños. Resultados: Tiene un notable interés para conocer cómo era la práctica de los médicos, su conocimiento de los avances médicos del siglo XIX y las relaciones que ese establecían con el pueblo llano y la estructura caquicil dominante. Conclusiones: Después de décadas de práctico olvido, Trigo vuelve a ser considerado como uno de los médicos escritores más notables de su generación. ABSTRACT Introduction: Felipe Trigo (1864-1916) was one of the most important writers of the Borbonic Restoration period. He was a country physician and military physician, but he was especially known by his literary and journalistic work. Material and methods: Among his most important literary, we should show up El médico rural (1912) and Jarrapellejos (1914), where he performed a strong critical approach of the Spanish society of his time. He was also known by his erotic novels, which were strongly attacked at the time. This fact contributed to the oblivion of his works after the Trigo's death. El médico rural contains many autobiographical elements of the time he worked as physician in country villages of Extremadura. Results: The novel has an outstanding interest to know how was the medical practice of country physicians, their knowledge of the medical advances of the late nineteenth century and their social relationships with plain people and the local rulers. Conclusions: After decades of being almost forgotten, Trigo is now recognized as one of the physician writers more noteworthy of his generation. more...

The publication collects the contributions presented during the International Symposium of the Italian UNESCO Chairs (CONIUS) entitled Human Rights and Sustainable Development Goals 2030, which took place on 16 November 2018 at the University of Florence. The contributions of national and international experts address the Global Aims for Sustainable Development of the UNESCO including Sustainable Development Goals (SDGs) n. 3 Improvement of the ‘Global Health’, n. 4 ‘Quality Education’, n. 11 ‘Cities and Inclusive Human Sett lements’ and n. 16 ‘Peace and Justice’, using transdisciplinary and transnational perspectives and implemented through theoretical studies and good practices. more...

Two hundred years after it was first published, Mary Shelley's Frankenstein; or, the modern Prometheus remains relevant. This novel has endured because of its literary merits and because its themes lend themselves to analysis from multiple viewpoints. Scholars from many disciplines have examined this work in relation to controversial scientific research. In this paper, we review the academic literature where Frankenstein is used to discuss ethics, bioethics, science, technology and medicine. We searched the academic literature and carried out a content analysis of articles discussing the novel and films derived from it, analyzing the findings qualitatively and quantitatively. We recorded the following variables: year and language of publication, whether it referred to the novel or to a film, the academic discipline in which it was published, and the topics addressed in the analysis. Our findings indicate that the scientific literature on Frankenstein focuses mainly on science and the personality of the scientist rather than on the creature the scientist created or ethical aspects of his research. The scientist's responsibility is central to the ethical interest of Frankenstein; this issue entails both the motivation underlying the scientist's acts and the consequences of these acts. more...

La comprensión del proceso de enfermar, el descubrimiento de la propia enfermedad y la actitud de las personas que rodean al que la sufre es un tema de notable importancia en la formación médica. No obstante, la comprensión de los complejos elementos psicológicos que aparecen en estas situaciones no es un tema sencillo para aquellos que no han estado enfermos o no han tenido familiares que hayan sufrido enfermedades graves. La lectura de un ensayo que teorice sobre las complejas relaciones fruto de la enfermedad no suele dar una imagen próxima de lo que sucede en realidad. La muerte de Iván Ilich es una obra capital para aproximarse a los sentimientos que se presentan en las personas que se ven afectadas por una grave enfermedad, que va mermando sus capacidades físicas y les produce, además, un insoportable dolor físico y moral. Este último se agrava además si los familiares ignoran el sufrimiento que el enfermo experimenta. La obra de Tolstói es una contribución muy importante para comprender todas estas situaciones desde la ficción. more...

La utilización de películas comerciales para ilustrar conflictos bioéticos es una experiencia frecuente en la docencia universitaria de ciencias de la salud. En este ámbito, la investigación clínica es un importante paradigma para conocer cómo los principios éticos pueden aplicar en situaciones de análisis complejo. En el presente artículo se analiza el interés de una película comercial, Al cruzar el límite/ Extreme Measures (1996) de Michael Apted, para presentar el difícil debate de aplicación de los principios de autonomía, justicia, beneficencia y no maleficencia. El film presenta diversas situaciones en el marco de un argumento policíaco inspirado en el libro del médico norteamericano Michael Palmer. Los autores comentan las fortalezas y las debilidades de la película, así como aquellos aspectos que pueden plantearse en el debate de la película, y sugieren su posible utilidad para debatir cómo los factores personales pueden influenciar la toma de decisiones en situaciones límite. La principal conclusión es que Al cruzar el límite puede ser un instrumento útil a pesar de que se necesitan pruebas empíricas para confirmarla. more...