Camilo Osorio

Comparison of two protective lung ventilatory regimes on oxygenation during one-lung ventilation: a randomized controlled trial

BackgroundThe efficacy of protective ventilation in acute lung injury has validated its use in the operating room for patients undergoing thoracic surgery with one-lung ventilation (OLV). The purpose of this study was to investigate the effects of two different modes of ventilation using low tidal volumes: pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on oxygenation and airway pressures during OLV.MethodsWe studied 41 patients scheduled for thoracoscopy surgery. After initial two-lung ventilation with VCV patients were randomly assigned to one of two groups. In one group OLV was started with VCV (tidal volume 6 mL/kg, PEEP 5) and after 30 minutes ventilation was switched to PCV (inspiratory pressure to provide a tidal volume of 6 mL/kg, PEEP 5) for the same time period. In the second group, ventilation modes were performed in reverse order. Airway pressures and blood gases were obtained at the end of each ventilatory mode.ResultsPaO2, PaCO2 and alveolar-arterial oxygen difference did not differ between PCV and VCV. Peak airway pressure was significantly lower in PCV compared with VCV (19.9 ± 3.8 cmH2O vs 23.1 ± 4.3 cmH2O; p < 0.001) without any significant differences in mean and plateau pressures.ConclusionsIn patients with good preoperative pulmonary function undergoing thoracoscopy surgery, the use of a protective lung ventilation strategy with VCV or PCV does not affect the oxygenation. PCV was associated with lower peak airway pressures.

Impacto de la estrategia de aula invertida en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral

INTRODUCTION The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. OBJECTIVE To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. MATERIALS AND METHODS The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p<0.05). The internal consistency was assessed using Cronbach´s alpha coefficient. RESULTS There were 207 participants (men: 36%) that completed the questionnaire (age: 21.9 ± 1.49 years old). The overall DREEM score and the subscales were higher with the flipped classroom, which suggests that this environment had a higher level of excellence. The ANOVA for each domain and the overall scores showed no differences with a flipped classroom. However, significant differences were identified in all domains and the overall scores with lectures (p<0.01). There were high levels of reliability (Cronbach>0.90) for all measurements in both environments, and there was consistency across all cohorts. CONCLUSIONS The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

Prognosis of patients with thyroid cancer who do not undergo surgical treatment: a SEER database analysis.

BackgroundThe treatment for thyroid cancer is surgical. However, some patients do not undergo operations because of comorbidities or other reasons. There is little information about the prognosis of these patients. The aim of the present study was to describe patients with well differentiated thyroid carcinoma who did not undergo surgical treatment and to identify differences in prognostic variables and survival compared with patients treated surgically.MethodsWe conducted a retrospective review of a prospective cohort collected by the National Cancer Institute obtained from the Surveillance, Epidemiology and End Results (SEER) Program. All patient fi les with a diagnosis of thyroid cancer were selected (38,493 cases). Finally, 12,416 cases were used for the analysis. Treatment was divided into surgical or nonsurgical groups. Five-year survival rates were estimated and classifi ed by the SEER stage.ResultsEighty-six patients did not receive surgical treatment. These patients were older, had more advanced tumours and their treatment was less associated with complementary radiotherapy. Five-year overall survival rates were 96.7% for surgical patients vs. 56.8% for nonsurgical patients (p<0.001). The overall survival in the nonsurgery group for localised tumours decreased 14.9%, for regional tumours decreased 49.9% and for distant tumours decreased 61.8%.DiscussionThe patients who did not undergo surgical treatment showed less than 5-year overall survival. The SEER database does not offer information about comorbidities that could explain these differences.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia

OBJECTIVE Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. METHODS Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. RESULTS The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US

Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis

0.05 incremental cost-effectiveness ratio. CONCLUSION Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Impacto de la estrategia “flipped classroom” en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral

INTRODUCTION Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. MATERIAL AND METHODS A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. RESULTS In a deterministic analysis, the cost, utility and cost-utility ratio was COP

The evolution of laparoscopy in abdominal surgery: A meta-analysis of the effect on infectious outcomes

12.981.801, 44.5 and COP

Routine postoperative administration of vitamin D and calcium after total thyroidectomy: a meta-analysis.

291.310 for total thyroidectomy and COP

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

14.309.889, 42.0 and

Early laparoscopy for the evaluation of nonspecific abdominal pain: a critical appraisal of the evidence

340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -