Resumen: Introducción: La recopilación de información a partir del usuario sobre un servicio o producto es esencial para la mejora del mismo. En medicina de urgencias, la pedagogía y supervisión no ...están sujetas a normativas homogéneas habituales en especialidades reconocidas y por lo tanto, con frecuencia, requieren modificaciones. Nos planteamos, cuál es el mejor método de recopilar la opinión de nuestros residentes: la encuesta retrospectiva anual, utilizada en la actualidad, o la recolección de información inmediatamente después de una guardia, atendiendo a una extrapolación de las técnicas de generación de índices de satisfacción del consumidor. Método: Encuestamos a 75 residentes de 4 hospitales distintos preguntando por su grado de acuerdo con 5 enunciados sobre sus guardias, tanto de forma retrospectiva anual como con respecto a la última guardia. Añadimos una pregunta control sobre la comida proveída por la correspondiente cafetería del hospital. Resultados: En todas las dimensiones encuestadas, los residentes fueron mucho más críticos cuando hicieron valoraciones retrospectivas que cuando opinaron sobre su guardia más reciente. Al repetir la encuesta en 35 residentes, preguntando por otra guardia de forma puntual, los porcentajes de acuerdo se mantuvieron similares. Conclusión: Nuestros resultados indican que, con el propósito de recoger información sobre supervisión y actividad asistencial en urgencias, la técnica de encuestas retrospectivas tiende a infravalorar la opinión real de los residentes. Estas observaciones coinciden con las recomendaciones universales sobre índices de satisfacción del consumidor y estrategias de corrección de los sesgos de memoria. Abstract: Introduction: Our aim is to determine which way to gather feedback form our residents Is better: an annual retrospective survey which is used nowadays, or to collect information immediately after an emergency ward, given the knowledge gained from the technics of development of customer satisfaction. Method: A survey was carried out on 75 residents from four different hospitals asking about their level of agreement with five statements related to their emergency wards, both retrospectively during the previous year and their last on-call session. A control question was also including asking their opinion about the meals provided by the hospital dining service. Results: In all the dimensions of the questionnaire, residents were much more critical when they made yearly retrospective assessments than when they asked about their last emergency on-call session. When the survey was repeated among 35 residents asking about another last emergency on-call session, the results remained similar. Conclusion: Our results show that a retrospective survey tends to underestimate the real opinion of residents about their experience during emergency sessions. This observation is coincident with the universal recommendations on user satisfaction index and strategies to avoid memory bias. Palabras clave: Urgencias, Emergencias, Docencia, Residentes, Encuestas, Retroalimentación, Keywords: Urgency units, Emergency departments, Post graduated teaching, Medical residents, Surveys, Feedback
Background Corrected carotid flow time (CFTc) and carotid blood flow (CBF) are sonographic measurements used to assess fluid responsiveness in hypotension. We investigated the impacts of mechanical ...ventilation on CFTc and CBF. Materials and methods Normotensive patients undergoing cardiac surgery were prospectively enrolled. Carotid ultrasound (US) was performed pre and post-intubation. Post-intubation measurements took place after the initiation of mechanical ventilation. To measure CFTc and CBF, a sagittal carotid view was obtained with pulse wave-Doppler (maximum angle 60°). CFTc was calculated with the Bazett formula (CFTc = systolic time/√cycle time). CBF was calculated using CBF (mL/min) = area (cm
) x time average mean velocity (TAMEAN) (cm/sec) x 60 (sec/min). The maximum carotid diameter was measured at the level of the thyroid. Results Twenty patients were enrolled. Mean CFTc pre-intubation was 328 ms (SD 43.9 ms) compared to CFTc post-intubation 336 ms (SD 36 ms). There was no significant difference between pre and post-intubation CFTc (mean differences=-0.008; t(19)=-0.71, p=.49). Mean CBF pre-intubation was 487 mL/min (SD 176 mL/min) compared to CBF post-intubation 447 mL/min (SD 187 mL/min). There was no significant difference between pre and post-intubation CBF (mean differences= 40; t(19)=1.24, p=.23). Conclusions In this study of normotensive patients, there were no detected differences in CFTc or CBF pre and post-intubation with mechanical ventilation.
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