Diez-Goñi, N. (Nieves)
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- La educación interprofesional en la universidad: retos y oportunidades(2021) Arbea-Moreno, L. (Leire); Rodriguez-Diez, M.C. (María Cristina); La-Rosa-Salas, V. (Virginia); Beitia, G. (Guadalupe); Marcos, B. (Beatriz); Diez-Goñi, N. (Nieves); Vidaurreta, M. (Marta); Sola-Juango, L. (Leire)La educación interprofesional (EIP) es clave para garantizar el aprendizaje integrado de los alumnos de diferentes titulaciones, que ejercerán una labor profesional basada en el cuidado centrado en la persona, de manera conjunta. El proyecto de EIP de la Universidad de Navarra pretende dar a los alumnos de medicina, enfermería y farmacia los conocimientos, habilidades y actitudes necesarias para trabajar de manera interprofesional, centrándonos en trabajo en equipo, conocimiento y respeto de roles, resolución de conflictos y comunicación interprofesional. Para ello, el equipo de docentes implicados en este proyecto ha tenido que trabajar colaborativamente, experimentando las claves de este trabajo interprofesional, centrado en el alumno, constituyendo una experiencia enriquecedora, constructiva, y que ha aportado las claves del trabajo en equipo necesario para llevar a cabo un proyecto docente de EIP.
- Diagnóstico diferencial de la hiperandrogenemia mediante inhibición hipofiso-ovárica y estimulación hipofiso-adrenal(Gobierno de Navarra. Departamento de Salud, 1999) Moncada, E. (Emilio); Alvarez, R. (Rosa); Salvador, J. (Javier); Diez-Goñi, N. (Nieves); Sopena, M. (Marcos); Calleja, A. (Amparo); Esparza, M.L. (M. L.); Gómez-Peralta, F. (F.)
- Experiencia del centro de simulación de la Facultad de medicina de la Universidad de Navarra(Facultad de Medicina y Ciencias de la salud de la Universidad de Alcalá, 2021) Uruñuela, N. (Nekane); Martin-Calvo, N. (Nerea); Fernández-González, S. (Secundino); Valencia, D. (David); Alcalde, J. (Juan); Pueyo-Villoslada, F.J. (Francisco Javier); Díez, J.C. (Juan Carlos); Diez-Goñi, N. (Nieves); Honorato-Cía, C. (Cristina); Orio, R. (Rubén)En los últimos años, las facultades de Medicina se han visto en la necesidad de ofrecer cambios en su forma de impartir la docencia; los alumnos, los pacientes y la normativa han cambiado. Estas circunstancias obligan a una renovación permanente con el objetivo de innovar y alcanzar la excelencia en la docencia universitaria. Fruto de esa renovación, la simulación ha adquirido un papel fundamental en la formación en el Grado de Medicina. La simulación ofrece un entorno seguro y controlado en el que reproducir, tantas veces como sea necesario, situaciones en las que el estudiante va construyendo su aprendizaje a partir de un trabajo explicativo, reflexivo, vivencial y colaborativo. Por otro lado, los avances tecnológicos hacen que las herramientas docentes en simulación sean altamente cambiantes, lo que obliga a una actualización permanente del equipo técnico y del equipo docente. En este monográfico acerca de la simulación en el Grado de Medicina se expondrá la experiencia del Centro de Simulación de la Facultad de Medicina (CSM) de la Universidad de Navarra, que se inauguró en 2011.
- Development and validation of a low-cost laparoscopic simulation box(Elsevier, 2022) Martin-Calvo, N. (Nerea); Fernández-González, S. (Secundino); Gómez, B. (Beatriz); Ferreiro-Abal, A. (Ane); Pueyo-Villoslada, F.J. (Francisco Javier); Llorente-Ortega, M. (Marcos); Diez-Goñi, N. (Nieves)Introduction The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand. Methods A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5. Results The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥4 points except for the question relating to the spatial realism (3.82 points). Conclusion The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique.
- Educación interprofesional: una propuesta de la Universidad de Navarra(Elsevier, 2020) Arbea-Moreno, L. (Leire); Rodriguez-Diez, M.C. (María Cristina); La-Rosa-Salas, V. (Virginia); Beitia, G. (Guadalupe); Marcos, B. (Beatriz); Diez-Goñi, N. (Nieves); Vidaurreta, M. (Marta); Sola-Juango, L. (Leire)La asistencia sanitaria centrada en el paciente es la clave para una atención humana a la persona y a su familia. La práctica colaborativa en equipos interprofesionales resulta imprescindible para alcanzar una atención sanitaria de calidad. La universidad tiene la responsabilidad de preparar a sus graduados para trabajar en equipos interprofesionales. Una enseñanza/aprendizaje centrada en la persona, fundamentada en las competencias que definen la educación interprofesional, es clave para que nuestros estudiantes reconozcan la necesidad del trabajo colaborativo. Este artículo detalla un proyecto docente de educación interprofesional de la Universidad de Navarra, donde estudiantes de las facultades de medicina, enfermería y farmacia aprenden juntos y de manera gradual, las claves de cómo trabajar en equipo.
- Comparative pharmacology of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia(Graphy, 2018) Sadaba, B. (Belén); Diez-Goñi, N. (Nieves); Azanza, J.R. (José Ramón)There are 5 BCR/ABL tyrosine kinase inhibitors (TKIs) for the treatment of chronic myeloid leukemia (CML): bosutinib, ponatinib, imatinib, nilotinib and dasatinib. The availability of several therapeutic options raises the possibility of individualizing patient treatment. When evaluating patients’ individual pharmacological profiles, it is important to take into account the differences in the chemical structures of the drugs. Bosutinib, which has a unique interaction and safety profile, is a quinazoline, unlike the other TKIs that have a pyrimidine structure. All 5 TKIs inhibit the BCR/ABL tyrosine kinase, although only ponatinib is active against the strains expressing the T315I mutation. In addition, the 5 TKIs are generally non-selective drugs that can also inhibit other tyrosine kinases, such as cKIT or PDGFR, leading to both benefits in the treatment of some gastrointestinal tumors as well as additional adverse events. These drugs are orally administered and show moderate bioavailability, a large volume of distribution, high protein binding, and elimination after intense metabolism involving various Cytochrome P450 (CYP). They are also substrates of transport proteins and interact with inducers and inhibitors. All TKIs, except bosutinib, can inhibit the activity of transport proteins, leading to important drug interactions. As such, bosutinib is the drug with the better pharmacological profile. There is a close relationship between drug concentration and the beneficial/toxic effects of imatinib, nilotinib, and dasatinib. Therefore, plasma levels should be monitored to optimize patient treatment. Currently, there is no information for ponatinib. Overall, there is a high incidence of adverse events; although these do not usually lead to treatment discontinuation. All 5 TKIs have a similar safety profile; however, each TKI has unique adverse events. Pharmacological differences can identify the drug that is best suited to each patient, helping optimize CML therapy.
- Papel de los polimorfismos de los genes CFH y ARMS2 en el desarrollo de la retinopatía y la cardiopatía isquémica en la diabetes tipo 1(Gobierno de Navarra, 2012) Goñi, M.J. (M. J.); Toni, M. (M.); Toledo, E. (Estefanía); Hermida, J. (José); Diez-Goñi, N. (Nieves)Fundamento. La diabetes tipo 1 (DT1) es un enfermedad con elevada morbilidad vascular. El objetivo de este estudio es valorar la asociación de los polimorfismos rs1410996 del gen CFH y rs10490924 del gen ARMS2 en pacientes con DT1. Material y métodos. Se trata de un estudio retrospectivo, en el que se han analizado las características clínicas y los polimorfismos rs1410996 del gen CFH y rs10490924 del gen ARMS2 de 147 pacientes con DT1 valorados en la consulta de Endocrinología. Resultados. Todos los pacientes que desarrollaron retinopatía diabética proliferativa en los primeros 20 años de evolución eran portadores del polimorfismo rs1410996 del gen CFH. La frecuencia del alelo de riesgo fue significativamente mayor en los pacientes con cardiopatía isquémica que en los que no la presentaban (75 frente a 53%, p<0,001). Conclusiones. Parece existir una tendencia a aumentar el riesgo de desarrollar retinopatía diabética proliferativa en los pacientes con DT1 asociado con el polimorfismo rs1410996 del gen CFH. Este polimorfismo parece asociarse también con el desarrollo de cardiopatía isquémica en estos pacientes. Sin embargo, el polimorfismo rs10490924 del gen ARMS2 no parece asociarse con la retinopatía ni con la cardiopatía isquémica.
- Validation of a sensor-fitted simulator for upper airway examination(Wiley, 2020) Fernández-González, S. (Secundino); Llorente-Ortega, M. (Marcos); Diez-Goñi, N. (Nieves); Pacheco, S. (Sofía)Objective: To validate a simulator for upper airway examination, fitted with sensors, for use as an academic tool for learning how to conduct examination of the upper airway and for evaluation of that learning. Study design: Validation study. Setting: Undergraduate medical education. Subjects and methods: A group of 18 fifth-year medical students and another of 6 otorhinolaryngology specialists conducted 6 examinations each with the simulator. To investigate concurrent validity, we calculated the correlation between damage scores provided by the simulator and damage assessment by a specialist. To evaluate construct validity, we compared both groups with regard to damage scores, technical procedure, and time spent. To examine content and face validity, we used questionnaires based on a 5-point Likert scale. Results: For concurrent validity, the correlation between the simulator's damage scores and the specialist's damage assessment was high: Spearman's ρ was 0.828 (P < .001). For construct validity, the group of students differed from the group of specialists in damage scores (P = .027) and in technical procedures (P < .001) but not in time spent. For content validity, all questionnaire statements were scored highly, and both groups had similar average scores. For face validity, the group of specialists considered the simulator to be realistic, and all statements on the questionnaire were rated with at least 4/5. Conclusion: Concurrent, construct, content, and face validity have been demonstrated for a sensor-fitted simulator for upper airway examination, which is therefore accurate enough to be used as an academic tool for learning and evaluation of learning.
- Association of increased fibrinogen concentration with impaired activation of anticoagulant protein C(Wiley-Blackwell, 2006) Hermida, J. (José); Alonso, A. (Andrés); Navarro, S. (Silvia); Diez-Goñi, N. (Nieves); España, F. (Francisco); Montes, R. (Ramón); Medina, P. (Pilar)BACKGROUND: Low levels of activated protein C (APC) are a risk factor for venous thrombosis. The mechanisms leading to interindividual differences in APC are not totally elucidated. Protein C is activated by the thrombin-thrombomodulin complex. As thrombin binds to fibrinogen and thrombomodulin through a common region, it is conceivable that fibrinogen influences the activation of protein C. This would help to explain the association between high levels of fibrinogen and an increased thrombotic risk. METHODS: We analyzed the association between circulating APC levels and fibrinogen concentration in 382 healthy subjects. Subsequently, we studied the effect of increasing fibrinogen concentrations on the APC generation on cultured endothelial cells. RESULTS: An independent inverse association between circulating APC levels and fibrinogen was found [betacoefficient, -0.16; 95% confidence interval (95% CI) -0.26, -0.06; P = 0.001]. For each 100 mg dL(-1) increase in fibrinogen, the independent risk of having low APC levels (<0.7 ng mL(-1)) was almost three times higher (OR 2.8; 95% CI 1.1, 7.2; P = 0.04). Accordingly, a notable association between increasing fibrinogen concentrations and the reduction in the thrombin-thrombomodulin dependent activation of protein C on endothelial cells was found (r = -0.57; P = 0.002). CONCLUSIONS: We present evidence of an inverse association between circulating APC and fibrinogen levels. According to this finding together with the results of our in vitro experiments, we propose that the impairment in the generation of APC on endothelial cells constitutes a new prothrombotic mechanism of fibrinogen.
- Cholinergic modulation of spontaneous hypothalamic-pituitary-adrenal activity and its circadian variation in man(The endocrine society, 1996) Lizcano, F. (Fernando); Llorente, I. (Ignacio); Alvarez, R. (Rosa); Salvador, J. (Javier); Diez-Goñi, N. (Nieves); Gil, M.J. (María José); Sopena, M. (Marcos)Controversy still exists regarding the role of cholinergic pathways in the regulation of the hypothalamic-pituitary-adrenal axis in man. We studied the effects of the administration of placebo, pyridostigmine (PD); 120 mg, orally), and the combination of PD and pirenzepine (PZP; 100 mg, orally) on ACTH, cortisol, and GH secretion at 0730 and 2230 h in seven normal males. PD induced a clear decrease in ACTH levels at both times of the day compared to treatment with placebo, producing higher suppression in the nocturnal period (34.4 +/- 5.8% vs. 21.8 +/- 10.7%). The combination PD and PZP prevented the inhibitory action of PD on ACTH secretion in the morning, but not in the evening, when ACTH values showed a decrease similar to that seen after giving PD alone (38.1 +/- 5.6% vs. 34.4 +/- 5.8%, respectively). Cortisol values declined only when the association PD plus PZP was given in the evening. GH levels had a significant increase after PD administration in the morning (4.1 +/- 1.2 ng/mL) and in the evening (10.2 +/- 1.6 ng/mL), confirming that cholinergic stimulation was taking place, whereas the addition of PZP to PD induced a significant attenuation of these responses. It is concluded that cholinergic pathways have a inhibitory role in ACTH secretion in man. M1 muscarinic receptors seem to be involved in the diurnal inhibition of PD, whereas our observations are consistent with the mediation of another type of cholinergic receptors as an explanation for the nocturnal effect of PD on ACTH secretion. PD did not alter the circadian variation in the hypothalamic-pituitary-adrenal axis, whereas the association of PD and PZP increased the differences between diurnal and nocturnal ACTH values, suggesting a modulatory effect of the cholinergic system on the circadian rhythm of ACTH secretion.