BACKGROUND: Identifying nurses\' perceptions of the knowledge-practice gap is a critical step toward developing evidence-based practice. Currently, multiple factors contribute to the gap between nursing education and actual practice. Addressing this gap requires a new perspective, not yet adequately represented in the literature, that includes nurses\' perceptions.
OBJECTIVE: This study aims to describe nurses\' perceptions of the knowledge-practice gap in the domains of knowledge, practice, environment, and learning. And it analyzes how nurses\' professional characteristics are associated with their perceptions of the gap in each of these domains as well as the relationships between the domains themselves.
METHODS: The study used a cross-sectional descriptive correlational design. A sample of 513 staff nurses recruited through a convenience sampling technique provided information on professional variables such as education and experience and completed a Likert-scale survey about their perceptions of the knowledge-practice gap.
RESULTS: Their answers were found to vary with educational level and history of workshop attendance. Items from the knowledge domain were positively and significantly correlated with items from the environment and learning domains, which were also positively and significantly correlated with each other. However, the knowledge and practice domains were not significantly correlated. In addition to showing correlations among the major domains (or aspects) of the knowledge-practice gap, the study highlights how nurses\' professional characteristics contribute to differences in their perceptions of this gap.
CONCLUSIONS: These findings can guide hospital-specific measures for bridging the gap. In addition, the scale can be employed by leaders as a tool for the purpose of conducting assessments.

OBJECTIVE: To bring up which was the surgical resident\'s perception about their learning experience during COVID-19 pandemic and if it interfered or not with their classes.
METHODS: Cross-sectional observational study through an anonymous survey conducted among surgical residents. The Mexican Association of General Surgery, through its Women in Surgery Committee, created a questionnaire that included 40 questions.
RESULTS: 465 participants were included in the survey: 225 women (48.3%), 240 men (51.7%); of 32 entities, only 26 participated. A great part of them said their skills and abilities were affected because elective surgeries were called off. While 303 residents stayed at hybrid hospitals, while a third of them were at 100% Covid facilities. Residents who were on call worked at COVID-19 units. They continued attending class through online platforms and only 134 were able to practice their skills using simulators. 71% of the residents were infected with COVID-19, all were tested to confirm it, and the number of asymptomatic cases was unknown.
CONCLUSIONS: COVID-19 pandemic has affected the learning process of surgical residents in Mexico.
OBJECTIVE: Citar cuál fue la percepción que tuvieron los médicos residentes quirúrgicos sobre su aprendizaje durante la pandemia de COVID-19 y si continuaron o no con sus clases.
UNASSIGNED: Estudio observacional, de corte transversal, mediante una encuesta anónima de 40 cuestionamientos diseñada por el Comité de Cirujanas de la Asociación Mexicana de Cirugía General, aplicada a los médicos residentes quirúrgicos. El tamaño de la muestra fue a conveniencia.
RESULTS: Se incluyeron 465 participantes, de los que 225 fueron mujeres (48.3%) y 240 hombres (51.7 %). De 32 entidades, solo participaron 26. La gran mayoría opinaron que sus habilidades y destrezas se vieron afectadas por la suspensión de cirugías electivas. Estuvieron en hospitales híbridos 303 participantes y en hospitales 100% COVID-19 una tercera parte. Las guardias fueron realizadas en áreas COVID-19 y continuaron con sus clases a través de plataformas digitales; solo 134 realizaron prácticas en simuladores. El 71% de los médicos residentes se contagiaron de la enfermedad; el diagnóstico fue corroborado con una prueba y se desconoce el porcentaje de casos asintomáticos.
CONCLUSIONS: La pandemia de COVID-19 afectó el aprendizaje de los médicos residentes de especialidades quirúrgicas en México.

Given the need to promote gender equity in healthcare, this research aimed to adapt and validate a short version of the Nijmegen Gender Awareness Scale (N-GAMN), that assesses attitudes and gender stereotyping of health sciences students.
A cross-sectional study was carried out using a questionnaire among health sciences students from the universities of Barcelona, Cantabria, Cartagena de Indias and the National Autonomous University of Nicaragua. Nine hundred fifty-six students filled out the questionary. A confirmatory factor analysis was performed to establish the relationship between the observed variables and the latent dimensions.
The factorial analysis evaluated the validity of the scale and confirmed the existence of a three-dimensional structure composed of: (F1) gender stereotypes towards patients, (F2) gender stereotypes towards professionals and (F3) gender sensitivity in the healthcare (fit data: CFI=0.917, TFI=0.899, RMSEA=0.08 and SRMEA=0.06). Descriptive statistics showed relatively high levels of gender awareness among the participants. Fewer stereotypes were observed towards professionals than towards patients. Women and students from Spanish universities showed a higher level of awareness. However, the significance values of the Mann-Whitney U test allow us to infer the existence of differences based on geographical area, but not based on gender.
The results suggest the potential application of the scale to assess the attitudes of students and professionals towards gender stereotypes and biases associated with clinical practice, as well as to assess the impact of gender awareness actions.

Since Jung\'s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.
Depuis la mort de Jung en 1961, les chercheurs ont tenté d’intégrer les données nouvelles de la biologie avec les concepts Jungiens tels que l’inconscient collectif, les instincts et les archétypes. Cette initiative a rencontré des difficultés car des dichotomies fausses mais tenaces sur le sujet des gènes et de l’environnement se manifestaient. Les travaux récents de Roesler (2022a, 2022b) par exemple ont exprimé des objections à la théorie biologique des archétypes. Cependant ces objections sont biaisées par les dichotomies mentionnées. Le concept de plasticité phénotypique, cependant, aide à la fois à éviter ce problème et à former une passerelle entre des théories rivales et un modèle mieux intégré et doté de solides fondements biologiques.
Seit dem Tode Jungs im Jahr 1961 haben Wissenschaftler versucht, wachsende biologisch-wissenschaftliche Daten in Jungianische Konzepte wie das kollektive Unbewußte, Instinkte und die Archetypen zu integrieren. Dieses Unterfangen bildete aufgrund der anhaltenden falschen Dichotomien von Gen und Umwelt, die gelegentlich auftauchten, eine Herausforderung. Zum Beispiel haben neuere Arbeiten von Roesler (2022a, 2022b) Einwände gegen die biologische Theorie der Archetypen erhoben, aber die Einwände sind von solchen Dichotomien geplagt. Das Konzept der phänotypischen Plastizität hilft jedoch sowohl dieses Problem zu vermeiden als auch die Kluft zwischen konkurrierenden Theorien hin zu einem stärker integrierten Modell mit soliden biologischen Grundlagen zu überbrücken.
Dalla morte di Jung nel 1961, gli studiosi hanno tentato di integrare i crescenti dati della scienza biologica in concetti junghiani come l’inconscio collettivo, gli istinti e gli archetipi. Questa impresa è stata resa complessa dalle persistenti e false dicotomie tra gene e ambiente che sono sorte periodicamente. Opere recenti di Roesler (2022a, 2022b), ad esempio, hanno sollevato obiezioni alla teoria biologica degli archetipi, ma le obiezioni sono afflitte da tali dicotomie. Il concetto di plasticità fenotipica, tuttavia, aiuta sia ad evitare questo problema che a colmare il divario tra le teorie concorrenti in un modello più integrato con solidi fondamenti biologici.
С тех пор как в 1961 году умер Юнг, предпринят ряд попыток интегрировать растущий массив исследовательских данных в области биологических наук в юнгианскую теорию с такими ее концепциями, как коллективное бессознательное, инстинкты и архетипы. Это сложная задача, поскольку ей сопутствует периодически дающее о себе знать стремление к постоянной неоправданной поляризации гена и среды. В последних работах Реслера (Roesler 2022a, 2022b), например, выдвинуты возражения против биологической теории архетипов, однако эти возражения инфицированы подобной поляризацией. Между тем концепция фенотипической пластичности помогает как избежать этой проблемы, так и преодолеть разрыв между конкурирующими теориями, объединив их в более интегрированную модель с прочными биологическими основаниями.
Desde la muerte de Jung en 1961, académicos han intentado integrar data creciente de las ciencias biológicas a conceptos Junguianos como inconsciente colectivo, instintos y arquetipos. Esta empresa ha sido desafiada debido al surgimiento ocasional de persistentes falsas dicotomías entre genes y medio ambiente. Trabajos recientes de Roesler (2022a, 2022b), por ejemplo, han planteado objeciones a la teoría biológica del arquetipo, pero las objeciones se encuentran afectadas por semejantes dicotomías. El concepto de plasticidad fenotípica, sin embargo, ayuda a evitar este problema, así como a subsanar la brecha entre teorías contrapuestas, hacia un modelo más integrado con fundamentos biógicos sólidos.
表型可塑性和原型:对原型和本能的生物学理论的常见反对意见的回应 自从荣格1961年去世后, 学者们便试图将不断增长的生物科学数据融入荣格的概念, 如集体无意识、本能和原型。但由于一直以来, 时而出现基因和环境的错误二分法, 这项事业一直具有挑战性。例如, 最近 Roesler (2022a, 2022b) 在其作品中, 对原型的生物学理论提出了反对意见, 但这些反对意见也受到了这种二分法的困扰。然而, 表型可塑性的概念既有助于避免这个问题, 也有助于在相互竞争的理论之间架起桥梁, 形成一个具有坚实生物学基础的更综合的模型。.

OBJECTIVE: (1) to design a training programme for newly hired nursing personnel and (2) to determine self-perception and perceived stress before and after the theoretical and practical parts of the programme with high fidelity simulation activities.
METHODS: A pilot quasi-experimental pretest-posttest study without control group conducted in a Paediatric Intensive Care Unit from October 2018 to April 2019 was conducted. A newly hired nursing personnel training programme was first designed and delivered. Later, the participants\' self-perception was assessed, as well as their perceived stress and grade of satisfaction using two different Likert scales.
RESULTS: A total of 20 newly hired nurses participated in the study, 90% (n = 18) were female with a median age of 25.5 ± 4.53 years. Higher scores were obtained in participants\' self-perception before and after the theoretical training. Lower significant median scores of the participants\' stress perception were found (6.9 ± 1.57 versus 5.6 ± 1.794). In the practical part of the programme, we obtained higher scores in all items, as well as lower median scores in stress perception (6.4 ± 1.73 versus 5.6 ± 1.93).
CONCLUSIONS: A theoretical and practical programme for newly hired nursing personnel in a Paediatric Intensive Care Unit improved participants\' self-perception and reduced their perceived median scores in stress levels.

Although some sectors have made significant progress in learning from failure, there is currently limited consensus on how a similar transition could best be achieved in conservation and what is required to facilitate this. One of the key enabling conditions for other sectors is a widely accepted and standardized classification system for identifying and analyzing root causes of failure. We devised a comprehensive taxonomy of root causes of failure affecting conservation projects. To develop this, we solicited examples of real-life conservation efforts that were deemed to have failed in some way, identified their underlying root causes of failure, and used these to develop a generic, 3-tier taxonomy of the ways in which projects fail, at the top of which are 6 overarching cause categories that are further divided into midlevel cause categories and specific root causes. We tested the taxonomy by asking conservation practitioners to use it to classify the causes of failure for conservation efforts they had been involved in. No significant gaps or redundancies were identified during this testing phase. We then analyzed the frequency that particular root causes were encountered by projects within this test sample, which suggested that some root causes were more likely to be encountered than others and that a small number of root causes were more likely to be encountered by projects implementing particular types of conservation action. Our taxonomy could be used to improve identification, analysis, and subsequent learning from failed conservation efforts, address some of the barriers that currently limit the ability of conservation practitioners to learn from failure, and contribute to establishing an effective culture of learning from failure within conservation.
Introducción de una taxonomía común como apoyo al aprendizaje a partir del fracaso en la conservación Resumen Mientras que algunos sectores han progresado significativamente en el aprendizaje a partir del fracaso, actualmente hay un consenso limitado sobre cómo podría lograrse una transición similar en la conservación y qué se requiere para facilitarla. Una de las condiciones habilitantes más importantes en otros sectores es un sistema de clasificación estandarizado y aceptado por la mayoría para la identificación y análisis de las causas fundamentales del fracaso. Diseñamos una taxonomía completa de las causas fundamentales del fracaso que afecta a los proyectos de conservación. Para desarrollarla, solicitamos ejemplos de esfuerzos de conservación reales que de alguna manera se consideraron como fracasos, identificamos las causas fundamentales no aparentes de su fracaso y luego las usamos para desarrollar una taxonomía genérica de tres niveles de las maneras en las que fracasan los proyectos, en cuyo nivel superior están seis categorías de causas generales que después se dividen en categorías de nivel medio de categorías de causas y causas fundamentales específicas. Pusimos a prueba la taxonomía al pedirle a los practicantes de la conservación que la usaran para clasificar las causas del fracaso de los esfuerzos de conservación en los que han participado. No identificamos vacíos o redundancias importantes durante esta fase de prueba. Después, analizamos la frecuencia con la que los proyectos de esta muestra se enfrentaron a causas fundamentales particulares, lo que sugirió que algunas causas fundamentales tienen mayor probabilidad de ocurrir y que un número reducido de causas fundamentales tiene mayor probabilidad de ocurrir en proyectos que implementan ciertos tipos de acciones de conservación. Nuestra taxonomía podría usarse para mejorar el análisis, identificación y aprendizaje subsecuente a partir del fracaso de los esfuerzos de conservación; tratar algunas de las barreras que en la actualidad limitan a los practicantes de la conservación a aprender del fracaso; y contribuir al establecimiento de una cultura efectiva del aprendizaje a partir del fracaso dentro de la conservación.
虽然一些部门能够很好地从失败中吸取教训, 但目前对于如何在保护中最好地实现类似的转变及其必需条件的共识仍十分有限。其他部门的关键赋能条件之一是有一个广泛被接受和标准化的分类系统来识别和分析失败的根本原因。本研究设计了一个影响保护项目失败的根本原因的综合分类法。为了建立这一套分类法, 我们收集了现实世界中被认为在某些方面失败了的保护工作的案例, 确定了其失败的根本原因, 并利用这些案例制定了一个通用的项目失败方式三层分类法, 其顶端是六个总体原因类别, 并进一步分为中层原因类别和具体根源。我们要求保护实践者使用该分类法对他们所参与的保护工作的失败原因进行分类, 以对该分类法进行测试。在测试阶段没有发现明显的空缺或冗余。接下来, 我们分析了测试样本项目遇到特定失败根源的频率, 结果表明一些根源更为常见, 少数根源更有可能在实施特定类型保护行动的项目中出现。我们的分类法可用于改进对失败保护工作的识别、分析及随后的教训学习, 解决目前限制保护实践者从失败中学习的能力的一些障碍, 并有助于在保护中建立有效的从失败中学习的文化。【翻译: 胡怡思; 审校: 聂永刚】.

UNASSIGNED: Describir y analizar aspectos clínicos y sociodemográficos de una cohorte de pacientes con trastornos del lenguaje, del habla y del aprendizaje.
UNASSIGNED: Estudio retrospectivo descriptivo. Se seleccionaron expedientes de 4632 pacientes (años 2011 a 2015). Se calcularon medias, desviaciones estándar, porcentajes y frecuencias, Con la finalidad de evaluar si existía diferencia significativa entre variables se utilizó la prueba de ji al cuadrado y se realizó un análisis de probabilidad condicional entre las variables para obtener la probabilidad a priori y a posteriori.
UNASSIGNED: Los trastornos del lenguaje, del habla y del aprendizaje se presentaron con mayor frecuencia en el sexo masculino, con 3358 pacientes (72.5%). El diagnóstico más frecuente fue el trastorno del lenguaje, diagnosticado en 2924 pacientes (63.1%). Se encontraron mayores incidencia y prevalencia de retraso del lenguaje en el sexo masculino (p < 0.05).
UNASSIGNED: De todas las variables estudiadas, solo la incidencia de retraso en el desarrollo del lenguaje con respecto al sexo masculino fue significativa; de cada cuatro pacientes, tres eran de sexo masculino y uno de sexo femenino.
OBJECTIVE: To describe and analyze clinical and sociodemographic aspects of a cohort of patients with language, speech and learning disorder.
METHODS: Descriptive retrospective study. Patient records (2011 to 2015) were selected, making up a total of 4632. Averages, standard deviations, percentages and frequencies were calculated; in order to assess whether there was a significant difference between variables, chi squared test and a conditional probability analysis was performed between the variables to obtain a priori and a posteriori probability.
RESULTS: Disorders of language, speech and learning occurred more frequently in males, 3358 patients (72.5%). The most frequent diagnosis was language development disorder, diagnosed in 2924 patients (63.1%). A higher incidence and prevalence of language delay were found for the male sex (p < 0.05).
CONCLUSIONS: Of all the variables studied, only the incidence of delay in language development with respect to the male sex was significant; three out of four patients were male and 1 female.

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language - the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.
Cet article est une étude de cas détaillée d’un homme péruvien de 60 ans, réfugié. L’étude met l’accent sur l’importance de construire en espagnol une résilience émotionnelle, afin de créer un espace pour que le patient apprenne l’anglais - le patient ne parle pas l’anglais après 20 ans de vie en Grande Bretagne. Le travail s’est fait avec la participation d’un interprète, et une partie des écrits concernant le travail avec interprète est examinée. L’article s’appuie aussi brièvement sur d’autre cas cliniques, et aborde de manière générale le voyage du réfugié: un voyage allant du culturellement connu au culturellement inconnu. L’article soulève la question de comment les travaux sur la résilience, qui s’inscrivent clairement dans une perspective développementale occidentale, peuvent s’appliquer aux réfugiés, dont la plupart viennent de cultures de groupe et de cultures familiales dominées par l’idée d’honneur et de honte. L’article aborde brièvement l’impact important de l’attitude du pays d’accueil, selon qu’il offre ou non un espace transitionnel pour les réfugiés qui ont perdu leur « chez eux » (home) et qui recherchent un havre de sécurité dans une culture qui ne leur est pas familière.
Dieser Artikel gibt ausführlich die Fallstudie eines 60-jährigen peruanischen Flüchtlings wieder. Der Fokus liegt auf der hohen Bedeutung die es hat, die emotionale Resilienz eines Patienten auf Spanisch zu verbessern, um einen Raum für das Erlernen der englischen Sprache zu schaffen - der Patient sprach kein Englisch nach 20 Jahren in Großbritannien. Die Arbeit wurde mit einem Dolmetscher durchgeführt. Ein Teil der verfügbaren Literatur zur Arbeit mit Dolmetschern wird hier besprochen. Das Text greift auch kurz auf andere Fallstudien zurück und erörtert auch die Flucht selbst in groben Zügen, die eine Reise vom kulturell Bekannten zum kulturell Unbekannten ist. Die Frage wird diskutiert, wie gut sich die Literatur zur Resilienz, die fest in der westlichen Entwicklungsperspektive verankert ist, auf Flüchtlinge übertragen läßt, von denen die meisten aus Gruppen- und Familienkulturen stammen, die von Ideen der Ehre und Schande geprägt sind. Das Artikel geht auch auf die Bedeutung des Aufnahmelandes ein, das Flüchtlingen, die ihre Heimat verloren haben und in einer fremden Kultur einen sicheren Hafen suchen, einen Übergangsraum ermöglicht oder nicht.
Questo articolo descrive nel dettaglio il caso di un rifugiato peruviano di 60 anni, concentrandosi sull’importanza del costruire la resilienza emotiva nel paziente in spagnolo, in modo da creare uno spazio per l’apprendimento della lingua inglese - il paziente non parlava inglese dopo 20 anni di vita in Inghilterra. Il lavoro è stato svolto con un interprete e viene discussa parte della letteratura sul lavorare con gli interpreti. L’articolo inoltre attinge brevemente da altri casi, oltre a discutere il viaggio dei rifugiati in termini generali, un viaggio da una cultura conosciuta verso una cultura sconosciuta. Viene discussa la questione di quanto la letteratura sulla resilienza, che si colloca saldamente all’interno di una prospettiva di sviluppo occidentale, possa essere applicata ai rifugiati, la maggior parte dei quali provengono da culture basate sulla famiglia e dominate da idee di onore e vergogna. L’articolo tratta inoltre dell’importanza per il paese di accoglienza di concedere o no, a seconda delle circostanze, uno spazio di transizione per i rifugiati che hanno perso la loro casa e sono alla ricerca di un rifugio sicuro in una cultura a loro estranea.
В этой статье подробно описывается анализ случая 60-летнего перуанского беженца, в котором особое внимание уделяется важности создания эмоциональной устойчивости пациента на испанском языке, которое впоследсвтии поможет создать пространство для изучения английского языка. Пациент не говорил по-английски после 20 лет жизни в Британии. Работа проводилась с переводчиком. В статье дан небольшой обзор литературы по работе с переводчиками, кратко рассмотрены другие случаи, а также в общих чертах обсуждается путешествие беженцев, которое представляет собой путешествие от культурно известного к культурно неизвестному. Обсуждается вопрос о том, насколько хорошо исследования устойчивости, которая прочно укрепилась в западной перспективе развития, может быть применена к беженцам, большинство из которых принадлежат групповым и семейным культурам, в которых доминируют идеи чести и стыда. В статье также затрагивается важная тема: принимающая страна помогает или нет, в зависимости от обстоятельств, создать переходное пространство для беженцев, которые потеряли свой дом и стремятся найти безопасное убежище в чужой культуре.
El presente trabajo describe en detalle, un estudio de caso de un refugiado Peruano de 60 años, haciendo foco en la importancia de construir resiliencia emocional en el paciente, en idioma Español, para poder crear un espacio para el aprendizaje del idioma Inglés - el paciente no hablaba inglés luego de 20 años de vivir en Gran Bretaña. El trabajo fue llevado a cabo con un intérprete y se discute cierta literatura sobre el trabajar con intérpretes. El artículo se basa también en otros estudios de caso, así como también en la discusión del viaje del refugiado en sentido amplio, el cual es un viaje desde lo conocido cultural hacia lo desconocido cultural. Se discute el modo en que la literatura sobre resiliencia, basada en una perspectiva desarrollista Occidental, puede aplicarse a refugiados, la mayoría de quienes provienen de familias y grupos culturales dominados por ideas de honor y vergüenza. El trabajo también plantea la importancia de que el país receptor posibilite o no, como puede ser el presente caso, un espacio transicional para refugiados que han perdido sus hogares y buscan un refugio seguro en una cultura extraña.
语言、政治和梦:难民建立弹性的挑战 这篇文章描述了一个60岁秘鲁难民的案例, 其工作重点在于病人如何在西班牙建构情感的弹性, 从而创建了一个学习英语的空间--病人在英国生活20年却不会说英文。工作是通过和一位翻译一起进行的, 文章也讨论了一些翻译用语的工作。文章还简要地讨论了另外一些个案研究, 同时在更广泛的层面上讨论了一些与难民之旅有关的话题。文章认为难民之旅程是从一个熟悉的文化向未知的文化的旅程。文章讨论了一个问题, 即根植于西方发展视角的那些关于弹性的话语, 如何应用于难民群体, 这些难民通常来源于群体与家庭为基础的文化, 其主导的关键词是忠诚和羞耻。文章还谈及接收国能否为难民提供一个过渡空间的重要性, 这些难民失去了家园, 并期待在一个陌生的文化中寻找安全的天堂。.

OBJECTIVE: To determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control.
METHODS: A mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed.
RESULTS: There was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins.
CONCLUSIONS: Only 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications.

BACKGROUND: Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation.
METHODS: A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators.
RESULTS: The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs. 5.7 (P < .001), eversion 3.3 vs. 5.9 (P = .004), tension 2.9 vs. 5.9 (P = .001), leak tightness 3.2 vs. 5.7 (P = .005), iatrogenesis 6.9 vs. 7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal\'s R of -0.71 (P < .001); with pressure R = -0.55 (P = .01).
CONCLUSIONS: The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak.