Introduction: The Calgary Family Medicine (FM) Residency Program implemented a competency-based curriculum in 2012 (Triple C). To meet the College of Family Physicians' accreditation standards, the Program also implemented a new assessment program. Field notes (FNs) were introduced to record feedback and to provide data for decisions around Resident competence and progress. Validation of inferences from data collected in field notes is sparse, particularly in relation to how the data can be extrapolated to competence and professional practice. This study investigates the quality and trustworthiness of FNs when their content is used to make decisions about a Resident's competence. Methods: Assessment data from over 3100 FNs, 99 inprogram progress decisions, and scores on the the SOOs and SAMPs components of the College of CFPC Certification Examination in FM were analysed for 16 randomly selected Residents who had successfully completed the Urban FM Residency Program in Calgary under the Triple C Curriculum. Six independent raters (FM community preceptors) were recruited to review copies of the same sets of FNs that were originally used by in-program preceptors to assess Resident progress. 2 independent blinded raters were randomly assigned to each set of FNs. Raters were asked to use FN data to decide on Resident progress, and indicate their level of confidence in their decisions. This was compared with Peer Review under the responsibility of Universidad Nacional Autónoma de México. the actual in-program progress decision previously made for each Resident. Quality of FNs was assessed using a Formative Feedback Evaluation Tool (FFET), and were scored 1-5. Results: The quality of the FN data was found to be suboptimal (mean 2.27). The consistency of raters' progress decisions was high (89%). Correlation analyses indicated a significant weak positive relationship between quality of FNs and raters' confidence, r(196) = .201, p = .005; a significant moderate positive linear relationship between number of FNs and raters' confidence, r(196) = .30, p < .001; and a significant moderate positive linear relationship between total number of FNs received by a resident and the residents z-scores in the SAMPS component of the CFPC exam, r(14) = .55, p = .026 Conclusion: The results provide evidence supporting the validity of assessment decisions based on Field Note data. The quality and number as well as the quality of the FNs appears important in supporting the trustworthiness of summative progress decisions.

Background: Background: Heart rate variability (HRV) analysis is a relevant indicator of autonomic nervous system function over the cardiovascular system. The usual way to measure this variability is from the electrocardiogram (ECG). Objective: To assess the validity of HRV measurements obtained from a heart rate monitor (HRM) Polar® V800 in critically ill adult subjects. Materials and Methods: A prospective, repeated measures, observational study was conducted in two in the Chilean intensive care units. Twenty-one different HRV variables were simultaneously assessed using a Polar® V800 HRMs and an ECG Mortara® H3 Holter device. The data was collected from the clinical record and physical examinations. The evaluations were conducted for 10 minutes at a time and simultaneously, during which the subjects had to remain supine and at rest. The sampling frequency was 1000 Hz, providing a temporal resolution of 1 millisecond for each RR period. Results: Thirty adult subjects were included with an average age of 33.63 ± 8.91 years. When comparing both HRV assessment methods, only 3 variables showed statistically significant differences (p ≤ 0.05). As well, the correlations showed 4 strong and 17 near-perfect associations, which were positive and statistically significant (p ≤ 0.001). In addition, intraclass correlation coefficients (between 0.744 and 1) and bias determined using the Bland-Altman method found both methods to be concordant. Conclusions: The Polar® V800 monitor is a valid tool for assessing HRV in critically ill adult subjects.

Aim:The aim of the study was to determine the usefulness of known biomarkers as pre-operative predictors of complicated acute appendicitis (CAA) and perforated appendicitis (PA). Materials and methods: This was an observational, analytic, cross-sectional, and prospective study at Hospital Teodoro Maldonado Carbo (August 2016-December 2017. Evaluated biomarkers: white blood cells count, neutrophil percentage (N%), neutrophil-to-lymphocyte ratio, glucose, total bilirubin, C-reactive protein, and procalcitonin (PCT). The statistical analysis was performed by means of the area under the receiver operating characteristics (AUROC) curve estimation. Biomarkers' cutoff point was identified using Youden's index. Sensitivity, specificity, positive, and negative predictive value (NPV) (positive predictive value [PPV] and NPV) were estimated. Results: One hundred and twenty-eight cases were included (median age 30 years, 44% female), 70 cases (54%) corresponded to CAA (PA 38/70).

Background: In a cesarean section, epidural analgesia with 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine concentrations can be used. A higher concentration of bupivacaine reaches better analgesia but with a higher rate of drug-related adverse events. Aim: The aim of the study was to assess analgesia and safety of 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine during cesarean. Materials and methods: Prospective cohort stratified following both bupivacaine concentrations. Results: One hundred women with full-term pregnancies were selected (fifty per cohort). At 20 and 30 min after epidural administration, there was a higher proportion of motor blockade cases from the 0.125% bupivacaine and 1.5% lidocaine cohort (p = 0.0229 and p = 0.0006, respectively). There was no significant difference among sensitive blockage. A 0.25% bupivacaine and 1.0% lidocaine concentration showed a tendency to hypotension (p < 0.001) and bradycardia (p = 0.4100). From 0.125% bupivacaine and 1.5% lidocaine cohort, 25 cases (50%) presented at least one adverse event; in contrast with 44/50 (88%) from 0.25% bupivacaine and 1.0% lidocaine cohort (p < 0.001). Conclusion: In epidural analgesia during cesarean, using 0.125% bupivacaine and 1.5% lidocaine presented similar analgesia than 0.25% bupivacaine and 1.0% lidocaine. However, a higher bupivacaine concentration is significantly related to more frequent drug-related adverse events (especially hypotension).