Introduction: in recent years postoperative cognitive dysfunction has received more and more attention, so it is essential to increase the knowledge of this very frequent disorder. Objective: to evaluate the effectiveness of a course on postoperative cognitive dysfunction in Cuban medical science students. Method: a non-observational, quasi-experimental, before and after study was carried out, without control group, of educational intervention, in medical science students, participants of the pre-event course on Postoperative Cognitive Dysfunction given in the framework of the I National Scientific Event of Surgery, CiruSan 2023, in April 2023. The universe was 248 medical science students, a purposive sample of 215 students enrolled in the course was chosen, who answered the two knowledge questionnaires applied and who, in addition, agreed to participate in the research. Results: students from Santiago de Cuba (58.60%) and from the Medicine course (76.28%) predominated. Inadequate knowledge predominated before the intervention, and a later modification was demonstrated (93.02 %). Conclusions: the intervention was effective because, after its application, knowledge about postoperative cognitive dysfunction increased in the participating medical students.
Postoperative complications, Knowledge, Postoperative cognitive dysfunction, Intervention studies, Students, Qui procedures.
Sustained progress in the field of medicine has led to improved quality of life and an increase in life expectancy in recent years. Advances in surgery and anesthesia, for their part, have led to greater safety and better outcomes in surgical procedures, allowing older patients with higher risk factors to access complex surgical treatments. [1]
In this case, geriatric surgery has evolved into a surgery that promotes quality of life, in which healthcare professionals face new perioperative problems, since old age and accompanying conditions increase morbidity and mortality; one of these complications is postoperative cognitive dysfunction (PCD). [2]
DCPOP is defined as a disorder characterized by a decrease in the patient's cognitive capacity, which occurs after a surgical intervention or the use of general anesthesia, and which affects higher mental processes, such as memory, information processing, attention, cognitive elasticity, among others [3] .
This condition is usually transient, it can begin between seven days and one year after surgery and, sometimes, it can persist for months or years and cause significant morbidity and mortality. [4]
Risk factors for this disorder are: advanced age, previous cognitive impairment, severity of coexisting diseases, severity of surgery, duration and type of anesthesia, occurrence of complications and educational level; a neuropsychological evaluation before and after surgery is essential for diagnosis [5] .
DCPOP is diagnosed through neurocognitive tests, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MOCA), which are performed before and after the procedure, with the intention of investigating this complication that is particularly more common in elderly people [4] . Various studies show an incidence of DCPOP in cardiac surgeries of 30-80% in the first weeks and 10-60% at 3-6 months. [6], [7]
For non-cardiac surgeries, the incidence is estimated to be between 7% and 26%, approximately 25.8% at one week and 9.9% at three months postoperatively. In a 2016 systematic review of 19 studies using the same neuropsychological tests before and at three months postoperatively, other authors reported an incidence of 11.7% (95% CI, 10.9%-12.5%). (6-8) The occurrence of this condition was also evaluated in specific procedures, such as elective hip surgery, where they reported an incidence of 22%. [7]
The study by Abildstrom et al. [9] is the only one to analyze the long-term incidence of POPCD. They evaluated adults >60 years of age who underwent major abdominal, noncardiac thoracic, or orthopedic surgery with general anesthesia and an expected minimum hospital stay of four days. These authors reported an incidence of this disorder of 10.4% (95% CI 7.2%-13.7%) at 12 months after surgery and was very similar to the rate of normal (nonsurgical) controls who suffered the disorder (10.6%; 95% CI 11.8%-19.4%), suggesting that it may be difficult to distinguish this disorder at a follow-up of more than one year, compared to non-operated individuals with deterioration in neuropsychological testing. [9], [10] In recent years, POPCD has received increasing attention in the literature. For all the reasons stated above, it is essential to increase awareness of this disorder, which is so common, especially in older adults, as it could contribute exponentially to improving the quality of care provided to patients with PCOPD. Therefore, the objective of this course is to evaluate the effectiveness of a course on postoperative cognitive dysfunction in Cuban medical students.
A non-observational, quasi-experimental, before and after study was carried out, without a control group, of educational intervention, in medical sciences students, participants in the pre-event course Postoperative Cognitive Dysfunction taught within the framework of the 1st National Scientific Event of Surgery " Cirusan 2023", in April 2023. The universe was 248 Cuban medical sciences students, enrolled in the pre-event course Postoperative Cognitive Dysfunction through the mechanism established by the CiruSan 2023 Organizing Committee, an intentional sample of 215 students was chosen.
Inclusion criteria:
-Be enrolled in the pre-event course on Postoperative Cognitive Dysfunction.-Have answered the two knowledge questionnaires applied.-Have agreed to participate in the research.
Exclusion criteria:
-Not having completed both questionnaires . The educational intervention consisted of four stages:
Registration:
A WhatsApp group was created for the course to facilitate access to the various educational resources and encourage group exchanges with students from different provinces. For registration, a virtual space was created on WhatsApp to allow students to enter the required information. The methodology to be developed during the course was explained, and participants were asked to participate in the research. Participants were asked to complete an initial diagnostic questionnaire, which would not impact the final evaluation of the course. This questionnaire was used to assess their knowledge of the topic and identify their greatest challenges (informed consent).
Diagnostic:
For diagnosis, the Uniform Resource Locator (URL) was published in the official WhatsApp group. The initial diagnostic questionnaire (pre-test) entitled "Postoperative Cognitive Dysfunction, General Aspects" was administered via Google Forms . This questionnaire, validated by the course tutor, included the five subtopics to be analyzed in the course:
•Definition.
•Classification.
•Epidemiology.
•Risk actors
•Diagnostic methods of the entity.
It was structured in 2 questions, one for each subtopic, a period of 24 hours was assigned for its completion and a general evaluation was carried out according to the total score (maximum 100 points) obtained once the five questions were answered, and by topics (each question with a maximum of 20 points), qualifying the results as adequate (≥ 70% of the points) and inadequate (< 70%).
Intervention or training:
The intervention program consisted of two sessions. The first, held over an eight-hour period, featured educational materials consisting of PowerPoint presentations, explanatory audio clips, and a supplementary PDF, corresponding to a single lecture prepared by the authors of this research, as well as bibliographical reference materials intended to promote knowledge acquisition on the topic through independent study. The summary of the lecture included:
•Postoperative Cognitive Dysfunction. Definition.
•Classification of disorders associated with Postoperative Cognitive Dysfunction.
•Epidemiology.
•Pathophysiology of DCPOP.
•Risk factors.
•Diagnostic methods for DCPOP.
•Action of healthcare personnel before the DCPOP.
During the two-hour second session, communication among participants was encouraged, and group or individual consultations were held on specific aspects that were not well explained or raised questions. The entire sample of participants participated in both sessions.
Assessment:
A second questionnaire (post-test) was administered as an assessment activity, with different questions, the same knowledge objectives, and the methodology of the initial questionnaire. It was structured into five questions, with one question for each subtopic. This allowed for a comparison of pre- and post-course knowledge, both of the topic in general and of the five topics covered. This made it possible to assess the impact of the resource used.
Variables studied
•University of Medical Sciences of origin.
•Academic year.
•Medical sciences degree.
•Specific knowledge about:
•Definition
•What is Postoperative Cognitive Dysfunction?
•DCPOP Classification
•Mention the DCPOP classification.
•Explain the characteristics of the different DCPOPs.
•Epidemiology
•Mention the statistical differences between DCPOP in patients with cardiac surgery and those resulting from other surgeries.
•In which age group is this disorder most evident?
•Risk Factors
•Mention at least 3 risk factors for this clinical entity.
•Diagnostic methods for DCPOP
•Mention at least 5 diagnostic methods for this clinical entity.
•Explain one of them.
Data were collected through the application of instruments and processed using the SPSS version 15 statistical package. They are presented in double contingency tables and graphs, using descriptive statistical techniques such as absolute frequency and percentage as summary measures; as well as the McNemar test , with a significance level of 0.05 and 95% confidence, which allowed the results to be inferred from the rest of the population and the effectiveness of the program used to be evaluated through two hypothesis tests:
Hypothesis Test No. 1:
H0: The educational program is not effective in increasing knowledge about DCPOP. (p>0.05)
H1: The educational program is effective in increasing knowledge about DCPOP. (p<0.05)
For this study, approval was requested from the Scientific Council of the Event and the directors of the Faculty of Medicine No. 1 of the University of Medical Sciences of Santiago de Cuba, taking into account the ethical principles established in the Declaration of Helsinki. Informed consent was also obtained digitally from each student prior to the study.
| Province to which the study center belongs | Number of participants | |
|---|---|---|
| No. | (%) | |
| Santiago de Cuba | 126 | 58.60 |
| Cienfuegos | 40 | 18.60 |
| Las Tunas | 22 | 10.23 |
| Ciego de Ávila | 22 | 10.23 |
| Sagebrush | 5 | 2.34 |
| Total | 215 | 100 |
| Province to which the study center belongs | Number of participants | |
|---|---|---|
| No. | (%) | |
| Santiago de Cuba | 126 | 58.60 |
| Cienfuegos | 40 | 18.60 |
| Las Tunas | 22 | 10.23 |
| Ciego de Ávila | 22 | 10.23 |
| Sagebrush | 5 | 2.34 |
| Total | 215 | 100 |
TABLE 2 shows the level of knowledge among participants regarding the definition of Postoperative Cognitive Dysfunction. Initial ignorance is evident, as there were a large number of errors in all aspects evaluated, with 152 (70.70%) being evaluated as inadequate; all of these were positively modified; once the course was delivered, 198 of the participants responded adequately, representing a total of 92.09%.
| Knowledge | After | Total | |||||
|---|---|---|---|---|---|---|---|
| Appropriate | Inappropriate | ||||||
| No. | (%) | No. | (%) | No. | (%) | ||
| Before | Suitable | 63 | 100 | - | - | 63 | 29.30 |
| Inadequate | 135 | 88.81 | 17 | 11.19 | 152 | 70.70 | |
| Total | 198 | 92.09 | 17 | 7.91 | 215 | 100 | |
According to TABLE 3 , 168 participants (78.13%) had inadequate knowledge about POPCD classification before the intervention. After the intervention, only 20 participants (9.3%) had inadequate knowledge.
| Knowledge | After | Total | |||||
|---|---|---|---|---|---|---|---|
| Appropriate | Inappropriate | ||||||
| No. | (%) | No. | (%) | No. | (%) | ||
| Before | Suitable | 47 | 100 | - | - | 47 | 21.87 |
| Inadequate | 148 | 88.10 | 20 | 11.9 | 168 | 78.13 | |
| Total | 195 | 90.70 | 20 | 9.3 | 215 | 100 | |
TABLE 4 shows that before the intervention , 206 students (95.81%) had inadequate knowledge about the epidemiology of PCPD; this result was modified with the intervention, in which a total of 179 students (83.25%) received adequate responses.
| Knowledge | After | Total | |||||
|---|---|---|---|---|---|---|---|
| Appropriate | Inappropriate | ||||||
| No. | (%) | No. | (%) | No. | (%) | ||
| Before | Suitable | 9 | 100 | - | - | 9 | 4.19 |
| Inadequate | 170 | 82.52 | 36 | 17.48 | 206 | 95.81 | |
| Total | 179 | 83.25 | 36 | 16.75 | 215 | 100 | |
Regarding risk factors for this condition, TABLE 5 shows inadequate knowledge of these factors before the intervention in 126 students, representing 58.61% of the students in the study; while after the intervention, no students showed inadequate knowledge on the subject.
| Knowledge | After | Total | |||||
|---|---|---|---|---|---|---|---|
| Appropriate | Inappropriate | ||||||
| No. | (%) | No. | (%) | No. | (%) | ||
| Before | Suitable | 89 | 100 | - | - | 89 | 41.39 |
| Inadequate | 126 | 100 | - | - | 126 | 58.61 | |
| Total | 215 | 100 | - | - | 215 | 100 | |
According to the level of knowledge about diagnostic methods, it can be seen in TABLE 6 that there are only 3 students (1.4 %) who had adequate knowledge of these methods before the intervention and after the intervention 200 students (93.02 % ) had adequate knowledge on the subject.
| Knowledge | After | Total | |||||
|---|---|---|---|---|---|---|---|
| Appropriate | Inappropriate | ||||||
| No. | (%) | No. | (%) | No. | (%) | ||
| Before | Suitable | 3 | 100 | - | - | 3 | 1.4 |
| Inadequate | 197 | 92.92 | 15 | 7.08 | 212 | 98.60 | |
| Total | 200 | 93.02 | 15 | 6.98 | 215 | 100 | |
Medical education was greatly affected by the Covid-19 pandemic, which forced the development of various strategies that allowed the change from the face-to-face environment to the virtual environment of the teaching-learning process through teleconferences, webinars and online learning that are still maintained today due to the importance of the introduction of technological media in the teaching of medical sciences, which also promotes the self-preparation of students from the first years of their career and throughout their training as professionals and forms habits of continuous improvement. [11]
This new teaching-learning strategy, implemented in recent years with information technologies, requires the use of these virtual spaces as the main venue for various scientific events and courses.
The province of origin of the participating students is another aspect to consider for the analysis of the study due to the national nature of the event. In two studies conducted by Monet Álvarez et al. [11], [12] , the province of Ciego de Ávila stands out as the most represented. The present study does not agree with these results, since Santiago de Cuba stands out with 58.60%. This may be due to the fact that the availability of information about the event and how to participate can vary; that is, those with better communication and promotion channels could generate more interest and participation.
A standardized definition of PCOPD has not been established, since there is a great heterogeneity of clinical studies on which its definition has been based, which generates a problem for the study and estimation of its severity. [14] In addition, there is controversy regarding defining PCOPD as a clinical entity, since some researchers consider that it occurs associated with mild cognitive impairment (MCI) already existing prior to anesthesia and surgery. [15]
Cognition is the combination of brain processes that intervene in all aspects of life, such as thinking, memory, language, judgment and the ability to learn new things [16] , so in general, PCOPD can be defined as the deterioration of cognitive functions after the use of anesthetics and a surgical event . The cognitive functions affected are diverse, including memory (mainly short-term memory, with the ability to store recent information being compromised, as well as the acquisition of new data), learning capacity, perception, verbal abilities , execution and abstract thinking; and can be summarized as affecting memory, concentration and learning. [14], [17], [18]
According to Gómez Tejeda et al. [19] in their study of modification of knowledge on natural and traditional medicine as a therapy for bronchial asthma, although in patients, before the intervention only 23.16% had adequate knowledge on the subject in general and less knowledge on specific topics, which were positively modified after the intervention by more than 89%. In the analysis of the present research the authors show coincidences with the previous study regarding important differences with respect to the initial levels of knowledge according to the different subtopics, the least prominent topic among the students was the one related to the diagnostic methods of the DCPOP in which initially only 3 participants responded adequately (1.40%) which was positively modified once the intervention was carried out; this may be due to a clear lack of understanding of how they are applied, or because of how complex it can be, causing them to feel overwhelmed by the amount of information or by the need for specific skills to apply them correctly.
The current use of virtual platforms by students in their teaching-learning process enables these platforms to become a useful space for modifying knowledge in the health area in recent times, which demonstrates the effectiveness of these technologies.
Researchers such as Medina-Fuentes et al. [20] and Puyén Goicochea et al. [21] have used new technologies to implement programs to modify knowledge and have obtained positive results; a criterion with which the authors of the present study agree since satisfactory results were obtained during the same with the use of new technologies, by modifying the knowledge that students presented on the DCPOP. It also allowed to verify the hypothesis of the present study, because these tools not only facilitate access to information but also promote a more active and collaborative learning.
The research is evidence of the importance of using new technologies in educational processes.
The educational intervention strategy for Postoperative Cognitive Dysfunction in medical science students was effective in increasing their level of knowledge on the topic and enhancing their preparation as future professionals. It also established the foundation for this program's treatment using new information technologies.
Conceptualization: Dalianna Milagros Montalvo Sánchez, Juana Mirtha González Ferrer
Methodology: Dalianna Milagros Montalvo Sánchez, Ariane Hernández Trujillo
Research: Dalianna Milagros Montalvo Sanchez, Juana Mirtha Gonzalez Ferrer, Ariane Hernandez Trujillo, Roger Alejandro Leyva Poblador, Marlon Omar Leyva Rodriguez, Yudel Tomas Fabars Bueno
Project Management: Dalianna Milagros Montalvo Sánchez
Data curation: Ariane Hernández Trujillo
Formal analysis: Juana Mirtha González Ferrer
Software: Juana Mirtha González Ferrer, Ariane Hernández Trujillo
Resources: Juana Mirtha González Ferrer, Ariane Hernández Trujillo
Validation: Dalianna Milagros Montalvo Sánchez
Visualization: Dalianna Milagros Montalvo Sanchez, Juana Mirtha Gonzalez Ferrer, Ariane Hernandez Trujillo, Roger Alejandro Leyva Poblador, Marlon Omar Leyva Rodriguez, Yudel Tomas Fabars Bueno
Supervision: Dalianna Milagros Montalvo Sánchez
Writing - original draft: Dalianna Milagros Montalvo Sánchez, Ariane Hernández Trujillo
Writing - review and editing: Dalianna Milagros Montalvo Sánchez, Juana Mirtha González Ferrer, Roger Alejandro Leyva Poblador, Marlon Omar Leyva Rodríguez, Yudel Tomás Fabars Bueno
The authors declare that there are no conflicts of interest.
The authors did not receive funding for the development of this article.
Copyright 2024 Dalianna Milagros Montalvo Sánchez et al.
Este es un artículo publicado bajo una licencia del Creative Commons