Fifth-year internal medicine residents in Spain: A survey on education, assessment of competencies and job perspectives. / Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo.

BACKGROUND: Specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training. MATERIAL AND METHODS: This was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017. RESULTS: A total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1month after completing their residence. CONCLUSIONS: The residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists.

Getting to know internal medicine mentors: new training requirements. / Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación.

INTRODUCTION AND OBJECTIVES: Mentors are responsible for planning the residents' learning. The aim of this study was to determine the situation of internal medicine mentors in Spain and detect areas of improvement that can facilitate their work. MATERIAL AND METHODS: Online surveys were sent to internal medicine mentors from May to July 2017, the results of which were subsequently analysed. RESULTS: A total of 110 mentors from 13 autonomous communities and from hospitals of all levels with courses in internal medicine responded to the survey. Of these mentors, 63 were men (57.3%), and the mean age was 48 years. The mean experience as mentors was 8.5 years. Some 88.2% of the cases had a ratio of 5 residents to 1 mentor; 46% of the mentors believed this ratio should be decreased to optimize their work. A third of the mentors were chosen by the heads of the department, and 30% had not previously taken courses on training. The mentor-resident interview was used by most mentors (96.4%) as a communication tool. A quarter of the rotations were not planned by the mentors, and only half had contact with the centres where the residents performed the external rotations. Sixty-one percent of the mentors were of the opinion that resident assessments were not conducted properly, with very little use of the new assessment tools. CONCLUSIONS: Reducing the mentor-resident ratio and adding training in assessment techniques and learning development could improve the quality of the mentoring.

[Epidemiological characteristics and mortality risk factors in patients admitted in hospitals with soft tissue infections. A multicentric STIMG (Soft Tissue Infections Malacitan Group) study results]. / Características clínicas, epidemiológicas y factores asociados a mortalidad en los pacientes hospitalizados por infecciones de piel y partes blandas. Resultados del estudio multicéntrico STIMG.

OBJECTIVES: To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. METHOD: retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. RESULTS: We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%). We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 +/- 9 g/L vs. 63 +/- 8 g/L; p = 0.0231) and (22 +/- 7 g/L vs. 29 +/- 7 g/L; p = 0.0125) respectively. CONCLUSIONS: Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and don t follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infection s mortality is low and it s restricted to people with chronic illness, deep infections and bad nutritional status.

[Incidence and natural history of hepatocellular carcinoma in patients with chronic hepatitis C virus infection]. / Incidencia e historia natural del carcinoma hepatocelular en los pacientes con infección crónica por el virus de la hepatitis C.

OBJECTIVE: To report the natural history of patients with hepatitis C virus (HCV) infection and hepatocarcinoma (HCC) and to define clinico-biological variables with prognostic and predictive value of this complication. MATERIALS AND METHODS: A total of 543 patients consecutively diagnosed of chronic infection with HCV were included and followed prospectively and observationally regarding the development of HCC by means of semestral abdominal ultrasonography and measurement of serum alpha-fetoprotein (AFP). To determine variables with predictive value of HCC, the parameters determined at the start were compared, and all subjects diagnosed of hepatoma during the first twelve months after admission were excluded from the analysis. The Kaplan-Meier method was used to evaluate both survival and accumulated probability of HCC. RESULTS: During a mean follow-up period of 28.9 months, an incidence density of HCC of 2.6 per 100 inhabitants-year was obtained (n = 35). 52.6% of those with HCC in the first year were asymptomatic. The only initial variables associated with further development of HCC were age (64.6 vs 58.4 years; p = 0.0039) and alkaline phosphatase (373.5 vs 259 U/l; p = 0.001). Patients with cirrhosis at the start of the study had a higher risk of developing hepatoma than non-cirrhotic patients (RR: 11.5; 95% CI: 4.25-29.9; p < 0.0001). The presence of HCC decreased the survival of patients with cirrhosis (median 20 vs 75 months; log rank < 0.0001), with the exception of patients in stage C of the Child-Pugh classification. CONCLUSIONS: a) In the chronic infection with HCV, HCC showed to be an oligosymptomatic complication affecting almost exclusively patients with long-lasting cirrhosis. b) Survival in patients in the stage C of the Child-Pugh classification is independently associated with the coexistence of hepatoma; therefore, the early diagnosis of this complication should be restricted to those with a better liver functional reserve.

Absence of the inferior vena cava causing repeated deep venous thrombosis in an adult--a case report.

Agenesis of the inferior vena cava is an uncommon congenital vascular malformation. Although theoretically it may favor venous stasis, it is not normally associated with venous thrombosis. The authors found only three reports of the coexistence of both entities, and only one of these rules out the existence of associated hypercoagulability. They report the case of a patient with a history of repeated venous thrombosis. Magnetic resonance angiography and venography demonstrated complete agenesis of the inferior vena cava and persistence of a cardinal venous system with azygos and hemiazygos continuation, associated with right renal hypoplasia. Studies ruled out hypercoagulability syndrome, either primary or secondary to an occult neoplasm. The authors conclude that venous malformations, although rare, may cause thromboembolic disease, especially in young patients, and that magnetic resonance angiography is a useful diagnostic alternative to conventional phlebography.

[Evaluation of anti-thrombosis treatment in patients with chronic non-valvular atrial fibrillation]. / Valoración del tratamiento antitrombótico en pacientes con fibrilación auricular crónica no valvular.

OBJECTIVES: To assess both the indications of anti-thrombosis treatment in patients in our ambit with chronic non-valvular atrial fibrillation, and its observance in Primary Care. DESIGN: A descriptive, crossover, observational study of consecutive cases. SETTING: Third-level referral hospital in our Health District. PATIENTS: 132 adults first diagnosed with chronic atrial fibrillation between July 1st and December 31st 1996. MEASUREMENTS AND MAIN RESULTS: Patients' clinical records were used to assemble data on risk factors of embolism and counter-indications to prescribing antithrombosis treatment. A logistic regression model was performed to analyse the variables affecting the treatment at the time it was first given. 65 men (mean age 68.3) and 67 women (mean age 74.6) were included in the study. 87.9% of the patients had embolism risk factors; and 30.3% had at least one absolute or relative counter-indication to anti-coagulation. 79 patients had risk factors but no counter-indication, of whom 28% took anticoagulants, 39% had anti-aggregates prescribed and the remaining 33% received no anti-thrombosis treatment at all. Only 3 patients taking anticoagulants were referred to the Primary Care doctor. The regression model worked out signalled age under 75 and a previous embolism as factors associated with the indication and anticoagulants: We found no coherent regression model for the indication of anti-aggregates. CONCLUSIONS: Anti-thrombosis treatment is underused in Primary Care. An antecedent of an embolism is the most weight criterion for giving anticoagulants to patients. Age is shown to be the main reason for therapeutic reluctance to give anticoagulants to patients without counter-indications. There should be more patients being treated with anticoagulants in Primary Care.

[A 73 year-old patient with thrombocytopenia and a giant cerebral vascular malformation]. / Paciente de 73 años con trombopenia y malformación vascular cerebral gigante.

We report the case of a patient who was seen by purpura and thrombocytopenia. The differential diagnosis in this patient included the presence of cerebral giant vascular malformation, the intake antiepileptic drugs and the presence of a chronic liver disease caused by viral hepatitis C infection. However the final diagnoses of Idiopathic Thrombocytopenia Purpura was made because of the presence of antiplatelets antibodies, the fluctuate evolution, and the increase of platelet count after costicosteroid therapy.