Burnout syndrome in internal medicine specialists and factors associated with its onset. / Síndrome de burnout en especialistas de medicina interna y factores asociados a su desarrollo.

BACKGROUND AND OBJECTIVES: Burnout is a psychosocial syndrome caused by stressful working conditions and affects 30-60% of medical personnel. The aim of this study was to assess the burnout rate of Spanish internists and the factors related to its onset. MATERIAL AND METHODS: We conducted a survey of work conditions followed by the Maslach Burnout Inventory, which was disseminated through the email registry and social networks of the Spanish Society of Internal Medicine. We performed a descriptive study and a univariate and multivariate analysis assessing the variables associated with burnout syndrome. RESULTS: A total of 934 internists (58.8% women and a median age of 40.0 years) answered the survey. Some 55.0% of the internists indicated high emotional fatigue, 61.7% indicated a high sense of depersonalisation, and 58.6% indicated low personal fulfilment. Some 33.4% of the interns experienced burnout. Burnout syndrome was independently related to age (OR 0.96; 95% CI 0.94-0.98), poor work environment (OR 1.94; 95% CI 1.31-2.82), insufficient wages (OR 1.79; 95% CI 1.20-2.67), receiving threats (OR 1.703; 95% CI 1.204-2.410) and the feeling of a lack of professional progress (OR 2.83; 95% CI 1.92-4.17). CONCLUSIONS: Burnout syndrome affects 33.4% of internists in Spain, and its onset is independently related with age, poor work environment, a lack of professional progress, insufficient financial remuneration and experiencing threats by patients or colleagues.

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.

[The spectrum of bronchopulmonary infection caused by Pseudomonas aeruginosa in patients infected with the human immunodeficiency virus]. / Espectro de la infección broncopulmonar por Pseudomonas aeruginosa en pacientes infectados por el virus de la immunodeficiencia humana.

OBJECTIVE: To describe the clinical spectrum of bronchopulmonary infections caused by Pseudomonas aeruginosa in patients infected with HIV. METHODS: A retrospective study of cases with P. aeruginosa pneumonia and tracheo-bronchitis in patients infected with HIV, diagnosed over a 5-year period (January 1990-December 1994) in a third level university hospital. RESULTS: Seven patients with pneumonia and 15 with tracheobronchitis were identified, with a mean age of 33 years. All patients were in an advanced stage of immunosuppression (median CD4 count 11/mm3) and 21 (95%) had AIDS. In 6 cases (86%) pneumonia was acquired in the community and no patient had severe neutropenia. Clinical presentation ranged from severe pneumonia with respiratory insufficiency and shock to subacute less severe disease. Two patients (29%) died in the first episode as a result of pneumonia. The combination of cough, purulent expectoration and fever was the usual presenting form of tracheo-bronchitis. Nine out of the 15 patients (60%) had been treated previously because of tracheo-bronchitis and/or bacterial pneumonia episodes not caused by P. aeruginosa. Twelve patients required hospital admission; ten patients (83%) because of tracheo-bronchitis symptoms. The initial response to therapy was satisfactory, but 12 (80%) relapsed, with 2.6 relapses per patient after a mean follow-up of 7.4 months. CONCLUSIONS: P. aeruginosa bronchopulmonary infections emerge in late stages of HIV disease. P. aeruginosa should be considered in the differential diagnosis of every patient with pneumonia and advanced AIDS, even in the absence of the traditionally reported risk factors. Initially, tracheo-bronchitis responds well to therapy, but its management is difficult because of the frequent relapses and the development of antibiotic resistance.