[Lower urinary tract symptoms in medical residents as reflection of a stressful work environment.] / Síntomas del tracto urinario inferior como reflejo del ambiente laboral hospitalario en médicos residentes.

OBJECTIVE: To determine if the presence of moderate to severe lower urinary tract symptoms in medical resident are associated with workplace bullying. MATERIAL AND METHODS: Cross-sectional study conducted in medical residents. Moderate to severe lower urinary tract symptoms were defined as greater than 8 points on the International Prostate Symptom Score. Residents were classified as bullied if their total score on the Negative Acts Questoinnarie-Revised, was above 41 points. Perceived bullying was considered as present when any positive answer was documented in a specific question to measure this variable. Bivariate analysis to determine statistical differences between presence of lower urinary tract symptoms and exposure to both types of bullying was performed using χ² . The magnitude and directions of all associations were determined by calculating the Odds Ratio with 95% level of confidence. RESULTS: 209 residents were included, 63% men; 68% reported at least one lower urinary tract symptom, of which, 56% were mild, 10% moderate and 2% severe. The prevalence of bullying was 42% while perceived bullying was present in 39%. Residents with ≥8 points on the International Prostate Symptom Score had higher risk of being exposed to bullying (OR: 2.8, 95% CI: 1.1-6.7, p=0.01) and/or perceived bullying (OR: 3.1 95% CI: 1.3-7.5, p=0.00). Female gender had greater risk than man for presenting lower urinary tract symptoms at basal state (OR: 2.8, 95% CI: 1.1-6.6, p=0.01). CONCLUSIONS: Medical residents with moderate or severe urinary tract symptoms may be related to bullying. Being a woman is associated with an increased risk of developing LUTS.

OBJETIVO: Determinar si la presencia de síntomas del tracto urinario inferior moderados a severos en médicos residentes se asocian con la exposición a bullying laboral.MATERIAL Y MÉTODOS: Estudio transversal realizado en médicos residentes. Se definió síntomas del tracto urinario inferior moderados a severos como más de 8 puntos en el Índice Internacional de Síntomas Prostáticos. Los residentes se consideraron como expuestos a bullying si el puntaje total en la Escala de Conductas Negativas era mayor a 41 puntos. Se consideró como bullying percibido cualquier respuesta positiva en una pregunta específica para medir esta variable. Se realizó un análisis bivariado utilizando la χ² para determinar diferencias estadísticas entre la presencia de síntomas del tracto urinario inferior y la exposición a ambos tipos de bullying. La magnitud y dirección de las asociaciones se establecieron calculando el Odds Ratio con un intervalo de confianza al 95%. RESULTADOS: Se incluyeron 209 residentes, 63% hombres; 68% refirieron algún síntoma del tracto urinario, de los cuales, 56% fueron leves, 10% moderados y 2% severos. La prevalencia de bullying fue de 42% y el bullying percibido se presentó en el 39%. Los residentes con ≥8 puntos en el Índice Internacional de Síntomas Prostáticos tuvieron mayor riesgo de estar expuestos a bullying (OR: 2,8, IC 95%: 1,1-6,7, p=0,01) y bullying percibido (OR: 3,1 95% CI: 1,3-7,5, p 0,00). Ser mujer se asoció con mayor riesgo de presentar síntomas del tracto urinario inferior (OR: 2,8, IC 95%: 1,1-6,6, p=0,01). CONCLUSIONES: Los médicos residentes con síntomas del tracto urinario moderados o severos pueden estar relacionados a bullying. Ser mujer se asocia a mayor riesgo de presentar STUI.

[Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea].

Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Tasa libre de litos sin complicación mayor como definición de éxito en nefrolitotomía percutánea / Stone-free rate without major complication as a definition of success in percutaneous nephrolithotomy

Resumen Introducción: El éxito en nefrolitotomía percutánea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definición de éxito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Método: Cohorte histórica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, índice de comorbilidad de Charlson (ICC) y lito complejo. Se definió éxito: sin litos, sin o con complicación Clavien ≤ 2; éxito intermedio: con litos sin o con complicación Clavien ≤ 2; fracaso: con o sin litos con complicación Clavien > 2. Se realizó análisis bivariado para identificar los factores asociados con el desenlace. Por regresión logística múltiple se calculó el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 años; 65, 22 y 13 % de los casos tuvieron éxito, éxito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusión: La probabilidad de éxito fue directamente proporcional al número de factores de riesgo.

Abstract Introduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson's comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

Rearrangement of the Guy's stone score improves prediction of stone-free rate after percutaneous nephrolithotomy.

OBJECTIVE: We propose a modification of the original Guy's Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone- free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups. RESULTS: Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). CONCLUSION: The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.

Elaboración de un artículo de reporte de caso clínico o de revisión, en la materia de metodología de la investigación en medicina / Elaboration of a case report or review paper in the course of methodology for research in medicine

Introducción. La formación en redacción y metodología de la investigación es importante en la formación médica. En el plan de estudios de la licenciatura en medicina de la universidad marista de Mérida, Yucatán, México, se imparte la materia de metodología de la investigación en el sexto semestre y actualmente involucra la generación de competencias para la comunicación escrita. En el presente artículo, presentamos los resultados obtenidos en el programa académico de la materia, en la cual los alumnos desarrollaron un borrador de artículo académico y posteriormente elaboraron un artículo, para lo cual optaron por un reporte de caso clínico o un artículo de revisión. Métodos. Este es un estudio descriptivo, observacional mediante encuesta a los alumnos. Adicionalmente se analiza los productos académicos derivados del curso que fueron sometidos para su publicación seis meses después de iniciado el curso y las experiencias y percepciones expresadas por los alumnos. Resultados. De una generación de 60 alumnos, 19 (32%) optaron por un manuscrito de reporte de caso clínico y 41 (68%) eligieron un tema de revisión. Un artículo derivado de la materia ha sido publicado, dos de revisión y tres de caso clínico se encuentran ahora bajo revisión. Conclusiones. Los alumnos de pregrado fueron capaces de desarrollar manuscritos de revisión y de reportes de caso clínico de calidad y eligieron el tipo de artículo tomando en cuenta el acceso a los datos, el tiempo requerido y la estructura del manuscrito.

Introduction: In medical education, it is important to train students in scientific writing and research methods, relevant for progress of health sciences. The curriculum for the undergraduate program of medical education at the Marista University of Merida, Yucatan, Mexico, includes the subject of research methodology in the sixth semester, and currently involves the generation of skills for written communication. In this article, we present the results obtained in the academic program of the research methods course, in which the students develop a draft of an academic article and subsequently an original article consisting of a clinical case report or a review article. Methods: Descriptive, observational study obtained from a survey applied to the students. Additionally, we discuss on the academic products derived from the course that were submitted for publication, six months after the commencement of the course; we also discuss the experiences and perceptions expressed by the students. Results: From 60 students, 19 (32%) opted for writing a clinical case report and 41 (68%) for a review paper. To this day one article derived from the material has been published, and two review papers and three clinical cases are currently under peer review. Conclusions: Undergraduate students were able to develop review manuscripts and clinical case reports of quality and to choose them taking into account access to the data, the time required and the structure of the manuscript.