Students' perception of instructors and burnout levels in chilean dental students

The educational environment affects dental students' well-being and academic achievement, with unclear impact from clinical instructors on burnout levels. This study is aimed to determine the impact of students' perception about their clinical instructors in its burnout levels in a sample of Chilean dental students. Methods: A cross-sectional study was conducted among fourth and fifth-year dental students at the University of Concepción (Chile), collecting data on various variables including demographics, effective teaching hours, instructor treatment, knowledge delivery, student appreciation, and burnout assessed using Maslach's Burnout Inventory (MBI). Data were gathered through a self-administered survey and analyzed using STATA 10/SE software (p<0.05). Results: One-hundred and seventy students participated, high levels of emotional exhaustion (51.76%), depersonalization (56.47%), and personal accomplishment (60.59%) were found. Female students (p=0.0008), those who perceive inadequate treatment from instructors towards patients (p=0.0496), and those who rate the instructor as obstructionist (p=0.0208) reported higher levels of emotional exhaustion. 5th year students (p=0.0142), students who perceive indifferent treatment from instructors towards students (p=0.0002), and those who rate the instructor as obstructionist (p=0.0026) exhibited higher levels of depersonalization. 4th year students (p=0.0475) and those who perceive indifferent treatment from instructors towards students (p=0.0221) showed lower levels of personal accomplishment. There was a correlation between depersonalization and effective teaching hours (rho=-0.2166, p=0.0046). Conclusion: Students' perception about their clinical instructors as indifferent towards the students, obstructionist in the teaching process, with inadequate treatment towards the patients, and less effective teaching hours is associated with higher students' burnout levels.

Infección del sitio quirúrgico en niños sometidos a cirugía cardíaca con cierre esternal diferido: estudio de casos y controles / Surgical site infections in children undergoing cardiac surgery with delayed sternal closure: case-control study

Introduction: Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown. Aim: To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors. Methodology: A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010. SSI was diagnosed according to the criteria of the nosocomial infections committee of our institution, based on international recommendations. Univariate and multivariate analysis of variables was performed. A p < 0.05 was considered significant. Results: 58 patients were included; the average age was 9.5 days. The most frequent diagnosis were transposition of the great arteries (36%) and hypoplastic left heart syndrome (27%). 13 patients had SSI (22%); 11 incisional and 2 mediastinitis. It was independently associated to SSI by-pass (BP) time longer than 200 min (OR adjusted = 9,53; IC 95% 1,37-66,35) and mechanical ventilation (MV) more than 5 days (OR adjusted = 8,98; IC 95% 1,16-69,40). Conclusion: The duration of BP and MV are risk factors of SSI in children undergoing cardiac surgery with DSC.

Introducción: Las infecciones del sitio quirúrgico (ISQ) son importante causa de morbilidad en cirugía cardíaca pediátrica. Los factores de riesgo en pacientes que requieren cierre esternal diferido (CED) se desconocen. Objetivos: Reportar la tasa de ISQ en niños sometidos a cirugía cardíaca con CED y determinar factores de riesgo de ISQ. Metodología: Estudio retrospectivo de casos y controles en pacientes bajo 15 años de edad, sometidos a cirugía cardíaca con CED, en los años 2009 y 2010. Se consideró casos aquellos con ISQ diagnosticada según criterios del comité de IAAS local. Se realizó análisis uni y multivariado de las variables. Se consideró significativo un p < 0,05. Resultados: Se incluyeron 58 pacientes; la mediana de edad fue 9,5 días. Diagnósticos más frecuentes fueron transposición de grandes arterias (36%) e hipoplasia de ventrículo izquierdo (27%). Trece pacientes presentaron ISQ (22%); 11 incisionales y 2 me-diastinitis. Se asociaron de manera independiente a ISQ: circulación extracorpórea (CEC) mayor a 200 min (OR ajustado = 9,53; IC 95% 1,37-66,35) y ventilación mecánica invasora (VMI) más de 5 días (OR ajustado = 8,98; IC 95% 1,16-69,40). Conclusión: La duración de CEC y VMI son factores de riesgo de ISQ en niños sometidos a cirugía cardíaca con CED.

Expectativas docentes acerca de la formación de los profesionales de la salud versus rendimiento académico / Teaching expectations about the formation of health professionals versus academic efficiency

En los distintos niveles educativos se ha estudiado acerca de las expectativas docentes, sean estas conscientes o no, en cuanto a la formación, el aprendizaje y el rendimiento académico del alumno. Uno de los puntos clave es cómo se establece la relación docente-alumno, por lo que es importante reconocer cuáles son los factores que están involucrados en ella y pueden repercutir posteriormente en dicho fenómeno. El objetivo de este artículo es precisamente exponer los resultados de la búsqueda actualizada realizada por los autores en esta área e invitar a seguir profundizando en la comprensión de las expectativas docentes en la formación de los profesionales de la salud.

It has been studied about the teaching expectations in the different educational levels, either conscious or not, in respect to the formation, learning and academic efficiency of the students. One of the key points is how the professor-student relationship is established, that's why it is important to recognize which factors are involved in it and they can have an impact on this phenomenon later. The objective of this article is to expose the results of the updated search carried out by the authors in this area and to invite to continue deepening in the understanding of the teaching expectations in the formation of health professionals.

Síndrome de hipoplasia de corazón izquierdo: experiencia de 10 años de un programa de etapificación quirúrgica / Hypoplastic left heart syndrome: 10 year experience with staged surgical management

Resumen El síndrome de hipoplasia de corazón izquierdo (SHCI) es una cardiopatía congénita con letalidad superior al 95%. La etapificación quirúrgica es la principal vía de tratamiento, y se inicia con la operación de Norwood; la sobrevida a largo plazo de los pacientes tratados es desconocida en nuestro medio. Objetivos 1) Revisar nuestra experiencia en el manejo de todos los pacientes con SHCI evaluados entre enero 2000 y junio 2010. 2) Identificar factores de riesgo de mortalidad quirúrgica. Pacientes y método Estudio retrospectivo de una única institución con una cohorte de pacientes con SHCI. Se revisan antecedentes clínicos, quirúrgicos, y registros de seguimiento. Resultados Se evaluaron 76 pacientes con SHCI; 9/76 tenían comunicación interauricular (CIA) restrictiva, y 8/76, aorta ascendente de < 2 mm; 65/76 fueron tratados: 77% tuvieron operación de Norwood con conducto entre ventrículo derecho y ramas pulmonares como fuente de flujo pulmonar, 17% Norwood con shunt de Blalock-Taussig, y 6% otra cirugía. La mortalidad en la primera etapa quirúrgica fue del 23%, y en operación de Norwood, del 21,3%. En el período 2000-2005 la mortalidad en la primera etapa quirúrgica fue del 36%, y entre 2005-2010, del 15% (p = 0,05). La sobrevida global fue del 64% a un año y del 57% a 5 años. Por análisis multivariado fueron factores de riesgo para mortalidad la presencia de aorta ascendente diminuta y CIA restrictiva. Conclusiones Nuestros resultados inmediatos y a largo plazo en la etapificación quirúrgica de SHCI son similares a la experiencia de grandes centros. Hay una mejoría en mortalidad operatoria en la segunda mitad de la serie. Se identifican factores de riesgo de mortalidad.

Abstract Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. Objectives 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. Patients and method Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. Results Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤ 2 mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P = .05). Actuarial survival was 64% at one year, and 57% at 5 years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. Conclusions Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

Infection in Health Personnel with High and Low Levels of Exposure in a Hospital Setting during the H1N1 2009 Influenza A Pandemic.

A novel H1N1 influenza A virus caused the first pandemic of the 21st century in 2009. Hospitals had an increased demand of health consultations, that made it difficult to estimate the incidence of infection in hospital personnel due to asymptomatic presentations and the under notification of cases. To estimate and compare the rate of exposure of high versus low risk health personnel to 2009 pandemic H1N1 (H1N1pdm2009) influenza A virus in a University Hospital in Chile, we performed a comparative and prospective study. Serum samples were obtained from 117 individuals that worked in the emergency room (ER) and the operating room (OR) during the peak of the pandemic. Antibody titers were determined by the hemagglutination inhibition (HI) assay. Of the samples analyzed, 65% were workers at the ER and 35% at the OR. Of the total number of the subjects tested, 29.1% were seropositive. One out of 3 (36.8%) workers at the ER had positive HI titers, meanwhile only 1 out of 7 (14.6%) workers from the OR was seropositive to the virus. The possibility of being infected in the ER as compared to the OR was 3.4 times greater (OR 3.4; CI 95%, 1.27-9.1), and the individuals of the ER had almost twice as much antibody titers against H1N1pdm2009 than the personnel in the OR, suggesting the potential of more than one exposure to the virus. Of the 34 seropositive subjects, 12 (35.3%) did not develop influenza like illness, including 2 non-clinical personnel involved in direct contact with patients at the ER. Considering the estimated population attack rate in Chile of 13%, both groups presented a higher exposure and seropositive rate than the general population, with ER personnel showing greater risk of infection and a significantly higher level of antibodies. This data provide a strong rationale to design improved control measures aimed at all the hospital personnel, including those coming into contact with the patients prior to triage, to prevent the propagation and transmission of respiratory viruses, particularly during a pandemic outbreak.

[Surgical site infections in children undergoing cardiac surgery with delayed sternal closure: Case-control study]. / Infección del sitio quirúrgico en niños sometidos a cirugía cardíaca con cierre esternal diferido: Estudio de casos y controles.

INTRODUCTION: Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown. AIM: To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors. METHODOLOGY: A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010. SSI was diagnosed according to the criteria of the nosocomial infections committee of our institution, based on international recommendations. Univariate and multivariate analysis of variables was performed. A p < 0.05 was considered significant. RESULTS: 58 patients were included; the average age was 9.5 days. The most frequent diagnosis were transposition of the great arteries (36%) and hypoplastic left heart syndrome (27%). 13 patients had SSI (22%); 11 incisional and 2 mediastinitis. It was independently associated to SSI by-pass (BP) time longer than 200 min (OR adjusted = 9,53; IC 95% 1,37-66,35) and mechanical ventilation (MV) more than 5 days (OR adjusted = 8,98; IC 95% 1,16-69,40). CONCLUSION: The duration of BP and MV are risk factors of SSI in children undergoing cardiac surgery with DSC.

[Hypoplastic left heart syndrome: 10 year experience with staged surgical management]. / Síndrome de hipoplasia de corazón izquierdo: experiencia de 10 años de un programa de etapificación quirúrgica.

UNLABELLED: Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. OBJECTIVES: 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. PATIENTS AND METHOD: Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. RESULTS: Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤2mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P=.05). Actuarial survival was 64% at one year, and 57% at 5years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. CONCLUSIONS: Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

Atenolol versus propranolol for the treatment of infantile hemangiomas: a randomized controlled study.

BACKGROUND: Infantile hemangiomas have a dramatic response to propranolol, a nonselective beta-blocker. However, this treatment is not risk-free and many patients are excluded because of respiratory comorbidities. Atenolol is a cardioselective beta-blocker that may have fewer adverse events. OBJECTIVE: We sought to evaluate the effectiveness of atenolol against propranolol in a noninferiority trial. METHODS: In all, 23 patients met the inclusion criteria and were randomized to receive either atenolol or propranolol. Thirteen patients were treated with atenolol and 10 with propranolol. Follow-up was made at baseline, 2 weeks, 4 weeks, and then monthly for 6 months. RESULTS: Patients treated with atenolol had a complete response of 53.8% and 60% with propranolol, respectively. These results were nonsignificant (P = .68). Relevant adverse events were not reported. LIMITATIONS: The reduced number of patients could have influenced our results. CONCLUSION: Atenolol appears to be as effective as propranolol. We did not find significant differences between these results or any adverse events.

Seguimiento audiológico del recién nacido de muy bajo peso / Hearing assesment in extremely low birth weight infants

Introducción: Los recién nacidos de muy bajo peso (RNMBP) pueden tener diversas deficiencias sensoriales como secuela de las patologías perinatales propias de esta población, entre ellas la hipoacusia sensorioneural (HSN). Objetivos: El objetivo del presente trabajo es establecerla prevalencia de HSN en lactantes con el antecedente de ser RNMBP, es decir, con peso de nacimiento menor a 1500 gramos. Material y método: Se incluyeron los pacientes con peso de nacimiento < 1500 gr, que nacieron en el Hospital San Juan de Dios (Santiago, Chile) entre el 1o de enero de 1999 y el 31 de diciembre de 2004. A todos los pacientes se les realizó examen de potenciales auditivos evocados y evaluación por otorrinolaringólogo. Se definió como audición normal un umbral < - 40 dBHL. Resultados: Ingresaron al seguimiento 147 pacientes, con una edad gestacional promedio de 30 + -2 semanas y peso de nacimiento promedio de 1235 + - 254 gr. De ellos 113 tuvieron umbral normal (76,9 por ciento), con una latencia para la onda I de 1,78 + - 0,21 ms, para la onda V de 6,34 + - 0,29 ms y para el intervalo l-V de 4,55 + - 0,26 ms. En 16 pacientes se diagnosticó hipoacusia bilateral (11 por ciento). En seis de ellos se confirmó el diagnóstico de HSN bilateral, lo que equivale al 4 por ciento > de la población Incluida en el estudio. Conclusión: La prevalencia de un 4 por ciento > de HSN en el grupo estudiado coincide con la literatura Internacional. Los potenciales auditivos evocados en la detección de HSN en RNMBP constituyen un examen confiable con una especificidad del 90 por ciento > y una sensibilidad del 100 por ciento.

Introduction. Very low birth weight newborns (ELBW) may present with different sensory deficiencies as a result of perinatal pathologies characteristic to this group; among them, sensorineural hearing loss (SNHL). Aims. The aim of the present study was to establish the prevalence of sensorineural hearing loss in ELBW (birth weight of less than 1500g) infants in a public hospital. Materials and Methods. Premature infants born with a birth weight < 1500 g, born at the Hospital San Juan de Dios (Santiago, Chile) between January 1st 1999 and December 31st 2004 were included. All patients were evaluated by auditory brainstem response, recording the hearing threshold, wave I and V latencies, and l-V interval. A normal threshold was defined as less or equal to 40 dB hearing level. Results. 147 patients were evaluated, with a gestational age of 30 +- 2 weeks and a birth weight of 1235 +-254 g. Ofthese, 113 had a normal ABR threshold (76.9%), withawavel latency of 1.78 +- 0.21, wave V latency of 6.37 +- 0.29, l-V interval 4.55 +- 0.26. Sixteen patients hada bilateral threshold higher than 40 dB (11 %). Of these patients, six had bilateral threshold elevation with an increase in l-V interval, suggesting central hearing impairment. Conclusion. In the population of premature infants evaluated, the prevalence of bilateral SNHL was 4%.