Psychometric analyses and internal consistency of the PHEEM questionnaire to measure the clinical learning environment in the clerkship of a Medical School in Chile.

BACKGROUND AND AIMS: The Spanish version of the Postgraduate Hospital Educational Environment Measure (PHEEM) was evaluated in this study to determine its psychometric properties, validity and internal consistency to measure the clinical learning environment in the hospital setting of Pontificia Universidad Católica de Chile Medical School's Internship. METHODS: The 40-item PHEEM questionnaire was translated from English to Spanish and retranslated to English. Content validity was tested by a focus group and minor differences in meaning were adjusted. The PHEEM was administered to clerks in years 6 and 7. Construct validity was carried out using exploratory factor analysis followed by a Varimax rotation. Internal consistency was measured using Cronbach's alpha. RESULTS: A total of 125 out of 220 students responded to the PHEEM. The overall response rate was 56.8% and compliances with each item ranged from 99.2% to 100%. Analyses indicate that five factors instrument accounting for 58% of the variance and internal consistency of the 40-item questionnaire is 0.955 (Cronbach's alpha). The 40-item questionnaire had a mean score of 98.21 +/- 21.2 (maximum score of 160). CONCLUSIONS: The Spanish version of PHEEM is a multidimensional, valid and highly reliable instrument measuring the educational environment among undergraduate medical students working in hospital-based clerkships.

Measuring students' perceptions of the educational climate of the new curriculum at the Pontificia Universidad Católica de Chile: performance of the Spanish translation of the Dundee Ready Education Environment Measure (DREEM).

CONTEXT: During the last decade a major curriculum reform was carried out at the Pontificia Universidad Católica de Chile Medical School. The process included changes in curriculum development, staff development and in the infrastructure. However, it is not known how students perceived the climate of their education within the new model. OBJECTIVES: To measure students' perceptions of the educational environment of the new curriculum and to evaluate the internal consistency of the 50-item Dundee Ready Education Environment Measure (DREEM) Spanish version questionnaire. METHODS: The DREEM Spanish version questionnaire was administered to undergraduate medical students in training years 3, 4 and 5. Internal consistency of the instrument and its subscales were measured with the method described by Cronbach, and the results were expressed with alpha coefficient ranging from 0 to 1. FINDINGS: Responses were received from 297 out of 328 students (90.5%). The 50-item DREEM Spanish version was found highly reliable with an alpha coefficient of 0.91. The subscale with the highest mean score was "Academic Self-Perceptions", which indicates students' perceptions of their academic achievements. Mean score of this subscale was 22.3 +/- 4.1 corresponding to 69.7% of the maximum score. The lowest mean score was for the Students' Perceptions of their Social Environment: 15.9 +/- 4.0 (56.8%). The overall mean score for the 50 items was 127.5 +/- 20.9 (63.8% of maximum). Scores observed in students in year 5 were significantly lower for several subscales, including Students' Perceptions of Learning, Students' Perceptions of Teachers, Students' Perceptions of the Learning Atmosphere and Students' Perceptions of the Social Environment, and also lower for the overall mean score (119.3 +/- 20.2) compared to scores in years 3 and 4 (128.8 +/- 21 and 132.5 +/- 19.7, respectively; p<0.001). CONCLUSIONS: The school's educational climate was generally perceived positively by students, although they viewed the school's social environment less favorably. Specific areas identified by students as needing improvement included an overloaded curriculum and inadequate student supports. The DREEM Spanish version proved generally reliable, by internal consistency scores based on ratings by Chilean undergraduate medical students; it should be a useful tool for assessing students' perceptions of the educational environments of other Latin American medical schools.

Bilateral diffuse uveal melanocytic proliferation associated with renal cell carcinoma.

PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation associated with an asymptomatic renal cell carcinoma. DESIGN: Clinical case report. METHODS: A 70-year-old man presented with a 7-month history of bilateral visual loss. Ophthalmoscopic examination, fluorescein angiography, ocular coherence tomography, and a search for underlying systemic malignancy were performed. RESULTS: Examination revealed multiple melanocytic uveal proliferations in both eyes. Fluorescein angiography revealed a pattern of multiple areas of early hyperfluorescence, and ocular coherence tomography showed serous detachment of the central retina. Abdominal computerized tomography scans showed a large tumor in the left kidney and nodular involvement in the right kidney. Pathologic examination revealed a clear cell carcinoma of the kidney. CONCLUSION: A literature review revealed a total of 40 cases of bilateral diffuse uveal melanocytic proliferation. To our knowledge, this is the first case to be associated with renal cell carcinoma.

Frequent Evaluation To Improve Compliance In Patients Treated With Occlusion For Amblyopia: A Randomized controlled Trial.

BACKGROUND: The benefits of occlusion treatment for amblyopia are well established.True compliance can be difficult to assess and is usually based on patient history. We hypothesize that more visits to the physician provides more chances to improve compliance. METHODS: We conducted a prospective, comparative, blind trial in which 30 children with amblyopia were randomly assigned to be followed up more frequently (every 4 to 6 weeks) (study group) or as established on our standard regular basis (month intervals based on age in years) (control group). The primary outcome was to study differences in treatment compliance between these groups. The secondary outcome was to report compliance in a group of Chilean children and to compare survey results with adherence, to assess concordance between them. RESULTS: Baseline clinical characteristics were similar in the two groups. 30 patients were recruited. Mean compliance for all patients was 82%. Study group compliance was 83% versus 76% in control group (p = 0.5). Without epidemiology, intention to treat analysis (ITT), study group compliance was 97% compared to 76% in control group (p = 0.049). Pearson correlation between negative responses to a parental survey after treatment, of the percentage of adherence and compliance, was -0.57 and statistically significant (p = 0.013). CONCLUSIONS: There were no differences in patient compliance comparing more frequent evaluation versus a follow up evaluation based in an age according scheme. There is a high compliance to occlusion therapy in this group of Chilean children. If parents reported more negative adherence aspects in the survey, the worse the compliance.

La atorvastatina no modifica el incremento agudo de los niveles de p-selectina y fibrinógeno inducido con esfuerzo físico máximo / Atovastatin does not modify the acutely increased levels of P-selectin and fibrinogen induced by maximal physical exercise

Introducción: Las estatinas han demostrado disminuir los eventos cardiovasculares en sujetos con y sin enfermedad aterosclerótica establecida. Se ha demostrado, que sus efectos benéficos no sólo dependen de la reducción del colesterol, sino que también podrían ser secundarios a otros efectos de las estatinas, como su efectos de reducción de inflamación y/ o trombogénesis entre otros. Sin embargo, no existen trabajos que demuestren que las estatinas sean capaces de frenarla activación de la cascada de inflamación y/o trombogénesis. Objetivos: Determinar el efecto de la administración oral de atorvastatina por 7 días sobre los niveles plasmáticos de proteína C- reactiva ultrasensible (PCR us), fibrinógeno y P-selectina, pre y post prueba de esfuerzo máximo inmediato y a las 24 horas de su ejecución. Métodos: Ensayo clínico en 50 hombres sanos (18 a 50 años), randomizado atorvastatina 80 mg/día - placebo por 7 días, doble ciego. Muestras tomadas en sangre para PCRus, fibrinógeno y P-selectina, perfil lipídico, creatin kinasa y transaminasas hepáticas, pre y post test de esfuerzo, y a las 24 horas. Los resultados para datos continuos se expresan como medias +/- desviación estándar, test de student para muestras independientes, ANOVA para muestras repetidas. Programa estadístico SPSS 14.0. Resultados: Un grupo de 44 sujetos completaron el estudio: atorvastatina 80 mg (n=24) o placebo (n=20). En el grupo atorvastatina, después de una semana de tratamiento, los niveles de LDLc disminuyeron en 38 por ciento (LDL basal: 97 +/- 27 mg/dL vs LDL post: 62 +/- 31 mg/dL, p < 0.001). Sin embargo, no se observaron cambios en ese mismo período en los niveles de PCRus, fibrinógeno y P-selectina con respecto a placebo. Los niveles de fibrinógeno se elevaron 8 por ciento entre la etapa pre y post ejercicio inmediato (341 +/- 56 mg/dL vs 368 +/- 65 mg/dL, p<0.001), retornando a los niveles basales a las 24 horas; no hubo diferencias entre atorvastatina - placebo...

Background: Chronic statin therapy is known to decrease ínflammation and platelet aggregation. However, little data exist regarding acute effect of statins upon these variables. Exercise can be used to induce ínflammation and platelet aggregation. Aim: to determine the acute effect of atorvastatin upon plasma levels of ultra sensitive C reactive protein (US-PCR), fibrinogen and P selectin before, immediately after and 24 hr following a maximal exercise test in healthy subjects. Methods: This was a double blind, randomized prospective study Fifty healthy male subjects (aged 18to 50years) received atorvastatin 80 mg or placebo daily for 7 days. US-PCR, fibrinogen, P-selectin, blood lipids, total creatin-kinase (CK) and transaminases were determined pre and immediately after maximal treadmill exercise. Repeat determinations were performed 24 following the test. Results were analyzed using the SPSS statistical package, and are expressed as mean +/- SD. Student's t and repeated measures ANOVA were used as appropriate. Results: 44 subjects completed the study (atorvastatin =24; placebo= 20). LDL cholesterol decreased from 97 +/- 27 to 62 +/- 31 mg/dl in the atorvastatin group (p<0.001). US-PCR, After 1 week, Fibrinogen and P-selectin were not significantly modified from baseline, and no differences were observed between groups (atorvastatin vs. control). However, fibrinogen increased 8 percent from baseline to immediately post exercise (341 +/- 6 vs. 368 +/- 65mg/dl (95 percent CI. 21/.3 - 33.6). 24hr after exercise, fibrinogen levels returned to baseline. Similar changes were observed for P-selectin (25 +/- 5, 28 +/- 1.7 ng/dl, baseline and post exercise respectively p<0.01), again returning to baseline 24hr after exercise. No significant changes were observed for US-PCR after exercise in neither group. CK increased 43 percent in the atorvastatin group and 12 percent in controls (NS). Conclusion: Atorvastatin...

First record of pseudoterranova (nematoda: anisakidae) from the chilean dolphin, cephalorhynchus eutropia (cetacea: delphinidae)

Por primera vez fueron aisladas larvas de tercer y cuarto estadios de Pseudoterranova del delfín Cephalorhynchus eutropia del sur de Chile. Se dan a conocer características morfológicas de huéspedes y parásitos