[Summarized real clinical cases use to learn clinical aptitude]. / Resúmenes clínicos problematizados para el aprendizaje de la clínica.

OBJECTIVE: to evaluate clinical skills indicators (CSI) with summarized real clinical cases (SRCC) by two generations of pregraduates interns. METHODS: with a descriptive survey design 430 SRCC were elaborated according to the CSI: risk factors, clinical diagnosis, laboratory and x-ray diagnosis, commission and omission iatrogenesis procedures, therapeutics, nosology and peer critical medical actions. An evaluation scale for the clinical cases included: a relationship with the clinical experience, and the CSI selected. The final evaluation was considered as adequate or inadequate and was performed independently by three medical social service students. RESULTS: except for family medicine, the SRCC were related to the clinical experience of the students. A 62 % of the total was considered as adequate. The CSI assessed were related to risk factors (18 %), clinical diagnosis (32 %), omission and commission iatrogenesis (9 %), laboratory and x-ray diagnosis resources (16 %), therapeutics (17 %), nosology (9 %) and a critical to peer medical actions (3 %). CONCLUSIONS: the SRCC patients studied from different points of view by the interns included the CSI. Therefore, this action is advisable for the improvement of the patients' clinical approach.

[Effects of incorporating group visits on the metabolic control of type 2 diabetic patients]. / Diabetes y consulta médica grupal en atención primaria. ¿Vale la pena el cambio?

BACKGROUND: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. AIM: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. MATERIAL AND METHODS: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. RESULTS: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 +/- 59.5 and 175.7 +/- 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 +/- 13.4 and 127.5 +/-12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 +/-8.5 and 79.4 +/-6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. CONCLUSIONS: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.

Diabetes y consulta médica grupal en atención primaria: ¿Vale la pena el cambio? / Effects of incorporating group visits on the metabolic control of type 2 diabetic patients

Background: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. Aim: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. Material and methods: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. Results: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 ± 59.5 and 175.7 ± 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 ± 13.4 and 127.5 ±12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 ±8.5 and 79.4 ±6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. Conclusions: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.