[Retrospective analysis of the work of a medical education office]. / Gestión de una oficina de educación médica: evidencia de 10 años y planteamientos de nuevos desafíos para el siglo XXI.

BACKGROUND: Training of health care students at universities is a great challenge for Medical Education Offices. Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students. AIM: To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results. MATERIAL AND METHODS: A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared. RESULTS: A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education. CONCLUSIONS: The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

Gestión de una oficina de educación médica: evidencia de 10 años y planteamientos de nuevos desafíos para el siglo XXI / Retrospective analysis of the work of a medical education office

BACKGROUND: Training of health care students at universities is a great challenge for Medical Education Offices. Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students. AIM: To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results. MATERIAL AND METHODS: A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared. Results: A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education. CONCLUSIONS: The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

Impacto de la aplicación del enfoque de autorregulación del aprendizaje sobre los resultados en asignaturas de corte científico en estudiantes de medicina de la Universidad Finis Terrae / The impact of a self-directed teaching approach on academic performance of medical students

Background: Students should be encouraged to become reflexive and develop autonomous, lifelong learning habits. Therefore, teachers should focus on learning strategies which stimulate autonomous learning. Aim: To assess the impact of a self-directed teaching methodology on the academic performance of medical students in cellular biology and biochemistry. Materials and Methods: During 2013, 85 students received a traditional teaching methodology and during 2014, 85 students received a self-directed learning methodology. The grades obtained and the number of failures in the courses of cellular biology and biochemistry were compared in both groups. Results: The percentages of students approved at the end of the courses during 2013 and 2014 were 64 and 96% respectively (p < 0.01). The grades obtained by the 2014 students were also significantly higher than those obtained by 2013 students. Conclusions: This study confirms that academic performance improves with a self-directed teaching approach.

Evaluación de un programa de perfeccionamiento docente implementado en la Facultad de Medicina de la Universidad Finis Terrae / Evaluation of a teaching training program implemented in a faculty of medicine

Background: Since 2010, the Faculty of Medicine at Finis Terrae University implemented a training program aiming to train health professionals in effective educational practices. Aim: To evaluate the effect of training in teachers who are in charge of planning courses, conducting classes and learning assessment. Material and Methods: Quality of planning, lecture performance and academic performance of students were evaluated in 55 teachers prior and after attending the training course on teaching methodologies and in 47 teachers not attending the course. Results: The percentage of trained teachers complying with the aforementioned indicators was significantly higher than those without training (p < 0.01). There were significant differences in favor of the group of teachers who attended and passed the Diploma. Trained teachers had significantly higher students’ approval rate. (Odds ratio 4.5, p < 0.01). Conclusions: The teaching Diploma in Health Sciences improved the planning, teaching and academic performance of teachers.

Efecto del enfoque de autorregulación del aprendizaje en la enseñanza de conceptos científicos en estudiantes universitarios en ciencias de la salud / The efficiency of self-regulated learning in the teaching of scientific concepts to health sciences students

Background: In health sciences, the predominant teaching methodology is traditional and emphasizes conveying knowledge. Nonetheless, new abilities must be taught now. This change shifts the prominence from professor to student and incorporates a concept called self-regulated learning, which involves the professor as a mediator and incorporates guidelines that facilitate learning diverse skills. Aim: To compare the effects of two teaching methodologies on the learning of key scientific concepts among health science students. Material and Methods: Two subgroups of equally complex concepts were randomly chosen to be taught either using traditional or self-regulation methodology. For the self-regulation methodology, two groups were formed. One learned only through self-regulation guidelines and the other learned through classes where the professor was a mediator. One hundred thirty seven freshman students from medicine, physical therapy, and nursing careers participated voluntarily in the study. Results: Self-regulation methodology impacted the learning process of scientific concepts in a positive way and showed significant differences with traditional teaching. The sole use of self-regulation guidelines alone generated similar results, compared to those obtained by students who attended lectures. Conclusions: Self-regulated learning would improve in learning efficiency and would reduce face-to-face class time.

Impacto de un programa de nivelación de ciencias básicas en estudiantes de primer año de la carrera de Medicina / Effects on academic performance of a leveling program in basic sciences in first year medical students

Background: A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed. Aim: To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students. Material and Methods: We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC. Results: Fifty seven of89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively Conclusions: This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC.

Lipoperoxidation and protein oxidative damage exhibit different kinetics during septic shock.

Septic shock (SS)-related multiorgan dysfunction has been associated with oxidative damage, but little is known about the temporal damage profile and its relationship to severity. The present work investigated prospectively 21 SS patients. Blood samples were obtained at diagnosis, 24, 72 hours, day 7, and at 3 months. At admission, thiobarbituric acid reactive substances (TBARSs), plasma protein carbonyls, plasma protein methionine sulfoxide (MS), ferric/reducing antioxidant power (FRAP), total red blood cell glutathione (RBCG), uric acid (UA), and bilirrubin levels were increased (P < .05). Total radical-trapping antioxidant potential (TRAP) and vitamin-E were similar to controls, and vitamin-C was decreased (P < .05). During evolution, TBARS and RBCG increased (P < .001), vitamin-E levels remained stable, whereas plasma protein carbonyls and MS, TRAP, vitamin-C, reduced glutathione, and UA levels decreased (P < .006). After 3 months, plasma protein carbonyls and MS persisted elevated. More severe patients exhibited higher TBARS, TRAP, FRAP, vitamin-C, UA, and bilirrubin levels. Our results suggest early and persistent oxidative stress during septic shock and a correlation between increasing levels of lipoperoxidation and sepsis severity.

Los predictores de satisfacción de pacientes en un centro hospitalario universitario / Predictors of the level of patient satisfaction in a university hospital

Background: Client satisfaction is an important indicator of the quality of services, and health care is not an exemption. Aim: To explore and establish the predictors that exert the greater influence on the level of satisfaction with the service offered in a University Hospital. Material and method: The source of the study is a data base, obtained from a survery made to 355 patients of the Hospital Clínico de la Pontificia Universidad Católica de Chile prior to discharge. A multiple regression analysis was used to determine the relative importance of the different factors in the quality of service. The regression variables were reduced to a number of factors, obtained of Factorial Analysis and a Varimax rotation, allowing them to clarify their relations. Results: After performing the main components analysis, seven factors or dimensions that explained a 69 percent of the total variance were obtained. The predictive model explains up to 40 percent of the criterion variable (Global Satisfaction during the hospitalization). The factor with the greatest predictive power was the relationship between the patients and nursing staff. Other factors that emerged as important were communication, medical attention and room conditions. Conclusions: Perceptive type components had the greater relative weight to determine the level of patient satisfaction in this survey.

Embolia por líquido amniótico: una puesta al día a propósito de un caso / Amniotic fluid embolism: a case report and update

Se presenta el caso clínico de una mujer de 17 años de edad, cursando un embarazo de 33 semanas, que ingresa al hospital por trabajo de parto prematuro. Se descartó infección de la unidad feto-placentaria y materna. Se manejo mediante inhibición del trabajo de parto con fenoterol e inducción de madurez pulmonar con corticoides. Evolucionó satisfactoriamente. En el puerperio inmediato, la madre presenta cuadro de insuficiencia respiratoria aguda, por lo que debe ser trasladada a Unidad de Cuidados Intensivos donde es estabilizada inicialmente con oxígeno 100 por ciento por mascarilla de recirculación, diuréticos e infusión continua de nitroglicerina. Se realizó angiografía pulmonar por tomografía axial computarizada, que evidenció la presencia de imágenes compatibles con embolia por líquido amniótico. El diagnóstico se planteó una vez excluidos sistemáticamente los diagnósticos de edema pulmonar agudo cardiogénico, tromboembolismo pulmonar, aspiración bronquial y neumonía. La paciente evolucionó satisfactoriamente, disminuyendo paulatinamente sus requerimientos de oxígeno, siendo dada de alta días más tarde, asintomática.

[Vibrio vulnificus: an infrequent cause of septic shock]. / Vibrio vulnificus: una causa infrecuente de shock séptico.

Vibrio vulnificus is a lactose positive Gram negative rod that lives in warm seas and can infect wounds and produce sepsis. Its infection is acquired after eating oysters or other filtering marine organisms. We report a 53 years old diabetic male who started with fever after a voyage to Central America. He was admitted febrile, hypotense, dehydrated and polypneic. Painful erythematous lesions and lumps were observed in his upper and lower limbs. After 72 hours of evolution, the lesions became violaceous, with crepitating vesicles full of hemorrhagic exudate. He developed a renal failure and a disseminated intravascular coagulation. Blood cultures demonstrated the presence of Vibrio vulnificus and the patient died 68 hours after admission.

Eficacia de la ventilación con presión positiva nasal en el manejo de la insuficiencia respiratoria aguda sobre crónica / Efficacy of positive nasal pressure ventilation in the management of acute respiratory failure over chronic

En las descompensaciones graves de los enfermos con limitación crónica del flujo aéreo frecuentemente se debe recurrir al apoyo ventilatorio mecánico, el que puede presentar complicaciones que retardan y dificultan el período de retiro, determinando una mayor letalidad. La ventilación con presión positiva por vía nasal es una alternativa atractiva que evita la intubación endotraqueal, con la que disminuyen las complicaciones relacionadas con la ventilación mecánica. Con el propósito de evaluar la utilidad del apoyo ventilatorio por vía nasal a traves de una mascarilla estudiamos a 19 pacientes con LCFA que ingresaron a la UCI, por una descompensación y eventual uso de ventilación mecánica. Los pacientes se dividieron al azar en dos grupos: el grupo 1 estuvo formado por 9 enfermos (edad 59ñ2 años) que recibieron desde el inicio tratamiento médico convencional más ventilación con mascarilla nasal y en grupo 2 por 10 pacientes (edad 65ñ3 años) que recibieron sólo en tratamiento médico convencional. No hubo diferencias entre las características de ambos grupos, excepto en la edad. EL grupo 1 se ventiló por vía nasal durante 3.6ñ0.42 días, su estadía en la UCI fue de 5.3ñ0.6 días y de 14.7ñ12.8 días en el hospital. En el grupo 2 la estadía de la UCI fue de 22,8ñ9.8 días y la hospitalización duró 35.5ñ14.5 días. Sólo 1 de los pacientes del grupo 1 debió ser ventilado por vía endotraqueal, mientras que 6 de los 10 sujetos del grupo 2 requirieron uso del tubo endotraqueal y ventilación mecánica clásica que se prolongó por 34.3ñ15 días. Concluímos que la ventilación por vía nasal es útil en las descompensaciones agudas de los pacientes con LCFA, pues evita la ventilación mecánica clásica en la mayoría de ellos y disminuye los días de permanencia en UCI y en el hospital