Conocimiento y perfil de uso de la biblioteca Cochrane en médicos asistentes a un congreso de Medicina Interna / Knowledge and use profile of the Cochrane library in doctors attendees of an Internal Medicine congress

Introducción: las Revisiones Sistemáticas (RS) son herramientas para practicar Medicina Basada en la Evidencia. La Colaboración Cochrane genera RS, pero el conocimiento y uso de la Biblioteca Cochrane (BC) es heterogéneo. Nuestro objetivo fue describir el nivel de conocimiento y el perfil de uso de la BC entre asistentes a una Conferencia Mundial de Medicina Interna (WCIM). Método:estudio transversal vía encuesta electrónica entre asistentes al XXXI WCIM, recabando información demográfica de los participantes; su conocimiento, acceso y usos de la BC. Resultados: 413 asistentes aceptaron participar y 198 (47,9 por ciento) de 24 países respondieron. 91,4 por ciento eran Latinoamericanos, 50,5 por ciento eran internistas. El conocimiento de la BC fue del 96,5 por ciento. El 76% de quienes respondieron usaban la BC al menos una vez al mes. No encontramos diferencias en la frecuencia de uso según edad o ámbito académico. Las principales razones para utilizar RS-BC fueron: toma de decisiones clínicas (67,6 por ciento), actualización (64,2 por ciento) y docencia (31,8 por ciento); 46 por ciento consideraron la BC muy útil para sus propósitos. Los <35 años utilizaban significativamente más la BC para guiar las decisiones clínicas que los >35 años (70 por ciento vs 53 por ciento, p: 0,017). Quienes consideraron muy útil la BC la utilizaron significativamente más para propósitos docentes (41 por ciento vs. 24 por ciento, p: 0,019) y toma de decisiones clínicas (79 por ciento vs. 58 por ciento, p: 0,003) que quienes la declararon como a veces útil o no útil. Hubo también diferencias estadísticamente significativas en la distribución del acceso a la BC según región geográfica (p: 0,001). Conclusiones: encontramos un alto nivel de conocimiento de la BC entre los asistentes a WCIM. Los usuarios describen un uso frecuente para diversos propósitos, considerándola útil para estos. (AU)

Introduction: Systematic Reviews (SR) are tools for practicing Evidence Based Medicine. Cochrane Collaboration generates SRs, but awareness and uses of Cochrane SR, changes over time and across different countries and medical specialties. We aimed to describe awareness and user's profile of Cochrane Library (CL) SR among attendants to a World Conference of Internal Medicine (WCIM). Methods: Cross sectional online survey study among attendants to the XXXI WCIM asking about demographic information, awareness of, access to and uses of CL-SRs. Results: 413 attendants to WCIM volunteered to participate and 198 (47.9 percent) from 24 countries replied; 91.4 percent) were from Latin-America. Mean age was 37 years and 50.5 percent) were general internists or internal medicine subspecialists. Awareness of the CL was 96.5 percent). The frequency of CL-SR use was at least once a month for 76 percent) of responders. We found no difference in frequency of use according to age or academic setting. Main reasons to use CL-SR were: guide clinical decisions (67.6 percent)), personal update (64.2 percent) and teaching (31.8 percent)); 46 percent) considered CL-SR very useful to their purposes. People <35y used CL-SR significantly more for guiding clinical decisions than those >35y (70 percent) vs 53 percent), p: 0.017). Users who considered CL-SR very useful use it significantly more for teaching purposes (41 percent) vs 24 percent), p: 0.019) and for clinical decision-making (79 percent) vs 58 percent), p: 0.003) than those declaring CL-SR as sometimes useful or not useful. Also there was statistically significant difference in distribution of access to CL by geographic region (p: 0.001). Conclusions: We found high awareness of CL-SRs among attendants to WCIM. Users describe frequent use, for several purposes and find it helpful for their purposes; however, access varied across regions. (AU)

Percepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna / Students’ perceptions comparing standardized and non-standardized oral exams in internal medicine

Background: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. Aim: To compare students’ perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). Material and Methods: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. Results: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. Conclusions: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade.

Definición actual de la medicina interna y el internista / A consensus definition of internal medicine and the internist

Internal Medicine is a basic clinical specialty in Medicine, but due to it’s vast field of action it is quite difficult to define. This consensus article analyzes different definitions and proposes a current definition while analyzing several aspects of the specialty along with its strengths and weaknesses. We propose to define Internal Medicine as a clinical specialty devoted to the comprehensive care of adults, from adolescence to senility, particularly the diagnosis and non surgical treatment as well as primary and secondary prevention of their diseases, in hospital or ambulatory settings. We propose to define Internal Medicine as a clinical specialty devoted to the comprehensive care of adults in hospital or ambulatory settings, from adolescence to end of life, in terms of prevention, diagnosis and non-surgical treatments of disease.

Consenso: manejo racional del paciente con cáncer, neutropenia y fiebre / Consensus: rational approach towards the patient with cancer, fever and neutropenia

La intensidad y duración de la neutropenia post quimioterapia fueron identificadas en la década del 60 como los factores de mayor relevancia predisponentes a infecciones en pacientes con cáncer. A inicios de la década del 70 se estableció un manejo estandarizado para todos los episodios de neutropenia febril (NF), consistente en hospitalización y terapia antimicrobiana intravenosa empírica, de amplio espectro, lo que se tradujo en una importante disminución de la mortalidad por infecciones bacterianas en estos pacientes. En los últimos 10 a 15 años, distintos grupos de investigadores han considerado poco beneficiosas estas estrategias estandarizadas, que proporcionan un manejo uniforme a todos los pacientes con episodios de NF, independiente de la gravedad de estos. Así, se acuñaron en la década pasada los conceptos de NF de alto y bajo riesgo, lo que ha permitido implementar estrategias terapéuticas diferenciadas según el riesgo que entrañe el episodio para cada paciente en particular. La Sociedad Chilena de Infectología ha tenido la iniciativa de proponer, en un trabajo conjunto con dos programas gubernamentales: Programa Infantil de Drogas Antineoplásicas y Programa Adulto de Drogas Antineoplásicas y la Sociedad Chilena de Hematología, un consenso de diagnóstico, manejo terapéutico y prevención de NF en adultos y niños con cáncer, considerando básicamente dos aspectos: el cambio de enfoque que esta patología ha tenido en la última década, lo que obliga a una revisión sistematizada del tema, y en segundo lugar, una población creciente de pacientes oncológicos, cada vez con mejores expectativas terapéuticas para su patología de base, lo que exige ofrecer en forma acorde un muy buen manejo de esta complicación. Entregamos este documento con una completa revisión de la literatura médica sobre epidemiología, exploración de laboratorio, categorización de riesgo, enfoque terapéutico y quimioprofilaxis, con la mayor cantidad de datos nacionales disponibles, para ofrecer al equipo de salud que atiende a estos pacientes recomendaciones basadas en evidencias, y acotadas a nuestra realidad nacional.

Estudio clínico epidemiológico de los pacientes ingresados a UCI según grupo etáreo / Clinical epidemiological study of patients admitted at ICU according to age

The charts of all patients admitted to an intensive care unit of a University Hospital, during 1 year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assesses using the Apache asore. A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57 percent) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14,8 percent of patients over 65 years old and 18.7 percent in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. Patients older than 65 years old admitted to intensive care units are very similar to the younger counterparts in their prognosis and causes of admission