[Clinical guideline. Obstetrical hemorrhage in the second half of pregnancy]. / Guía de práctica clínica. Hemorragia obstétrica en la segunda mitad del embarazo.

Pregnancy at older ages and the increased frequency of caesarean births may increase the incidence of diseases associated with obstetric haemorrhage. Obstetric haemorrhage is the second leading cause of maternal mortality, preceded only by preeclampsia-eclampsia in Mexico and the Instituto Mexicano del Seguro Social. In recent years several studies have been conducted to improve the detection, diagnosis and treatment of women at risk of obstetric haemorrhage to reduce maternal and perinatal mortality. The objective of this clinical practice guideline is defining recommendations based in the best available evidence to standardize actions regarding the diagnosis and management of obstetric haemorrhage in hospital units.

[Critical reading of clinical investigation reports in pregraduate students]. / Lectura crítica de informes de investigación clínica en estudiantes de pregrado.

OBJECTIVE: To evaluate the development of critical reading (CR) of clinical research texts (CRT) in medical students. METHODS: In 65 students an instrument for the evaluation of CR of CRT was applied. Four groups from three universities were studied: an academic excellence group (n = 21), B1 (n = 19) and B2 (n = 12), C (n = 13). The instrument had eight CRT with 150 items; 50 items to any of the following indicators: interpretation, judgment and proposition. The items were balanced in 50 % false and 50 % true. It was analyzed the global management degrade and by indicator. STATISTICAL ANALYSIS: Kruskal-Wallis and Mann-Whitney U test was used. RESULTS: Age 22 (median) 20-28 (range) years, gender 56.9 % women, without differences between the three universities. The global score was 50.5 (8 to 112). Group A had statistically significant higher results in global score and by indicator (p < 0.001) in relation with the other universities. According to the interpretation, judgment and proposition indicators, group A had the higher score. CONCLUSIONS: The results are similar to those observed in medical residents, because the development degrade for CR reading was low.

[Educative strategy evaluation to improve critical reading skills on clinical research texts in second year gyneco-obstetrics residents]. / Evaluación de una estrategia educativa para mejorar la aptitud para la lectura crítica de textos de investigación clínica en residentes de ginecoobstetricia de segundo año.

BACKGROUND: The educative models and strategies to achieve a significant learning have a wide variety. The development of clinical aptitude for clinical research papers lecture has an important place to maintain the physician actualized and for resident formation. OBJECTIVE: To evaluate the degree of development of the aptitude for the reading of clinical research articles in 2nd grade residents of the gynecology and obstetrics speciality alter an educative strategy. MATERIAL AND METHODS: In 16 2nd year gynecology and obstetrics residents, a previously validated instrument was applied for the evaluation of critical lecture of clinical research articles in general medicine previous and after and educative strategy. Statistical analysis was with Kruskal-Wallis analysis of variance. Also Wilcoxon test was used to assess the differences between baseline and final results. RESULTS: The median of age was 27 (24-31) years, gender 56.3% women and 43.8% men. A statistically significant increase in global score was observed after the educative strategy. After it only there was a significant increase in the indicator to interpret. After evaluating the domain degrees according to the indicator to interpret, in baseline evaluation it predominated the very low level and at the final evaluation the very low and low levels. In the indicator to judge at baseline the majority were in the very low level, and at the end in very low and low levels. According to the indicator to propose at baseline all were in the level expected by hazard, and at the end a minimal proportion was at very low level. CONCLUSION: These results traduce a discrete improvement in critical lecture process, which makes to consider the educative strategy that was used, since the objective to improve critical lecture capacity was not achieved.