Depression and geriatric assessment in older people admitted for hip fracture.

BACKGROUND: Depression is common among older people with hip fracture. AIM: To assess depression scores and other mental and physical health variables in older people with and without depression, admitted to a traumatology ward for a hip fracture. MATERIAL AND METHODS: Cross sectional study of older patients admitted for surgical treatment of hip fracture. Demographic, clinical and laboratory variables were recorded. Twelve surveys were applied to assess general wellbeing, mental health, fall risk, nutritional status, basic and instrumental activities of daily living, social resources and depression (using Yesavage Depression Scale). RESULTS: We assessed 310 patients aged 78 (72-83) years, 72% women. Overall depression prevalence was 46% and its frequency was significantly higher in women, people over 81 years of age, diabetics and subjects with anxiety. The Yesavage score in patients with and without depression was 6.5 and 3, respectively. The median number of medications used by patients with and without depression was 3 and 2 (p < 0.01). CONCLUSIONS: There is a high frequency of depression in these patients, especially in women and subjects older than 81 years of age. Routine geriatric assessments should be performed in hospitalized older patients with hip fracture.

Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability.

Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.

Risk of positive screening for anorexia nervosa, bulimia nervosa and night eating syndrome and associated risk factors in medical fellows in Northeastern Mexico: a multicenter study.

BACKGROUND: Eating disorders and food ingestion (EDs) are serious mental illnesses with a higher prevalence in young adults, with difficult diagnoses that cause serious morbidity and mortality problems. There is not much information about the risk of positive screening for EDs, specifically, anorexia nervosa (AN) and bulimia nervosa (BN) and night eating syndrome (NES) in undergraduate medical interns (UMI) and medical residents (MR) in Mexico. AIM: To determine the risk of AN, BN and NES and to determine the risk factors of such conditions such as age, body mass index (BMI) and gender of MR and UMI with AN/BN and NES at four private hospitals in northeastern Mexico. METHODS: A cross-sectional, descriptive, non-randomized survey in MR and UMI in four hospitals in Northeastern Mexico was conducted using an electronic questionnaire that included: informed consent signature, SCOFF questionnaire for AN and BN screening, NES questionnaire. Also, a survey on general sociodemographic data of each participant was included. Chi-square test and a logistic regression model were computed for analyses. RESULTS: The population included a total of 129 MR and UMI. It was observed that 48.8% were positive for AN or BN and 32.6% were positive for the NES. There was no difference between age, sex, BMI, or medical specialty (if they were MR); however, MR from the first year had a higher risk of AN or BN (OR 23.7, 95% CI 1.181-475.266). CONCLUSIONS: There was a higher risk of positive screening for AN or BN and NES in UMI and MR in our population. In the case of MR, those in first year have a higher risk of AN and BN. Timely diagnosis and treatment are mandatory in this population.

Eating disorders and food ingestion such as anorexia (AN) or bulimia (BN) nervosa and night eating syndrome (NES) are a group of mental illnesses that are frequently under diagnosed. Medical residents (MR) and undergraduate medical interns (UMI) are a high-risk population for such disorders due to their young age, stress environments, erratic eating patterns and long working hours. The aim of this study was to determine the risk of AN, BN and NES and to determine the risk factors of such conditions. One hundred twenty-nine UMI and MR were studied and showed that 48.8% were positive for AN or BN and 32.6% were positive for NES. MR in the first year of medical residency had a higher risk. Timely diagnosis and treatment are mandatory in this population.

Vertebral coccidioidomycosis with mechanical instability treated solely with antifungals: A case report.

Surgical treatment of vertebral coccidioidomycosis presents a challenge, with an unpredictable course and uncertain results. We present a 52-year-old man with disseminated infection due to coccidioidomycosis in the thoracolumbar spine, with vertebral instability, and deferral surgical treatment due to SARS-CoV-2 contingency. Treatment with itraconazole was initiated, followed by liposomal amphotericin B and fluconazole due to a relapse. The patient was discharged long-term with voriconazole. The axial pain improved without neurological deficits. Surgical treatment was not required. 2012 Elsevier Ltd. All rights reserved.

Closed reduction evaluation in dysplastic hip with the Ömeroglu system in children aged 24 to 36 months.

Closed reduction (CR) as an initial treatment for developmental hip dysplasia of the hip (DDH) in children aged 24 to 36 months is debatable; however, it could have better results than open reduction (OR) or osteotomies, because it is minimally invasive. The purpose of this study was to evaluate the radiological results in children (24-36 months) with DDH initially treated with CR. Initial, subsequent, final anteroposterior pelvic radiological records were retrospectively analyzed. The International Hip Dysplasia Institute was used to classify the initial dislocations. To evaluate the final radiological results after CR (initial treatment) or additional treatment (CR failed), the Ömeroglu system was used (6 points excellent, 5 good, 4 fair-plus, 3 fair-minus, and ≤2 poor). The degree of acetabular dysplasia was estimated using the initial acetabular index and the final acetabular index, Buchholz-Ogden classification was used to measure avascular necrosis (AVN). A total of 98 radiological records were eligible, including 53 patients (65 hips). Fifteen hips (23.1%) were redislocated, OR with femoral osteotomy and pelvic osteotomy was the preferred surgical treatment 9 (13.8%). The initial acetabular index versus final acetabular index in total population was (38.9º ± 6.8º) and (31.9º ± 6.8º), respectively (t = 6.5, P < .001). The prevalence of AVN was 40%. Overall AVN in OR, femoral osteotomy and pelvic osteotomy were 73.3% versus CR 30%, P = .003. Unsatisfactory results ≤ 4 points on the Ömeroglu system were observed in hips that required OR with femoral and pelvic osteotomy. Hips with DDH treated with CR initially might had better radiological results than those treated with OR and femoral and pelvic osteotomies. Regular, good, and excellent results, ≥4 points on the Ömeroglu system, could be estimated in 57% of the cases, in whom CR was successful. AVN is frequently observed in hips with failed CR.

[Prevalence of type 2 diabetes mellitus in elderly patients and associated factors in a general hospital of the north of Mexico]. / Prevalencia de diabetes mellitus de tipo 2 y factores asociados en la población geriátrica de un hospital general del norte de México.

UNLABELLED: There are few reports on the impact of diabetes in the geriatric population. OBJECTIVE: To determine the prevalence of diabetes in the geriatric population in a hospital in Northeast Mexico. DESIGN: A cross-sectional study and a probabilistic sampling were made. The files of outpatients of the geriatrics department in a General Hospital in Monterrey, Mexico,were examined. The information obtained from these files was related to the patient's personal pathological and non-pathological background, besides a full geriatric evaluation. RESULTS: A total of 171 files were examined, out of which 97 (56.7%) belonged to females and 74 (43.3%) to males. The mean age was 78 ± 6.9 years. Diabetes was found in 76 patients (44%), major depression was found in 85 patients (50%), with the latter being more common in diabetic patients (p = 0.002). It was also found that diabetic patients take more drugs during their disease. Adjusting for age, gender, and academic level, cognitive impairment was found in 110 patients (64.3%). CONCLUSIONS: Diabetes mellitus is more frequent in the geriatric population and it uses more resources.

Postaxial hypoplasia of the lower extremity associated with congenital dislocation of the patella: A case report.

RATIONALE: Evaluation of clinical and radiologic abnormalities in patients with postaxial hypoplasia of the lower extremity (PHLE) for treatment decisions represents a major challenge, which is more complicated when PHLE is associated with congenital dislocation of the patella. PATIENT CONCERNS: : Herein, we present the case of an 8-year-old female patient with evident length inequality in her left lower extremity and inability to walk. DIAGNOSES: Radiological evaluation revealed PHLE with fibular hemimelia, proximal femoral focal deficiency, tarsal coalition, and congenital patellar dislocation of the patella. The right lower extremity was also affected by fibular hemimelia. INTERVENTIONS AND OUTCOMES: Surgical management included the Roux-Goldthwait technique for patellofemoral joint realignment, a medial knee stapled with Blount technique, and femur enlargement using the Wagner technique. The results from surgical intervention included a left femoral elongation of 6.7 cm featuring callus with angulation, displacement, and a discrepancy of 5 cm between femurs with a flexor contraction in the knee of -15° and a centralized knee. LESSON: PHLE accompanied by congenital dislocation of the patella has not been extensively described in the literature; therefore, there is no established management. Starting reconstruction at an early age, together with an adequate classification of the deformity, are essential factors when opting for limb reconstruction.

[Role of creative discussion in the learning of critical reading of scientific articles]. / Papel de la discusión creadora en el aprendizaje de la lectura crítica de artículos científicos.

OBJECTIVE: To compare two active educational strategies on critical reading (two and three stages) for research learning in medical students. MATERIAL AND METHODS: Four groups were conformed in a quasi-experimental design. The medical student group, related to three stages (critical reading guide resolution, creative discussion, group discussion) g1, n = 9 with school marks > 90 and g2, n = 19 with a < 90, respectively. The two-stage groups (guide resolution and group discussion) were conformed by pre-graduate interns, g3, n = 17 and g4, n = 12, who attended social security general hospitals. A validated and consistent survey with 144 items was applied to the four groups before and after educational strategies. Critical reading with its subcomponents: interpretation, judgment and proposal were evaluated with 47, 49 and 48 items, respectively. The case control studies, cohort studies, diagnostic test and clinical trial designs were evaluated. Nonparametric significance tests were performed to compare the groups and their results. A bias calculation was performed for each group. RESULTS: The highest median was obtained by the three-stage groups (g1 and g2) and so were the medians in interpretation, judgment and proposal. The several research design results were higher in the same groups. CONCLUSIONS: An active educational strategy with three stages is superior to another with two stages in medical students. It is advisable to perform these activities in goal of better learning in our students.

Factors Associated with Urethral and Bladder Neck Stricture After Transurethral Resection of the Prostate.

Introduction: Urethral and bladder neck stricture (U/BNS) is a complication that occurs in up to 9% of patients following transurethral resection of the prostate (TURP). The most relevant risk factors reported are prolonged surgical duration and prostatic volume. The purpose of this study is to analyze risk factors associated with the development of U/BNS following TURP. Materials and Methods: Case-control study. Population: patients who underwent TURP. Cases: patients with U/BNS following TURP, diagnosed between January 2010 and December 2018. We included patients with obstructive symptoms after TURP with clinical or radiographical evidence of U/BNS. Controls were patients who underwent TURP between January 2016 and December 2017, without evidence of stricture. Patients with history of pelvic fracture and previous U/BNS were excluded. We analyzed as risk factors age, prostatic volume, diabetes mellitus, previous use of transurethral catheter, urinary tract infection, bladder calculi, prostate cancer, previous TURP, resection time, resected volume during TURP, transoperative complications, and number of surgical procedures performed during the same event. We used chi-square or Mann-Whitney's U test for between-group comparison; association was established by odds ratios (ORs) and 95% confidence interval (CI), variables with p < 0.05 were included in the logistic regression. Results: We included 101 cases and 207 controls. Cases had lower incidence of prostate cancer, smaller prostates, less resection time during TURP, lower grams resected and prostate-specific antigen values than controls. History of transurethral catheter was more frequent in controls than cases (46% vs 29%, p = 0.004); there were no differences between groups in the other factors analyzed. On multivariate analysis, the use of a transurethral catheter was a protective factor against U/BNS (OR 0.16, 95% CI 0.064-0.442, p < 0.001). Conclusions: In this study, the use of urethral catheter before TURP is a protective factor against U/BNS.

Survival at 30 days in elderly patients with hip fracture surgery who were exposed to hypothermia: Survival study.

ABSTRACT: The effect of hypothermia as a mortality risk factor at 30 days in the elderly who had hip fracture (HF) surgery is still controversial because it may be due to a set of poorly identified factors. In this study, we aim to determine if exposure to intra and immediate postoperative hypothermia increases the incidence of mortality at 30 days in elderly patients who had HF surgery.Survival study in the elderly who had HF surgery with and without exposure to hypothermia. Sociodemographic, anesthetic and surgical factors were collected. The temperature of the rectum was measured at the end of the surgery and in the recovery room. The effect of hypothermia was analyzed by the incidence of mortality at 30 days. Other results were considered, such as, surgical site infection (SSI), blood transfusions, and influence of implants used in the 30-day mortality.Three hundred eighty five subjects were eligible, to include 300. Inadvertent hypothermia was 12%, the 30-day overall mortality was 9% and in subjects with hypothermia it was 25% (P = .002). Subjects with hypothermia had a higher risk of SSI (relative risk 4.2, 95% confidence interval 1.3-13.6, P = .03) and receive more transfusions (relative risk 3.6, 95% confidence interval 2.0-6.5, P < .001).Elderly subjects with HF exposed to hypothermia who undergo hip hemiarthroplasty and who receive 2 or more blood transfusions during their treatment, are at greater risk of dying after 30 days of the surgery. Hypothermia, as a possible causative factor of mortality, should continue to be studied.

Predictive markers of nonalcoholic fatty liver disease in lean patients. A multinomial regression model and a 2k factorial analysis.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and insulin resistance; however, there is a group of non-obese patients with NAFLD that need to be characterized. Our aim was to evaluate the factors associated with NAFLD in non-obese subjects in a third-level hospital. METHODS: A comparative cross-sectional study was performed. Participants were divided into four groups: non-obese without NAFLD (group 1), non-obese with NAFLD (group 2), obese without NAFLD (group 3), and obese with NAFLD (group 4). We evaluated the effect of clinical and biochemical characteristics with the disease by groups using a multinomial regression model and a 2K factorial analysis. RESULTS: We included 278 participants. Low platelet-lymphocyte ratio (PLR) as a novel parameter associated with NAFLD in non-obese subjects. Age, uric acid, alanine transaminase (ALT), high-density lipoprotein (HDL)-cholesterol, and neutrophil-lymphocyte ratio (NLR) were other related parameters (akaike information criterion = 557). NLR had the larger OR in groups with NAFLD (lean with NAFLD 7.12, obese with NAFLD 13.02). The 2k factorial design found inverse effect on PLR by NAFLD (effect -21.89, P < 0.001), which was higher than BMI (effect -1.33, P < 0.045). CONCLUSION: Our study found that PLR is a novel parameter with inverse correlation with NAFLD in non-obese patients. Other related parameters are age, hyperuricemia, elevation of ALT and NLR, and low HDL-cholesterol.

[Cognitive performance and mortality in people over 50 in Mexico]. / Desempeño cognoscitivo y mortalidad en personas mayores de 50 años en México.

OBJECTIVE: Determine the correlation between the low cognitive performance recorded in 2001 in the National Study on Health and Aging in Mexico (ENASEM) and the mortality reported in 2003 during the second phase of that same study. METHODS: The subjects selected were people aged 50 or over who had completed the sections in the 2001 survey pertaining to cognitive exercises, health status, and functionality and assistance with daily activities. Cognitive performance was assessed in 2001 using an abridged version of the Cross-Cultural Cognitive Examination (scale: 0 to 80 points). In 2003, there was a follow-up to the interviewees, in which their survival or death was recorded. RESULTS: The groups of interviewees scoring less than 40 had a cumulative survival rate of 96.1%, with a mean of 26.49 months of survival (CI 95% 26.41-26.57), while those scoring 40 points or over had a cumulative survival rate of 98.7%, with a mean of 28.76 months (CI 95% 28.68-28.85) (Log Rank chi(2) = 59,230 P < 0,001). A score of less than 40 in the cognitive assessment was associated with a relative risk of death of 1.863 (CI: 95% 1.30-2.65) in the multivariate analysis. Also associated with higher mortality was older age, self-reported diabetes, cancer, having smoked at some time, receiving assistance in at least one instrumental activity of daily living, and scoring higher on the depression scale. CONCLUSIONS: A score of less than 40 in the abridged version of the Cross-Cultural Cognitive Examination was independently correlated with an increase in mortality within the next two years.

Depresión en el adulto mayor intervenido quirúrgicamente.

OBJECTIVE: To determine the degree of depression in elderly adults after surgery and its relation with the duration of anesthesia. METHOD: We conducted an observational, comparative, prospective and longitudinal study. We included 73 elderly adults aged 60 scheduled for different surgical procedures. Their degree of depression was evaluated prior to and after the surgery with the short version of the Yasavage Geriatric Depression Scale. They were classified according to the score: no depression (0-5), mild depression (6-9) and established depression (10-15). The relation of depression with anesthesia duration was determined. The sample size was calculated for proportions. Descriptive statistics were used as well as χ2 (p < 0.05). RESULTS: In the first evaluation 47 patients (64%) were not depressed, 21 (29%) had mild depression and 5 (7%) had established depression. In the second evaluation, we found that 44 patients (60%) were not depressed, 21 (29%) had mild depression and 8 (11%) had established depression. The relation between depression and anesthesia duration was χ2 = 0.81. CONCLUSIONS: We did not establish a relation between depression and anesthesia duration in surgically intervened elderly adults.

OBJETIVO: Determinar el grado de depresión en el adulto mayor tras una cirugía y su relación con el tiempo anestésico. MÉTODO: Estudio observacional, comparativo, prospectivo y longitudinal. Se incluyeron 73 adultos mayores de 60 años programados para diferentes cirugías. Se evaluó el grado de depresión antes y después de la cirugía con la Escala de Depresión Geriátrica de Yasavage versión corta. Se clasificó según la puntuación: sin depresión (0-5), depresión leve (6-9) y depresión establecida (10-15). Se relacionó la depresión con el tiempo anestésico. El tamaño muestral se calculó para proporciones. Se utilizó estadística descriptiva y prueba χ2 (p < 0.05). RESULTADOS: En la primera evaluación se observaron 47 (64%) pacientes sin depresión, 21 (29%) con depresión leve y 5 (7%) con depresión establecida. En la segunda evaluación se encontraron 44 (60%) pacientes sin depresión, 21 (29%) con depresión leve y 8 (11%) con depresión establecida. Para la relación entre depresión y tiempo anestésico, χ2 = 0.81. CONCLUSIONES: No se encontró relación entre la depresión y el tiempo anestésico en adultos mayores intervenidos quirúrgicamente.

Obesity, depression and factors associated to the quality of life in total knee arthroplasty.

BACKGROUND: Knee osteoarthritis can be accompanied by depression and obesity, which could affect the quality of life (QOL) and function after a total knee arthroplasty (TKA). OBJECTIVE: To compare the QOL in subjects with depression and obesity 5 years after TKA. METHODS: Cross-sectional study of prospectively collected data, with two and three groups based on depression and obesity status. Sociodemographic variables, QOL and pain were compared. Depression was evaluated with a screening geriatric depression questionnaire used in the Mexican Health and Age Study (CENASEM). QOL was evaluated with the health survey SF-36. RESULTS: 378 participants were reviewed, 266 were included. Depression was detected in 24.1%, female (p < 0.001), with comorbidity (p = 0.04) and anxiety (p < 0.001), and the QOL score in subjects with depression was lower (p < 0.001). Obese subjects had greater pain (analogous visual scale 3 vs. 2; p = 0.002) and affection of the vitality domain in the QOL (75 vs. 80; p = 0.02). CONCLUSIONS: Evaluating depression and QOL with questionnaires such as CENASEM and SF-36 in elderly subjects who undergo ATR should be indispensable, since detecting and treating depression could increase QOL and function. Obese elderly with TKA may present greater pain.

ANTECEDENTES: La gonartrosis puede acompañarse de depresión y obesidad, afectando la calidad de vida (CV) y la funcionalidad después de una artroplastia total de rodilla (ATR). OBJETIVO: Comparar la CV en sujetos con depresión y obesidad 5 años después de una ATR. MÉTODO: Estudio transversal prolectivo, con dos y tres grupos basados en el estatus de depresión y la obesidad. Se obtuvieron variables sociodemográficas, clinimétricas, antropométricas y de CV. La depresión se evaluó con el cuestionario de tamizaje del Estudio Nacional sobre Salud y Envejecimiento de México (CENASEM). La CV se evaluó con la encuesta de salud SF-36. RESULTADOS: Se revisaron 378 participantes, para incluir 266. Se detectó depresión en el 24.1%, mujeres (p < 0.001), con comorbilidad (p = 0.04) y ansiedad (p < 0.001). El puntaje en la CV en sujetos con depresión fue menor (p < 0.001). Las personas obesas tuvieron mayor dolor (escala visual análoga 3 vs. 2; p = 0.002) y afección del dominio de vitalidad en la CV (75 vs. 80; p = 0.02). CONCLUSIONES: Es indispensable evaluar la depresión y la CV con cuestionarios como el CENASEM y el SF-36 en ancianos que se sometan a ATR, ya que detectar y tratar la depresión podría aumentar la CV y la función. Las personas ancianas obesas con ATR pueden presentar mayor dolor.

[Influence of sub-group discussion on the developing skills for critical reading of research papers]. / Influencia de la discusión subgrupal en el desarrollo de la aptitud de lectura crítica de documentos de investigación.

OBJECTIVE: To compare a three steps (3S) vs. two steps (2S) active participative promoting strategies (APPS) in critical reading of research papers in first degree residents. METHODS: An APPS educational intervention in 3S vs. 2S was developed. Two groups by simple random technique were study. The experimental group (A) with 13 residents and a control group (B) with 12. Three indicators were use (interpretation, judgement and proposal). The instrument had 120 items. In both groups, the educational strategies used were similar in contents. In-group A (3S) the subgroup discussion was emphasized. Group discussion and the resolution of extra classroom item guides performed was similar in both groups. Non parametric statistical tests were performed by a blind researcher. RESULTS: The reliability of the instrument was 0.89 by Kuder-Richardson procedure. The initial results were very low and showed an increase in the median in both groups. More students in-group A were located out of a random category. In both groups, Mc Nemar test results were significant. CONCLUSIONS: The 3S strategy is better than 2S in developing critical reading in research papers.

[Psychiatric assessment skills in physical and rehabilitation medicine residents]. / Aptitud clínica en psiquiatría de los residentes de medicina física y rehabilitación.

OBJECTIVE: To value the psychiatric clinical aptitude (CA) in physical medicine and rehabilitation residents (PMR). METHODS: An instrument of evaluation of the psychiatric clinical aptitude was built, with five summarized real clinical cases, with 120 items to respond, 60 with true answer and 60 with false. The instrument was validated by experts, three psychiatrists and two specialists in physical medicine and rehabilitation that coincided completely in 44 % of the answers and in 56 % four of the five experts. It was applied to all medical residents of this specialty (n = 16), the internal consistency of the instrument was measured by the test of Kuder-Richardson (formula 20) showing a coefficient of 0.85, the random response was calculated by the Pérez Padilla-Viniegra test, being of 20 (17 %). Comparisons among the groups with U of Mann-Whitney and Kruskal-Wallis were made. RESULTS: Degrade of CA in the whole sample was low and there were differences statistically significant in favor of the third year residents. CONCLUSIONS: The educational strategies in the psychiatry area do not enhance the development of the CA in this specialty.

[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.

[Comparison of two educational strategies in teacher formation courses]. / Comparación de dos modalidades educativas en diplomados de formación docente.

OBJECTIVE: To compare the achievement of promotional strategies on the participation in two educational modalities for the development of skills for the elaboration of the knowledge (SSEK) in courses of teacher formation (TF). METHODS: A quasi-experimental design was performed in four courses of TF with similar contents and strategies with seven students each one. As independent variable the presence and semipresence modalities were considered. In order to measure the development of the SSEK reliable; a validated instrument were used. RESULTS: No significant differences were found among or between evaluations before and after interventions in the four groups. The students of the semipresencial course well as the presence advanced significantly in the development of the aptitudes and educative posture according to Wilcoxon test. CONCLUSIONS: Both modalities increase the SSKE to development therefore represents an option for medical education in health professionals.

[The scope of educational strategy in teaching education of visiting professors]. / Alcante de la estrategia de visita de profesores para formación docente.

INTRODUCTION: Professors of Medicine usually lack teaching education apart from their speciality. This kind of education and the development of researchers in education are now a priority. OBJECTIVE: To evaluate the scope of the visit of professors in the development of aptitude for critical reading of reports on educational research and educational texts in a teaching-education program. MATERIALS AND METHODS: An educational strategy was implemented to promote the development of a stance on education and on aptitudes for criticism of educational texts and research reports, which were assessed by means of previously validated instruments. A group of 10 professors was studied. RESULTS: After the course, all the participants increased their scores. A p = 0.005 value was obtained with the Wilcoxon test in the three instruments applied. All the participants showed a stance on education in the retest. CONCLUSIONS: The educational strategy modified and increased the professors' stance on education. The results showed a significant change of stance for critical reading. Even though they are incipient, these results should be encouraged through continuing formation of teaching education.

[Critical reading ability in research during medical internship]. / Lectura crítica de investigación en el internado de pregrado en hospitales generales.

OBJECTIVE: To evaluate level of development that medical interns achieve, before graduating, in critical reading ability during their internship in five general hospitals. MATERIAL AND METHODS: During the academic year, we compared the initial and final scores of critical reading of medical interns before graduation in five general hospitals in IMSS. An instrument using 98 items that explored interpretation, judgment and proposal was developed and validated by four medical education researchers. In hospitals 1, 4, and 5, professors developed active-participative strategies related to critical reading in clinical research. In Hospital 2, no course was given and in Hospital 3, a traditional course (mainly clinical exposure) was offered. RESULTS: The final global scores were better for those students in Hospitals 1, 4 and 5 versus Hospitals 2 and 3 (median: 31, 29, 31 versus 9 and 24) (Kruskal-Wallis < 0.05). Initial and final differences in global and interpretation, judgment and proposal were also better in those same students. CONCLUSIONS: Active-participative educational strategies may develop the ability for critical reading of clinical research in internship and these strategies must be included in the curriculum during internship.