Subject(s)
Humans , History, 20th Century , General Practice , Medicine , Specialization , Internal Medicine , Prognosis , History of MedicineABSTRACT
Introducción: El aprendizaje a largo plazo es uno de los objetivos de la educación médica. Combinar cine-educación y simulación ha demostrado ser eficaz para enseñar seguridad del paciente a estudiantes de medicina. Este artículo describe la evaluación de la retención de conocimientos sobre seguridad del paciente al cabo de un año aplicados a un nuevo contexto clínico.Sujetos y métodos.En un escenario de simulación de error transfusional, se evalúan los comentarios sobre seguridad del paciente de 59 estudiantes de tercer curso de medicina que el año anterior habían participado en una sesión de seguridad del paciente con cine-educación y simulación. El análisis de los datos se realiza desde un enfoque cualicuantitativo, agrupando y cuantificando los comentarios de los estudiantes en función de cinco de los 11 dominios de seguridad del paciente, según la Organización Mundial de la Salud (OMS).Resultados.La mayoría de los estudiantes recuerda el escenario audiovisual y es capaz de aplicar en el nuevo escenario conceptos complejos de seguridad del paciente y las actuaciones recomendadas por la OMS aprendidos un año atrás.Conclusión.La combinación de cine-educación y simulación permite la retención y transferencia de conceptos complejos de seguridad del paciente a otro contexto al cabo de un año. Esto puede vincularse con la buena recepción que las series de televisión médicas tienen entre los estudiantes de medicina. Éstas sustituyen el componente experiencial de la simulación, el cual proporciona los componentes de briefing, debriefing y transferencia que le son propios. (AU)
Introduction: Long-term learning is one of the goals of medical education. Combining cinemeducation and simulation was proven effective to teach patient safety (PS) to medical students. This paper describes the evaluation of PS knowledge retention after one year applied to a new clinical context.Subjects and methods.In a transfusion error simulation scenario, the comments of 59 3rd year medical students who had participated in PS session with cinemeducation and simulation the previous year were evaluated. Data analysis was performed from a qualitative-quantitative approach, grouping and quantifying student feedback based on 5 of the 11 PS topics according to WHO.Results.Most of the students remember the audiovisual scenario and are able to applied complex PS concepts and the actions recommended by the WHO learned a year ago in the new setting.Conclusion.The combination of cinemeducation and simulation has allowed the retention and transfer of complex PS concepts to another context after one year. This can be linked to the good reception that medical TV series have among medical students. These can replace the experiential component of the simulation, which in turn provides its own briefing, debriefing and transfer components. (AU)
Subject(s)
Humans , Learning , Patient Safety , Patient Simulation , Education, Medical , Students, Medical , Motion Pictures , PatientsABSTRACT
BACKGROUND: The first years of university can be very challenging for students. Previous research has focused on the study of the prevalence of burnout and of psychological distress in medical students. The aim of this study was to investigate the prevalence of psychological symptoms and burnout reported by first-year students, the relationship between these variables and their academic performance, and the differences between health and non-health sciences students. METHODS: An observational study with a cross-sectional design was performed. Students of health sciences (medicine, nursing, physiotherapy, psychology), and non-health sciences (biology, social sciences, business management, and engineering) undergraduate programs completed the Brief Symptom Inventory (BSI-18) and the Maslach Burnout Inventory-Student Survey (MBI-SS). Students' grades for the first semester were collected. RESULTS: A sample of 506 students participated. Prevalence of psychological distress was 27.1% and burnout was 7.3%. Academic performance was unaffected in relation to either psychological distress or burnout. Non-health sciences students showed a greater risk of depression. CONCLUSIONS: This study provides evidence of the high prevalence of psychological distress in the first year of college. Even when burnout prevalence was low, the results suggest the need to introduce prevention programs to improve the psychological wellbeing of these students.
Subject(s)
Academic Performance , Burnout, Professional , Psychological Distress , Students, Medical , Burnout, Professional/psychology , Burnout, Psychological/epidemiology , Cross-Sectional Studies , Humans , Stress, Psychological/epidemiology , Students, Medical/psychology , Surveys and QuestionnairesABSTRACT
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Humans , Internal Medicine/education , Physician's Role , Education, Medical, Graduate , Clinical CompetenceABSTRACT
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Humans , Internal Medicine/education , Professional Role , Faculty, Medical , Self-Directed Learning as Topic , ThinkingABSTRACT
Whether a repeat renal biopsy is helpful during lupus nephritis (LN) flares remains debatable. In order to analyze the clinical utility of repeat renal biopsy in this complex situation, we retrospectively reviewed our series of 54 LN patients who had one or more repeat biopsies performed only on clinical indications. Additionally, we reviewed 686 well-documented similar cases previously reported (PubMed 1990-2015).The analysis of all patients reviewed showed that histological transformations are common during a LN flare, ranging from 40% to 76% of cases. However, the prevalence of transformations and the clinical value of repeat biopsy vary when they are analyzed according to proliferative or nonproliferative lesions.The great majority of patients with class II (78% in our series and 77.5% in the literature review) progressed to a higher grade of nephritis (classes III, IV, or V), resulting in worse renal prognosis. The frequency of pathological conversion in class V is lower (33% and 43%, respectively) but equally clinically relevant, since almost all cases switched to a proliferative class. Therefore, repeat biopsy is highly advisable in patients with nonproliferative LN at baseline biopsy, because these patients have a reasonable likelihood of switch to a proliferative LN that may require more aggressive immunosuppression.In contrast, the majority of patients (82% and 73%) with proliferative classes in the reference biopsy (III, IV or mixed III/IVâ+âV), remained into proliferative classes on repeat biopsy. Although rebiopsy in this group does not seem as necessary, it is still advisable since it will allow us to identify the 18% to 20% of patients that switch to a nonproliferative class. In addition, consistent with the reported clinical experience, repeat biopsy might also be helpful to identify selected cases with clear progression of proliferative lesions despite the initial treatment, for whom it is advisable to intensify inmunosuppression. Thus, our experience and the literature data support that repeat biopsy also brings more advantges than threats in this group.The results of the repeat biopsy led to a change in the immunosuppresive treatment in more than half of the patients on average, intensifying it in the majority of the cases, but also reducing it in 5% to 30%.
Subject(s)
Kidney/pathology , Lupus Nephritis/pathology , Biopsy , Disease Progression , Female , Humans , Immunosuppressive Agents/therapeutic use , Kidney/drug effects , Lupus Nephritis/drug therapy , Lupus Nephritis/metabolism , Male , Middle Aged , Retrospective Studies , Severity of Illness IndexABSTRACT
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Humans , Male , Aged , Spondylitis, Ankylosing/complications , Glucocorticoids/therapeutic use , Lung Neoplasms/diagnosis , Cryptogenic Organizing Pneumonia/diagnosis , Fever/etiology , Hypertension/physiopathology , Dyslipidemias/physiopathology , Endosonography , Sirolimus/adverse effects , Clavicle/pathology , Neoplasm Invasiveness , /diagnosisABSTRACT
El objetivo principal en el tratamiento de la osteoporosis es prevenir la aparición de las fracturas por fragilidad y con ello reducir su morbimortalidad. Entre los diversos abordajes terapéuticos de esta enfermedad se incluye asegurar una ingesta apropiada de calcio y obtener unos niveles adecuados de vitamina D. Prácticamente todos los ensayos clínicos con fármacos utilizados en el tratamiento de la osteoporosis incluyen la administración de suplementos de calcio y de vitamina D de manera sistemática. A la luz de la publicación de recientes ensayos clínicos y metanálisis, existe la hipótesis de un posible aumento del riesgo cardiovascular en los pacientes que toman suplementos de calcio, sobre todo en forma de infarto de miocardio. Sin embargo, los datos publicados hasta la fecha no son concluyentes. Hasta la obtención de nuevas evidencias científicas, parece razonable recomendar, siempre que sea factible e individualizando para cada paciente, aumentar el aporte de calcio con los alimentos y reservar los suplementos para aquellos pacientes con ingesta de calcio muy bajas en la dieta. Además, sería recomendable que la administración total diaria se realizara de forma fraccionada y con las comidas, así como también es básico obtener unos niveles apropiados de vitamina D (25 hidroxicolecalciferol o calcidiol), añadido todo ello al tratamiento de base de la osteoporosis que se decida prescribir a cada paciente (AU)
The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Calcium/therapeutic use , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Osteoporosis/drug therapy , Osteoporosis/prevention & control , Risk Factors , Intestinal Absorption , Intestinal Absorption/physiology , Hip Fractures/drug therapy , Hip Fractures/prevention & control , Fractures, Bone/drug therapy , Fractures, Bone/prevention & control , Vitamin D/therapeutic useABSTRACT
The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascular risk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients.
Subject(s)
Calcium/adverse effects , Cardiovascular Diseases/chemically induced , Dietary Supplements/adverse effects , Aged , Cardiovascular Diseases/epidemiology , Humans , Osteoporosis/drug therapy , Risk FactorsSubject(s)
Humans , Male , Aged, 80 and over , Thrombocytopenia/chemically induced , Ofloxacin/administration & dosage , Ofloxacin/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/etiology , Adrenal Cortex Hormones/therapeutic use , Thrombocytopenia/complications , Thrombocytopenia/drug therapy , Thrombocytopenia/physiopathologyABSTRACT
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Humans , Patient Discharge/standards , Forms and Records Control/standards , Medical Records/standards , Practice Guidelines as TopicABSTRACT
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