Effectiveness of a communication skills training program for medical students to identify patients communicative clues.

OBJECTIVE: This study explores whether an Experiential Training Programme (ETP) in communication skills (CS) improves students' ability to identify patients clues compared to those who follow a non-experiential training throughout their medical studies. METHOD: Intervention Group (IG): 85 4th-year medical students who received the ETP and Control Group (CG): 67 recently graduated students who did not receive it. Their immediate (written) response was requested to three expressions offered by patients containing communicative clues. The answers were grouped into 2 categories: Clue recognised and response patient-centred and the opposite. Three researchers analysed the answers. RESULTS: Responses 366 (65 from the CG and 77 from the IG): 280 did not recognise clues: 131 (62%) in IG and 149 (96%) in CG and 86 recognised them: 80 (37.9%) in IG and 6 (3.9%) in CG (p = 0.000). Some clues were more elusive than others (p = 0,003). CONCLUSIONS: The students who received the ETP in CS showed greater ability to explore patients perspective taking advantage of different types of communicative clues than those who did not receive it in a non-relational context. PRACTICE IMPLICATIONS: Further research is needed to assess whether this ability is maintained in simulated or real clinical situations.

La materia terapéutica en La Arcadia, de Lope de Vega / The therapeutic subject in La Arcadia by Lope de Vega

En la actualidad, aún se desconoce el verdadero alcance de la vasta cultura de Lope de Vega, pues, aunque se sabe que fue un gran lector, que legó más de 1500 libros, sus títulos se han perdido a lo largo de la historia. No obstante, en sus obras trasciende una serie de textos que contribuyeron a su formación. En el presente trabajo se analiza La Arcadia (1598), considerada la novela pastoril más erudita del Siglo de Oro, desde la perspectiva de los agentes terapéuticos. En esta obra se mencionan remedios de procedencia herbal (romero, helenium, verbena, lupino, narciso, lirio, jacinto, lechuga o lino), de procedencia mineral (rubí, diamante, esmeralda, pórfido y oro) y también de procedencia animal (sustancias obtenidas del asno, caballo, conejo, zorro, víboras o arañas, entre otros animales). Los resultados confirman que Lope de Vega pudo utilizar una serie de textos científicos en sus citas sobre la materia terapéutica. Entre ellos cabe destacar a Andrés Laguna y su Dioscórides y Plinio el Viejo, cuya Historia Natural pudo haber consultado como fuente primaria, a través de alguna traducción comentada, como la de Gerónimo de Huerta o a través de alguna otra obra basada en ella, como el opúsculo de Constantino Castriota, pues, en este último caso, se encuentran párrafos muy similares y, en algunos casos, casi literales.

Nowadays, the true extent of the vast culture of Lope de Vega is still largely unknown. Although it is known that he was a great reader, who bequeathed more than 1500 books, his titles have been lost throughout history. However, a series of texts that contributed to his education become known in his works. In the present paper, La Arcadia (1598), considered the most erudite pastoral romance of Spanish Golden Age, is analyzed from the therapeutic perspective. Remedies of herbal origin (rosemary, helenium, verbena, lupine, narcissus, lily, hyacinth, lettuce or flax, among others), of mineral origin (ruby, diamond, emerald, porphyry and gold) and also of animal origin (substances obtained from donkeys, horses, rabbits, foxes, vipers or spiders, among other animals) are mentioned in this novel. The results achieved confirm that Lope de Vega was able to use a series of scientific texts in his quotations on the therapeutic subject. Among them, it is worth mentioning Andres Laguna (and his Dioscorides), and Pliny the Elder, whose Natural History could have been consulted as a primary source, through some commented translation, such as that of Geronimo de Huerta, or through some other work based on it, like Constantino Castriota's opuscule. In the latter case, there are very similar and, in some cases, almost literal paragraphs.

Borderline personality disorder: a review and reformulation from evolutionary theory.

A number of authors have provided a useful evolutionary perspective on personality disorders, arguing that personality traits can be conceptualized in terms of evolutionary strategies. If we consider personality traits not as illnesses but as stable evolutionary strategies, the characteristic features of borderline personality disorder may respond to a behavioral pattern which, although deviating from the norm, would be in the service of survival of the species. Early environments involving factors such as childhood physical/sexual abuse may prove useful for explanation of personality traits based on gene-environment interaction, potentially providing a model for understanding borderline personality traits. We also review the question of whether personality traits exist in animals to also provide a translational perspective. We propose that certain traits in borderline personality disorder may derive from evolved mechanisms which in the short-term serve to help respond to adversity, but which when activated in an ongoing way prove maladaptive.

Adjunctive treatment with risperidone in clozapine-resistant schizophrenia: a case report and review.

OBJECTIVES: Long-term studies show that 47% to 63% of schizophrenic patients treated with clozapine fail to respond after 12 years of treatment. Such high rates of resistance justify the growing interest in therapeutic strategies based on enhancing the effect of clozapine with other antipsychotics. The combination of clozapine and risperidone in the treatment of partial responders to clozapine has been one of those receiving most interest from research. METHODS AND RESULTS: The present work reports the case of a 26-year-old man, diagnosed with schizophrenia who, after treatment with clozapine at appropriate doses over 12 weeks without observable response, showed a marked and sustained improvement after the addition of risperidone to the clozapine treatment. We also present a detailed review of publications related to the therapeutic combination of clozapine and risperidone in clozapine-resistant schizophrenia. CONCLUSIONS: Despite the contradictory nature of the published data, our results are in support of other work reporting that treatment with a combination of clozapine and risperidone, apart from being well tolerated, may constitute an effective alternative in this type of patient. Nevertheless, there is a need for further, controlled studies, with larger samples, with a view to drawing definitive conclusions and making specific recommendations.

Psychopathology in the Lujan-Fryns syndrome: report of two patients and review.

We report on two new patients, the propositus and his maternal uncle, with Lujan-Fryns syndrome (LFS). One presented with mild mental retardation and both patient had Marfanoid habitus and similar craniofacial anomalies (they had a long and narrow face, small mandible, high-arched palate, and hypernasal voice) as previously reported by Lujan et al. in 1984 and Fryns and Buttiens in 1987. One of our patients had agenesis of the corpus callosum as described by Lujan. The second patient had an ascending aortic aneurysm like the patient described by Wittine et al. 1999. Both patients showed similar behavior and psychiatric disorders. In addition, we reviewed the literature for the presence of psychopathology in LFS. After studying the 32 published cases and the 2 described in this article, we found that more than 90% of the patients present with some type of psychopathology, the most frequent being an autistic-like disorder. In our opinion, the agenesis of the corpus callosum (complete or partial) and ascending aorta aneurysm are manifestations of LFS, and thus brain MRI and echocardiogram should be part of the routine evaluation. Additionally, the high prevalence of psychopathological alterations in these patients suggests the need for psychiatric evaluation at the time of diagnosis.

Satisfacción laboral de los profesionales de atención primaria del área 10 del Insalud de Madrid / Job satisfaction among primary care professionals in area 10 Insalud, Madrid

Fundamento: La implantación de un modelo de calidad total requiere conocer la satisfacción laboral de los trabajadores. Pretendemos averiguar el nivel de satisfacción global y de cada uno de los trabajadores de Atención Primaria del Área 10.Métodos: Estudio descriptivo transversal realizado en el Area 10 del Insalud de Madrid, Atención Primaria. Trabajan en este Área 668 profesionales sanitarios y no sanitarios. Se utiliza el cuestionario de satisfacción Font Roja, adaptado por J. Aranaz, que mide la satisfacción laboral a través de una escala de 1 (menor grado de satisfacción) a 5 (mayor grado de satisfacción).Resultados: Respondió el cuestionario un 80 por ciento de la población. La puntuación media de la satisfacción es de 3,12 (Error Típico ET= 0,017). Las dimensiones menos valoradas han sido la tensión relacionada con el trabajo, con una media de 2,30 (ET= 0,041) y la promoción profesional con una media de 2,42 (ET= 0,038). La dimensión más valorada es la competencia profesional con una media de 4,01 (ET= 0,058).Conclusiones: Los profesionales se encuentran medianamente satisfechos en su trabajo. Comparando este estudio con el realizado en este Área en 1992, concluimos que las dimensiones tensión laboral y promoción profesional siguen siendo las peor valoradas, lo que debería de activar medidas correctoras por parte de los equipos directivos (AU)