[Retrospective analysis of the work of a medical education office]. / Gestión de una oficina de educación médica: evidencia de 10 años y planteamientos de nuevos desafíos para el siglo XXI.

BACKGROUND: Training of health care students at universities is a great challenge for Medical Education Offices. Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students. AIM: To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results. MATERIAL AND METHODS: A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared. RESULTS: A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education. CONCLUSIONS: The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

Gestión de una oficina de educación médica: evidencia de 10 años y planteamientos de nuevos desafíos para el siglo XXI / Retrospective analysis of the work of a medical education office

BACKGROUND: Training of health care students at universities is a great challenge for Medical Education Offices. Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students. AIM: To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results. MATERIAL AND METHODS: A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared. Results: A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education. CONCLUSIONS: The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

[The impact of a self-directed teaching approach on academic performance of medical students]. / Impacto de la aplicación del enfoque de autorregulación del aprendizaje sobre los resultados en asignaturas de corte científico en estudiantes de medicina de la Universidad Finis Terrae.

BACKGROUND: Students should be encouraged to become reflexive and develop autonomous, lifelong learning habits. Therefore, teachers should focus on learning strategies which stimulate autonomous learning. AIM: To assess the impact of a self-directed teaching methodology on the academic performance of medical students in cellular biology and biochemistry. MATERIALS AND METHODS: During 2013, 85 students received a traditional teaching methodology and during 2014, 85 students received a self-directed learning methodology. The grades obtained and the number of failures in the courses of cellular biology and biochemistry were compared in both groups. RESULTS: The percentages of students approved at the end of the courses during 2013 and 2014 were 64 and 96% respectively (p < 0.01). The grades obtained by the 2014 students were also significantly higher than those obtained by 2013 students. CONCLUSIONS: This study confirms that academic performance improves with a self-directed teaching approach.

Impacto de la aplicación del enfoque de autorregulación del aprendizaje sobre los resultados en asignaturas de corte científico en estudiantes de medicina de la Universidad Finis Terrae / The impact of a self-directed teaching approach on academic performance of medical students

Background: Students should be encouraged to become reflexive and develop autonomous, lifelong learning habits. Therefore, teachers should focus on learning strategies which stimulate autonomous learning. Aim: To assess the impact of a self-directed teaching methodology on the academic performance of medical students in cellular biology and biochemistry. Materials and Methods: During 2013, 85 students received a traditional teaching methodology and during 2014, 85 students received a self-directed learning methodology. The grades obtained and the number of failures in the courses of cellular biology and biochemistry were compared in both groups. Results: The percentages of students approved at the end of the courses during 2013 and 2014 were 64 and 96% respectively (p < 0.01). The grades obtained by the 2014 students were also significantly higher than those obtained by 2013 students. Conclusions: This study confirms that academic performance improves with a self-directed teaching approach.

[Evaluation of a teaching training program implemented in a faculty of medicine]. / Evaluación de un programa de perfeccionamiento docente implementado en la Facultad de Medicina de la Universidad Finis Terrae.

BACKGROUND: Since 2010, the Faculty of Medicine at Finis Terrae University implemented a training program aiming to train health professionals in effective educational practices. AIM: To evaluate the effect of training in teachers who are in charge of planning courses, conducting classes and learning assessment. MATERIAL AND METHODS: Quality of planning, lecture performance and academic performance of students were evaluated in 55 teachers prior and after attending the training course on teaching methodologies and in 47 teachers not attending the course. RESULTS: The percentage of trained teachers complying with the aforementioned indicators was significantly higher than those without training (p < 0.01). There were significant differences in favor of the group of teachers who attended and passed the Diploma. Trained teachers had significantly higher students' approval rate. (Odds ratio 4.5, p < 0.01). CONCLUSIONS: The teaching Diploma in Health Sciences improved the planning, teaching and academic performance of teachers.

Evaluación de un programa de perfeccionamiento docente implementado en la Facultad de Medicina de la Universidad Finis Terrae / Evaluation of a teaching training program implemented in a faculty of medicine

Background: Since 2010, the Faculty of Medicine at Finis Terrae University implemented a training program aiming to train health professionals in effective educational practices. Aim: To evaluate the effect of training in teachers who are in charge of planning courses, conducting classes and learning assessment. Material and Methods: Quality of planning, lecture performance and academic performance of students were evaluated in 55 teachers prior and after attending the training course on teaching methodologies and in 47 teachers not attending the course. Results: The percentage of trained teachers complying with the aforementioned indicators was significantly higher than those without training (p < 0.01). There were significant differences in favor of the group of teachers who attended and passed the Diploma. Trained teachers had significantly higher students’ approval rate. (Odds ratio 4.5, p < 0.01). Conclusions: The teaching Diploma in Health Sciences improved the planning, teaching and academic performance of teachers.

[The efficiency of self-regulated learning in the teaching of scientific concepts to health sciences students]. / Efecto del enfoque de autorregulación del aprendizaje en la enseñanza de conceptos científicos en estudiantes universitarios en ciencias de la salud.

BACKGROUND: In health sciences, the predominant teaching methodology is traditional and emphasizes conveying knowledge. Nonetheless, new abilities must be taught now. This change shifts the prominence from professor to student and incorporates a concept called self-regulated learning, which involves the professor as a mediator and incorporates guidelines that facilitate learning diverse skills. AIM: To compare the effects of two teaching methodologies on the learning of key scientific concepts among health science students. MATERIAL AND METHODS: Two subgroups of equally complex concepts were randomly chosen to be taught either using traditional or self-regulation methodology. For the self-regulation methodology, two groups were formed. One learned only through self-regulation guidelines and the other learned through classes where the professor was a mediator. One hundred thirty seven freshman students from medicine, physical therapy, and nursing careers participated voluntarily in the study. RESULTS: Self-regulation methodology impacted the learning process of scientific concepts in a positive way and showed significant differences with traditional teaching. The sole use of self-regulation guidelines alone generated similar results, compared to those obtained by students who attended lectures. CONCLUSIONS: Self-regulated learning would improve in learning efficiency and would reduce face-to-face class time.

Efecto del enfoque de autorregulación del aprendizaje en la enseñanza de conceptos científicos en estudiantes universitarios en ciencias de la salud / The efficiency of self-regulated learning in the teaching of scientific concepts to health sciences students

Background: In health sciences, the predominant teaching methodology is traditional and emphasizes conveying knowledge. Nonetheless, new abilities must be taught now. This change shifts the prominence from professor to student and incorporates a concept called self-regulated learning, which involves the professor as a mediator and incorporates guidelines that facilitate learning diverse skills. Aim: To compare the effects of two teaching methodologies on the learning of key scientific concepts among health science students. Material and Methods: Two subgroups of equally complex concepts were randomly chosen to be taught either using traditional or self-regulation methodology. For the self-regulation methodology, two groups were formed. One learned only through self-regulation guidelines and the other learned through classes where the professor was a mediator. One hundred thirty seven freshman students from medicine, physical therapy, and nursing careers participated voluntarily in the study. Results: Self-regulation methodology impacted the learning process of scientific concepts in a positive way and showed significant differences with traditional teaching. The sole use of self-regulation guidelines alone generated similar results, compared to those obtained by students who attended lectures. Conclusions: Self-regulated learning would improve in learning efficiency and would reduce face-to-face class time.

[Effects on academic performance of a leveling program in basic sciences in first year medical students]. / Impacto de un programa de nivelación de ciencias básicas en estudiantes de primer año de la carrera de Medicina.

BACKGROUND: A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed. AIM: To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students. MATERIAL AND METHODS: We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC. RESULTS: Fifty seven of 89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively. CONCLUSIONS: This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC.

Impacto de un programa de nivelación de ciencias básicas en estudiantes de primer año de la carrera de Medicina / Effects on academic performance of a leveling program in basic sciences in first year medical students

Background: A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed. Aim: To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students. Material and Methods: We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC. Results: Fifty seven of89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively Conclusions: This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC.

Lipoperoxidation and protein oxidative damage exhibit different kinetics during septic shock.

Septic shock (SS)-related multiorgan dysfunction has been associated with oxidative damage, but little is known about the temporal damage profile and its relationship to severity. The present work investigated prospectively 21 SS patients. Blood samples were obtained at diagnosis, 24, 72 hours, day 7, and at 3 months. At admission, thiobarbituric acid reactive substances (TBARSs), plasma protein carbonyls, plasma protein methionine sulfoxide (MS), ferric/reducing antioxidant power (FRAP), total red blood cell glutathione (RBCG), uric acid (UA), and bilirrubin levels were increased (P < .05). Total radical-trapping antioxidant potential (TRAP) and vitamin-E were similar to controls, and vitamin-C was decreased (P < .05). During evolution, TBARS and RBCG increased (P < .001), vitamin-E levels remained stable, whereas plasma protein carbonyls and MS, TRAP, vitamin-C, reduced glutathione, and UA levels decreased (P < .006). After 3 months, plasma protein carbonyls and MS persisted elevated. More severe patients exhibited higher TBARS, TRAP, FRAP, vitamin-C, UA, and bilirrubin levels. Our results suggest early and persistent oxidative stress during septic shock and a correlation between increasing levels of lipoperoxidation and sepsis severity.

[Predictors of the level of patient satisfaction in a university hospital]. / Los predictores de satisfacción de pacientes en un centro hospitalario universitario.

BACKGROUND: Client satisfaction is an important indicator of the quality of services, and health care is not an exemption. AIM: To explore and establish the predictors that exert the greater influence on the level of satisfaction with the service offered in a University Hospital. MATERIAL AND METHOD: The source of the study is a data base, obtained from a survery made to 355 patients of the Hospital Clínico de la Pontificia Universidad Católica de Chile prior to discharge. A multiple regression analysis was used to determine the relative importance of the different factors in the quality of service. The regression variables were reduced to a number of factors, obtained of Factorial Analysis and a Varimax rotation, allowing them to clarify their relations. RESULTS: After performing the main components analysis, seven factors or dimensions that explained a 69% of the total variance were obtained. The predictive model explains up to 40% of the criterion variable (Global Satisfaction during the hospitalization). The factor with the greatest predictive power was the relationship between the patients and nursing staff. Other factors that emerged as important were communication, medical attention and room conditions. CONCLUSIONS: Perceptive type components had the greater relative weight to determine the level of patient satisfaction in this survey.

[Prevalence of severe sepsis in intensive care units. A national multicentric study]. / Prevalencia de sepsis grave en las Unidades de Cuidado Intensivo. Primer estudio nacional multicéntrico.

BACKGROUND: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). AIM: To study the prevalence of SS in Chilean ICUs. MATERIAL AND METHODS: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. RESULTS: Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66%. Mean age of patients was 57.7+/-18 years and 59% were male, APACHE II score was 15+/-7.5 and SOFA score was 6+/-4. SS was the admission diagnosis of 94 of the 283 patients (33%) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. CONCLUSIONS: SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APACHE II and SOFA scores were independent predictors of mortality.

[Thiazide induced acute pulmonary edema: report of one case]. / Edema pulmonar agudo por uso de tiazidas, ¿existe falla cardíaca?: Comunicación de un caso.

Acute pulmonary edema caused by thiazides is uncommon and of difficult diagnosis. It is considered an idiosyncratic reaction and the physiopathology or cardiac function changes are not well known. We report a 60 year-old female with a thiazide induced acute pulmonary edema who was followed with serial measurements of type B n-terminal natriuretic peptide fraction as marker for cardiac dysfunction. There was a significant elevation of the peptide, not associated to evidences of ventricular dysfunction. Its normalization paralleled the resolution of the clinical picture.

Los predictores de satisfacción de pacientes en un centro hospitalario universitario / Predictors of the level of patient satisfaction in a university hospital

Background: Client satisfaction is an important indicator of the quality of services, and health care is not an exemption. Aim: To explore and establish the predictors that exert the greater influence on the level of satisfaction with the service offered in a University Hospital. Material and method: The source of the study is a data base, obtained from a survery made to 355 patients of the Hospital Clínico de la Pontificia Universidad Católica de Chile prior to discharge. A multiple regression analysis was used to determine the relative importance of the different factors in the quality of service. The regression variables were reduced to a number of factors, obtained of Factorial Analysis and a Varimax rotation, allowing them to clarify their relations. Results: After performing the main components analysis, seven factors or dimensions that explained a 69 percent of the total variance were obtained. The predictive model explains up to 40 percent of the criterion variable (Global Satisfaction during the hospitalization). The factor with the greatest predictive power was the relationship between the patients and nursing staff. Other factors that emerged as important were communication, medical attention and room conditions. Conclusions: Perceptive type components had the greater relative weight to determine the level of patient satisfaction in this survey.

High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock.

OBJECTIVES: To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality. DESIGN AND SETTING: Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center. PATIENTS: Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (>0.3 microg kg(-1) min(-1)) and lactic acidosis. INTERVENTIONS: Single session of 12-h HVHF. MEASUREMENTS AND RESULTS: We measured changes in NE requirements and perfusion parameters every 4h during HVHF and 6h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9). CONCLUSIONS: A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.

[Comparison of cardiac output measurement in critical patients using transesophageal Doppler or thermodilution: a preliminary report]. / Determinación y análisis comparativo de gasto cardíaco en enfermos críticos mediante Doppler transesofágico y termodilución en bolos: experiencia preliminar.

BACKGROUND: Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery. AIM: To compare both methods of cardiac output measurement. MATERIAL AND METHODS: Simultaneous measurement of cardiac output by transesophageal Doppler and thermodilution with a catheter in the pulmonary artery in four male critical patients, aged 60+/-12 years, hospitalized in a University Hospital. The Bland and Altman method to compare the concordance between two measurements, was used. RESULTS: Forty measurements were performed. The results of both methods had a correlation coefficient of 0.98. According to the Bland and Altman method, the difference between both methods was -0.5 L with a precision of 0.52 L/min (95% confidence interval -1.51 to 0.52 L/min). Considering that a change between two sequential measurements is considered significant when the difference is more than 15%, both measurements agreed in 83% of cases, that there was a change in cardiac output. CONCLUSIONS: Transesophageal Doppler is a promising non invasive technique to measure cardiac output in critical care patients. It becomes a valid alternative to the thermodilution technique. This preliminary experience must be confirmed in a larger series.

Massive pulmonary embolism: percutaneous mechanical thrombectomy during cardiopulmonary resuscitation.

Seven patients with massive pulmonary embolism (PE) causing cardiac arrest underwent percutaneous mechanical thrombectomy (PMT) with Hydrolyser and Oasis catheters during cardiopulmonary resuscitation (CPR). Three received adjunctive recombinant tissue plasminogen activator. Thrombectomy was successful in restoring pulmonary perfusion in six patients (85.7%). One patient died of cardiac arrest. Systolic pulmonary pressure decreased after thrombectomy from a median of 73 mm Hg (range, 63-90 mm Hg) to 42 mm Hg (range, 32-81 mm Hg; P < .05). There was one groin hematoma that required blood transfusion. In conclusion, massive PE causing cardiac arrest can be treated with PMT simultaneously with CPR maneuvers to rapidly revert circulatory collapse, with restoration of pulmonary circulation. Larger series are needed to validate this method.

Embolia por líquido amniótico: una puesta al día a propósito de un caso / Amniotic fluid embolism: a case report and update

Se presenta el caso clínico de una mujer de 17 años de edad, cursando un embarazo de 33 semanas, que ingresa al hospital por trabajo de parto prematuro. Se descartó infección de la unidad feto-placentaria y materna. Se manejo mediante inhibición del trabajo de parto con fenoterol e inducción de madurez pulmonar con corticoides. Evolucionó satisfactoriamente. En el puerperio inmediato, la madre presenta cuadro de insuficiencia respiratoria aguda, por lo que debe ser trasladada a Unidad de Cuidados Intensivos donde es estabilizada inicialmente con oxígeno 100 por ciento por mascarilla de recirculación, diuréticos e infusión continua de nitroglicerina. Se realizó angiografía pulmonar por tomografía axial computarizada, que evidenció la presencia de imágenes compatibles con embolia por líquido amniótico. El diagnóstico se planteó una vez excluidos sistemáticamente los diagnósticos de edema pulmonar agudo cardiogénico, tromboembolismo pulmonar, aspiración bronquial y neumonía. La paciente evolucionó satisfactoriamente, disminuyendo paulatinamente sus requerimientos de oxígeno, siendo dada de alta días más tarde, asintomática.