El residente como docente: percepción de estudiantes de medicina de una universidad española / The resident as teacher: medical students’ perception in a Spanish university

Fundamento y objetivos. El médico residente desempeña una labor importante, aunque escasamente evaluada, en la enseñanza del estudiante de medicina. El objetivo de este estudio fue conocer la opinión de los estudiantes sobre la actividad docente del residente. Material y método. Encuesta autocumplimentada por estudiantes de medicina de la Universidad de Alcalá (España) durante el último año de su formación universitaria. Se evaluó la opinión de los estudiantes en relación con las habilidades docentes y asistenciales de los residentes y de los facultativos especialistas según una escala de Likert de 5 puntos. Resultados. Se obtuvieron 104 encuestas. Un 69,9% de los alumnos percibían al residente como fuente de más de la mitad de lo aprendido durante sus prácticas. Los estudiantes piensan que la labor docente del residente no está suficientemente reconocida (94,2%), creen necesaria la adquisición de habilidades docentes durante la residencia (82,7%) y se muestran favorables a tutorizar a alumnos de cursos anteriores (88,5%). Además, puntúan mejor al residente en habilidades relacionales en comparación con los facultativos especialistas. Conclusiones. Existe una percepción positiva del residente como docente entre los estudiantes de medicina, lo que sugiere la necesidad de mejorar las habilidades docentes del residente (AU)

Background and objectives. Residents play an important but scanty assessed role in medical students teaching. The aim of this study was to assess the perception of medical students about residents’ teaching activity. Material and methods. Autofilled survey provided to medical students of the University of Alcalá (Spain) in the final year in their school of medicine. Student opinion about care and teaching abilities of residents and physicians was evaluated using a 5-point Likert scale. Results. 104 surveys were collected. A 69,9% of students consider that as much as 50% of their knowledge came from rounds with residents. Students believe that resident teaching lacks enough academical acknowledgment (94.2%); they estimate necessary to acquire teaching skills during residency (82,7%), and they would like to provide tutoring other medical students (88,5%). Students rated residents better than physicians on relational and motivational abilities. Conclusions. There is a positive view about resident as a teacher among medical students, which suggests the need to improve the resident's teaching skills (AU)

The resident as teacher: Medical students' perception in a Spanish university. / El residente como docente: percepción de estudiantes de medicina de una universidad española.

BACKGROUND AND OBJECTIVES: Residents play an important but scanty assessed role in medical students teaching. The aim of this study was to assess the perception of medical students about residents' teaching activity. MATERIAL AND METHODS: Autofilled survey provided to medical students of the University of Alcalá (Spain) in the final year in their school of medicine. Student opinion about care and teaching abilities of residents and physicians was evaluated using a 5-point Likert scale. RESULTS: 104 surveys were collected. A 69,9% of students consider that as much as 50% of their knowledge came from rounds with residents. Students believe that resident teaching lacks enough academical acknowledgment (94.2%); they estimate necessary to acquire teaching skills during residency (82,7%), and they would like to provide tutoring other medical students (88,5%). Students rated residents better than physicians on relational and motivational abilities. CONCLUSIONS: There is a positive view about resident as a teacher among medical students, which suggests the need to improve the resident's teaching skills.

Enseñanza de la Patología General en España: ¿es el residente un convidado de piedra? / General Pathology training in Spain: is the resident a stone guest?

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Effectiveness of a diagnostic algorithm combining clinical probability, D-dimer testing, and computed tomography in patients with suspected pulmonary embolism in an emergency department.

OBJECTIVE: The aim of our study was to assess the clinical effectiveness of a simplified algorithm using the Wells clinical decision rule, D-dimer testing, and computed tomography (CT) in patients with suspected pulmonary embolism (PE) in an Emergency Department (ED). METHODS: Patients with clinically suspected PE from the Emergency Department were included from May 2007 through December 2008. Clinical probability was assessed using the Wells clinical decision rule and a VIDAS D-dimer assay was used to measure D-dimer concentration. Patients were categorized as "pulmonary embolism unlikely" or "pulmonary embolism likely" using the dichotomized version of the Wells clinical decision rule. Pulmonary embolism was considered excluded in patients with unlikely probability and normal D-dimer test (< 500 ng/ml). All other patients underwent CT, and pulmonary embolism was considered present or excluded based on the results. Anticoagulants were withheld from patients classified as excluded, and all patients were followed up for 3 months. RESULTS: 241 patients were included in the study. The prevalence of PE in the entire population was 23.6%. The combination of unlikely probability using the dichotomized Wells clinical decision rule and a normal D-dimer level occurred in 23.6%, thus making CT unnecessary. During the followup period, no thromboembolic events were recorded and there were no deaths related to venous thromboembolic disease (3-month thromboembolic risk 0% [95% CI, 0%-8%]). CONCLUSIONS: In this study we have confirmed the effectiveness of a diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT in the evaluation and management of patients with clinically suspected pulmonary embolism.

Demencia reversible por neurosífilis (parálisis general progresiva) / Reversible dementia due to neurosyphilis

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Neutropenia grave asociada a indapamida / Serious neutropenia associated to indapamide

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[The value of the polymerase chain reaction in cerebrospinal fluid for the diagnosis of herpetic encephalitis: a report of 2 cases and a review of the literature]. / Valor de la reacción en cadena de la polimerasa en líquido cefalorraquídeo para el diagnóstico de la encefalitis herpética: presentación de dos casos y revisión de la literatura.

Brain biopsy has been considered the gold-standard test for the diagnosis of herpetic encephalitis. However, because of its cruence, other non invasive methods have been developed for its diagnosis. In recent years polymerase chain reaction (PCR) in cerebrospinal fluid has been employed for the diagnosis of herpetic encephalitis (HE). We report two cases of clinically suspected HE in which DNA of herpes simplex virus was amplified by PCR from cerebrospinal fluid, and review the role of this method for the diagnosis of HE. Two patients were admitted to the emergency room presenting clinical pictures and cerebrospinal fluid samples suggestive of lymphocytic meningoencephalitis. Both were admitted in the intensive care unit because of altered level of consciousness, beginning empiric treatment with intravenous acyclovir as HE was suspected. Clinical outcomes were favourable in both cases, being confirmed the presence of herpes simplex DNA in cerebrospinal fluid by PCR in the two patients. We have reviewed in the literature the value of PCR for the diagnosis of HE in comparison with other ancillary tests as brain biopsy and serology. PCR could reach according with some authors a sensibility of 98% and a specificity of 94%.

Valor de la reacción en cadena de la polimerasa en líquido cefalorraquídeo para el diagnóstico de la encefalitis herpética: presentación de dos casos y revisión de la literatura / The value of the polymerase chain reaction in cerebrospinal fluid for the diagnosis of herpetic encephalitis: a report of 2 cases and a review of the literature

La biopsia cerebral ha sido la prueba de referencia para el diagnóstico de la encefalitis herpética. Sin embargo, dado lo cruento de esta prueba, se han desarrollado otros métodos no invasivos para su diagnóstico. En los últimos años se ha empleado la reacción en cadena de la polimerasa (RCP) en el líquido cefalorraquídeo (LCR) para el diagnóstico de la encefalitis herpética (EH). Presentamos dos casos con sospecha clínica de EH en los que se amplificó, mediante RCP, ácido desoxirribonucleico (ADN) de virus herpes simplex en LCR y revisamos el valor de esta técnica para el diagnóstico de EH. Se trata de dos pacientes que acudieron a urgencias presentando un cuadro clínico y características de LCR sugestivos de meningoencefalitis linfocitaria. Ambos requirieron ingreso en la Unidad de Cuidados Intensivos por disminución del nivel de conciencia, iniciándose tratamiento empirico con aciclovir intravenoso ante la sospecha de EH. La evolución clínica fue favorable en los dos casos, confirmándose la presencia de ADN del virus herpes simplex en el LCR mediante RCP en los dos pacientes. Hemos revisado en la literatura el valor de la RCP para el diagnóstico de la EH en comparación con otras pruebas como biopsia cerebral y serología. La RCP alcanzaría según algunos autores una sensibilidad del 98 y una especificidad del 94 porciento (AU)