Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty.

AIM: This work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. METHODS: This cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. RESULTS: A total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12-1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. CONCLUSIONS: Patients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.

Cómo perciben los estudiantes del primer curso clínico del Grado en Medicina la prueba de Evaluación Clínica Objetivada Estructurada (ECOE) / How medical students perceive the Objective Structured Clinical Examination (OSCE) in their first clinical year

INTRODUCCIÓN: La pruebas de Evaluación Clínica Objetiva Estructurada (ECOE) son cada vez más utilizadas para evaluar a los estudiantes de medicina. Suelen emplearse al finalizar los estudios y no se valora la opinión de los estudiantes. OBJETIVO: Evaluar la utilidad de la ECOE, desde el punto de vista del estudiante de medicina, en su primer año de prácticas clínicas. Material y métodos Se diseñó una ECOE reducida que incluyó tres estaciones clínicas con actores y evaluadores estandarizados. Posteriormente fue evaluada mediante una encuesta con 5 preguntas previamente validadas. RESULTADOS: Participaron 104 estudiantes y se obtuvieron 97 (92,3%) respuestas. El 89,7% consideró que la prueba fue muy útil para su formación. El 92,8% opinó que sería muy positivo incluir ECOE en sus prácticas clínicas y que ayudaría a adquirir competencias clínicas. CONCLUSIONES: La prueba ECOE es una herramienta útil de evaluación y aprendizaje en los primeros años de prácticas clínicas

BACKGROUND: The Objective Structured Clinical Examination (OSCE) is commonly used for the evaluation of medical students. OSCE is normally used at the end of their training and there is no feed-back with the students. AIM: To evaluate the utility of OSCE, from the student point of view, at their first clinical year. MATERIAL AND METHODS: A reduced OSCE with three clinical stations was designed. The participants and evaluators were previously standardised. The students then evaluated the OSCE using a previously validated survey. RESULTS: Of the 104 medical students that participated, 97 (92.3%) completed the questionnaire. The OSCE was considered a useful tool by 89.7%, and 92.8% thought that it would be really positive to include OSCEs in their clinical practice in order to achieve clinical competence. CONCLUSION: The OSCE is a useful tool for evaluation and learning by students in their first clinical years