Educación inclusiva en Medicina: una experiencia formativa sobre personas con discapacidad / Inclusive education in Medicine: Awareness health care for persons with disabilities

FUNDAMENTO: La educación inclusiva universitaria trata de transformar y mejorar el rol competencial de los futuros médicos en relación con las personas con discapacidad (PcD), grupo poblacional vulnerable y prevalente que necesita una atención de calidad para hacer efectivo su derecho a la salud. OBJETIVO: Analizar y valorar la sensibilización y la formación de una experiencia desarrollada en Medicina en relación con la atención integral a las PcD. MÉTODO: Se ha realizado un estudio de intervención, tipo antes y después, sin grupo control, en 120 alumnos del grado de Medicina. RESULTADOS: Los estudiantes perciben que falta de formación en este tema y son conscientes de su rol sanitario y social en la reducción de desigualdades en las PcD. Entre los conocimientos profesionales que mejoran con la intervención, de manera significativa, están los relacionados con los derechos de las PcD, los factores de riesgo, el grado de discapacidad, el diseño universal, las medidas de acción positiva y las adaptaciones curriculares asociadas a la educación inclusiva. En relación con las competencias que deben ser adquiridas, se debe destacar su sensibilización sobre la necesidad de habilidades sociales y de comunicación, y la capacidad para emitir informes médicos sobre la incapacitación. CONCLUSIÓN: La intervención formativa se muestra efectiva en relación con la sensibilización sobre la importancia del rol del médico en relación con los pacientes con discapacidad y, en consecuencia, se valoran los conocimientos y competencias necesarias para conseguir una mejor atención sanitaria

BACKGROUND: Inclusive higher education aims to transform and improve the competence role of the future doctors in relation to people with disabilities (PwD), a vulnerable and prevalent population group which needs Quality Care to fulfil the right to health. AIM: To analyse and assess the awareness and training received of an experience developed in the School of Medicine related to the comprehensive care for PwD. METHOD: A before- and after-intervention, with no control group, of 120 students enrolled in the School of Medicine. RESULTS: Students perceive a lack of training on this topic and are aware of their health and social role to reduce inequalities in PwD. The professional knowledge that significantly improved with the intervention are the related with the rights of PwD, risk factors, degree of disability, universal design, positive action measures, and curriculum adaptations. As regards to the competences that must be acquired, the awareness of social and communications skills needed should be noted, as well as the ability to issue medical reports about disability. CONCLUSION: The training intervention is effective in terms of awareness about the importance of the medical role related to PwD, and consequently, the knowledge and skills needed to achieve a better Health Care are assessed

Comparación de la eficacia y seguridad de flecainida y dronedarona como terapias antiarrítmicas para mantenimiento de ritmo sinusal en fibrilación auricular / Comparison of the efficacy and safety of dronedarone and flecainide as maintenance antiarrhythmic therapy for sinus rhythm in atrial fibrillation

Resumen Introducción y objetivos: Dronedarona y flecainida son antiarrítmicos de primera elección para reducir recurrencias de fibrilación auricular (FA), sin existir estudios que los comparen entre sí. Nuestro objetivo es comparar la eficacia en cuanto a prevención de recurrencias y seguridad de ambos fármacos. Métodos: Estudio retrospectivo en el que se incluyeron 123 pacientes de forma consecutiva en tratamiento con flecainida o dronedarona desde octubre de 2010 hasta febrero de 2013 por FA paroxística (76.4%) y FA persistente (23.6%). Se realizó cardioversión eléctrica en un 7.3% de los pacientes y farmacológica en un 16.3%. La mediana (rango intercuartílico) de seguimiento fue de 301 días (92-474), con una media de 2.8 revisiones por paciente. Se realizó análisis de tiempo hasta el primer evento mediante Kaplan-Meier y regresión de Cox ajustada por un índice de propensión. Resultados: De entre los 123 sujetos incluidos con FA, 71 fueron tratados con flecainida y 52 con dronedarona. Durante el seguimiento se registraron 36 recurrencias y 20 efectos adversos. Se documentaron un 36.6% de recurrencias en los pacientes tratados con flecainida en comparación con un 21% en los tratados con dronedarona (p = 0.073). En el análisis multivariante, dronedarona se mostró al menos tan eficaz como flecainida para prevenir recurrencias de FA (HR: 0.53, IC 95%: 0.20-1.44, p = 0.221) y demostró un perfil de seguridad comparable al de flecainida (HR: 0.68, IC 95%: 0.18-2.53, p = 0.566). Conclusiones: Según nuestra experiencia, dronedarona resulta al menos tan eficaz como flecainida para el mantenimiento de ritmo sinusal, con un buen perfil de tolerabilidad, a pesar de pautarse en pacientes con un perfil clínico más desfavorable.

Abstract Introduction and objectives: Dronedarone and flecainide are the first pharmacological choice to reduce recurrence of atrial fibrillation (AF); however, there are no studies comparing them. A study was performed to compare the efficacy in terms of recurrence of AF and safety of both drugs. Methods: A retrospective cohort study was conducted that included 123 consecutive patients treated with flecainide or dronedarone due to paroxysmal AF (76.4%) or persistent AF (23.6%), from October 2010 to February 2013. Electrical cardioversion was performed in 7.3% of patients and pharmacological cardioversion in 16.3%. The median (interquartile range) follow-up was 301 days (92-474) with a mean of 2.8 reviews per patient. Time to first event analysis was performed using Kaplan-Meier and Cox regression, adjusted for propensity score. Results: Of the 123 consecutive patients with AF included, 71 were on dronedarone and 52 on flecainide. During the follow-up, there were 36 AF recurrences and 20 safety events. There were recurrences in 36.6% of patients treated with flecainide, compared with 21% of those receiving dronedarone (P = .073). Dronedarone showed to be at least as effective as flecainide in preven- ting recurrence of atrial fibrillation (HR: 0.53, 95% CI: 0.20-1.44, P = .221), and demonstrated an acceptable safety profile when compared with flecainide (HR: 0.68, 95% CI: 0.18-2.53, P = .566). Conclusions: In our experience, dronedarone has been at least as effective and safe as flecainide, despite it was most frequently prescribed in patients with worse baseline risk profile.

[Comparison of the efficacy and safety of dronedarone and flecainide as maintenance antiarrhythmic therapy for sinus rhythm in atrial fibrillation]. / Comparación de la eficacia y seguridad de flecainida y dronedarona como terapias antiarrítmicas para mantenimiento de ritmo sinusal en fibrilación auricular.

INTRODUCTION AND OBJECTIVES: Dronedarone and flecainide are the first pharmacological choice to reduce recurrence of atrial fibrillation (AF); however, there are no studies comparing them. A study was performed to compare the efficacy in terms of recurrence of AF and safety of both drugs. METHODS: A retrospective cohort study was conducted that included 123 consecutive patients treated with flecainide or dronedarone due to paroxysmal AF (76.4%) or persistent AF (23.6%), from October 2010 to February 2013. Electrical cardioversion was performed in 7.3% of patients and pharmacological cardioversion in 16.3%. The median (interquartile range) follow-up was 301days (92-474) with a mean of 2.8 reviews per patient. Time to first event analysis was performed using Kaplan-Meier and Cox regression, adjusted for propensity score. RESULTS: Of the 123 consecutive patients with AF included, 71 were on dronedarone and 52 on flecainide. During the follow-up, there were 36 AF recurrences and 20 safety events. There were recurrences in 36.6% of patients treated with flecainide, compared with 21% of those receiving dronedarone (P=.073). Dronedarone showed to be at least as effective as flecainide in preventing recurrence of atrial fibrillation (HR: 0.53, 95% CI: 0.20-1.44, P=.221), and demonstrated an acceptable safety profile when compared with flecainide (HR: 0.68, 95% CI: 0.18-2.53, P=.566). CONCLUSIONS: In our experience, dronedarone has been at least as effective and safe as flecainide, despite it was most frequently prescribed in patients with worse baseline risk profile.

Influence of antibody profile in clinical features and prognosis in a cohort of Spanish patients with systemic sclerosis.

OBJECTIVES: To assess the clinical manifestations and prognosis of Spanish patients with systemic sclerosis (SSc) according to their immunological profile. METHODS: From the Spanish Scleroderma Study Group or RESCLE (Registro de ESCLErodermia as Spanish nomenclature) Registry we selected those patients in which anti-centromere (ACA), anti-topoisomerase I (ATA), and anti-RNA polymerase III (ARA) antibodies had been determined, and a single positivity for each SSc specific antibody was detected. Demographic, clinical, laboratory, and survival data were compared according to the serologic status of these antibodies. RESULTS: Overall, 209 SSc patients were included. In 128 (61%) patients ACA was the only positive antibody, 46 (22%) were only positive for ATA, and 35 (17%) for ARA. Of note, the three groups were mutually exclusive. In univariate analysis, patients with ACA presented more frequently limited cutaneous SSc (lcSSc) (p<0.001), whereas diffuse cutaneous SSc (dcSSc) was the most frequent subtype in patients with ATA (54%) and ARA (62%) (both p<0.001). Positive patients for ARA showed the highest prevalence of joint involvement (p<0.001) and those from ATA group had a higher prevalence of interstitial lung disease (ILD) (p<0.001). Scleroderma renal crisis was more frequent in the ARA group (p<0.001). In multivariate analysis, ACA were associated with female gender and were protective for dcSSc and ILD. ATA were found to be protective for lcSSc and they were independently associated with interstitial reticular pattern. ARA positivity was independently associated with dcSSc. We did not find differences in mortality between the three groups. CONCLUSIONS: In Spanish SSc patients, the presence of SSc specific antibodies conferred a distinctive clinical profile.

Very early and early systemic sclerosis in the Spanish scleroderma Registry (RESCLE) cohort.

OBJECTIVES: According to the existence of subclinical organ involvement pre-scleroderma should be divided into two subsets: very early and early disease. Pre-scleroderma patients included in the Spanish Scleroderma Registry (RESCLE) Cohort were reclassified into subsets. Differences were evaluated and the risk of progression to definite systemic sclerosis was estimated. METHODS: The characteristics of very early and early SSc patients were compared. A logistic regression model was used to determine the risk factors of progression. RESULTS: 1632 patients were included, 36 (2.2%) in the very early subset and 111 (6.8%) in the early subset. There were no differences in sex, age at disease onset, duration of Raynaud's phenomenon, antinuclear antibodies or capillaroscopic findings. Three (8.3%) very early SSc patients evolved to definite SSc, 2 (5.6%) of them meeting the ACR/EULAR 2013 criteria, unlike 31 (28%) early SSc patients, 20 (24%) of them meeting the criteria (p=0.034). Digestive involvement was an independent risk factor of progression (OR 17; 95% CI, 6.1-47.2). CONCLUSIONS: The classification of early forms of scleroderma identifies patients with different prognostic risk of progression. The evolution to definite SSc is more frequent in early than in very early SSc patients. Digestive involvement is a risk factor of progression. An active assessment of organ damage in preclinical stages allows a correct classification and risk stratification, with implications for monitoring and treatment.

Pericarditis recurrente como presentación en enfermedad de Still del adulto / Recurrent pericarditis as the presenting form of adult Still's disease

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B-learning training in the certification of causes of death.

INTRODUCTION: An adequate certification of causes of death is essential for Public Health. The objective of this work is to improve the professional competence of medicine students and family doctors with regard to the certification of causes of death according to the international regulations of the WHO. METHODS: Intervention-formation, before and after design, addressed to students of Medicine in their last year (6th year), and Family Doctors and Interns. The blended learning or b-learning program consisted in an on-site seminar-workshop, plus basic information/documentation stored in an on-line platform, together with the preparation of Certificates of Causes of Death based on Clinical Histories of real cases. RESULTS: 308 students participated in the program. We observed an individual improvement in the professional competence in all certifications of death, which was significant in 3 out of 5 cases (it was not significant in a medical-legal case of violent death and the case of a pluripathological chronic patient). The intermediate causes improved in all cases. Most formal aspects of the certification improved with significant changes. In the group of 62 Family Doctors and interns who took part in the program there were improvements in the basic or underlying causes in 4 of the 5 cases and improvements in the formal quality of the assessment, although less significantly than in students, because they started with better basal indexes in their certificates in the Before stage of the study. CONCLUSIONS: Blended learning training has shown to be effective in improving the professional competence, both in students of the Degree of Medicine and in practicing Family Doctors and Interns.