Conocimiento de los pacientes sobre el consentimiento informado en un hospital general / Patients' knowledge about informed consent in a general hospital

Resumen Introducción: El consentimiento informado es un documento escrito firmado por el paciente o su representante legal en el que acepta, bajo debida información otorgada por el médico, los riesgos y beneficios esperados. Objetivo: Determinar el grado de conocimiento del consentimiento informado en los pacientes de un hospital general de zona. Método: Encuesta transversal. Se estudiaron 220 pacientes (tamaño muestral determinado) hospitalizados por tamaño muestral, seleccionados por aleatorización sistemática en los servicios de cirugía, pediatría y medicina interna. Se construyó y aplicó un instrumento válido y consistente con 13 reactivos (validado por dos anestesiólogos, un pediatra, un urgenciólogo y un intensivista en dos rondas, miembros del Comité de Bioética) que indagaban edad, género, escolaridad, autorización y tipo de atención médica, responsable legal, lectura completa del documento, causas de no lectura, información médica previa firma. Variable dependiente: conocimiento general (una pregunta con 5 reactivos, un punto para cada uno si se conocía qué indagaban las características del consentimiento), los resultados se clasificaron como sabe mucho 5 puntos, sabe poco 2 a 3 puntos, y no sabe 0 a 1 puntos y además del trato del personal hospitalario. Encuesta autoaplicada. Se incluyeron documentos con las firmas del paciente, del médico, dos testigos y procedimiento a autorizar. Se eliminaron encuestas incompletas. Las encuestas se cotejaron con el expediente. Se determinó la consistencia del instrumento y se compararon las respuestas cualitativas por chi cuadrada. Resultados: Se estudiaron 74 pacientes por servicio; 26% ignoraba el consentimiento informado y 63% tuvo poco conocimiento, aun así 62% lo firmó. Sólo 56% de los expedientes tuvieron consentimiento considerado válido. Conclusiones: La mayoría de los pacientes ignora a qué se refiere el consentimiento informado, pero aun así lo firman. El índice de consentimientos informados en los expedientes fue deficiente.

Abstract Introduction: The informed consent is a written document signed by the patient or by his legal representative, in which risks and benefits are understood and accepted, once the physician has informed them about medical procedures to be performed. Objective: To determine the level of knowledge about the informed consent in patients from a general hospital. Methods: Transversal survey. 220 hospitalized patients of surgery from pediatrics and internal medicine wards were studied, sampling was chosen randomly, systematically and by ward. A validated and consistent instrument was applied consisting of 13 questions (validated by two anesthesiologists, one pediatrician, one emergency physician and one intensive care physician in two rounds, which were members of the Bioethics Committee), that explored age, genre, education, authorization and type of medical care, the legal responsible, full reading of the document, reasons for not reading, and medical information before signature. The general knowledge was the dependent variable (explored through a question with five possible answers, each one worth one point, that analyzed the document characteristics, classifying results as "knows a lot" with five points, "knows little" two to three points and "doesn't know" with 0 to one point. The survey was self-applied. A document was valid when it included the signatures of the patient, the physician, and two witnesses, as well as the proposed procedure. Incomplete surveys were eliminated. The surveys were compared to the clinical file. The consistency was determined and the qualitative answers were compared through chi-square. Results: 74 patients by service; 26% had no knowledge about the informed consent, 63% had limited knowledge, even though 62% signed the document. Only 56% of the clinical files had a valid informed consent. Conclusion: the majority of patients ignore the informed consent, although they still sign it. The rate of informed consents present in clinical files was deficient.

Escasa lectura crítica de investigación entre los alumnos de pre grado de medicina / Little critical reading of research at an undergraduate medical internship

Introducción: La lectura crítica de la investigación está escasamente desarrollada entre los internos de pregrado y los programas institucionales la ignoran. Informes transversales lo confirman, así como intervenciones exitosas. Los estudios longitudinales son escasos. Objetivo: Evaluar el desarrollo y la persistencia de la lectura crítica de investigación en un internado de pregrado con énfasis en investigación (IPI). Material y métodos: Estudio de cohortes; cinco grupos con 77 alumnos, aleatorizados, de cinco universidades, con cinco profesores (diferentes años de docencia). Estrategia: Frecuencia semanal (90 min); lectura de artículo y resolución de guía, discusión plenaria (profesor y compañeros) y elaboración de protocolo. Se aplicó (inicio, 6 y 11 meses) un instrumento de 108 reactivos, equilibrado (interpretación, juicio y propuestas), validado, consistente, con seis resúmenes (encuesta, instrumento, casos y controles, ensayos controlados y aleatorizados [ECA], prueba diagnóstica y cohorte). Estadísticos: No paramétricos intragrupo e intergrupo y el azar. Resultados: No se observaron diferencias iniciales entre los promedios universitarios, medianas globales (13, rango 10 a 17), o sub componentes. Se observaron diferencias posteriores al curso en la calificación global a favor del G2 (mediana 23, rango: 22 a 39); todos los grupos avanzaron (p < 0.05). El avance se mantiene en la calificación global final (mediana 29, rango: 23 a 35). El azar disminuyó (60% a 8%) del inicio al final. No hubo avances en ECA y cohortes. Conclusiones: El aprendizaje de la investigación es fundamental en el pregrado y permite evaluar las publicaciones médicas. Un programa y actividades específicas que incluyan este aprendizaje, así como la guía por parte de los docentes con la implementación de estrategias participativas permitirán desarrollar esta habilidad que persistirá a mediano plazo

Introduction: Critical reading of research papers is poorly developed among undergraduate interns, and institutional programs ignore it. Cross-sectional reports confirm this, as well as successful interventions. Longitudinal studies are scarce. Objective: To evaluate the development and continuity of critical reading of research papers in undergraduate internship with emphasis on research. Material and methods: co-hort study; five groups with 77 students, randomized, from five universities, with five teachers (of varied teaching experience). Strategy: Weekly basis (90 min); reading of an article and guidance resolution, plenary discussion (teacher and classroom) and creation of a protocol. A balanced (interpretation, judg-ment and proposals), validated, consistent 108-item instrument was applied (baseline, 6-11 months) plus six abstracts (survey, instrument, cases and controls, randomized controlled trials [RCTs], diagnostic test and cohort). Statistics: Nonparametric, intra- and intergroup, randomized analysis. Results: No baseline differences between the grade-point averages, median global rating (13, range 10 to 17), or subcom-ponents were observed. Overall rating favored G2 (median 23, range 22-39) by the end of the course; all groups performed better (p < 0.05). Progress was maintained at the overall final rating (median 29, range: 23-35). Random performance decreased (60% to 8%) from beginning to end. No progress was observed in RCTs or cohorts. Conclusions: Learning about research is essential in undergraduate studies and allows medical literature to be assessed. A study program and specific activities including it, and a guide from teachers with participatory strategies, help develop this skill, which is maintained in the medium term.

Surveillance of methicillin-resistant Staphylococcus aureus causing nosocomial infections in five medical centers of Monterrey, Nuevo León, México from 2005-2009.

BACKGROUND AND AIMS: Staphylococcus aureus is a principal cause of human bacterial infection worldwide. The dissemination of antibiotic resistance among S. aureus strains is very import in the treatment of Staphylococcal infections. We undertook this study to identify methicillin-resistant Staphylococcus aureus (MRSA) clones responsible for nosocomial infection in five medical centers in Monterrey, Nuevo León (N.L.), México from 2005-2009. METHODS: One hundred ninety MRSA strains collected from 2005-2009 from five hospitals affiliated with the Instituto Mexicano del Seguro Social (IMSS) in Monterrey, N.L., México were characterized by antimicrobial susceptibility, pulsed field gel electrophoresis (PFGE) and Staphylococcal Cassette Chromosome mec (SCCmec) typing. RESULTS: Only one clone was present in the five hospitals (clone C); this clone is strongly associated with the New York-Japan clone (SCCmec II) with a broad resistance profile. CONCLUSIONS: This study clearly documented the high ability for dissemination and the persistence of the New York-Japan clone in these centers.

[Role of creative discussion in the learning of critical reading of scientific articles]. / Papel de la discusión creadora en el aprendizaje de la lectura crítica de artículos científicos.

OBJECTIVE: To compare two active educational strategies on critical reading (two and three stages) for research learning in medical students. MATERIAL AND METHODS: Four groups were conformed in a quasi-experimental design. The medical student group, related to three stages (critical reading guide resolution, creative discussion, group discussion) g1, n = 9 with school marks > 90 and g2, n = 19 with a < 90, respectively. The two-stage groups (guide resolution and group discussion) were conformed by pre-graduate interns, g3, n = 17 and g4, n = 12, who attended social security general hospitals. A validated and consistent survey with 144 items was applied to the four groups before and after educational strategies. Critical reading with its subcomponents: interpretation, judgment and proposal were evaluated with 47, 49 and 48 items, respectively. The case control studies, cohort studies, diagnostic test and clinical trial designs were evaluated. Nonparametric significance tests were performed to compare the groups and their results. A bias calculation was performed for each group. RESULTS: The highest median was obtained by the three-stage groups (g1 and g2) and so were the medians in interpretation, judgment and proposal. The several research design results were higher in the same groups. CONCLUSIONS: An active educational strategy with three stages is superior to another with two stages in medical students. It is advisable to perform these activities in goal of better learning in our students.

[Nutritional indicators in children with acute lymphoblastic leukemia]. / Indicadores nutricionales en niños con leucemia linfoblástica aguda.

BACKGROUND: A nutritional assessment allows to determine the state of nutrition and to predict the possibility of displaying additional risks for a disease. Previous investigations have verified that it is not sufficient for children with acute lymphoblastic leukemia (ALL) to have registry of anthropometric measurements such as age, weight, and height. Given the previous information, it is necessary to conduct studies with nutritional indicators that contribute to understanding their importance in children with ALL. OBJECTIVE: To compare the nutritional values of five indicators of children with and without ALL. METHODS: A sample of 21 children with a diagnosis of ALL and 54 children without ALL (control) participated in the study; the children's ages ranged between 1.3 to 10 years. Comparisons between cases and controls were performed. RESULTS: Indicators of albumin and triceps skin fold showed differences between the groups (p < 0.005). CONCLUSIONS: Children with ALL at time of diagnosis had nutritional deficiencies of subcutaneous fat reserve and protein. These indicators could be part of the prognostic and standard of care for children with this cancer.

[Summarized real clinical cases use to learn clinical aptitude]. / Resúmenes clínicos problematizados para el aprendizaje de la clínica.

OBJECTIVE: to evaluate clinical skills indicators (CSI) with summarized real clinical cases (SRCC) by two generations of pregraduates interns. METHODS: with a descriptive survey design 430 SRCC were elaborated according to the CSI: risk factors, clinical diagnosis, laboratory and x-ray diagnosis, commission and omission iatrogenesis procedures, therapeutics, nosology and peer critical medical actions. An evaluation scale for the clinical cases included: a relationship with the clinical experience, and the CSI selected. The final evaluation was considered as adequate or inadequate and was performed independently by three medical social service students. RESULTS: except for family medicine, the SRCC were related to the clinical experience of the students. A 62 % of the total was considered as adequate. The CSI assessed were related to risk factors (18 %), clinical diagnosis (32 %), omission and commission iatrogenesis (9 %), laboratory and x-ray diagnosis resources (16 %), therapeutics (17 %), nosology (9 %) and a critical to peer medical actions (3 %). CONCLUSIONS: the SRCC patients studied from different points of view by the interns included the CSI. Therefore, this action is advisable for the improvement of the patients' clinical approach.