Assessing student perceptions of the clinical teachers' performance during early clinical exposure.

BACKGROUND: The clinical teachers' attributes can be grouped into physician competencies, teacher competencies, and personal characteristics. Global performance is considered the clinical teacher's capacity to facilitate an active and stimulating learning process for medical students and a warm, supportive, and pleasant environment. AIM: To determine which attributes of the clinical teacher influence their global performance from the students' point of view. MATERIAL AND METHODS: The Role Model Apperception Tool questionnaire (RoMAT) was answered by 133 second-year medical students at the University of Chile during 2018. RESULTS: The students assessed 37 clinical teachers. Teaching competencies had the higher influence in global performance. Personal characteristics also had a significant influence. Physician competencies had an indirect influence on teaching competencies. The model obtained 88% of the explained variance of the teacher's global performance. CONCLUSIONS: This study showed that teacher competencies, personal characteristics, and physician competencies are qualities that influence the perception of the global performance of clinical teachers.

Assessing student perceptions of the clinical teachers' performance during early clinical exposure / Evaluación de la percepción de los estudiantes acerca de los atributos de sus tutores en los primeros cursos clínicos

ABSTRACT BACKGROUND: The clinical teachers' attributes can be grouped into physician competencies, teacher competencies, and personal characteristics. Global performance is considered the clinical teacher's capacity to facilitate an active and stimulating learning process for medical students and a warm, supportive, and pleasant environment. AIM: To determine which attributes of the clinical teacher influence their global performance from the students' point of view. MATERIAL AND METHODS: The Role Model Apperception Tool questionnaire (RoMAT) was answered by 133 second-year medical students at the University of Chile during 2018. RESULTS: The students assessed 37 clinical teachers. Teaching competencies had the higher influence in global performance. Personal characteristics also had a significant influence. Physician competencies had an indirect influence on teaching competencies. The model obtained 88% of the explained variance of the teacher's global performance. CONCLUSIONS: This study showed that teacher competencies, personal characteristics, and physician competencies are qualities that influence the perception of the global performance of clinical teachers.

ANTECEDENTES: Los atributos de un tutor clínico pueden agruparse en competencias clínicas, competencias docentes y características personales. En el desempeño global del tutor se considera su capacidad de facilitar un proceso de aprendizaje activo y estimulante y generar un ambiente cálido y de soporte. OBJETIVO: Determinar qué atributos del tutor clínico, evaluados por los estudiantes, influyen sobre su desempeño global. MATERIAL Y MÉTODO: La escala "Role Model Apperception Tool" fue contestada por 133 estudiantes de segundo año de medicina en la Universidad de Chile durante el 2018. RESULTADOS: Los estudiantes evaluaron 37 tutores clínicos. Las competencias docentes tuvieron la mayor influencia sobre el desempeño global. Las características personales también mostraron influencia significativa. Las competencias clínicas influyeron indirectamente a través de las competencias docentes. El modelo logró explicar 88% de la varianza del desempeño global del tutor clínico. CONCLUSIONES: El estudio muestra que las competencias docentes, características personales y competencias clínicas influyen sobre la evaluación de los estudiantes sobre el desempeño global del tutor.

Determinants of the intention to speak up about medical error in primary healthcare settings in Chile.

Medical error frequently occurs in ambulatory care, and healthcare professionals may encounter situations in which they need to speak up to ensure better practice. This study aims to investigate the factors that influenced the intention to speak up about medical errors among healthcare professionals in primary care settings. Data were generated through a national cross-sectional survey of primary healthcare centres in the Republic of Chile. A research instrument was designed using the constructs of the theory of planned behaviour and was analysed using the structural equation model technique. In total, 203 healthcare professionals were recruited between March and May 2020. The model showed that the intention to speak up was directly and positively influenced by attitudes towards speaking up and perceived control (standard deviation [SD] = 0.284 and 0.576, respectively). Subjective norms indirectly and negatively influenced the intention to speak up through attitudes towards speaking up and perceived control (total effect SD = -0.303). The exploratory construct of willingness to change self-behaviour positively influenced the attitude towards behaviour. The intention to speak up strongly influenced the speaking up behaviour (total effect SD = 0.631). The proposed model explained 40% of the variance in behaviour. Based on this model, it was concluded that the intention to speak up strongly influenced the speaking up behaviour and predicted it by 40%. Factors that modify the intention to speak up are expected to influence the occurrence of this behaviour. This knowledge will inform strategies to enhance communication among healthcare professionals, improve speaking up behaviour and improve patient care.

[Severe hyponatremia secondary to Phyllomedusa bicolor (Kambó frog) poisoning. Report of one case]. / Hiponatremia grave secundaria a la exposición a veneno de Phyllomedusa Bicolor (Rana Kambó). Caso clínico.

Phyllomedusa bicolor or Kambo is a frog that lives in the Amazon rainforest. It can release through its skin a substance used in healing rituals that are common among South-American tribes, as well as in urban people of America and Europe. We report a 41-year-old female patient who, during a healing ritual consumed ayahuasca (a drink obtained from the mixture of Banisteriopsis caapi, Psychotria viridis and Mimosa hostilis) and 12 hours later received the poison of Kambo Frog (Phyllomedusa bicolor) on superficial right shoulder skin burns. The ritual included a minimum of six-liter water intake over a few hours period. She evolved with clouding of sensorium, motor agitation, frequent vomiting, and generalized tonic-clonic seizures. She presented lethargic to the emergency room, with a weak pupillary light reflex, generalized stiffness, moving all four limbs. Laboratory showed severe hyponatremia (120 mEq/L) and a creatine kinase level of 8,479 UI/L, that increased 107,216 IU/L within few days. An admission CT Brain scan was normal. The toxicological screening did not identify the presence of other substances. During hospitalization the patient developed severe psychomotor agitation controlled by a dexmedetomidine infusion, hyponatremia, low plasma osmolality (248 mOsm/kg), and disproportionately high urinary osmolality (448 mOsm/kg), suggestive of inappropriate antidiuretic hormone secretion syndrome (SIADH). With correction of hyponatremia, the patient gradually recovered consciousness. Rhabdomyolysis was assumed to be secondary to seizure and managed by volume and bicarbonate infusions with a positive response.

Hiponatremia grave secundaria a la exposición a veneno de Phyllomedusa Bicolor (Rana Kambó): caso clínico / Severe hyponatremia secondary to Phyllomedusa bicolor (Kambó frog) poisoning: report of one case

Phyllomedusa bicolor or Kambo is a frog that lives in the Amazon rainforest. It can release through its skin a substance used in healing rituals that are common among South-American tribes, as well as in urban people of America and Europe. We report a 41-year-old female patient who, during a healing ritual consumed ayahuasca (a drink obtained from the mixture of Banisteriopsis caapi, Psychotria viridis and Mimosa hostilis) and 12 hours later received the poison of Kambo Frog (Phyllomedusa bicolor) on superficial right shoulder skin burns. The ritual included a minimum of six-liter water intake over a few hours period. She evolved with clouding of sensorium, motor agitation, frequent vomiting, and generalized tonic-clonic seizures. She presented lethargic to the emergency room, with a weak pupillary light reflex, generalized stiffness, moving all four limbs. Laboratory showed severe hyponatremia (120 mEq/L) and a creatine kinase level of 8,479 UI/L, that increased 107,216 IU/L within few days. An admission CT Brain scan was normal. The toxicological screening did not identify the presence of other substances. During hospitalization the patient developed severe psychomotor agitation controlled by a dexmedetomidine infusion, hyponatremia, low plasma osmolality (248 mOsm/kg), and disproportionately high urinary osmolality (448 mOsm/kg), suggestive of inappropriate antidiuretic hormone secretion syndrome (SIADH). With correction of hyponatremia, the patient gradually recovered consciousness. Rhabdomyolysis was assumed to be secondary to seizure and managed by volume and bicarbonate infusions with a positive response.

Identification of Non-Nucleoside Inhibitors of the Respiratory Syncytial Virus Polymerase Complex.

Respiratory syncytial virus (RSV) represents a threat to infants, the elderly, and the immunocompromised. RSV entry blockers are in clinical trials, but escape mutations challenge their potential. In search of RSV inhibitors, we have integrated a signature resistance mutation into a recombinant RSV virus and applied the strain to high-throughput screening. Counterscreening of candidates returned 14 confirmed hits with activities in the nano- to low-micromolar range. All blocked RSV polymerase activity in minigenome assays. Compound 1a (GRP-74915) was selected for development based on activity (EC50 = 0.21 µM, selectivity index (SI) 40) and scaffold. Resynthesis confirmed the potency of the compound, which suppressed viral RNA synthesis in infected cells. However, metabolic testing revealed a short half-life in the presence of mouse hepatocyte fractions. Metabolite tracking and chemical elaboration combined with 3D-quantitative structure-activity relationship modeling yielded analogues (i.e., 8n: EC50 = 0.06 µM, SI 500) that establish a platform for the development of a therapeutic candidate.

[Glycemic control in diabetic patients hospitalized in a non-critical care hospital setting]. / Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna.

BACKGROUND: During hospitalization, hyper and hypoglycemia impairs the prognosis of diabetic patients. Strict glycemic control improves survival in intensive care units. There is no evidence to support it for patients in non-critical wards. AIM: To evaluate the glycemic control of diabetic patients in a non-critical medical unit, and estimate its effect on hospitalization and survival. MATERIAL AND METHODS: Prospective study of all patients admitted to a non-critical ward with a fasting blood glucose (BG) > 126 mg/dl or > 200 mg /dl at any time, and patients with known diabetes. Age, sex, type of diabetes, time since diagnosis, chronic complications, prior treatment, length of stay, admission and discharge diagnosis were registered. All capillary BG levels obtained from each patient until discharge, death or transfer, were registered. RESULTS: Ninety nine patients aged 63 ± 13.4 years (42 males,) were included. Ninety one percent had a type 2 diabetes with a mean duration of 13.8 years. Mean hospital stay was 10.9 days. At least one hypoglycemia below 70 mg/dl occurred in 21% of patients and 39.4% had at least one episode with blood glucose over 300 mg/dl. Median hospital stay of patients with no episode of BG > 200 mg/dl was 6 days, 10.5 days among patients with at least one episode of BG > 300 mg/dl and 13 days among patients that had at least one episode of hypoglycemia (p = 0.02). Diabetes lasted nine years more among the latter (p < 0.01). Three patients that suffered hypoglycemia and two in the rest of the groups, died (NS). CONCLUSIONS: Two of three diabetic patients admitted to our non-critical medical ward have a non-optimal glycemic control. Appearance of hypoglycemia is associated with a longer hospital stay.

Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna / Glycemic control in diabetic patients hospitalized in a non-critical care hospital setting

Background: During hospitalization, hyper and hypoglycemia impairs the prognosis of diabetic patients. Strict glycemic control improves survival in intensive care units. There is no evidence to support it for patients in non-critical wards. Aim: To evaluate the glycemic control of diabetic patients in a non-critical medical unit, and estimate its effect on hospitalization and survival. Material and Methods: Prospective study of all patients admitted to a non-critical ward with a fasting blood glucose (BG) > 126 mg/dl or > 200 mg /dl at any time, and patients with known diabetes. Age, sex, type of diabetes, time since diagnosis, chronic complications, prior treatment, length of stay, admission and discharge diagnosis were registered. All capillary BG levels obtained from each patient until discharge, death or transfer, were registered. Results: Ninety nine patients aged 63 ± 13.4 years (42 males,) were included. Ninety one percent had a type 2 diabetes with a mean duration of 13.8 years. Mean hospital stay was 10.9 days. At least one hypoglycemia below 70 mg/dl occurred in 21% of patients and 39.4% had at least one episode with blood glucose over 300 mg/dl. Median hospital stay of patients with no episode of BG > 200 mg/dl was 6 days, 10.5 days among patients with at least one episode of BG > 300 mg/dl and 13 days among patients that had at least one episode of hypoglycemia (p = 0.02). Diabetes lasted nine years more among the latter (p < 0.01). Three patients that suffered hypoglycemia and two in the rest of the groups, died (NS). Conclusions: Two of three diabetic patients admitted to our non-critical medical ward have a non-optimal glycemic control. Appearance of hypoglycemia is associated with a longer hospital stay.

Trastornos lipídicos en pacientes de 15 a 64 años en un consultorio médico del municipio de Rodas / Lipid disorders in patients of 15 to 64 years old in a medical doctor's office in the municipalty of Rodas

Dentro de las enfermedades crónicas no trasmisibles, las de índole vascular encabezan a escala mundial lo registros de morbi-mortalidad de la población adulta. Los trastornos lipídicos aumentan estas afecciones. Determinar la presencia de trastornos lipídicos en pacientes de 15 a 64 años, del consultorio 3 del área de salud urbana del municipio de Rodas, Cienfuegos. Estudio descriptivo y de corte transversal, realizado en un universo constituido por 438 pacientes con edades comprendidas entre los 15 y 64 años, del que se obtuvo una muestra representativa de 263 pacientes, mediante la aplicación del método estratificado por sexo y edad, tomándose como grupo de edades estratos de 10 años y por sexo. A todos los pacientes se les realizó la prueba de frío y los exámenes de colesterol y triglicéridos. Resultados y Conclusiones: Los factores de riesgo que más se relacionaron con el tipo de hiperlipoproteinemia fueron la ingestión de bebidas alcohólicas, la alimentación inadecuada, el sedentarismo y el sobrepeso. El 26, 9 porciento de los pacientes objeto de estudio presentaron diagnóstico de hiperlipoproteinemia, de ellos el 63, 4 porciento pertenecen al sexo masculino y el 50,7 porciento al grupo de edad de 45 a 54 años que fue el que predominó en nuestro trabajo. El tipo de hiperlipoproteinemia que se encontró con mayor porcentaje fue la tipo IIb con un 38 porciento, seguida de la tipo IIa y la tipo IV con 23, 9 porciento y 22, 5 porciento respectivamente. Las enfermedades no trasmisibles que más se asociaron fueron la hipertensión arterial con un 29, 6 porciento, la diabetes mellitus con un 18, 3 porciento y la angina de pecho un 12, 7 porciento(AU)

[Selective intra arterial calcium stimulation for the localization of insulinomas. Report of two cases]. / Test de estimulación intraarterial selectiva con calcio en el diagnóstico de localización de insulinomas. Casos clínicos.

Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonogrphy did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done.