Representaciones sociales de la práctica formativa en estudiantes de fisioterapia en Colombia / Social representations of formative practice in physical therapy students, Santiago de Cali, Colombia

INTRODUCCIÓN: Las prácticas formativas son estrategias pedagógicas con las que los estudiantes se acercan a la práctica profesional y desarrollan destrezas y habilidades en fisioterapia. OBJETIVO: Analizar las representaciones sociales del concepto de práctica formativa en estudiantes de fisioterapia en la ciudad de Cali (Colombia). MATERIAL Y MÉTODOS: Estudio cualitativo con diseño descriptivo, transversal y exploratorio. Los datos se recolectaron con la técnica de listado de palabras de asociación libre aplicada a 135 participantes. El análisis se realizó a través del modelo de los dominios culturales. RESULTADOS: El concepto de práctica formativa en fisioterapia se estructuró a través de los lexemas centrales definición, sentimientos positivos, sentimientos negativos. Los elementos más relevantes de la lista fueron felicidad y ansiedad. CONCLUSIONES: Las representaciones sociales más notables en los estudiantes están asociadas con aspectos relacionados con el ser y las de menos interés corresponden a los relacionados con la adquisición de destrezas y habilidades fisioterapéuticas

INTRODUCTION: Formative practices are pedagogical strategies where students enter professional practice and develop skills and abilities in physiotherapy. OBJECTIVE: To analyse the cultural meanings of the concept of formative practice in physical therapy students in the city of Cali, Colombia. MATERIAL AND METHODS: Qualitative study with descriptive design, cross-sectional and exploratory. The data were collected using the free association word list method from 135 participants. The analysis was conducted through the cultural domain model. RESULTS: The concept of formative practice in physiotherapy was structured through the central lexemes definition, positive feelings, negative feelings. The most relevant elements of the list were happiness and anxiety. CONCLUSIONS: The most notable social representations in students are associated with aspects related to the self, and those of less interest correspond to the acquisition of physiotherapy skills and abilities

Evaluating the Reliability and Validity Evidence of the RIME (Reporter-Interpreter-Manager-Educator) Framework for Summative Assessments Across Clerkships.

PURPOSE: The ability of medical schools to accurately and reliably assess medical student clinical performance is paramount. The RIME (reporter-interpreter-manager-educator) schema was originally developed as a synthetic and intuitive assessment framework for internal medicine clerkships. Validity evidence of this framework has not been rigorously evaluated outside of internal medicine. This study examined factors contributing to variability in RIME assessment scores using generalizability theory and decision studies across multiple clerkships, thereby contributing to its internal structure validity evidence. METHOD: Data were collected from RIME-based summative clerkship assessments during 2018-2019 at Virginia Commonwealth University. Generalizability theory was used to explore variance attributed to different facets through a series of unbalanced random-effects models by clerkship. For all analyses, decision (D-) studies were conducted to estimate the effects of increasing the number of assessments. RESULTS: From 231 students, 6,915 observations were analyzed. Interpreter was the most common RIME designation (44.5%-46.8%) across all clerkships. Variability attributable to students ranged from 16.7% in neurology to 25.4% in surgery. D-studies showed the number of assessments needed to achieve an acceptable reliability (0.7) ranged from 7 in pediatrics and surgery to 11 in internal medicine and 12 in neurology. However, depending on the clerkship each student received between 3 and 8 assessments. CONCLUSIONS: This study conducted generalizability- and D-studies to examine the internal structure validity evidence of RIME clinical performance assessments across clinical clerkships. Substantial proportion of variance in RIME assessment scores was attributable to the rater, with less attributed to the student. However, the proportion of variance attributed to the student was greater than what has been demonstrated in other generalizability studies of summative clinical assessments. Overall, these findings support the use of RIME as a framework for assessment across clerkships and demonstrate the number of assessments required to obtain sufficient reliability.

Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria / Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice

OBJETIVO: Describir en el entorno de la práctica clínica diaria, el perfil del paciente con vejiga hiperactiva (VH) tratado con dosis flexible de antimuscarícos. MÉTODOS: Estudio observacional, retrospectivo y multicéntrico llevado a cabo en 88 Hospitales públicos y privados. Se incluyeron pacientes adultos, diagnosticados de VH que iniciaron tratamiento con algún antimuscarínico a dosis flexible. Se recogió tipo de antimuscarínico, dosis, tratamientos concomitantes, beneficio aportado y cumplimiento terapéutico. RESULTADOS: Población constituida por 846 pacientes mayores de 60 años, pluripatológica (83,5%) y polimedicada (73,4%), formada mayoritariamente por mujeres (74,5%) y con más de un año de evolución de la VH. Principales antimuscarínicos inicialmente prescritos: fesoterodina (66,9%) y solifenacina (31,0%). El 68,2% de los pacientes iniciaron el tratamiento con la dosis baja. En la visita de seguimiento, el 47,0% modificó dosis (84,2% aumentaron la dosis, 15,8% disminuyeron la dosis). Los grupos que tuvieron que modificar dosis presentaron significativamente mayor morbilidad, peor sintomatología, mayor empleo de recursos sanitarios y peor cumplimiento terapéutico que el grupo de pacientes tratados siempre a dosis alta. CONCLUSIÓN: En determinados pacientes, el empleo desde el inicio del tratamiento antimuscarínico de dosis- flexible a la dosis más alta, podría proporcionar mayor beneficio terapéutico, adherencia y menor empleo de recursos sanitarios que el escalado de dosis

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5%) and polymedicated (73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose

Búsqueda de cáncer oculto en pacientes con tromboembolismo venoso: un dilema por resolver / Search for occult cancer in patients with venous thromboembolism: A dilemma to resolve

No disponible

Ready for action / Listos para la acción

No disponible

Perfil clínico de la mujer con cardiopatía isquémica estable en España. Son necesarios más esfuerzos en prevención secundaria. Estudio SIRENA / The clinical profile of women with stable ischaemic heart disease in Spain. More effort is needed in secondary prevention. SIRENA study

Objetivos. Las enfermedades cardiovasculares son la primera causa de muerte en mujeres, particularmente la cardiopatía isquémica, que aún se sigue considerando una enfermedad de hombres. En España hay diversos registros sobre cardiopatía isquémica, aunque ninguno exclusivo de mujeres. Los objetivos de SIRENA fueron describir el perfil clínico de las mujeres con cardiopatía isquémica atendidas en las consultas de cardiología, estimar su prevalencia de factores de riesgo cardiovascular y conocer su manejo clínico y tratamiento. Pacientes y métodos. Estudio multicéntrico, observacional, con una muestra de 631 mujeres con cardiopatía isquémica estable, incluidas consecutivamente en las consulta de cardiología. Participaron 41 investigadores de toda España. Resultados. La edad media fue de 68,5 años. La presentación clínica fue en forma de síndrome coronario agudo hasta en un 67,2%. La prevalencia de factores de riesgo cardiovascular fue elevada (77,7% hipertensión, 40,7% diabetes y 68% dislipidemia), con un 30,7% de hipertensión no controlada, un 78,4% con cifras de colesterol-LDL superiores a 70mg/dl y un 49,2% con HbA1c superior al 7%. La gran mayoría de las pacientes recibían tratamiento médico óptimo con antiagregantes, betabloqueantes, bloqueadores del eje renina-angiotensina-aldosterona e hipolipidemiantes. Se realizó coronariografía en el 88,3% de los casos e intervencionismo coronario percutáneo en el 63,4%. Conclusiones. La mujer con cardiopatía isquémica estable en España tiene una presentación clínica inicial con alguna forma de síndrome coronario agudo y una elevada prevalencia de factores de riesgo cardiovascular inadecuadamente controlados, pese a recibir terapia médica óptima. Un elevado porcentaje se somete a revascularización coronaria. Son precisos más esfuerzos en la prevención secundaria de las mujeres con cardiopatía isquémica estable (AU)

Objectives. Cardiovascular diseases are the leading cause of death for women, especially ischaemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischaemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischaemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. Patients and methods. A multicentre observational study was conducted with a sample of 631 women with stable ischaemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. Results. The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. Conclusions. Women with stable ischaemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischaemic heart disease (AU)

Evaluación de la adherencia al tratamiento con calcio y vitamina D en ancianos de una zona básica de salud / Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area

Introducción y objetivo. El déficit de vitamina D en los ancianos es elevado. Complementar con suplementos de calcio y vitamina D es una práctica habitual en individuos con riesgo de caídas y/o fracturas que, sin embargo, obtiene un bajo grado de cumplimiento. El objetivo es determinar la adherencia al calcio y vitamina D en ancianos con hipovitaminosis D en una zona urbana de Madrid. Pacientes y métodos. Estudio de intervención en 438 individuos ≥ 65 años con hipovitaminosis D procedentes de la «Cohorte Peñagrande». Se les pautó calcio y vitamina D y se valoró la adherencia a los 3 y 12 meses mediante el test de Morisky-Green y el recuento de recetas prescritas. Resultados. Se analizaron 413 de los 438 individuos con hipovitaminosis D (18 casos no se trataron por contraindicaciones y 7 se perdieron). A los 3 y 12 meses el 63,9 y el 47,2%, respectivamente, fueron adherentes. El 19,3% de los no adherentes a los 3 meses fueron buenos cumplidores al año tras una intervención educativa breve. La comorbilidad se asoció con menor adherencia al año (46,3% versus 35,2%, p = 0,027). La principal causa de no adherencia al calcio fue la intolerancia digestiva, y a la vitamina D, los olvidos. Se observó concordancia entre valorar la adherencia con el test de Morisky y recuento de recetas prescritas (índice Kappa = 69,8%). Conclusiones. La falta de adherencia a tratamientos crónicos con calcio y vitamina D es un problema relevante en ancianos. Es importante evaluar la adherencia y aplicar estrategias de educación sanitaria en la práctica clínica (AU)

Background and objective. The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. Patients and methods. Intervention study performed on 438 individuals ≥ 65 years from the ‘Peñagrande Cohort’ with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. Results. A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P = .027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index = 69.8%). Conclusions. Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice (AU)

Los grandes olvidados: Los trastornos cognitivos en la enfermedad de Parkinson / No disponible

Los trastornos cognitivos forman parte de la sintomatología de la enfermedad de Parkinson, son muy frecuentes, heterogéneos y pueden presentarse incluso desde el inicio de la enfermedad. Aunque durante años han recibido poca atención, tanto desde la investigación como desde la práctica clínica, la publicación en 2007 de los criterios de Demencia asociada a la EP y especialmente de Deterioro cognitivo Leve asociado a la EP (DCL-EP) en 2012 ha contribuido a que haya un renovado interés de clínicos y científicos en caracterizar dichos trastornos y en optimizar su tratamiento. Este interés ha hecho que se progrese en pocos años de una manera rápida en esta área. Los datos actuales muestran que es necesario actualizar los criterios de DCL-EP para poder seguir avanzando: requerir una exploración neuropsicológica completa y bien definida, establecer un punto de corte explícito con datos aceptables en sensibilidad y especificidad, y, sobre todo, poder clasificar el DCL-EP en unos subtipos que puedan guiarnos acerca del pronóstico, manejo y tratamiento del paciente

Cognitive disorders are part of the symptomatology of Parkinson’s disease. They are very common, heterogeneous and can be found since the onset of the disease. Nevertheless, for years, cognitive symptoms in PD have received scant attention both from research and from clinical practice. The pu-blication of criteria for dementia associated with PD in 2007 and especially the criteria for Mild Cognitive Impairment associated with PD (PD-MCI) in 2012, has contributed to a renewed interest in clinicians and scientists, to classify these disorders and optimize their treatment. This attention has helped on improving in this area quite fast. Current data show a need to update the criteria for MCI -EP to move forward: Ask for an exhaustive and well defined neuropsychological examination, establish an accurate cut-off with acceptable sensitivity and specificity data, and let classify the DCL-EP in subtypes that can help us the patient’s prognosis, management and treatment

Tratamientos psicológicos con apoyo empírico y práctica clínica basada en la evidencia / No disponible

La investigación sobre el efecto de los tratamientos psicológicos ha ido progresando desde una postura de validación y apoyo empírico hasta su formulación como un modelo de práctica basada en la evidencia. Encontrar la evidencia más válida, desarrollar teorías coherentes y comprensibles, trabajar con clínicos expertos y reconocer la importancia del paciente permitirá componer un modelo que facilite el avance del conocimiento sobre los tratamientos psicológicos más eficaces (AU)

The investigation on the effect of psychological treatments has gone progressing since a position of validation and empirical support to its formulation as a model of practice based on the evidence. To find the most valid evidence, develop understandable and coherent theories, work with clinical experts and recognize the importance of the patient will permit to compose a model that facilitate the advance of the knowledge on the most efficacy psychological treatments (AU)