RESUMEN
BACKGROUND: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. AIM: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. PATIENTS AND METHODS: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. RESULTS: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. CONCLUSIONS: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.
Asunto(s)
Toma de Decisiones Clínicas , Servicio de Urgencia en Hospital , Mortalidad Hospitalaria , Equipo Hospitalario de Respuesta Rápida/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Signos Vitales , Cuidados Críticos , Diagnóstico Precoz , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Factores de TiempoAsunto(s)
Pandemias , Estudiantes de Enfermería , Curriculum , Evaluación Educacional , Humanos , AprendizajeAsunto(s)
Absceso/etiología , Aspergilosis/etiología , Aspergillus fumigatus/aislamiento & purificación , Trasplante de Hígado , Nefritis/etiología , Infecciones Oportunistas/etiología , Complicaciones Posoperatorias/etiología , Absceso/microbiología , Absceso/cirugía , Adulto , Aspergilosis/cirugía , Hepatitis Autoinmune/cirugía , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , Nefrectomía , Nefritis/microbiología , Nefritis/cirugía , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/cirugía , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: The first part of the medical interview is perhaps one of the most significant components of the doctoras role. How to collect relevant information and how to build a therapeutic relationship with the patient must be taught during the undergraduate curriculum. Clinical teachers have little experience in the teaching skills required to help students learn about doctor-patient communication. AIM: To measure outcomes and perceptions of using a co-teaching model in a course on interviewing during the third year of medical school in the Pontificia Universidad Católica de Chile. MATERIAL AND METHODS: A mixed methods controlled study in which the intervention group participated in a co-teaching workshop with a clinical teacher and a specialist in doctor-patient communication skills (SDPC). The control group participated in a workshop with one clinical teacher. All students completed a questionnaire measuring perception of their learning in communication skills. Semi-structured interviews were used to collect the clinical teachers' perception. At the end of the course, the clinical and communication skills of all the students were measured in an objective structured clinical examination. RESULTS: Students and teachers agreed that co-teaching allows greater emphasis and practice in communication skills. The results of the objective structured clinical examination show that despite this greater emphasis, no deleterious effect on the clinical skills was demonstrated during the exam. CONCLUSIONS: The use of co-teaching in a course on interviewing allows students to perceive a higher level of learning in communication skills, and possibly enhances their skills. The clinical teachers felt that the co-teacher was an important support.
Asunto(s)
Comunicación , Educación de Pregrado en Medicina , Anamnesis/métodos , Relaciones Médico-Paciente , Enseñanza/métodos , Chile , HumanosRESUMEN
Urticaria pigmentosa, also known as maculopapular mastocytosis, is the most common type of paediatric mastocytosis. It presents with yellow to brown macules or papules, usually located on trunk and extremities. Regarding its diagnostic and therapeutic implications, the objective of this article is to serve as an update for the paediatrician on the most relevant aspects of this pathology.
La urticaria pigmentosa, también conocida como mastocitosis maculopapular, es el tipo de mastocitosis más común en la edad pediátrica. Se presenta con máculas o pápulas de color amarillo-marrón, usualmente localizadas en el tronco y las extremidades. Considerando sus implicancias diagnósticas y terapéuticas, el objetivo de este artículo es brindar al pediatra una actualización de los aspectos más relevantes de esta patología.
Asunto(s)
Urticaria Pigmentosa/diagnóstico , Urticaria Pigmentosa/terapia , Niño , Humanos , PediatríaRESUMEN
No disponible
Asunto(s)
Humanos , Educación Médica/métodos , Modelos Educacionales , Aprendizaje , Aprendizaje Basado en Problemas , Estudiantes del Área de la Salud , Pandemias , Infecciones por CoronavirusRESUMEN
Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.
Asunto(s)
Ectima/microbiología , Ectima/patología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/patología , Anciano , Biopsia , Ectima/tratamiento farmacológico , Epidermis/microbiología , Epidermis/patología , Femenino , Gangrena , Humanos , Inmunocompetencia , Factores de Riesgo , Infecciones Estafilocócicas/tratamiento farmacológicoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Aspergilosis/complicaciones , Aspergilosis/tratamiento farmacológico , Trasplante de Hígado , Voriconazol/uso terapéutico , Nefrectomía/métodos , Sirolimus/uso terapéutico , Factores de Riesgo , Aspergillus fumigatus , Aspergillus fumigatus/aislamiento & purificación , Fallo Hepático/complicaciones , Dolor de la Región Lumbar/etiología , Terapia de InmunosupresiónRESUMEN
Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.
Asunto(s)
Humanos , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Mortalidad Hospitalaria , Servicio de Urgencia en Hospital , Signos Vitales , Equipo Hospitalario de Respuesta Rápida/estadística & datos numéricos , Toma de Decisiones Clínicas , Factores de Tiempo , Cuidados Críticos , Diagnóstico Precoz , Hospitales UniversitariosAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Pacientes Internos , Examen Físico , Sacroileítis/diagnóstico , Sacroileítis/tratamiento farmacológico , Bartonella henselae , Infecciones por Bartonella/diagnóstico , Infecciones por Bartonella/tratamiento farmacológico , Enfermedad por Rasguño de Gato , Enfermedades Transmisibles , Resorción Ósea , Esplenomegalia , Combinación Piperacilina y Tazobactam , VancomicinaRESUMEN
El ectima gangrenoso es una vasculitis necrosante poco frecuente, en la mayoría de los casos secundaria a sepsis por Pseudomonas aeruginosa en pacientes inmunocomprometidos. Sin embargo, existen reportes de ectima gangrenoso secundarios a otras etiologías infecciosas. Presentamos un caso de ectima gangrenoso asociado a una infección por Staphylococcus aureus resistente a meticilina en una paciente sin los factores de riesgo clásicos de inmunosupresión que se describen en la literatura médica.
Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.
Asunto(s)
Humanos , Femenino , Anciano , Infecciones Estafilocócicas/patología , Ectima/microbiología , Ectima/patología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/tratamiento farmacológico , Biopsia , Factores de Riesgo , Ectima/tratamiento farmacológico , Epidermis/microbiología , Epidermis/patología , Gangrena , InmunocompetenciaRESUMEN
Background: The first part of the medical interview is perhaps one of the most significant components of the doctoras role. How to collect relevant information and how to build a therapeutic relationship with the patient must be taught during the undergraduate curriculum. Clinical teachers have little experience in the teaching skills required to help students learn about doctor-patient communication. Aim: To measure outcomes and perceptions of using a co-teaching model in a course on interviewing during the third year of medical school in the Pontificia Universidad Católica de Chile. Material and Methods: A mixed methods controlled study in which the intervention group participated in a co-teaching workshop with a clinical teacher and a specialist in doctor-patient communication skills (SDPC). The control group participated in a workshop with one clinical teacher. All students completed a questionnaire measuring perception of their learning in communication skills. Semi-structured interviews were used to collect the clinical teachers' perception. At the end of the course, the clinical and communication skills of all the students were measured in an objective structured clinical examination. Results: Students and teachers agreed that co-teaching allows greater emphasis and practice in communication skills. The results of the objective structured clinical examination show that despite this greater emphasis, no deleterious effect on the clinical skills was demonstrated during the exam. Conclusions: The use of co-teaching in a course on interviewing allows students to perceive a higher level of learning in communication skills, and possibly enhances their skills. The clinical teachers felt that the co-teacher was an important support.
Asunto(s)
Humanos , Comunicación , Educación de Pregrado en Medicina , Anamnesis/métodos , Relaciones Médico-Paciente , Enseñanza/métodos , ChileRESUMEN
No disponible