Lo que nos preocupa a los médicos. Reflexión y enseñanza: Una experiencia educativa en el Grado de Medicina Universidad Autónoma de Madrid

Los valores clínicos en el ejercicio de la medicina son múltiples y muchas veces los médicos no somos conscientes de los mismos cuando trabajamos. No existen técnicas suficientemente contrastadas para la enseñanza efectiva de la reflexión y el profesionalismo. Objetivos: Integrar la enseñanza del humanismo y del profesionalismo en el currículum del estudiante de medicina en etapas tempranas. Utilizar la reflexión personal, como técnica más efectiva para la docencia del profesionalismo. Material y Métodos: Se invitó, a través del envío de un vídeo, a los estudiantes de 2º curso Medicina, en la asignatura Introducción a la Práctica clínica y tras la rotación por consulta en el centro de salud, a participar en un seminario de reflexión "sobre lo que nos preocupa a los médicos", vivencia de la enfermedad y profesionalismo. La sesión de 90 minutos, fue dirigida por los profesores responsables de la asignatura y grabada. Se acompañó de un observador externo, psiquiatra, para la evaluación posterior. Resultados: Las preocupaciones recogidas fueron: Lograr una calidad humana en la atención al individuo y la comunidad, Habilidades en comunicación, Compromiso emocional. Gestionar sus miedos. Tras el feed back expresan ganaron en confianza, al poder dar salida a sus dudas, y reforzada la vocación médica. Conclusiones: La reflexión se identifica como un componente clave del profesionalismo, y se debiera incluir en los planes de estudio formativos de los profesionales de la saludThe clinical values in the practice of medicine are multiple and many times doctors are not aware of them when we work. There are no sufficiently proven techniques for effective teaching of reflection and professionalism. Objectives: Integrate the teaching of humanism and professionalism in the curriculum of the medical student in early stages. Use personal reflection as the most effective technique for teaching professionalism. Material Methods: Through the sending of a video, the students of the 2nd year Medicine were invited in the subject Introduction to Clinical Practice and after the rotation by consultation in the health center, to participate in a reflection seminar "on what we care about doctors ", experience of the disease and professionalism. The 90-minute session was directed by the teachers responsible for the subject and recorded. He was accompanied by an external observer, a psychiatrist, for further evaluation. Results: The concerns collected were: Achieve a human quality in the attention to the individual and the community, Communication skills, Emotional commitment and Manage your fears. After the feedback they expressed confidence, being able to answer their questions, and reinforced the medical vocation. Conclusions: Reflection is identified as a key component of professionalism, and should be included in the training curricula of health professional

Medical students maintain their humanistic and patient‑centred vocation throughout Medicine Degree in Spain: a study based on narratives

Narrative medicine has great educational potential in the degree of medicine. This study explores for the frst time the use of narrative medicine in relation to longitudinal evolution of medical vocation for the same group of students. In the context of the Degree in Medicine at the Universidad Autónoma de Madrid (Spain), students wrote narratives about what it meant to them to be a doctor at the beginning and end of their studies. The narratives of 338 students of the academic years 2012/13– 2017/18 and 2013/14–2018/19 were analysed and compared. Students mostly pursued a degree in medicine on account of humanistic motivations, which are reinforced throughout their degree. In contrast, up to 10% of students reference to have experienced vocational crises and sufered frustration, with up to 25% of the references pertaining to having made signifcant sacrifces. Students maintain and evolve their humanistic, patient-centred vision throughout their degree studies, despite the difculties they appear to encounter. We suggest that eforts must be made to include more humanistic perspectives in the medical degree to keep this trend, which may improve both the educational experience created in universities and the health care given to patient

Analysis of the common genetic component of large-vessel vasculitides through a meta- Immunochip strategy

Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are major forms of large-vessel vasculitis (LVV) that share clinical features. To evaluate their genetic similarities, we analysed Immunochip genotyping data from 1,434 LVV patients and 3,814 unaffected controls. Genetic pleiotropy was also estimated. The HLA region harboured the main disease-specific associations. GCA was mostly associated with class II genes (HLA-DRB1/HLA-DQA1) whereas TAK was mostly associated with class I genes (HLA-B/MICA). Both the statistical significance and effect size of the HLA signals were considerably reduced in the cross-disease meta-analysis in comparison with the analysis of GCA and TAK separately. Consequently, no significant genetic correlation between these two diseases was observed when HLA variants were tested. Outside the HLA region, only one polymorphism located nearby the IL12B gene surpassed the study-wide significance threshold in the meta-analysis of the discovery datasets (rs755374, P?=?7.54E-07; ORGCA?=?1.19, ORTAK?=?1.50). This marker was confirmed as novel GCA risk factor using four additional cohorts (PGCA?=?5.52E-04, ORGCA?=?1.16). Taken together, our results provide evidence of strong genetic differences between GCA and TAK in the HLA. Outside this region, common susceptibility factors were suggested, especially within the IL12B locus

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

IMPACTO DE VARIÁVEIS CONGNITIVAS E CONTEXTUAIS SOBRE O SUCESSO ACADÊMICO E O BEM ESTAR NA UNIVERSIDADE – QUE FAZER? QUE DEIXAR DE FAZER?

Este estudo parte de uma investigação longitudinal (2019-2022) mais ampla, vinculada ao Grupo Multidisciplinar de Pesquisa em Educação, Psicopedagogia e Psicologia Escolar, UFAM/CNPq, PROCAD/AMAZÔNIA-PPGEUFAM/UFPA/UFMT, Processo CAPES 8881.314288/2019-0, articula-se metodológica e teoricamente com interfaces entre a psicologia escolar, psicologia educacional, pedagogia do ensino superior e educação escolar. Atua no sentido de entender os efeitos de variáveis cognitivas e contextuais sobre o sucesso acadêmico e o bem estar na universidade. A metodologia para coleta de dados é a aplicação de caderno de instrumentos próprios com apoio do Googleodocs, a amostra atual é de n=1112 estudantes de diferentes países (Brasil, México, República Dominicana, Bolívia, Moçambique, Angola, Venezuela, Colômbia, Espanha e Portugal), do sexo masculino e feminino, idade entre 18 e 54 anos e de 51 universidades públicas e privadas que colaboram com a iniciativa. Os dados são analisados com auxílio do Excel e SPSS, de acordo com os interesses dos pesquisadores e objetivos da investigação. Os resultados atuais demonstram a importância da pesquisa sobre os temas abordados pela iniciativa considerando o impacto das variáveis estudadas sobre o rendimento acadêmico e bom estar tanto de estudantes como de docentes e técnicos no ensino superior. Foram identificadas diferenças de países, renda, etnia, gênero e renda. No caso dos docentes e técnicos verificamos evidências da exaustão feminina. Os resultados podem apoiar a administração geral e coordenação educativa e psicopedagógica universitária em sentido amplo, visando a melhoria dos indicadores de sucesso acadêmico e bem estar, por meio da proposição de novas políticas e gestão da educação superior. Palavras-chave: Pesquisa em educação, Ensino superior, Rendimento acadêmico, Bem estar. Políticas de gestão da educação superior. Educação comparada.   IMPACT OF COGNITIVE AND CONTEXTUAL VARIABLES ABOUT ACADEMIC PERFORMANCE AND  WELLBEING IN THE UNIVERSITY. Whato to do? Qhato not to do?   Abstract: This study, part of a further longitudinal investigation (2019-2022), attached to a multidisciplinary group of Educational Research  Scholar Psychotherapy and Psychology, UFAM/CNPq, PROCAD/AMAZONIA-PPGEUFAM/UFPA/UFMT, CAPES process 8881.314288/2019-0, it is articulated methodological and theoretically with interfaces between the scholar and educational psychology, upper and scholar education pedagogy. It acts in the direction of understanding 5he effects og cognitive and contextual variables about the academic achievement and wellness in the university. The methodology to data collection is the application of own instrument cards with the support of Googledocs, the actual sample is quantity of n=1112 students from 51 private and public universities of different countries (Brazil, Mexico, Dominican Republic, Bolivia, Mozambique, Angola, Venezuela, Colombia, Spain and Portugal), from both male and female genders, aging between 18 and 54 years-old. The data were analyzed with the support of software Excel and SPSS, according to the interests of researchers and investigation focus. The actual results show the importance of the research about the themes cited in the initiative considering the impacts of the studied variables over the academic performance and wellness of the students as the teachers and technicians from upper education. There were found differences between countries, income, ethnic and gender. In the cases of the teachers and technicians it was found evidences of female exhaustion. The results could support the general administration, educative and psychopedagogy coordination and in a wide range, looking forward the better successful academic indicators and wellness, through the proposition of new policies and management of upper education. Keywords: Educational Reserch, upper educatión, academic performance, wellness, upper educaciton mangement policies, compared education. &nbsp

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049