Evaluation of learning outcomes of humanities curricula in medical students. A meta-review of narrative and systematic reviews

ObjectivesTo assess the expected learning outcomes of medical humanities subjects in medical studies curricula. To connect those expected learning outcomes with the types of knowledge to be acquired in medical education.MethodsMeta-review of systematic and narrative reviews. Cochrane Library, MEDLINE (Pubmed), Embase, CINAHL, and ERIC were searched. In addition, references from all the included studies were revised, and the ISI Web of Science and DARE were searched.ResultsA total of 364 articles were identified, of which six were finally included in the review. Learning outcomes describe the acquisition of knowledge and skills to improve the relationship with patients, as well as the incorporation of tools to reduce burnout and promote professionalism. Programs that focus on teaching humanities promote diagnostic observation skills, the ability to cope with uncertainty in clinical practice, and the development of empathetic behaviors.ConclusionThe results of this review show heterogeneity in the teaching of medical humanities, both in terms of content and at the formal level. Humanities learning outcomes are part of the necessary knowledge for good clinical practice. Consequently, the epistemological approach provides a valid argument for including the humanities in medical curricula

Consentimiento de Zelen y autonomía del paciente: una revisión narrativa

La obtención del consentimiento informado previo a la inclusión de los participantes en un ensayo clínico es un requisito ético-jurídico. En el diseño de Zelen la aleatorización es previa al consentimiento. En esta revisión se describen los estudios con aleatorización de Zelen y se analizan según lo establecido en España por la Ley 41/2002 Básica de Autonomía del Paciente, el RD 1090/2015 y la Ley 14/2007 de Investigación Biomédica. Se encontraron 78 estudios y se seleccionaron 23. El 61% eran “doble consentimiento”. En el 17,3% se justificaba el uso de este consentimiento porque incrementaba el reclutamiento de pacientes. El diseño de Zelen tiene varias limitaciones éticas. En los estudios revisados no aparecen argumentos claros para su utilización

Consentimiento de Zelen y autonomía del paciente: una revisión narrativa

Obtaining informed consent (CI) prior to the inclusion of participants in a clinical trial is an ethical-legal requirement. In the Zelen design randomization of subjects is prior to the application for consent to participate. In this review the studies with random of Zelen are described and analyzed according to the established in Spain by the Law 41/2002 Basic of Autonomy of the Patient, the RD 1090/2015 and the Law 14/2007 of Biomedical Investigation. 78 studies were found and 23 were selected. 61% was a "double assent". In 17,3% there was justifying itself the use of this consent because it was increasing the patients' recruitment. Zelen's design has several ethical limitations. In the studies analysed are no clear arguments for his utilization.La obtención del consentimiento informado previo a la inclusión de los participantes en un ensayo clínico es un requisito ético-jurídico. En el diseño de Zelen la aleatorización es previa al consentimiento. En esta revisión se describen los estudios con aleatorización de Zelen y se analizan según lo establecido en España por la Ley 41/2002 Básica de Autonomía del Paciente, el RD 1090/2015 y la Ley 14/2007 de Investigación Biomédica. Se encontraron 78 estudios y se seleccionaron 23. El 61% eran “doble consentimiento”. En el 17,3% se justificaba el uso de este consentimiento porque incrementaba el reclutamiento de pacientes. El diseño de Zelen tiene varias limitaciones éticas. En los estudios revisados no aparecen argumentos claros para su utilización

PCR persistentemente positiva tras la COVID-19 ¿Cómo diagnósticar las reinfecciones?.

La persistencia de una prueba de reacción en cadena de la polimerasa (PCR) positiva durante un tiempo prolongado en pacientes que han presentado un síndrome respiratorio grave asociado a coronavirus puede interferir en el diagnóstico de las reinfecciones, ocasionando así falsos positivos de la enfermedad, con las implicaciones que ello tiene para la necesidad de aislamiento y, en consecuencia, para la Salud Pública. Presentamos aquí la experiencia de una paciente con PCR positiva de ocho meses de evolución a la que se le diagnosticó erróneamente una reinfección de COVID-19 por una gastroenteritis aguda, resultando en realidad ser una infección por Campylobacter jejuni.post-print651 K

Evolution of a Cohort of COVID-19 Infection Suspects Followed-Up from Primary Health Care

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p < 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission

Persistently positive PCR after COVID-19. How to diagnose reinfections?

La persistencia de una prueba de reacción en cadena de la polimerasa (PCR) positiva durante un tiempo prolongado en pacientes que han presentado un síndrome respiratorio grave asociado a coronavirus puede interferir en el diagnóstico de las reinfecciones, ocasionando así falsos positivos de la enfermedad, con las implicaciones que ello tiene para la necesidad de aislamiento y, en consecuencia, para la Salud Pública. Presentamos aquí la experiencia de una paciente con PCR positiva de ocho meses de evolución a la que se le diagnosticó erróneamente una reinfección de COVID-19 por una gastroenteritis aguda, resultando en realidad ser una infección por Campylobacter jejuni.Persistence of a long-term positive polymerase chain reaction (PCR) test in patients with severe coronavirus-associated respiratory syndrome may interfere with the diagnosis of reinfections, causing false positives of the disease, with the potential implications to determine the need for isolation and, consequently, for Public Health. In these field notes we present the experience of a patient with positive PCR of eight months of evolution to which an erroneous diagnosis of COVID-19 reinfection was made due to a gastrointestinal disease, resulting in a Campylobacter jejuni infection

Design of Fear and Anxiety of COVID-19 Assessment Tool in Spanish Adult Population

The aim of this study was to develop a specific scale to measure anxiety and fear levels in the general Spanish population. For this, a transcultural adaptation to Spanish of the fear of coronavirus disease 2019 (COVID-19) scale, in its original version of 10 items, was carried out. Then, the Anxiety and Fear of COVID-19 Assessment Scale (AMICO, for its acronym in Spanish) was designed by translating the tool and Delphi technique into three rounds. Ten experts participated voluntarily, and inter-observer match rates and the reliability study of the designed scale were calculated. A pilot study was carried out with the final version of the scale for the validity and reliability study. The instrument did not raise problems in semantic and cultural terms during the first and second rounds of the translation process, with an overall weighted Kappa value of 0.9. In the third round, eight new items were designed and consensual, obtaining a weighted overall value of 0.89. The pilot study sample was made up of 445 subjects, of which 60.3% were women with a mean age of 46.2 years. The final version consisted of 16 items, 2 factors, and a Cronbach’s alpha value of 0.92. The AMICO scale was developed to assess the level of anxiety and fear of COVID-19 and proved to be valid and reliable for its use in the adult Spanish population.Junta de Andalucía PI 036/2

Telephone Monitoring of Isolated Patients With Suspected COVID-19 Disease in Primary Care: Prospective Cohort Study.

Objective: Isolation of suspected cases of COVID-19 has been shown effective in reducing disease transmission and monitoring these patients from primary care allows to detect complications. The objective of this study is to determine the evolution of a cohort of patients with suspected COVID-19, and to analyse the factors associated with hospital admissions due to their unfavourable evolution. Methods: Prospective cohort study. A cohort of 166 patients with COVID-19 symptoms was selected and was followed-up by telephone calls during 14 days of home isolation. Results: By the end of the follow-up, a hospital admission had taken place in 14.7% of patients. The mean survival time until admission among diabetics was 12.6, 10.9 days for chronic kidney diseases, and 9.3 days in immunocompromised patients. Immunosuppression was a risk factor for admission over 50 years of age. Conclusion: Hospital admissions for suspected cases of COVID-19 are associated with diabetes, chronic kidney disease, and immunosuppression. Telephone monitoring of these patients from primary care allows for home isolation and early detection of disease complications.post-print774 K

Evaluación en resultados de salud del proceso diabetes tipo 2

ResumenObjetivoAnalizar la asociación entre el desarrollo del proceso diabetes tipo 2 (DM2) y la calidad de vida relacionada con la salud (CVRS).DiseñoEstudio descriptivo transversal.EmplazamientoUnidad de Gestión Clínica (Ayamonte, Huelva).ParticipantesSelección por muestreo aleatorio simple entre los pacientes registrados en el proceso DM2: n=143.El proceso DM2 es una herramienta que utiliza indicadores de buena práctica clínica para el seguimiento de los pacientes.Recogida de datos desde registros y entrevista personal para el cuestionario de CVRS SF-36.ResultadosSe analizaron 101 pacientes. 51,5% mujeres. Edad media: 66,8 años (DE 11,3). Realizan actividad física: 52,5%. Tiempo de evolución de la diabetes: 9,6 años (DE 7,7). Índice de calidad del proceso (ISCD): 64,5%.Peor puntuación en componente físico de CVRS, media de 41,9 (DE 9,6).Mayor puntuación en hombres. Practicar ejercicio físico regular mejora la puntuación (diferencia de medias de 19,5 IC95% 10,2–28,8). Asociación negativa entre: edad y función física (r=−0,354 p<0,005), tiempo de evolución de diabetes y componente sumario físico (r=−0,278 p<0,005).Retinopatía (t=2,03 p<0,04) y cardiopatía (t=2,6 p<0,008) se relacionan con menor puntuación en componente físico.La asociación de CVRS con control metabólico, automedida de glucemia y educación diabetológica es no significativa.Predictores de la CVRS son: actividad física y enfermedades comórbidas.ConclusionesLa CVRS es mala en los diabéticos tipo 2 a pesar de tener buenos indicadores en el proceso.Debería incluirse la CVRS como estándar del proceso DM2.AbstractObjectiveTo analyse association between the development of type 2 diabetes and the health-related quality of life (HRQL).DesignDescriptive cross-sectional study.SettingPrimary care centre in Ayamonte (Huelva). Participants: Selection by simple random sampling between the patients registered with type 2 diabetes: n=143.The type 2 diabetes process is a tool that uses indicators of good clinical practice for the follow-up of the patients.Collection of data from records and personal interview for the questionnaire HRQL SF-36.ResultsA total of 101 patients were analysed, of which 51.5% were women. the average age was 66.8 years (SD 11.3). Performing physical activity 52.5%. Time of evolution of diabetes: 9.6 years (SD 7.7). Quality Index of the process: 64.5%. Worst score in physical component HRQL, mean of 41.9 (SD 9.6). Men had a better score, and it improves if there is regular physical exercise (mean difference 19.5% IC95%CI: 10.2–28.8). Age was inversely associated with physical function (r −0.354 P<0,005); and the time of evolution of diabetes with physical component (r −0.278 P<0.005). Retinopathy (t=2.03 P<0.04) and heart disease (t=2.6 P<0.008) were associated with lowest score in physical component. The association of HRQL with metabolic control, self control of glucose and diabetes education was not significant. Physical activity and comorbid diseases predict HRQL.ConclusionsThe HRQL is poor in type 2 diabetics despite having good indicators in the process. The HRQL should be included as standard in the type 2 diabetes process