Numerus clausus in medical schools. Criteria and responsibilities in the number of admissions and in their distribution

Este número de la revista FEM incluye la transcripción integra de la reciente declaración del Foro de la Profesión Médica de España que, bajo el título '¿Por qué numerus clausus en medicina?', desgrana una serie de cuestiones, ciertamente opinables, pero que se sustentan básicamente en tres principios no refutables: mantener o mejorar la calidad de la formación de los médicos (y, por ende, la calidad de la asistencia), mantener o mejorar la relación coste-eficacia de la formación y mantener o mejorar el sentido común

Retos de la formación médica de grado

Las Facultades de Medicina españolas han iniciado un nuevo proceso de reforma curricular en el marco de la implantación del Espacio Europeo de Educación Superior (EEES). Este proceso constituye, sin duda, una nueva oportunidad, quizás la última en mucho tiempo, para llevar a cabo de una vez por todas la reforma en profundidad que nuestra formación de grado requiere. Los retos que se nos plantean son muchos y nada fáciles de afrontar. En este artículo vamos a discutir cuáles son estos retos y cómo deberíamos alcanzarlos. Para saber hacia dónde hemos de ir es imprescindible saber de dónde partimos y sobre todo dónde estamos. Por ello dividiremos nuestra exposición en tres períodos: el primero, que engloba el siglo XX desde 1930 a 1990, es un período en el que a pesar de su dilatada extensión apenas se producen cambios substanciales en nuestra formación de grado; el segundo, que se extiende desde finales del siglo XX a los principios del siglo actual (concretamente desde 1990 al 2003), abarca nuestro presente actual; y el tercero a partir del 2004, en el que comienzan a surgir los retos que el futuro nos depara

El 'Real Decreto de Troncalidad' de la formación especializada

Una vez la troncalidad ha dejado de ser un proyecto para convertirse en un RD tangible en el papel del BOE, la Fundación Educación Médica (FEM)considera oportuno y pertinente reflexionar sobre qué es la troncalidad, para qué es necesaria aquí y ahora, y cómo debería ser el proceso de su desarrollo

¿Qué opinan los expertos en educación médica sobre la sentencia de la troncalidad? What do the experts in medical education think about the ruling on the core curriculum?

Desde la Sociedad Española de Educación Médi­ca (SEDEM) y desde la Fundación Educación Mé­dica (FEM) ya hemos manifestado en diversos ám­bitos, que la tronca­ lidad transformaría el SNS

Bologna: excellence and ASPIRE

En editoriales anteriores reflexionamos sobre la excelencia y la calidad de la universidad que deseamos. De la excelencia decíamos que era un deseo, un camino y un esfuerzo, puesto que como meta, al igual que el horizonte, es inalcanzable. Respecto a la mejora de la calidad, decíamos que existen metodologías para ordenar la complejidad del proceso y señalábamos que precisa la participación de todos los agentes internos y de los relevantes externos a la propia universidad. La mejora de la calidad y la persecución de la excelencia docente son dos elementos claves del ADN del proceso de Bolonia

Compliance with Guidelines-Recommended Processes in Pneumonia: Impact of Health Status and Initial Signs

Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose 65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care

Predictors of severe sepsis among patients hospitalized for community-acquired pneumonia

Background Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP). Objective To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP. Results We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospi- talized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age ( > 65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07 - 1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50 - 2.04) and renal disease (OR, 1.57; 95% CI, 1.21 - 2.03), whereas prior antibiotic treat- ment was a protective factor (OR, 0.62; 95% CI, 0.52 - 0.73). Bacteremia (OR, 1.37; 95% CI, 1.05 - 1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31 - 1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10 - 2.49) were associated with severe sepsis CAP. Conclusions CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis

[4-(2-Hydroxyphenyl)imidazolium Salts as Organocatalysts for Cycloaddition of Isocyanates and Epoxides to Yield Oxazolidin-2-ones

Novel salts based on 1,3-dibutyl-4-(2-hydroxyphenyl)-1H-imidazolium bromide or iodide have been developed as bifunctional organocatalysts for the cycloaddition reaction of epoxides and isocyanates to form 3,4- and 3,5-disubstituted oxazolidin-2-ones. The molecular structure of these compounds was determined spectroscopically and confirmed by X-ray diffraction analysis. Imidazolium compounds were screened as catalysts to produce a range of oxazolidinones. The influence of the substituents on the aromatic ring and the counterion of the catalysts on the catalytic activity have been studied, showing that 1,3-dibutyl-4-(5-fluro-2-hydroxyphenyl)-1H-imidazolium iodide (4 d) was the most active catalyst for this process in the absence of a cocatalyst

Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study

Introduction: Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory. Methods: We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (±10 years), gender and period of admission (±10 weeks). Results: 476 patients (238 cases, 238 controls) were recruited for 2 years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcus pneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7 days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p<0.05, each). Conclusions: Despite a similar clinical presentation, HCAP was more severe due to patients' conditions (comorbidities) and showed worse clinical outcomes. Microbial aetiology of HCAP did not differ from CAP indicating that it is not related to increased mortality and in Spain most HCAP patients do not need nosocomial antibiotic coverage

GEHEP 010 study: Prevalence and distribution of hepatitis B virus genotypes in Spain (2000–2016)

[Objective] To study the prevalence and distribution of HBV genotypes in Spain for the period 2000–2016.[Methods] Retrospective study recruiting 2559 patients from 17 hospitals. Distribution of HBV genotypes, as well as sex, age, geographical origin, mode of transmission, HDV-, HIV- and/or HCV-coinfection, and treatment were recorded.[Results] 1924 chronically HBV native Spanish patients have been recruited. Median age was 54 years (IQR: 41–62), 69.6% male, 6.3% HIV-coinfected, 3.1% were HCV-coinfected, 1.7% HDV-co/superinfected. Genotype distribution was: 55.9% D, 33.5% A, 5.6% F, 0.8% G, and 1.9% other genotypes (E, B, H and C). HBV genotype A was closely associated with male sex, sexual transmission, and HIV-coinfection. In contrast, HBV genotype D was associated with female sex and vertical transmission. Different patterns of genotype distribution and diversity were found between different geographical regions. In addition, HBV epidemiological patterns are evolving in Spain, mainly because of immigration. Finally, similar overall rates of treatment success across all HBV genotypes were found.[Conclusions] We present here the most recent data on molecular epidemiology of HBV in Spain (GEHEP010 Study). This study confirms that the HBV genotype distribution in Spain varies based on age, sex, origin, HIV-coinfection, geographical regions and epidemiological groups.This study has been funded in part by the funds of the research project GEHEP-2018-010, granted by the Hepatitis Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (Grupo de Hepatitis de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, GEHEP/SEIMC)