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

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

Objectives: To 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. Methods: Meta-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. Results: A 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. Conclusion: The 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.Departamento de Biología Ambiental y Salud Públic

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

Assessment of a medical student mentoring programme to improve attitudes related to grief and coping with death

Objectives: To evaluate the impact of a mentoring programme for medical students doing a palliative care rotation, aimed at improving coping with death and attitudes towards the suffering produced by illness. Methods: A quasi-experimental study without a control group was carried out on second-year medical students. Five 1-h group sessions were conducted. Attitudes towards grief and coping with death were assessed before the mentoring programme began and afterwards, using the Brief Humanizar Scale and the Bugen’s Coping with Death Scale, respectively. Results: In terms of the sense of grieving as measured by the Brief Humanizar Scale, the mean score for the ‘Burden’ factor was 7 points and for the ‘Change’ factor it was 28.6, indicating that suffering makes more sense as a lever for positive change than as a burden. Regarding Bugen’s Coping with Death Scale, the mean score was 127.8 points before the mentoring programme and 139.2 afterwards. Hence, the score after the mentoring programme increased by 11.4 points, improving strategies to cope with death. Conclusion: Medical professionals must cope with death and end-of-life patients. In addition to scientific knowledge, students need to acquire competencies for better coping with the death of patients, with mentoring programmes helping to enhance this process of learning.Departamento de Biología Ambiental y Salud Públic

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