Evaluación de motivación y satisfacción en la intervención educativa "Diseño de Casos Clínico Patológicos": estudio piloto en estudiantes de medicina / Motivation and satisfaction of medical students participating in an educational intervention on Pathology

BACKGROUND: Undergraduate Pathology training in medicine is based on modalities centered on the teacher and associated with controlled motivation, with low satisfaction with the educational process. According to the Self-determination Theory, an early participation with responsibilities in clinical practice and an educational environment that promotes autonomy and basic psychological needs satisfaction (BPNS), would generate intrinsic motivation. AIM: To develop an educational intervention based on the pathologists' workplace model, which supports a learning environment intended to the satisfaction of BPNS in medical students. To evaluate the results of the intervention on the levels of motivation and satisfaction. MATERIAL AND METHODS: In the first phase of the study, an educational modality focused on the student was planned, consisting of the design of a pathological clinical case (DPC), performing the specialist's steps under minimal supervision and a contextualized environment. In the second phase, the level of satisfaction (Scale of student experience) and intrinsic motivation in 3rd year medical students was evaluated. RESULTS: After the intervention, 99 students showed high levels of satisfaction (94% of agreement) and intrinsic motivation (6.7 of 7 points), including all sub-scales. They considered that their competences had increased and assessed the intervention as useful. CONCLUSIONS: DPC is an innovative, feasible and attractive methodology for Pathology learning, with a high degree of satisfaction and intrinsic motivation. This experience can be extended to similar disciplines.

Nuevas perspectivas en el manejo de la hipertensión / New perspectives in the management of arterial hypertension

Arterial hypertension is one of the biggest public health problems. The research in this area has been relentless and productive, allowing to identify new pathophysiological mechanisms from which new therapeutic options are under development. Despite the recognized efficacy and tolerability of currently available drugs, a high number of patients still do not comply with treatment and maintain inadequate blood pressure levels. This review summarizes the literature about new pharmacological alternatives to treat hypertension. The development state of these new medications ranges from a preclinical state to their clinical use in hypertensive patients. Technological strategies aiming at increasing the compliance with anti-hypertensive medications are also mentioned.

Consideraciones en torno a las Guías USA 2017 de hipertensión arterial / A word of caution about the 2017 hypertension management guidelines

The 2017 Guidelines on hypertension of the American College of Cardiology and American Heart Association, which proposed values of 130/80 mmHg as the cutoff points for the onset of hypertension, aroused great interest. This recommendation is based in the SPRINT study (The Systolic Pressure Intervention Trial), which included hypertensive patients over 50 years of age, non-diabetic, without a history of stroke and with a low representation of subjects with a history of coronary artery disease (16%). A group with intensive anti-hypertensive therapy (pressure achieved 121.5 mmHg) achieved a significantly lower cardiovascular risk as compared with a group with standard therapy (pressure achieved 134.6 mmHg). The Guide proposes immediate pharmacological therapy in diabetic hypertensive patients, in those with stage 3 chronic kidney disease or with persistent albuminuria, and in patients with atherosclerotic disease. The Guideline does not include the management of isolated systolic hypertension of the elderly and did not consider studies that show an increased risk when pressure is reduced below 130/80 mmHg in patients with coronary disease, peripheral vascular disease, diabetes mellitus or chronic renal failure. The new classification of hypertension would increase the number of hypertensive patients in our country by more than one million, would increase the risk associated with diastolic pressure reductions in older adults and ignores the evidence indicating a risk associated with reductions below 130/80 mmHg in patients with diabetes, with chronic renal failure or with atherosclerotic disease. Therefore, it is advisable to maintain a threshold of 140/90 mmHg and perform a careful and gradual management of blood pressure in the latter group of hypertensive patients.

Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina / Relationship between self-directed learning and value profile in Chilean medical students

Background: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. Aim: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. Material and Methods: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. Results: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. Conclusions: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

Atributos del profesionalismo estimados por estudiantes de medicina y médicos: análisis mediante el modelo de disponibilidad léxica / Professionalism of physicians from the point of view of physicians and students

Background: Professionalism should be included as a fundamental component in the curriculum of undergraduate as well as graduate students of Medicine. Future physicians should be aware of the attributes that a professional should possess. Aim: To analyze the ideal medical doctor attributes from the point of view of physicians and students of Medicine. Material and methods: One hundred four physicians (MD) and 47 students answered a free association test on the attributes they would assign to a good physician. The test was applied via Internet to professionals, and students were tested in group dynamics at the beginning of the class on Bioethics and Professionalism. Data were processed according to the Lexical Availability Model (LAM) which provides quantitative as well as qualitative evaluations. Results: The attributes with higher scores among MD's were honesty (0.379), regular academic updating (0.373), ability (0.325) and empathy (0.241). Among students, the selected attributes were excellence (0.625), empathy (0.511), responsibility (0.280) and ability (0.209). A general agreement was found among physicians and students, excepts by the fact that MD's consider continuing academic updating as the most important attribute. Conclusions: The attributes that physicians and medical students evaluate as essential in professionalism were identified using the LAM approach. At the beginning of the career, students have a definite humanistic approach to their future profession.

Función de los músculos inspiratorios, parámetros hemodinámicos y disnea en pacientes con estenosis mitral / Inspiratory muscle function, hemodynamic parameters and dyspnea in patients with mitral valve stenosis

Background: The mechanism involved in dyspnea in patients with mitral valve stenosis (MS) is not completely understood. Aim: To evaluate in patients with MS, changes in hemodynamic parameters during the assessment of inspiratory muscle endurance (IME) and the relationship between IME, hemodynamics and dyspnea. Subjects and methods: We studied 13 patients (9 in NYHA class II and 4 in class III). Endurance was evaluated using a two minute incremental threshold loading test, to obtain the maximal sustainable inspiratory pressure (SIP), and maximal inspiratory load (MIL). During the test, cardiac output (CO), mean pulmonary and capillary pressures (PAP and PCP, respectively), were evaluated. Results: Compared to six normal subjects, MS patients had reduced SIP and MIL (p <0.01), which correlated with baseline index of dyspnea (r= 0.57 and r=0.52, respectively, p <0.05). At the end of the test period, basal CO, cardiac index (CI), PAP and PCP increased from 3.4 to 4.0 l/min-1; 2.1 to 2.5 l/min-1/m-2; 15 to 25 and 11 to 18 mmHg, respectively (p <0.01). No relationship between IME and hemodynamic parameters was found. Conclusions: IME is reduced and is closely related to dyspnea in these patients with MS. The observed low CI, suggests that muscle underperfusion could contribute to this dysfunction during the inspiratory effort.

Efectos de la supresión de un programa especial de control y tratamiento de pacientes hipertensos / Effects of the suppression of a special program of control and treatment for hypertensive patients

Se efectúa una revaluación de 91 hipertensos después de 4 años de suprimido el Programa de Control y Tratamiento al que habían permanecido adscritos por 32 meses. La evaluación consistió en un examen físico con determinación de presión arterial según normas de la OMS, un electrocardiograma (ECG) de 12 derivaciones y una encuesta orientada a conocer la adhesividad al tratamiento, la modalidad de control adoptada y el grado de conocimientos sobre la enfermedad. Los niveles de presión arterial, tanto sistólica como diastólica, fueron tan altos como al momento de su incorporación al Programa original pero eran normales en el grupo que declaró terapia ininterrumpida controlada por especialistas. Estos sujetos poseían el mayor nivel de escolaridad y demostraron un alto conocimiento de su enfermedad. Los índices de hipertrofia ventricular izquierda (HVI) estudiados por el ECG sufrieron cambios: aquéllos que normalizaron el ECG presentaban cifras normales de presión arterial mientras que éstas seguían elevadas en quienes mantuvieron o desarrollaron HVI. Se llama la atención sobre la necesidad de propiciar Programas especiales para pacientes hipertensos, con especial atención en los contenidos educativos

Evaluación de un programa de control y tratamiento de pacientes hipertensos / Evaluation of a program for control and treatment of hypertensive patients

Se presenta la experiencia de un programa de control y tratamiento de 222 pacientes hipertensos seguidos entre 24 y 32 meses. Entre las características de la población de estudio destacan el elevado número de hombres (72%) y el adecuado nivel de escolaridad. El rendimiento del programa se mide a través del análisis complementario de la adhesividad a los controles y el comportamiento de las cifras tensionales. Para utilizar una medida comparable del índice de casos perdidos o que abandonan se propone el método actuarial que en este estudio fue de 7,2 por mil meses-persona. Se analiza el comportamiento de la presión arterial logrando reducciones significativas tanto para la sistólica (29,5 mmHg) como para la diastólica (21,5 mmHg) en un corte a los 2 años que englobó a los 222 casos. Se pone de relieve la importancia de la motivación del equipo de salud y la labor educativa sobre los pacientes