ABSTRACT
Background: Clinical reasoning is the most important competente in the training process of a physician. Aim: To develop a method for teaching clinical reasoning based on prototypes of clinical cases. Material and Methods: The study was conducted on sixty-four third year medical students. The study and control groups attended lectures and tutorial sessions with patients. The study group attended additionally discussion seminars of prototypical clinical cases. A clinical reasoning test was applied at the start and end of the learning period to both groups. At the end of the study, the opinions of students of the study group were collected in afocus group. Results: After the learning period, both groups significantly increased their clinical reasoning skills. However, the improvement in the study group was more than double than that ofthe control group. The absolute improvement in the study group was 30.9%. Students interviewed in the focus group were unanimous in expressing their satisfaction in each and every aspect discussed. Conclusions: The teaching of clinical reasoning to third year medical students by means of pattern recognition in seminars with clinical cases improved significantly their skills.
Subject(s)
Humans , Clinical Competence , Education, Medical, Undergraduate/methods , Educational Measurement , Focus Groups , Problem-Based Learning/methods , Qualitative Research , Surveys and Questionnaires , Students, MedicalABSTRACT
Myasis is the parasitism of organs and tissues of warm-blooded vertebrates by flies larvae. D hominis is a flie geographically restricted to tropical America from Mexico to northern Argentina. The adult flie, which is not hematophagous, needs to put its eggs on the abdominal surface of hematophagous arthropods which serve as carriers of future larvae which are deposited on the skin of the hosts (mammals, birds and accidentally men) when biting. Seven patients (two females) aged 7 to 35 years old, of different nationalities, recalled receiving mosquito bites, after staying in tropical American areas in the previous forty days. They presented furuncle-like lesions in exposed surfaces of the body. These lesions, 2-3 cm long, pruritic and mildly tender, broke and released a serous or serohematic fluid. Through the resulting opening, it was possible to partially observe the larva. Larvae were extracted by manual pressure (4) or surgical incision (3) and identified as D hominis larvae. Diagnosis of dermatobiasis, an imported myasis, must be based on the characteristics of lesions and the previous residence in endemic areas of America
Subject(s)
Humans , Female , Male , Adolescent , Adult , Myiasis , Skin Diseases, Parasitic/diagnosis , Diptera/pathogenicity , Tropical Zone , Insect Bites and Stings , Insect Vectors , Larva , Culicidae , Myiasis , Diptera/growth & developmentABSTRACT
Con el propósito de describir los aspectos clínicos de la infección de la VRS se estudiaron 131 lactantes menores de dos años hospitalizados por infección respiratoria aguda baja en los inviernos de 1988 y 1989 en santiago. Al ingreso se les hizo aspirado nasofaríngeo para inmunofluorescencia anti-VRS, hemograma, velocidad horaria de eritrosedimentación, radiografía de tórax y se consignaron los signos clínicos. 53 de ellos tenían una infección por VRS. La recolección de muestras de aspirado nasofaríngeo día por medio en dos salas de hospitalización permitió detectar 42 casos nososcomiales entre 251 ingresos no infectados originalmente. No se encontraron diferencias en los signos clínicos, hematológicos y radiológicos de ingreso entre casos con y sin VRS. La tasa de infección nosocomial fue 16,7 por ciento; en 76 por ciento de estos casos ella se adquirió durante la primera semana, su frecuencia no fue proporcional a la magnitud del contacto con lactantes excretores de VRS y los afectados no tuvieron mayor estadía hospitalaria que los restantes pacientes. La ausencia de signos diferenciales entre infecciones respiratorias bajas virales y bacterianas hace resaltar la utilidad de los métodos rápidos de diagnóstico para virus en el manejo racional de estas afecciones