[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

Una estrategia para la formación en seguridad del paciente durante la residencia: desde el incidente crítico a la simulación. Parte 2 / A strategy for training in patient safety during residency programme: From critical incident to simulation. Part 2

La formación en seguridad del paciente durante la residencia contribuye a la cultura de la seguridad y a la calidad asistencial. Un currículum para formar en seguridad incorpora distintas actividades formativas a lo largo de la especialidad y adecuadas a cada momento: cursos, talleres, sesiones de incidente crítico, rondas de seguridad, que se han descrito anteriormente, y simulación. La simulación permite el entrenamiento seguro de situaciones clínicas complejas en equipos multiprofesionales. Estructurar el aprendizaje de factor humano mediante el manejo de recursos en las crisis, y proporcionar feedback en el debriefing mejora la competencia. La simulación puede formar parte de la evaluación formativa objetiva de los residentes. Se ha demostrado que tiene resultados en el desempeño de los profesionales sanitarios, mejora la calidad de la asistencia y tiene efectos sobre los pacientes

Patient safety training during residency contributes to the culture of safety and quality of care. Patient safety curriculum incorporates different activities throughout the specialty and appropriate to each moment: courses, workshops, critical incident sessions, safety rounds, which have been described above, and simulation. The simulation allows the safe training of complex clinical situations in multiprofessional teams. Structure the learning of human factor through the management of resources in crises, and provide feedback in debriefing improves competition. The simulation can be part of the objective formative evaluation of the residents. It has been shown to have results in the performance of health professionals, improves the quality of care and has effects on patients

Una estrategia para la formación en seguridad del paciente durante la residencia: desde el incidente crítico hasta la simulación. Parte 1 / A strategy for training in patient safety during residency programme: From critical incident to simulation. Part 1

La formación en seguridad del paciente durante la residencia contribuye a la cultura de la seguridad y a la calidad asistencial. Un currículum para formar en seguridad incorpora distintas actividades formativas a realizar a lo largo de la especialidad y adecuadas a cada momento formativo. Desde la incorporación del residente, los cursos de seguridad, comunicación, ética, los talleres de lavado de manos, de técnicas, junto con los recursos de Internet, lo van dotando de diferentes competencias. Adquiere la competencia en seguridad con la integración en la actividad asistencial diaria de la valoración de los riesgos, la detección y la comunicación de incidentes, y el análisis de eventos adversos. Acelera el aprendizaje reflexionando de forma estructurada y aprendiendo del error con los incidentes críticos y la simulación

Patient safety training during residency contributes to the culture of safety and quality of care. Patient safety curriculum incorporates different activities to be carried out throughout the residence and appropriate to each training moment. Since the incorporation of the resident the courses of security, communication, ethics, hand washing workshops, techniques, together with Internet resources are endowing him with knowledge and skills. Acquires security competence with the integration of risk assessment, detection and communication of incidents and the analysis of adverse events into the daily assistance activity. Accelerates learning by reflecting in a structured way and learning from error with critical incidents and simulation

Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna / Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine

Objetivo: Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atención clínica requerida y cuantificar la carga de trabajo que supone. Material y método: Estudio multicéntrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del año 2016. Se estimó la carga de trabajo relacionada con dicha actividad (1UT=10min). Resultados: Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) años, 51,2% hombres. El índice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta más frecuentes fueron: valoración general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabólico (9,6%), HTA (6,3%) y síndrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirúrgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p=0,0001) y precisaron más días de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p=0,009). Los siguientes aspectos fueron más frecuentes en el formato de las IC realizadas por servicios médicos: número de IC ordinarias (respuesta >24h), especificación del motivo de IC, datos mínimos referentes a la historia clínica y coincidencia de la adecuación en el tiempo con el consultor. Conclusión: Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuación al formato de solicitud de IC es mayor en las procedentes de servicios médicos

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format

Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine. / Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna.

OBJECTIVE: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. MATERIAL AND METHOD: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). RESULTS: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. CONCLUSION: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.

Fever of unknown origin: classic and associated with human immunodeficiency virus infection. a comparative study.

Fever of unknown origin (FUO) associated with HIV infection is different from classic FUO. Relevant etiologies, procedures and time to diagnosis were analyzed. Patients admitted with FUO from 1991 to 1996 were prospectively followed. Thirty with classic FUO (group I) and 46 with FUO and HIV (group II) were included. Data on diagnosis, time to achieve it, and procedures were registered. Diagnosis was obtained in 87% and 93% of cases in groups I and II. Infections were the most frequent cause in group II. Collagen diseases were found in group I and absent in group II. Prevalence of neoplasia was similar. Mean time to diagnosis was near 5 weeks. In HIV the predominant diagnostic method was the Lowenstein culture. Invasive methods were similarly employed. It is concluded that predominance of Mycobacteria and absence of collagen diseases make FUO associated with HIV a different form of FUO. No differences were found in approach and time to diagnosis.

Two cases of laryngeal leishmaniasis in patients infected with HIV.

A high incidence of visceral leishmaniasis has been documented in HIV-infected patients in endemic areas. In these patients, atypical locations and a chronic course of the disease are more frequent. Two AIDS patients with laryngeal leishmaniasis are reported. These cases are believed to be the first of this type documented in the literature. The possible pathogenic mechanisms of the disease are discussed. Infection with Leishmania donovani may eventually be described for every organ containing phagocytic cells.

[Terminal ileitis due to cryptosporidium and cytomegalovirus in a patient with AIDS]. / Ileítis terminal por criptosporidium y citomegalovirus en un paciente con SIDA.

Terminal patients with infection by the Human Immunodeficiency Virus (HIV), gastrointestinal affection is frequently observed, caused by many etiological agents. However, the affection of the terminal ileon is and generally associated to cytomegalovirus (CMV), intracellular Mycobacterium avium (IMA) and Mycobacterium tuberculosis. We present a patient diagnosed of AIDS with clinical signs of chronic diarrhea secondary to terminal ileitis by Cryptosporidium and CMV. We discuss the radiological and hystological findings and the potential pathogenic synergism.

[Peritoneal tuberculosis. The characteristics of a not infrequent tuberculosis site]. / Tuberculosis peritoneal. Características de una no rara localización tuberculosa.

Laparoscopic, clinical and biological features of 51 patients admitted over a period of 22 years in two university hospitals of Madrid are analyzed. Mean age was 43 years, 30 patients were diagnosed in the period from 1967 to 1978 and in 32 of them, there was predisposing pathology. Main symptoms were abdominal pain, fever, general syndrome and ascites. Ascitic fluid was an exudate in 97% of cases, finding BAAR in one case, being the culture positive in four cases. Diagnostic was made through laparoscopy in 42 cases and using laparotomy in 9 cases, being confirmed with histological procedures in 38 cases and with microbiological procedures in 11 cases. Peritoneal tuberculosis is a non unfrequent tuberculosis localization. Laparoscopy is the more cost-effective diagnostic method of peritoneal tuberculosis.

[Waldenström's macroglobulinemia, cryoglobulinemia type I and membranous glomerulonephritis]. / Macroglobulinemia de Waldenström, crioglobulinemia tipo I y glomerulonefritis membranosa.

Renal complications in Waldenström's macroglobulinemia (WM) are infrequent and are characterized by the presence of PAS positive amorphous hyaline deposits in the capillary lumen, infiltrated with lymphoplasmatic cells with PAS positive inclusions in the interstices and intratubular hyaline cylinders. Membranous glomerulonephritis may be a paraneoplastic manifestation of the lymphoproliferative processes. A 67-year-old male was diagnosed of WM, type-I cryoglobulinemia with renal insufficiency without proteinuria. Renal histological examination revealed changes characteristic of nephropathy associated to WM as well as membranous glomerulonephritis. This association has not been described previously. The coexistence of two pathogenic mechanisms with a common base, lymphoproliferative disease, may explain this association.