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1.
Acad Med ; 99(4S Suppl 1): S25-S29, 2024 04 01.
Article in English | MEDLINE | ID: mdl-38109651

ABSTRACT

ABSTRACT: The next era of assessment in medical education promises new assessment systems, increased focus on ensuring high-quality equitable patient care, and precision education to drive learning and improvement. The potential benefits of using learning analytics and technology to augment medical training abound. To ensure that the ideals of this future for medical education are realized, educators should partner with trainees to build and implement new assessment systems. Coproduction of assessment systems by educators and trainees will help to ensure that new educational interventions are feasible and sustainable. In this paper, the authors provide a trainee perspective on 5 key areas that affect trainees in the next era of assessment: (1) precision education, (2) assessor education, (3) transparency in assessment development and implementation, (4) ongoing evaluation of the consequences of assessment, and (5) patient care data as sources of education outcomes.As precision education is developed, it is critical that trainees understand how their educational data are collected, stored, and ultimately utilized for educational outcomes. Since assessors play a key role in generating assessment data, it is important that they are prepared to give high-quality assessments and are continuously evaluated on their abilities. Transparency in the development and implementation of assessments requires communicating how assessments are created, the evidence behind them, and their intended uses. Furthermore, ongoing evaluation of the intended and unintended consequences that new assessments have on trainees should be conducted and communicated to trainees. Finally, trainees should participate in determining what patient care data are used to inform educational outcomes. The authors believe that trainee coproduction is critical to building stronger assessment systems that utilize evidence-based educational theories for improved learning and ultimately better patient care.


Subject(s)
Clinical Competence , Education, Medical , Humans , Learning , Quality of Health Care , Educational Measurement , Education, Medical, Graduate
2.
J Grad Med Educ ; 15(6): 638-647, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38045934

ABSTRACT

Background Best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood. The Accreditation Council for Graduate Medical Education launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion award for sponsoring institutions to celebrate efforts to improve DEI in graduate medical education (GME). Objective To identify themes in practices used by award applicants to improve DEI efforts at their institutions, using a qualitative design. Methods This qualitative study employed an exploratory, inductive approach and constant comparative method to analyze award applications from 2 submission cycles (2020, 2021). Data analysis involved the use of a preliminary codebook of 29 program applications used in a previous study, which was modified and expanded, to perform a subsequent analysis of 12 sponsoring institution applications. Seven adjudication sessions were conducted to ensure coding consistency and resolve disagreements, resulting in the identification of final themes. Results Institutions' approaches to advancing DEI resulted from work within 5 themes and 10 subthemes. The themes encompassed organizational commitment (policies that reflect DEI mission), data infrastructure (tracking recruitment, retention, and inclusion efforts), community connection (service-learning opportunities), diverse team engagement (coproduction with residents), and systematic strategies for DEI support throughout the educational continuum. Consistent across themes was the importance of collaboration, avoiding silos, and the need for a comprehensive longitudinal approach to DEI to achieve a diverse GME workforce. Conclusions This qualitative study identified 5 themes that can inform and guide sponsoring institutions in promoting DEI.


Subject(s)
Diversity, Equity, Inclusion , Internship and Residency , Humans , Accreditation , Education, Medical, Graduate , Learning
3.
Am Surg ; 89(5): 1688-1692, 2023 May.
Article in English | MEDLINE | ID: mdl-35099317

ABSTRACT

BACKGROUND: Since 2013, we have offered a robust "Introduction to Surgery" elective (ITS) for preclinical medical students. The present study investigates whether participants of the ITS elective were more likely to match into surgical residencies than non-ITS participants. METHODS: This is a retrospective case-control study of medical students from two medical schools in Southern California who participated in the ITS elective and those who did not. Descriptive results and univariate analysis using STATA were utilized to analyze the de-identified data who matched between 2016 and 2021 were included. RESULTS: Overall, 87 (8.9%) of the 982 matched students participated in the ITS elective, with an increase in participation from 1.2% in 2016 to 13.9% in 2021 (P < .001). Among ITS participants, 49.4% matched into a surgical specialty compared to only 22.9% for non-ITS students (P < .001). There was no difference between ITS and non-ITS students with regards to procedural specialty match (14.9% vs 12.6%, P = .537). CONCLUSION: ITS participants were more than twice as likely to match into a surgical specialty than non-participants. Future qualitative research will help discern the relative impact of the ITS course versus a student's baseline predisposition to surgery.


Subject(s)
Education, Medical, Undergraduate , Internship and Residency , Specialties, Surgical , Students, Medical , Humans , Retrospective Studies , Case-Control Studies , Curriculum , Career Choice
4.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1431727

ABSTRACT

Introducción: El intento suicida es uno de los factores de riesgo suicida más relevantes, conocer variables asociadas y estrategias de seguimiento post-intento suicida contribuye a prevenir el suicidio. Objetivos: el objetivo de este trabajo fue describir características clínico-sociodemográfica de las personas que presentan intento de suicidio, y dar a conocer una estrategia de vigilancia clínicoepidemiológica que se activa posterior al intento suicida. Método: Se utilizó un diseño transversal, participaron 170 personas de 15 y más años ingresados a la Unidad para Personas con Intento suicida entre los años 2015 al 2018 en la Región De Los Ríos, Chile. Se evaluaron estadísticamente datos de carácter sociodemográfico y clínicos, previos y posterior al intento suicida. Resultado: Los resultados sociodemográficos muestran predominancia de intentos de mujeres, con una muestra que tiene su lugar de residencia principalmente en sectores urbanos. Además, se observó que la pertenencia religiosa católica o evangélica, podría asociarse a mayor riesgo de reintento suicida (p=0,014). Conclusiones: Los factores clínicos muestran que presentar intentos suicidas previos, depresión en curso al momento del intento suicida y los conflictos de pareja son factores relevantes a considerar. La frecuencia de suicidio y los reintentos suicida en vigilancia fue baja, por lo que fortalecer la continuidad de cuidados podría tener un rol preventivo en el fenómeno suicida.


Introduction: Suicidal attempt is one of the most relevant suicide risk factors, knowing associated variables and post-suicide attempt follow-up strategies contributes to preventing suicide. Objective: the objective of this work was to describe the clinical-sociodemographic characteristics of people who present a suicide attempt, and to present a strategy of clinical-epidemiological surveillance that is activated after the suicide attempt. Methods: A cross-sectional design was carried out, involving 170 subjects aged 15 and over admitted to the Unit for People with a suicide attempt between 2015 and 2018 in the Los Ríos region, Chile. Sociodemographic and clinical data, before and after the suicide attempt, were statistically evaluated. Results: The sociodemographic results show a predominance of attempts by women, with a sample that has its place of residence mainly in urban areas. In addition, it was observed that Catholic or evangelical religious affiliation could be associated with a higher risk of suicidal retry (p = 0.014). Conclusions: The clinical factors show that having previous suicide attempts, ongoing depression at the time of the suicide attempt, and partner conflicts are relevant factors to consider. The frequency of suicide and suicide retries in surveillance was low, so strengthening the continuity of care could play a preventive role in the suicide phenomenon.

5.
BMC Med Educ ; 22(1): 904, 2022 Dec 30.
Article in English | MEDLINE | ID: mdl-36585706

ABSTRACT

BACKGROUND: Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture. METHODS: We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation. RESULTS: Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health. CONCLUSION: Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.


Subject(s)
Education, Medical , Students, Medical , Humans , Curriculum , Learning , Mentors
6.
Am J Surg ; 223(4): 662-669, 2022 04.
Article in English | MEDLINE | ID: mdl-34284882

ABSTRACT

BACKGROUND: The COVID-19 pandemic brings unforeseen challenges in medical education. The current study aims to: 1) describe third-year medical students' experiences with the novel Shelf-Exam-Type Question Didactics (SET QD) before (in-person) and during (virtual) COVID-19. METHODS: In this qualitative study using grounded theory, we conducted purposive sampling and used 23 in-depth semi-structured interviews. Audio recordings were transcribed verbatim and the Atlas.Ti software was used to manage the thematic analysis. RESULTS: There are three themes and eight subthemes that emerged: 1) The SET QD Framework (sub-themes: questions as learning opportunities; interleaving; notable clinical scenarios; team learning; accountability). 2) Experienced Educator (subtheme: transformational teaching). 3) Virtual Accessibility (sub-themes: alleviating time constraints, and mitigating life-stressors). CONCLUSIONS: Medical students regarded SET QD as impactful for shelf exam preparation, clinical preparation, and long-term retention of the material. This novel virtual didactic method may be used in non-surgical clerkships as well.


Subject(s)
COVID-19 , Clinical Clerkship , Education, Medical, Undergraduate , Students, Medical , COVID-19/epidemiology , Curriculum , Education, Medical, Undergraduate/methods , Humans , Pandemics
7.
Heliyon ; 7(3): e05797, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33768170

ABSTRACT

Capsaicin is an active compound in hot peppers. It has been studied for its health benefits for humans. Optical spectroscopy is an important tool for determining the optical properties or chemical composition of matter. The aim of this research is proposing an optical method to identify and quantify capsaicin in the visible range. To achieve this goal, we combined absorption and diffuse reflectance spectroscopy techniques to compute the extinction coefficient. Moreover, the concentration of the analytes was determined using the optical properties of capsaicin. Our method is a promising tool for developing a classification of capsaicin according to its percentage in chilies. The extinction coefficients are reported for 507nm and 663nm, which are the most significative. In addition, the coefficients to build the mathematical model for capsaicin are reported for Kubelka-Munk model. Finally, a comparison between capsaicin vs chilies spectra was obtained to identify spectral response. Diffuse reflectance signals allowed the identification of capsaicin and opened the possibility of this fast and easy to do method for classification and quantification of bioactive compounds.

8.
Cell Reprogram ; 22(6): 311-327, 2020 12.
Article in English | MEDLINE | ID: mdl-32991224

ABSTRACT

Equine endometrial and adipose mesenchymal stem cells (eMSCs and aMSCs, respectively) were isolated from the same donors of thoroughbred mares. The cells displayed characteristic features of MSCs, including trilineage mesodermal and also neurogenic differentiation. We evaluated the influence of cellular origin on their transcriptome profile. Cellular RNA was isolated and sequenced and extracellular vesicles (EVs) were obtained from conditioned medium of cells cultured in medium depleted of EVs, and their microRNA (miRNA) cargo analyzed by sequencing. Differential expression of mRNAs and EV-miRNA was analyzed, as well as pathways and processes most represented in each cell origin. mRNA reads from all expressed genes clustered according to the cellular origin. A total of 125 up- and 51 downregulated genes were identified and 31 differentially expressed miRNAs. Based on mRNA sequencing, endometrial MSCs strongly upregulated genes involved in the Hippo, transforming growth factor beta, and pluripotency signaling pathways. Alongside with this, pathways involved in extracellular matrix reorganization were the most represented in the miRNA cargo of EVs secreted by eMSCs. The niche from which MSCs originated defined the transcriptomic signature of the cells, including the secretion of lineage-specific loaded EV to ensure proper communication and homeostasis. Identification and testing their biological functions can provide new tools for the therapeutic use of horse MSC.


Subject(s)
Adipose Tissue/cytology , Cell Differentiation , Endometrium/cytology , Extracellular Vesicles/metabolism , Mesenchymal Stem Cells/cytology , MicroRNAs/genetics , Transcriptome , Adipose Tissue/metabolism , Animals , Cells, Cultured , Endometrium/metabolism , Extracellular Vesicles/genetics , Female , Horses , Mesenchymal Stem Cells/metabolism , Signal Transduction
9.
Animals (Basel) ; 10(6)2020 Jun 23.
Article in English | MEDLINE | ID: mdl-32585798

ABSTRACT

In mesenchymal stem cells (MSCs), it has been reported that prostaglandin E2 (PGE2) stimulation of EP2 and EP4 receptors triggers processes such as migration, self-renewal, survival, and proliferation, and their activation is involved in homing. The aim of this work was to establish a genetically modified adipose (aMSC) model in which receptor genes EP2 and EP4 were edited separately using the CRISPR/Cas9 system. After edition, the genes were evaluated as to if the expression of MSC surface markers was affected, as well as the migration capacity in vitro of the generated cells. Adipose MSCs were obtained from Chilean breed horses and cultured in DMEM High Glucose with 10% fetal bovine serum (FBS). sgRNA were cloned into a linearized LentiCRISPRv2GFP vector and transfected into HEK293FT cells for producing viral particles that were used to transduce aMSCs. GFP-expressing cells were separated by sorting to obtain individual clones. Genomic DNA was amplified, and the site-directed mutation frequency was assessed by T7E1, followed by Sanger sequencing. We selected 11 clones of EP2 and 10 clones of EP4, and by Sanger sequencing we confirmed 1 clone knock-out to aMSC/EP2 and one heterozygous mutant clone of aMSC/EP4. Both edited cells had decreased expression of EP2 and EP4 receptors when compared to the wild type, and the edition of EP2 and EP4 did not affect the expression of MSC surface markers, showing the same pattern in filling the scratch. We can conclude that the edition of these receptors in aMSCs does not affect their surface marker phenotype and migration ability when compared to wild-type cells.

10.
Eur J Dent Educ ; 23(2): 190-198, 2019 May.
Article in English | MEDLINE | ID: mdl-30659761

ABSTRACT

OBJECTIVE: It is recognised that professionalism should play a central role in dental education. However, its implementation into the curricula of dental schools is still limited. Our objective was to identify the main values related to professionalism based on the perceptions of students and faculty members from the Faculty of Dentistry, University of Chile. METHODS: A Dental Values Survey was validated and culturally adapted in order to guarantee the greatest possible internal validity. The adapted survey was administered to students and faculty members (416 and 225, respectively). The final survey contained 64 items rated on a Likert scale of 1-5. Each item was categorised according to five dimensions: Altruism, Consciousness, Personal Satisfaction, Quality of Life and Professional Status. The values were compared between faculty and students and among students at different courses. A values scale was constructed by selecting the five items with the highest average score for each dimension. RESULTS: Survey respondents composed 34.32% of the universe, of which 50.46% were faculty and 49.54% were students. Values associated with Altruism, Consciousness and Professional Status, were the highest rated by students and faculty. Values associated with Personal Satisfaction and Quality of Life received the lowest scores for both groups. CONCLUSIONS: To provide the best possible attention to patients (Consciousness), and that patients have access to affordable dental care (Altruism), are the values at the top of our scale. On the other hand, to maintain financial stability and to be well paid (Quality of Life) were the less considered.


Subject(s)
Education, Dental , Faculty, Dental/psychology , Perception , Professionalism/education , Schools, Dental , Students, Dental/psychology , Universities , Adolescent , Adult , Aged , Chile , Female , Humans , Male , Middle Aged , Young Adult
11.
Gac. sanit. (Barc., Ed. impr.) ; 31(6): 478-484, nov.-dic. 2017. graf, tab
Article in Spanish | IBECS | ID: ibc-168537

ABSTRACT

Objetivo: Adaptar un cuestionario conductual para la vigilancia de segunda generación del VIH/sida en mujeres trabajadoras sexuales (MTS) de la Región Metropolitana, Chile. Métodos: Estudio cualitativo de validación de instrumento. Se validó un cuestionario español adaptado en Cataluña (España) mediante traducción y retrotraducción del instrumento original. La validación de contenido se realizó a través de un grupo Delphi modificado, constituido por expertos en MTS y VIH, representantes de los ámbitos comunitario, político e institucional. Se evaluaron aspectos relacionados con la aplicabilidad del instrumento en terreno, encuestando a MTS de la Región Metropolitana. Resultados: El cuestionario, escrito en español de España, fue satisfactoriamente adaptado al español de Chile. En el proceso de validación de contenido se logró definir las secciones que abordan el VIH en la población MTS. El cuestionario adaptado tiene un tiempo de aplicación de menos de 15 minutos, por lo que es utilizable en terreno. Las 61 mujeres encuestadas presentan características diversas, tanto en país de origen (todas eran latinoamericanas) como en nivel de estudios, lo que permitió captar potenciales problemas en su aplicación. Discusión: El cuestionario adaptado para Chile contiene todos los indicadores para MTS recomendados por ONUSIDA, así como los recomendados por el Familly Health International para la vigilancia bioconductual. El instrumento definitivo emerge como una herramienta para la vigilancia de segunda generación del VIH y otras infecciones de transmisión sexual en Chile, y como un aporte al abordaje de políticas preventivas en la población de MTS (AU)


Objective: To adapt a behavioural questionnaire for second-generation HIV/AIDS surveillance in female sex workers (FSWs) in the Metropolitan Region, Chile. Methods: Qualitative study of instruments validation. A Spanish instrument adapted in Catalonia was validated through a translation and back-translation of the original version. The content validity was determined through a modified Delphi method, via FSW and HIV experts representing community, political and institutional levels. Applicability aspects were determined by the application of the questionnaire to FSW in the Metropolitan Region. Results: The questionnaire, drafted in Spain, was successfully adapted to Chilean Spanish. The content validity process enabled sections to be created that address HIV in FSWs. The adapted questionnaire takes less than 15minutes to complete, which makes it usable in fieldwork. The 61 women surveyed came from different countries (all were Latin Americans) and had different educational levels; all this enabled potential applicability problems to be detected. Discussion: The adapted questionnaire for Chile contains all the UNAIDS indicators for FSWs, as well as the recommended indicators of Family Health International for bio-behavioural surveillance. Said questionnaire serves as a tool for second-generation HIV/other STD surveillance and further contributes to preventive policies in Chilean FSWs (AU)


Subject(s)
Humans , Female , Sexual Behavior/statistics & numerical data , Epidemiological Monitoring/statistics & numerical data , HIV Infections/epidemiology , Sex Workers/statistics & numerical data , Surveys and Questionnaires , Chile/epidemiology , Delphi Technique , 25783/methods , Translating
12.
Gac Sanit ; 31(6): 478-484, 2017.
Article in Spanish | MEDLINE | ID: mdl-28411873

ABSTRACT

OBJECTIVE: To adapt a behavioural questionnaire for second-generation HIV/AIDS surveillance in female sex workers (FSWs) in the Metropolitan Region, Chile. METHODS: Qualitative study of instruments validation. A Spanish instrument adapted in Catalonia was validated through a translation and back-translation of the original version. The content validity was determined through a modified Delphi method, via FSW and HIV experts representing community, political and institutional levels. Applicability aspects were determined by the application of the questionnaire to FSW in the Metropolitan Region. RESULTS: The questionnaire, drafted in Spain, was successfully adapted to Chilean Spanish. The content validity process enabled sections to be created that address HIV in FSWs. The adapted questionnaire takes less than 15minutes to complete, which makes it usable in fieldwork. The 61 women surveyed came from different countries (all were Latin Americans) and had different educational levels; all this enabled potential applicability problems to be detected. DISCUSSION: The adapted questionnaire for Chile contains all the UNAIDS indicators for FSWs, as well as the recommended indicators of Family Health International for bio-behavioural surveillance. Said questionnaire serves as a tool for second-generation HIV/other STD surveillance and further contributes to preventive policies in Chilean FSWs.


Subject(s)
HIV Infections/epidemiology , Population Surveillance , Sex Work/statistics & numerical data , Sex Workers , Sexual Behavior , Surveys and Questionnaires , Adolescent , Adult , Chile , Cultural Characteristics , Delphi Technique , Educational Status , Female , HIV Infections/psychology , Humans , Substance-Related Disorders/epidemiology , Unsafe Sex , Young Adult
15.
Rev. chil. infectol ; 31(6): 645-650, dic. 2014. ilus, graf
Article in Spanish | LILACS | ID: lil-734755

ABSTRACT

Introduction: Meningococcal disease (MD) is a public health problem worldwide, due to its high morbidity and mortality. Most cases occur in sub-Saharan Africa, where there is a marked seasonal pattern with predominance during the dry season. Objectives: To describe the morbidity of MD in the Metropolitan Region (MR) of Chile and explore whether there is a correlation between the number of cases with the levels of atmospheric particulate matter PM 10 and PM 2.5, relative humidity (RH), temperature and total environmental pollen. Materials and Methods: Ecological time series study, statistical analysis with R 3.0.1, graphics with Excel 2013. Results: Between 2010 and 2013, 234 MD cases were reported in the MR with an increasing trend. There is a seasonal pattern with an increase of cases from August to October, and a decrease from March to April. There is no correlation with the levels of PM10 and PM2.5. There is a slight positive correlation with RH and a slight negative correlation with temperature. There is a moderate positive correlation with the levels of total environmental pollens. Discussion: Overcrowding and the winter viral infections could explain the increased incidence of MD and the slight correlation with RH and temperature. The moderate correlation with the pollens could be explained by an effect of irritation of the upper airway. Conclusions: More epidemiological studies whose designs allow a greater causal inference are required.


Introducción: La enfermedad meningocóccica (EM) constituye un problema de salud pública mundial debido a su alta morbi-mortalidad. La mayor cantidad de casos ocurre en África subsahariana, donde existe un marcado patrón estacional en la estación seca. Objetivos: Describir la morbilidad de la EM en la Región Metropolitana (RM) de Chile y explorar si existe correlación entre el número de casos con PM 10, PM 2,5 humedad relativa (HR), temperatura y pólenes ambientales totales. Materiales y Métodos: Estudio ecológico tipo series de tiempo, análisis estadístico con R 3.0.1, gráficos con Excel 2013. Resultados: En el período 2010-2013 se notificaron 234 casos de EM en la RM, con una tendencia al alza. Se observa un patrón estacional con aumento de casos entre agosto y octubre y una disminución entre marzo y abril. No existe correlación con los niveles de PM 10 ni de PM 2,5. Se describe una correlación positiva leve con la HR y negativa leve con la temperatura. Existe correlación moderada positiva con los niveles de pólenes totales ambientales. Discusión: El hacinamiento y las infecciones virales de invierno podrían explicar el aumento de casos de EM y la correlación leve con la HR y la temperatura. La correlación moderada con los pólenes podría explicarse por un efecto de irritación de la vía aérea superior. Conclusiones: Se requieren más estudios epidemiológicos cuyos diseños permitan una mayor inferencia causal.


Subject(s)
Humans , Air Pollution/adverse effects , Climate , Meningococcal Infections/epidemiology , Particulate Matter/toxicity , Chile/epidemiology , Environmental Exposure , Humidity , Incidence , Meningococcal Infections/etiology , Pollen , Seasons , Temperature , Urban Population
16.
Rev. méd. Chile ; 142(10): 1306-1315, oct. 2014. tab
Article in Spanish | LILACS | ID: lil-731663

ABSTRACT

Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized.


Subject(s)
Humans , Attitude of Health Personnel , Practice Patterns, Physicians' , Physician-Patient Relations , Truth Disclosure
17.
Rev Med Chil ; 142(10): 1306-15, 2014 Oct.
Article in Spanish | MEDLINE | ID: mdl-25601116

ABSTRACT

Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized.


Subject(s)
Attitude of Health Personnel , Physician-Patient Relations , Practice Patterns, Physicians' , Truth Disclosure , Humans
18.
Rev Chilena Infectol ; 31(6): 645-50, 2014 Dec.
Article in Spanish | MEDLINE | ID: mdl-25679918

ABSTRACT

INTRODUCTION: Meningococcal disease (MD) is a public health problem worldwide, due to its high morbidity and mortality. Most cases occur in sub-Saharan Africa, where there is a marked seasonal pattern with predominance during the dry season. OBJECTIVES: To describe the morbidity of MD in the Metropolitan Region (MR) of Chile and explore whether there is a correlation between the number of cases with the levels of atmospheric particulate matter PM 10 and PM 2.5, relative humidity (RH), temperature and total environmental pollen. MATERIALS AND METHODS: Ecological time series study, statistical analysis with R 3.0.1, graphics with Excel 2013. RESULTS: Between 2010 and 2013, 234 MD cases were reported in the MR with an increasing trend. There is a seasonal pattern with an increase of cases from August to October, and a decrease from March to April. There is no correlation with the levels of PM10 and PM2.5. There is a slight positive correlation with RH and a slight negative correlation with temperature. There is a moderate positive correlation with the levels of total environmental pollens. DISCUSSION: Overcrowding and the winter viral infections could explain the increased incidence of MD and the slight correlation with RH and temperature. The moderate correlation with the pollens could be explained by an effect of irritation of the upper airway. CONCLUSIONS: More epidemiological studies whose designs allow a greater causal inference are required.


Subject(s)
Air Pollution/adverse effects , Climate , Meningococcal Infections/epidemiology , Particulate Matter/toxicity , Chile/epidemiology , Environmental Exposure , Humans , Humidity , Incidence , Meningococcal Infections/etiology , Pollen , Seasons , Temperature , Urban Population
19.
In Vitro Cell Dev Biol Anim ; 49(9): 657-67, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23846396

ABSTRACT

Nuclear transfer (NT) is associated with epigenetic reprogramming of donor cells. Expression of certain genes in these cells might facilitate their expression in the NT embryo. This research was aimed to investigate the effect of constitutive expression of OCT4 in bovine somatic cells used for NT on the developmental potential of derived cloned embryos as well as in the expression of pluripotency markers in the Day-7 resulting embryos. Cloned blastocysts were generated from five cell lines that expressed OCT4. Pools of blastocysts were screened to detect OCT4, SOX2, and NANOG by qPCR. In vitro-fertilized time-matched blastocysts were used as controls. The development potential was assessed on the basis of blastocysts rate; grading and total cell counts at Day 7. OCT4 expression in the cell lines positively correlates with blastocysts rate (r = 0.92; p = 0.02), number of grade I blastocysts (r = 0.96; p = 0.01), and total cell number (r = 0.98; p = 0.002). The high expression of OCT4 in the cell line did not improve the final outcome of cloning. Somatic expression of OCT4 lead to increased expression of OCT4 and SOX2 in cloned grade I blastocysts; however, there was a bigger variability in OCT4 and SOX2 (p = 0.03; p = 0.02) expression in the embryos generated from cells expressing highest levels of OCT4. Probably the higher variability in OCT4 expression in cloned embryos is due to incorrect reprogramming and incapability of the oocyte to correct for higher OCT4 levels. For that reason, we concluded that OCT4 expression in somatic cells is not a good prognosis marker for selecting cell lines.


Subject(s)
Embryonic Stem Cells/cytology , Nuclear Transfer Techniques , Octamer Transcription Factor-3/biosynthesis , Oocytes/cytology , Animals , Blastocyst/cytology , Blastocyst/metabolism , Cattle , Cell Nucleus/genetics , Cell Nucleus/metabolism , Embryo, Mammalian , Embryonic Development , Embryonic Stem Cells/metabolism , Fertilization in Vitro , Gene Expression Regulation, Developmental , Oocytes/metabolism
20.
Bol. Cient. Asoc. Chil. Segur ; 4(7): 26-31, ene.-jun. 2002. ilus, tab
Article in Spanish | LILACS | ID: lil-348145

ABSTRACT

Hoy en día existe un creciente interés en el estudio de la rentabilidad de los proyectos de prevención, para lo cual existen varios modelos de estudios económicos y financieros en la literatura especializada. Sobre la base de los mismos y considerando los factores que intervienen en un proyecto de prevención de incendios forestales, se presenta una metodología de aplicación para un bosque con una superficie superior a las 50 hectáreas, en la VIII Región de Chile. Este estudio considera los costos de desarrollar y mantener una brigada de combatientes del fuego, torres de vigilancia y un campamento base dentro del bosque, durante un período de 10 años. Estos costos e inversiones serán llevados a un valor presente para poder compararlos con una pérdida estadísticamente probada hoy en día, generada por un incendio forestal de magnitudes. Estas pérdidas son ajustadas por la probabilidad de ocurrencia de un incendio forestal en esta región, de manera que representar con mayor fidelidad una cifra de deterioro económico de las empresas del rubro


Subject(s)
Humans , Disaster Emergencies , Disaster Warning , Disaster Planning , Disasters , Fires , Man-Made Disasters
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