Answer to Comment on article "Professionalism in physicians in a second-level hospital" / Respuesta a Comentario al artículo "Profesionalismo en médicos de un hospital de segundo nivel"

In relation to the letter to the editor on the article "Professionalism in physicians in a second-level hospital" this reply is issued.

En relación a la carta al editor sobre el artículo "Profesionalismo en médicos de segundo nivel" se emite esta réplica.

Determination of plasma lactate in the emergency department for the early detection of tissue hypoperfusion in septic patients.

OBJECTIVE: To determine the validity of plasma lactate in the emergency department for the early detection of tissue hypoperfusion in septic patients. MATERIALS AND METHODS: Longitudinal descriptive study. Non probabilistic sampling for convenience. Plasma lactate levels were determined in patients admitted to the emergency department with systemic inflammatory response data and clinical suspicion or documented infection. Follow-up was seven days. Complications were considered if the patients presented septic shock, severe sepsis, entry to intensive care or death. RESULTS: Ninety patients were included. The mean age was 57.4±20.31. Fifty five percent (n=49) were women. 25% (n=22) of the patients showed complications. Plasma lactate levels were 1.55mmol/L in uncomplicated patients and 3.72mmol/L for complicated patients (p<0.001). The area under the ROC curve was 0.72 (95% CI, 0.575-0.829). The cutoff point that best described the relationship with the probability of complications was that set at 4.2mmol/L. The variables studied that showed a significant association with the probability of complications were edema (p=0.004), and infections of the respiratory tract (p=0.037). A model that included lactate levels, using as adjustment variables edema and the presence of low respiratory tract infection explained between 0.234 and 0.349 of the dependent variant, correctly classifying 80% of the cases. CONCLUSION: Plasma lactate is useful in emergency departments as a predictive test for the early detection of patients with tissue hypoperfusion that evolve to severe sepsis, septic shock or death.

Professionalism in physicians in a second-level hospital / Profesionalismo en médicos de un hospital de segundo nivel

BACKGROUND: It takes many years to acquire abilities and technical skills necessary to do a good work as a doctor and even more years, for being "good professionals". Much of this training is based on old teaching schemes, but medicine has changed. So far no studies in our medium addressing the problem are known. The aim of this paper was to determine the level of professionalism in physicians that work in a second-level hospital. METHODS: Descriptive cross-sectional study. We apply a survey to physicians, residents and medical interns in a second-level hospital. We developed and implemented a questionnaire on professionalism, which contained 18 items, 3 demographic questions and 15 questions with a Likert scale, which identified four dimensions: specialized knowledge, autonomy in decision-making, self-regulation and social commitment. Descriptive and inferential statistics were used, considering significant a p-value <0.05. RESULTS: We surveyed 228 physicians, 57.5% demonstrated competence in professionalism. 93.3% of the participants were competent in specialized knowledge and 60.5% in social commitment. The physicians and residents got the higher scores, and these differences were significant between autonomy in decision-making and specialized knowledge (p < 0.001). The medical interns obtained lower scores in all dimensions compared with residents and physicians. CONCLUSIONS: More than a half of physicians surveyed had a competent level of professionalism but only in some dimensions. We observed higher scores with a higher academic grade.

Introducción: se requieren años para adquirir las habilidades y destrezas necesarias para un buen desempeño médico y varios más para ser "buen profesionista". Gran parte de este entrenamiento se fundamenta en esquemas de enseñanza antiguos, siendo que la práctica de la medicina ha cambiado notablemente. No se conocen estudios en nuestro medio que aborden el profesionalismo en médicos. El objetivo de este trabajo fue determinar el nivel de profesionalismo en médicos de un hospital de segundo nivel de atención. Métodos: estudio descriptivo-transversal. Se encuestaron médicos adscritos, residentes e internos en un hospital de segundo nivel. Se elaboró y aplicó un cuestionario sobre profesionalismo, con 18 ítems (3 preguntas demográficas y 15 tipo Likert), que incluyó 4 dimensiones: conocimiento especializado, autonomía en la toma de decisiones, autorregulación y servicio de compromiso social. Se utilizó estadística descriptiva e inferencial. Resultados: se incluyeron 228 médicos, el 57.5% fueron competentes en profesionalismo de manera global. El 93.3% en conocimiento especializado y 60.5% en compromiso social. Los médicos adscritos y residentes obtuvieron las calificaciones más altas, siendo significativas estas diferencias en conocimiento especializado y autonomía (p < 0.001). Los internos obtuvieron puntajes más bajos en todas las categorías. Conclusiones: poco más de la mitad de los médicos presentó un nivel de profesionalismo competente en algunas dimensiones. Se obtuvieron puntajes más altos a mayor grado académico.

[Burnout and quality of life in medical residents]. / Desgaste profesional y calidad de vida en médicos residentes.

BACKGROUND: burnout and quality of life are poorly studied phenomena in postgraduate students, and its effects are unknown. The aim was to investigate the relationship between quality of life and burnout in medical residents. METHODS: a longitudinal study was performed. We included medical residents who began their postgraduate studies in 2010. The Spanish version of the Quality of Life Profile for the Chronically Ill (PLC, according to its initials in German), and the Maslach Burnout Inventory specific to physicians were applied at the beginning, and six and 12 months later. Descriptive statistics were used for nominal variables. Chi-square and ANOVA were applied to numerical variables. RESULTS: we included 45 residents, the average age was 26.9 ± 2.93 years, 18 (40 %) were female and 27 (60 %) were male. The PLC survey found significant decrease in four of the six scales assessed in the three measurements. The Maslach Burnout Inventory found high levels of emotional exhaustion in the three tests, low levels of depersonalization and low personal gains at the beginning, rising at six and 12 months. The most affected specialty was Internal Medicine. CONCLUSIONS: burnout and impaired quality of life for residents exist in postgraduate physicians and it is maintained during the first year of residency.

Introducción: el burnout y la calidad de vida son fenómenos poco estudiados en estudiantes de posgrado y sus efectos se desconocen. Métodos: estudio descriptivo longitudinal. Se incluyeron residentes que iniciaron su primer año de posgrado en marzo de 2010. Se aplicó, a su ingreso, a los 6 y 12 meses, la versión española del cuestionario PEC VEC de perfil de calidad de vida validado al español y el inventario de burnout de Maslach específico para médicos. Para las variables nominales se utilizó ?2 y para variables numéricas Anova. Resultados: se incluyeron 45 residentes. La edad promedio fue de 26.9 ± 2.93; 18 (40 %) fueron del sexo femenino y 27 (60 %) del masculino. En la encuesta PEC VEC se encontró un descenso significativo en cuatro de las seis escalas valoradas en las tres mediciones realizadas. En el cuestionario de burnout se encontraron niveles altos de agotamiento emocional en las tres pruebas, bajo grado de despersonalización, y logros personales al ingreso, elevándolos a los 6 y 12 meses. La especialidad más afectada fue medicina interna. Conclusiones: hay presencia de burnout y deterioro de calidad de vida en médicos residentes que estudian posgrado y se mantiene durante el primer año de residencia.

[Quality of life in Mexican women with breast cancer at different stages and its association with sociodemographic characteristics, comorbidities and procedural factors at the Mexican Institute of Social Security]. / Calidad de vida en mujeres Mexicanas con cáncer de mama en diferentes etapas clínicas y su asociación con características socio-demográficas, estados co-mórbidos y características del proceso de atención en el Instituto Mexicano del Seguro Social.

INTRODUCTION: Quality of life is the most studied PRO (patient reported outcome) in cancer patients. With early diagnosis and better treatments in breast cancer, this entity has been transformed in a chronic disease with longer survival. The joint effects of diseases and treatment on quality of life are each day more important to consider in survival patients. OBJECTIVE: To evaluate quality of life, socioeconomic factors, co-morbidities, and the attendance process impact on quality of life in breast cancer women with different clinical stages attending at the Instituto Mexicano del Seguro Social using the EORCT QLQ-C30 RESULTS: The scores of EORTC QLQ-C30 (v3) were: Global health status / QoL: 73.47 (± 20.81), physical functioning 76.98 (± 20.85), role functioning 76.60 (± 27.57), emotional functioning 64.53 (± 26.81), cognitive functioning 74.47 (± 26.02), social functioning 84.96 (± 23.20), fatigue 31.94 (± 25.45), nausea and vomiting 19.49 (± 26.93), pain 28.95 (± 27.27), dyspnea 15.29 (± 24.62), insomnia 35.13 (± 32.10), appetite lost 18.04 (± 28.75), 18.04 (± 28.75), constipation 19.20 (± 32.11), diarrhea 12.9 (± 24.25), financial difficulties 40.57 (± 37.26). The scores with EORTC QLQ-BR23 were: body image 74.84 (± 31.69), sexual functioning 13.73 (± 22.55), sexual enjoyment 32.86 (± 36.17), future perspectives 51.69 (± 38.00), systemic therapy side effects 30.82 (± 20.71), breast symptoms 22.85 (± 23.49), arm symptoms 27.53 (± 24.75), upset by hair loss 43.80 (± 44.01). CONCLUSIONS: Clinical stage in breast cancer is associated with differences in the scores from fatigue, nausea and vomiting and financial difficulties according to the evolution of the disease and the physical detriment associated. Socio-demographic features were related role functioning, fatigue and pain in single women with higher scores.

El estudio histopatológico como auxiliar diagnóstico en el SIDA / Histopathologycal studios as diagnosis auxiliar in the AIDS

Para mostrar la utilidad del estudio histopatológico, se revisó la información de 134 pacientes infectados con el VIH, atendidos en el Hospital Regional Núm. 45 del Instituto Mexicano del Seguro Social de Guadalajara, Jalisco; de éstos, se seleccionaron 32 para su análisis y presentación. La candidiasis (46.87%), tuberculosis (40.62%) y el sarcoma de Kaposi (25%) fueron las complicaciones más frecuentes del síndrome de inmunodeficiencia adquirida. Se compararon los resultados con la bibliografía nacional e internacional. Se sugiere considerar el hábitat geográfico de los enfermos en el diagnóstico diferencial de las enfermedades complicantes y, finalmente, se enfatiza la necesidad de utilizar la biopsia y el estudio postmortem, como auxiliares importantes de diagnóstico en medios como el nuestro