El Libro Informático del Residente de Medicina Interna: adquisición de competencias y consecución de objetivos docentes / The Computer Book of the Internal Medicine Resident: competence acquisition and achievement of learning objectives

Antecedentes. El Libro Informático del Residente de Medicina Interna es un programa que ha sido validado para cuantificar la adquisición de competencias durante el periodo de formación en Medicina Interna. Objetivos. Este estudio se propone analizar las características de las rotaciones durante la formación en Medicina Interna e identificar las variables asociadas con la adquisición de competencias clínicas y comunicativas, la consecución de los objetivos docentes y la satisfacción del residente. Métodos. Participaron todos los residentes de nuestro servicio (n=20) durante un período de 40 meses. El Libro Informático del Residente de Medicina Interna está constituido por 22 cuestionarios de autoevaluación específicos para cada período de rotación, con ítems referentes a las características de los servicios dónde se desarrolló la rotación y a los resultados docentes (competencia clínica y comunicativa, consecución de los objetivos docentes y satisfacción global). Resultados. La dedicación asistencial intensa, con elevada responsabilización del residente y la protocolización se asociaron a una mayor adquisición de competencias clínicas. Una elevada competencia clínica y el trabajo en equipo se asociaron a mejores resultados en habilidades comunicativas. Finalmente, un entorno facilitador para el aprendizaje se asoció a mayor competencia clínica, mayor consecución de los objetivos docentes y mayor satisfacción global. Conclusiones. Diversos factores relacionados con el funcionamiento de los servicios influyeron de forma significativa en la adquisición de competencias, la consecución de los objetivos docentes y la satisfacción de los médicos residentes durante la formación especializada en Medicina Interna (AU)

Background. The Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents. Objectives. To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction. Methods. All residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis. Results. An intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction. Conclusions. Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine (AU)

The Computer Book of the Internal Medicine Resident: competence acquisition and achievement of learning objectives.

BACKGROUND: The Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents. OBJECTIVES: To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction. METHODS: All residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis. RESULTS: An intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction. CONCLUSIONS: Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine.

El Libro Informático del residente de Medicina Interna: validez y fiabilidad de un cuestionario para la autoevalución de competencias en residentes de Medicina Interna / The Computer Book of the Internal Medicine resident: validity and reliability of a questionnaire for self-assessment of competences in internal medicine residents

Antecedentes. No se dispone de instrumentos de evaluación de la formación de especialistas que sean simples y estén validados. Objetivos. Analizar la fiabilidad y validez de un método informático de autoevaluación para cuantificar la adquisición de competencias en la formación de especialistas en Medicina Interna. Métodos. Participaron todos los residentes de nuestro servicio durante un período de 28 meses. Se diseñaron 22 cuestionarios de autoevaluación específicos para cada rotación (Libro Informático del Residente de Medicina Interna) con ítems (preguntas) correspondientes a 3 dominios competenciales: competencias clínicas, habilidades comunicativas y competencia para el trabajo en equipo. La fiabilidad se analizó comprobando la consistencia interna de los ítems mediante alfa de Cronbach. La validación se efectuó mediante comparación de medias entre valores observados en residentes senior y junior. Asimismo, se establecieron unos niveles de corte en los valores de competencias para identificar fortalezas y debilidades de nuestro sistema formativo. Finalmente, se correlacionaron los valores de autoevaluación con las evaluaciones de los médicos de plantilla. Resultados. Se observó una elevada consistencia interna de los ítems de competencias clínicas, habilidades comunicativas y trabajo en equipo. Los valores de competencias clínicas y habilidades comunicativas, pero no los de trabajo en equipo, fueron significativamente más elevados en los residentes senior que en los junior. Asimismo, el Libro Informático del Residente de Medicina Interna permitió identificar las fortalezas y debilidades de nuestro sistema formativo. No se observó correlación entre los resultados de la autoevaluación y la evaluación de los médicos de plantilla. Conclusiones. Los ítems del Libro Informático del Residente de Medicina Interna ofrecieron una elevada consistencia interna y permitieron comprobar la adquisición de competencias clínicas y comunicativas en un equipo de residentes de Medicina Interna. Este método de autoevaluación debe complementarse con otros instrumentos para evaluar la adquisición de competencias por un residente individual(AU)

Background. There are no simple and validated instruments for evaluating the training of specialists. Objectives. To analyze the reliability and validity of a computerized self-assessment method to quantify the acquisition of medical competences during the Internal Medicine residency program. Methods. All residents of our department participated in the study during a period of 28 months. Twenty-two questionnaires specific for each rotation (the Computer-Book of the Internal Medicine Resident) were constructed with items (questions) corresponding to three competence domains: clinical skills competence, communication skills and teamwork. Reliability was analyzed by measuring the internal consistency of items in each competence domain using Cronbach's alpha index. Validation was performed by comparing mean scores in each competence domain between senior and junior residents. Cut-off levels of competence scores were established in order to identify the strengths and weaknesses of our training program. Finally, self-assessment values were correlated with the evaluations of the medical staff. Results. There was a high internal consistency of the items of clinical skills competences, communication skills and teamwork. Higher scores of clinical skills competence and communication skills, but not in those of teamwork were observed in senior residents than in junior residents. The Computer-Book of the Internal Medicine Resident identified the strengths and weaknesses of our training program. We did not observe any correlation between the results of the self- evaluations and the evaluations made by staff physicians. Conclusions. The items of Computer-Book of the Internal Medicine Resident showed high internal consistency and made it possible to measure the acquisition of medical competences in a team of Internal Medicine residents. This self-assessment method should be complemented with other evaluation methods in order to assess the acquisition of medical competences by an individual resident(AU)

[The Computer Book of the Internal Medicine resident: validity and reliability of a questionnaire for self-assessment of competences in internal medicine residents]. / El Libro Informático del residente de Medicina Interna: validez y fiabilidad de un cuestionario para la autoevalución de competencias en residentes de Medicina Interna.

BACKGROUND: There are no simple and validated instruments for evaluating the training of specialists. OBJECTIVES: To analyze the reliability and validity of a computerized self-assessment method to quantify the acquisition of medical competences during the Internal Medicine residency program. METHODS: All residents of our department participated in the study during a period of 28 months. Twenty-two questionnaires specific for each rotation (the Computer-Book of the Internal Medicine Resident) were constructed with items (questions) corresponding to three competence domains: clinical skills competence, communication skills and teamwork. Reliability was analyzed by measuring the internal consistency of items in each competence domain using Cronbach's alpha index. Validation was performed by comparing mean scores in each competence domain between senior and junior residents. Cut-off levels of competence scores were established in order to identify the strengths and weaknesses of our training program. Finally, self-assessment values were correlated with the evaluations of the medical staff. RESULTS: There was a high internal consistency of the items of clinical skills competences, communication skills and teamwork. Higher scores of clinical skills competence and communication skills, but not in those of teamwork were observed in senior residents than in junior residents. The Computer-Book of the Internal Medicine Resident identified the strengths and weaknesses of our training program. We did not observe any correlation between the results of the self- evaluations and the evaluations made by staff physicians. CONCLUSIONS: The items of Computer-Book of the Internal Medicine Resident showed high internal consistency and made it possible to measure the acquisition of medical competences in a team of Internal Medicine residents. This self-assessment method should be complemented with other evaluation methods in order to assess the acquisition of medical competences by an individual resident.

Pancoast's syndrome secondary to lung infection with cutaneous fistulisation caused by Staphylococcus aureus.

Apical bronchial carcinoma is the most common cause of Pancoast's syndrome. Of the many other causes reported, infection is a rare one. A literature review is presented and a case of Pancoast's syndrome, secondary to apical lung pneumonia with bronchocutaneous fistulisation caused by Staphylococcus aureus infection, is reported. Clinical and radiological resolution was achieved after treatment with antibiotics.

Four-day, twice daily, quadruple therapy with amoxicillin, clarithromycin, tinidazole and omeprazole to cure Helicobacter pylori infection: a pilot study.

BACKGROUND: The best regimen for the treatment of Helicobacter pylori infection has yet to be defined. Four-day quadruple therapy with tetracycline, metronidazole, bismuth, and a proton pump inhibitor has been shown to obtain a very high cure rate. However, the fact that it must be taken four times daily may interfere with compliance. The objective of the study was to test the efficacy and tolerability of a new 4-day therapy with 4 drugs taken every 12 hours to cure H. pylori infection. Patients and Methods. Fifty-six consecutive patients with peptic ulcer disease and H. pylori infection were treated with an oral 4-day course with omeprazole (20 mg/12 hours), clarithromycin (500 mg/12 hours), amoxicillin (1 g/12 hours) and tinidazole (500 mg/12 hours). Efficacy of the treatment was determined at least 2 months after therapy either by biopsy (in the case of gastric ulcer) or by 13C-urea breath test. A second breath test was performed at least 6 months after therapy. RESULTS: Two patients were lost to follow-up. Forty-nine of the remaining 54 patients were cured at the first control [intention-to-treat cure rate: 87.5% (CI 95% 75-94%); per protocol cure rate: 90.7% (CI 95% 81-98%)]. Forty-three of these 49 cured patients returned for a second 13C urea breath-test at 6-12 months. Two of them were not cured, giving a long-term cure rate of 85.5% per protocol and 73.2% by intention-to-treat. Compliance was good, although 25 patients had mild side effects. CONCLUSION: This particular four-day therapy is well tolerated, easy to follow, and achieves an acceptably high cure rate.

Two-day quadruple therapy for cure of Helicobacter pylori infection: a comparative, randomized trial.

OBJECTIVE: We sought to compare a 2-day quadruple therapy with a 14-day triple therapy in the treatment of Helicobacter pylori infection. METHODS: Eighty-one consecutive patients with an endoscopically diagnosed peptic ulcer and demonstrated infection by H. pylori were included in the study. Patients were randomized to receive omeprazole 40 mg b.i.d., amoxicillin 2.5 g once daily, metronidazole 500 mg t.i.d., and bismuth subcitrate 360 mg t.i.d. for 2 days, followed by omeprazole 20 mg once daily for 6 additional days (Group 1) or a 14-day course of omeprazole 20 mg b.i.d., amoxicillin 1 g t.i.d., and metronidazole 500 mg t.i.d. (Group 2). Eradication was evaluated by antral biopsy and rapid urease test at 2 months after therapy and by C13-urea breath test after a year. RESULTS: Two patients were lost to follow-up at 2 months. Intention-to-treat analysis showed that H. pylori infection was cured in 29 of 42 patients (69%; 95% CI: 53-82%) in Group 1 versus 36 of 39 (92%; 95% CI: 78-98%) of patients in Group 2 (p = 0.009). Per-protocol analysis showed a cure rate of 71% (95% CI: 55-84%) (29/41 patients) and 95% (95% CI: 81-99%) (36/38 patients), respectively (p = 0.007). Fifty-five of 65 cured patients returned 1 year after treatment (26 in Group 1, 29 in Group 2). All but one in Group 2 remained cured. There were no significant differences in compliance (88% in Group 1 versus 92% in Group 2) or in the presence of side effects (27%; 95% CI: 15-43% versus 41%; 95% CI: 26-58%; ns). CONCLUSION: Two-day quadruple therapy is significantly less effective than 2-wk triple treatment.

[Pulmonary hypoplasia in adults: embryology, clinical presentation and diagnostic methods. Our experience and review of the literature]. / Hipoplasia pulmonar en el adulto: embriología, presentación clínica y métodos diagnósticos. Experiencia propia y revisión de la literatura.

We report five patients diagnosed of pulmonary hypoplasia (PH) in adulthood (age > 18 years, range 45 to 67 years). PH was left-sided in four cases. The malformations found were 2 cases of renal agenesis, 2 diaphragmatic hernias and 1 hiatal hernia. Lung function data were FEV1 0.88 +/- 0.32 L; FVC 1.30 +/- 0.52 L; FEV 1/FVC 68.5 +/- 5%. Arterial gases (with FiO2 0.21) were PaO2 63.6 +/- 24 and PaCO2 47.1 +/- 11.2 mmHg. Three cases were referred for monitoring of respiratory insufficiency (2 requiring home oxygen therapy) and two for radiographic study of chest disease. The diagnoses were made by computerized tomography (CT) of the chest. Congenital diseases due to underdeveloped lungs in the pseudoglandular phase are rarely diagnosed in adults (48 cases, including ours, have been found in the literature), and PH is rarely diagnosed, possibly because the anomalies observed are attributed to old infections. Clinical presentation is highly variable, depending in large measure on a history of smoking and repeated respiratory infections. Chest CT is at present the diagnostic tool of choice.

[Seven-day omeprazole, clarithromycin, and amoxicillin for the therapy of Helicobacter pylori infection]. / Omeprazol, claritromicina y amoxicilina durante 7 días para el tratamiento de la infección por Helicobacter pylori.

BACKGROUND: There are few series reporting efficacy of seven-day therapy with omeprazole, amoxicillin and clarithromycin for cure of Helicobacter pylori infection in Spain. The aim of the present study was to evaluate the efficacy of this treatment to eradicate H. pylori infection. PATIENTS AND METHODS: One hundred consecutive patients with peptic ulcer disease and H. pylori infection were evaluated for eradication therapy between January and November 1996. Four of them were excluded because of reported penicillin allergy. The remaining 96 patients received a seven days course of omeprazole 20 mg/12h, clarithromycin 500 mg/12h and amoxicillin 1 g/12h. The efficacy of the treatment was evaluated at 2-4 months after therapy either by endoscopic biopsy or by 13C urea breath-test. RESULTS: Seventy-eight patients were found to be cured at the control evaluation. Intention to treat analysis showed a cure rate of 81.3% (95% CI: 74-89%). Per protocol analysis showed a cure rate of 85.7% (95% CI: 79-93%)--78 out of 91 patient who returned for follow-up-. Compliance with the treatment was good in 94.5% of patients. Five patients presented mild side effects (diarrhea, abdominal pain, oral candidiasis and metallic taste). None of them had to interrupt the treatment. CONCLUSION: Seven-day therapy with omeprazole, amoxicillin and clarithromycin achieves a 85% cure rate of H. pylori infection in our area.

[CT in radiation enteritis]. / El CT en la enteritis rádica.

The computed tomography findings of 18 patients who had received radiation therapy for pelvic malignancies were reviewed retrospectively. They include bowel wall thickening, mainly in central areas and in contact with anterior abdominal wall, mesenteric thickening, without masses and rectal and presacral space involvement. The differential diagnosis of these findings is discussed.

Psoas muscle pancreatic pseudocyst: CT--US diagnosis and percutaneous drainage.

We present 2 cases of psoas muscle pancreatic pseudocysts. In both cases there was no clinical or laboratory evidence of recent acute pancreatitis. The route of extension for the pseudocyst from the pancreas to the psoas was the perirenal space. In both cases the diagnosis was made on the basis of imaging studies and the pseudocysts resolved with percutaneous drainage only.

[Pregnancy-specific beta-1 glycoprotein (SP1) as a marker for tumors with or without trophoblastic character]. / La beta-1 glicoproteina específica del embarazo (SP1) como marcador de los tumores de naturaleza trofoblástica o no.

The pregnancy specific beta-1-glycoprotein (SP1) was measured by radioimmunoassay in 854 persons (control group 103, non-tumoral diseases 212, germinal tumors 30, and non-germinal tumors 509). Amounts higher than 2.5 ng/ml (upper normal limit) were observed in 35 cases with non tumoral diseases (specially chronic liver diseases), 97 of the non-germinal tumors (specially mammary, respiratory and digestive tumors), and 10 of the germinal tumors (pure and mixed choriocarcinomas, and embryonic carcinoma with yolk sac component). SP1 rarely is higher than 5 ng/ml in non-tumoral diseases and non-germinal tumors, while it is higher than 5 ng/ml in germinal tumors. SP1 is a good marker for trophoblastic neoplasms and shows a correlation with HCG-beta.

[Creatine phosphotransferase, B subunit, as a tumor marker. Preliminary results]. / La creatinfosfotransferasa, subunidad B, como marcador tumoral. Resultados preliminares.

Creatine kinase B (CK-B) was evaluated as a tumor marker by radioimmunoassay determination of the isoenzyme in 518 persons (control group, malignant tumors, and several other diseases). Amounts higher than 8 ng/ml (upper normal limit) was observed in 12.6 per 100 of the digestive tumors, 6.1 per 100 of the mammary tumors, 37.7 per 100 of the respiratory tumors, and 22.2 per 100 of the prostatic tumors. A relation exists between CK-B and sigmoid flexure, liver, pancreas and esophagus tumors, between CK-B and acid phosphatase in prostate tumors, and between CK-B and evolution of digestive tumor. The determination of CK-B is useful in the case of tumors lacking known tumor markers, and also as a complementary sign in the diagnosis and evolution of sigmoid flexure and prostate neoplasms.