Una estrategia educativa permite prevenir el síndrome de muerte súbita del lactante / An effective educational strategy can prevent sudden infant death syndrome

El síndrome de muerte súbita del lactante (SMSL) es una de las principales causas de muerte infantil. Aunque se desconoce su etiología, existen recomendaciones sencillas para evitar el riesgo de mortalidad. Objetivo: Determinar el efecto de una estrategia educativa en el desarrollo de conocimiento del personal de la salud sobre las medidas para evitar el SMSL. Material y métodos: Estudio cuasi experimental que analizó el efecto de una estrategia educativa en el personal de la salud que trabaja en áreas de pediatría del HGR 25. Se aplicó un instrumento diseñado ex profeso. Se empleó estadística descriptiva y no paramétrica. Resultados: La estrategia educativa constó de presentaciones y discusión dirigida, así como sesiones de preguntas y respuestas. Se incluyeron un total de 118 elementos del personal de la salud. Predominaron el género femenino (83.89%) y las enfermeras no especialistas (47.45%). El 85.59% correspondió a áreas de pediatría y el 14.49% a áreas de urgencias. Las pruebas de Kruskal-Wallis y de la U de Mann-Whitney no mostraron diferencias respecto de las respuestas entre las categorías tanto preestrategia como pos estrategia. La prueba de Wilcoxon encontró un avance significativo en cada una de las preguntas posteriores a la estrategia educativa. Conclusiones: Una estrategia educativa favorece el desarrollo de conocimiento...

[Procedures performed by emergency medicine residents in a Mexico City medical facility]. / Procedimientos realizados por residentes de la especialidad de urgencias en una sede de México.

OBJECTIVE: To determine the amount and type of procedures performed by three groups of emergency medicine residents in an emergency service in a Mexico City campus. METHODS: We carried out an observational study using a sampling type census with the authorization of the local internal review board (IRB). We followed 33 emergency medicine residents working in Mexico City during the 2007-2008 academic year. We registered the procedures performed and skills displayed by participants in a daily, weekly and monthly format. We included age, gender, academic degree and rotation service. Using descriptive statistics we calculated frequencies, means and standard deviations. RESULTS: All 33 residents (100%) participated in the study; 33.36% were first year, 33.36% second and 27.27% third year resident. Mean age was of 26.2 +/- 3.5 year and 81.81% were male. Eighteen services where residents carried out their duties were assessed. We recorded a total of 12,075 different procedures and grouped skills under 20 subtypes. 33.30% were performed by first-year, 38.29% by second-year, and 28.42% by third-year. The most common procedures included advanced handling of the aerial route (2,376), central venous accesses (2,307), and resuscitation maneuvers (1,624). CONCLUSIONS: The number of procedures carried out at this medical facility is high with a heavier work load than the one reported in the international literature. We should monitor and compare data among different sites in order to have a clearer picture of the status of emergency medicine specialists in Mexico.

Procedimientos realizados por residentes de la especialidad de urgencias en una sede de México / Procedures performed by emergency medicine residents in a Mexico City medical facility

Objetivo: Determinar la cantidad y tipo de procedimientos realizados por los tres grados académicos de la especialidad de urgencias de una sede de México durante un ciclo académico. Métodos: Estudio observacional en el que a través de un censo y con la autorización del comité local de investigación, se realizó el seguimiento de los 33 residentes de la especialidad de urgencias de una sede del Distrito Federal, ciclo académico 2007-2008. Se registraron en un formato ex profeso de forma diaria, semanal y mensual, los procedimientos realizados. Se analizó edad, sexo, grado académico, servicio de la rotación, número y tipo de procedimiento. Se llevó a cabo estadística descriptiva con determinación de frecuencias, medias y desviación estándar. Resultados: Participaron los 33 médicos residentes; 33.36 % de primer año, 33.36 % de segundo y 27.27 % de tercero. La edad media fue de 26.2 ± 3.5 años. El 81.81 % correspondió al sexo masculino. Se evaluaron los 18 servicios en los cuales rotaron los residentes. Se realizaron 12 075 diferentes procedimientos y destrezas agrupadas en 20 tipos; 33.3 % por residentes de primer año, 38.29 % por residentes de segundo y 28.42 % por residentes de tercero. De forma general, predominaron la intubación endotraquel (2376), los accesos venosos centrales (2307) y las maniobras de reanimación (1624). Conclusiones: El número de procedimientos realizados dentro de esta sede resultan elevados y mayores respecto a los informes internacionales. Será necesario plantear un seguimiento y estudio comparativo entre diferentes sedes a fin de tener una idea más clara de la situación de la formación de especialistas en urgencias dentro de México.

OBJECTIVE: To determine the amount and type of procedures performed by three groups of emergency medicine residents in an emergency service in a Mexico City campus. METHODS: We carried out an observational study using a sampling type census with the authorization of the local internal review board (IRB). We followed 33 emergency medicine residents working in Mexico City during the 2007-2008 academic year. We registered the procedures performed and skills displayed by participants in a daily, weekly and monthly format. We included age, gender, academic degree and rotation service. Using descriptive statistics we calculated frequencies, means and standard deviations. RESULTS: All 33 residents (100%) participated in the study; 33.36% were first year, 33.36% second and 27.27% third year resident. Mean age was of 26.2 +/- 3.5 year and 81.81% were male. Eighteen services where residents carried out their duties were assessed. We recorded a total of 12,075 different procedures and grouped skills under 20 subtypes. 33.30% were performed by first-year, 38.29% by second-year, and 28.42% by third-year. The most common procedures included advanced handling of the aerial route (2,376), central venous accesses (2,307), and resuscitation maneuvers (1,624). CONCLUSIONS: The number of procedures carried out at this medical facility is high with a heavier work load than the one reported in the international literature. We should monitor and compare data among different sites in order to have a clearer picture of the status of emergency medicine specialists in Mexico.

Frequency and factors associated with misuse of hospital emergency services.

BACKGROUND: Situations that affect the saturation of emergency services mention their misuse by patients. Identifying factors associated with this phenomenon will allow us to develop strategies to optimize its operation. METHODS: We conducted an observational study. The study was approved by the Research Committee and included randomized patients who requested emergency consultations during the month of October 2008. An instrument was expressly designed to study the application for inadequate attention and five indicators. We used descriptive statistics and odds ratio. RESULTS: We conducted 718 interviews: 74.14% in adults and 25.45% in children. Of these, 61.11% were male and the mean age was 65.15 ± 19.32 years. Of the consultations, 65.17% were considered inappropriate (61.67-75.20% for adult and pediatric patients). The association of factors are significant according to the following: service consultation on Friday (OR 4.21) and Monday (OR 3.45), perception of receiving rapid attention (OR 3.24), being denied care in this unit (OR 3.14), lower level of primary education (OR 3.21), arriving during the evening shift (OR 2.56), affiliation with family medical unit 35 (OR 2.19), and earning a minimum wage income (OR 2.27). CONCLUSIONS: Misuse of emergency department services is higher than that reported worldwide. Factors associated with this deviation may be solved by improving the processes of first-level units.

[Approaches to medical training among physicians who teach; analysis of two different educational strategies]. / Postura ante la educación en médicos con funciones docentes. Alcances de dos diferentes estrategias educativas.

OBJECTIVE: Compare the outreach of a promotional educational strategy that focuses on active participation and compare it with a more traditional approach to medical training. METHODS: A quasi-experimental design was approved by the research committee. We compared the outreach of two different approaches to medical training. We administered a validated instrument that included 72 items that analyze statements used to measure educational tasks in the form of duplets through 3 indicators. A group that included seven physicians that were actively participating in teaching activities was stratified according to teaching approaches. One of the approaches was a traditional one and the other included a promotional strategy aimed at increasing participation. All participants signed informed consent before answering the research instruments. Statistical analysis was done using non-parametric tests. RESULTS: Mann-Whitney results did not show differences among the group in the preliminary analysis. A second analysis with the same test after the interventions found significant differences (p d" 0.018) in favor of those subjects that had participated in the promotional approach mainly in the indicator measuring "consequence". The Wilcoxon test showed that all participants in the promotional approach increased significantly (pd" 0.018) in 3 main indicators as compared with the control group. CONCLUSIONS: A promotional strategy aimed at increasing physician participation constitutes a more profitable approach when compared with traditional teaching methods.

Postura ante la educación en médicos con funciones docentes. Alcances de dos diferentes estrategias educativas / Approaches to medical training among physicians who teach; analysis of two different educational strategies

Objetivo: Comparar el alcance de una estrategia educativa promotora de la participación con el de una tradicional, sobre el desarrollo de postura ante la educación en médicos docentes. Métodos: Estudio cuasiexperimental en el que se empleó un instrumento validado de 72 enunciados que abordan aspectos del quehacer docente en forma de duplas excluyentes a través de tres indicadores. Los grupos naturales se conformaron por siete médicos con actividades docentes cada uno, inscritos en dos diplomados en docencia: uno abordado de forma tradicional y otro con una estrategia promotora de la participación. Los instrumentos fueron aplicados previo consentimiento. El análisis estadístico utilizado fue no paramétrico. Resultados: La U de Mann-Whitney inicial no mostró diferencias entre los grupos; la misma prueba tras las intervenciones tuvo diferencia significativa (p≤0.018) a favor del grupo intervenido, principalmente en el indicador de consecuencia. La prueba de Wilcoxon mostró que todo el grupo intervenido incrementó significativamente (p≤0.018) en los tres indicadores; situación no encontrada en el grupo comparativo. Conclusiones: Una estrategia promotora de la participación alcanza mejores logros en el desarrollo de una postura ante la educación.

OBJECTIVE: Compare the outreach of a promotional educational strategy that focuses on active participation and compare it with a more traditional approach to medical training. METHODS: A quasi-experimental design was approved by the research committee. We compared the outreach of two different approaches to medical training. We administered a validated instrument that included 72 items that analyze statements used to measure educational tasks in the form of duplets through 3 indicators. A group that included seven physicians that were actively participating in teaching activities was stratified according to teaching approaches. One of the approaches was a traditional one and the other included a promotional strategy aimed at increasing participation. All participants signed informed consent before answering the research instruments. Statistical analysis was done using non-parametric tests. RESULTS: Mann-Whitney results did not show differences among the group in the preliminary analysis. A second analysis with the same test after the interventions found significant differences (p d[quot ] 0.018) in favor of those subjects that had participated in the promotional approach mainly in the indicator measuring [quot ]consequence[quot ]. The Wilcoxon test showed that all participants in the promotional approach increased significantly (pd[quot ] 0.018) in 3 main indicators as compared with the control group. CONCLUSIONS: A promotional strategy aimed at increasing physician participation constitutes a more profitable approach when compared with traditional teaching methods.

Estilos de aprendizaje de los médicos residentes de un hospital de segundo nivel / Learning styles of resident physicians in a 2nd. Level hospital

Se realizó un estudio observacional-transversal-comparativo, aprobado por el comité local de investigación para identificar los estilos de aprendizaje de los médicos residentes de las especialidades de Urgencias, Pediatría y Medicina Interna de un hospital sede de segundo nivel de la Ciudad de México. Se les aplicaron dos instrumentos previamente validados que evalúan los estilos de aprendizaje desde 2 percepciones distintas, el cuestionario Honey-Alonso de estilos de aprendizaje y el test inventario de estrategias de aprendizaje de Kolb. Se midieron además variables como edad, género, grado académico y especialidad. Se empleó estadística descriptiva, así como no paramétrica para la comparación de grupos. Se incluyeron un total de 37 médicos residentes, 67,6 % correspondieron al género masculino, la edad media fue de 27,45±1,95 años y 54,1 % eran residentes de primer año. Con el cuestionario de Honey-Alonso 54,1 % de la población se ubicó en el estilo teórico, en tanto que 27 % en el pragmático; 37,83 % de los residentes mostraron combinación en estilos de aprendizaje y la combinación más frecuente fue teórico-pragmático (71,42 %). La prueba de Kruskal Wallis no encontró diferencias significativas con respecto al grado académico (p=0,817) aunque sí en lo referente a la especialidad (p=0,0001). Con el inventario de Kolb predominó el estilo de conceptualización abstracta (59,5 %), seguido del de experiencia concreta (18,9 %). De acuerdo a la forma en que se procesa la información, el estilo convergente predominó con 56,75 %. La prueba de Kruskal Wallis no mostró diferencia en cuanto al tipo de estilo y los grados académicos (p=0,192), pero sí en lo referente al tipo de especialidad (p=0,0001). Los estilos de aprendizaje preferidos por los médicos residentes explorados son el teórico y el convergente. La especialidad fue la única variable que influyó en la preferencia del estilo. Sería conveniente determinar la repercusión en los aspectos cognitivos, emocionales y generales de los residentes, una vez que los docentes consideren, tanto en los programas como en sus estrategias educativas y en las formas de evaluación, los diferentes estilos de aprendizaje de sus alumnos.

A comparative-cross-observational study was conducted, approved by research local committee to identify learning stiles of resident physicians of Emergences, Pediatrics and Internal Medicine specialties in a hospital siege of 2nd. level in Mexico City. Were applied two previously validated tools evaluating learning stiles from distinct perceptions, Honey-Alonso questionnaire of learning stiles and Kolb learning strategies inventory test. Also, variables as age, gender, academic degree and specialty were measured. We used the descriptive statistics, as well non-parametric to groups comparison. Included are a total of 37 resident physicians, 67,6 % were of male sex, mean age was of 27,45±1,95, and 54,1 % were 1st year residents. Using Honey-Alonso questionnaire, sample was located in the theoretical style, whereas 27 % in the pragmatic one (71,42 %). Kruskal Wallis test no found significant differences as for academic degree (p=0,817) but yes in as for specialty (p=0,0001). For Kolb Inventory there was a abstract conceptual style (59,5 %), followed by concrete experience (18,9 %). According to way of information processing, convergent style prevails with a 56,75 %. Kruskal Wallis test don’t show difference as for type of style and academic degrees (p=0,192), but yes as for type of specialty (p=0,0001). Learning styles preferred by study resident physicians are the theoretical and the convergent ones. Specialty was the only variable influenced on style preference. It is essential to determine impact on cognitive, emotional, and general features of residents, provided that professors considers the different learning styles of their pupils, both, in programs, and in its teaching strategies.

Reanimation Unit experience of a second-level hospital in Mexico City.

OBJECTIVES: The objectives of this study were to determine the clinical characteristics of patients who presented to the Reanimation Unit (RU) of a second-level hospital during one year, and the number and type of emergency procedures performed. METHODS: A cross-sectional study was designed that enrolled all patients >15 years of age who presented to the RU from 01 January through 31 December 2003. The age, gender, diagnosis, site of origin, and disposition of each patient was recorded, as well as the distribution by time of day, the number and type of emergency procedures performed, complications, and mortality rate. RESULTS: Of the 3,741 patients enrolled in the study, 57.0% were male; predominantly 41-50 years old (20%). Most patients presented to the RU from their homes during the afternoon. There were 60 different admission diagnoses: more of the emergencies were for medical than for traumatic emergencies. The predominant pathologies were bronchospasm, hypertensive crisis, and upper gastrointestinal bleeding. Initially, patients either were admitted to the observation unit, the consulting office for the emergency department, or the intensive care unit. There were a total of 2,753 emergency procedures performed: orotracheal intubations were the most common, followed by installation of a catheter into the central venous circulation. Of all of the patients admitted to the RU, 31% were not insured. CONCLUSIONS: There exists a remarkable combination between medical and traumatic emergencies, which is not encountered frequently in other second level-hospitals in Mexico City. A high proportion of the patients who received medical attention were not insured and there were a large number of emergency invasive procedures performed.