Cross-sectional study of the association between empathy and burnout and drug prescribing quality in primary care.

OBJECTIVE: The aim of this study was to assess whether burnout and empathy levels among general practitioners (GPs) might influence prescribing performance assessed using pharmaceutical prescription quality standard indicators. DESIGN AND SETTING: Cross-sectional descriptive study of 108 GPs from 22 primary care centers in Lleida, Spain, and of centralized data corresponding to 183 600 patients under their care. The study was conducted between May and July 2014. MAIN OUTCOME MEASURES: Burnout and empathy were measured using the Spanish versions of the Maslach Burnout Inventory and the Jefferson Scale for Physician Empathy, and prescribing quality was measured using the Catalan Pharmaceutical Prescription Quality Standard (EQPF). Normal distribution of scores was verified using the Chi-square and Kolmogorov-Smirnov-Lilliefors tests. The effect of each of the variables was evaluated using crude odds ratios. RESULTS: Older GPs scored significantly higher in the EQPF (P < 0.05). High empathy scores were positively associated with high EQPF scores. GPs with low burnout also performed better in the EQPF. CONCLUSIONS: More empathic, less burned-out, older GPs showed better prescribing performance according to quality indicators. However, further studies are needed to evaluate other factors influencing prescribing habits. The promotion of communication skills may increase empathy and reduce burnout, thus benefiting patients.

Ética y empatía: relación entre razonamiento moral, sensibilidad ética y empatía en estudiantes de medicina / Ethics and empathy: the relationship between moral reasoning, ethical sensitivity and empathy in medical students

La práctica clínica de calidad no incluye tan solo la mejora de conocimientos en aspectos científicos y técnicos, sino también en la gestión de valores, la sensibilidad ética y las habilidades en la valoración y manejo de los conflictos éticos. La literatura revisada sugiere la existencia de la llamada «erosión ética», según la cual la competencia ética y la empatía disminuyen, o no progresan, durante la formación médica. La finalidad del presente estudio es determinar la relación entre estas variables: ética (razonamiento moral y sensibilidad ética) y empatía en un grupo de estudiantes de medicina, así como determinar la relación con otras variables como el curso académico y el género. Material y método: estudio observacional transversal realizado a 193 estudiantes de medicina de diferentes cursos. Se les administró un cuestionario sociodemográfico, escala de dilemas sociomorales de Rest, viñetas clínicas de medida de sensibilidad ética (Problem Identification Test) y el Test de empatía cognitiva y afectiva.Resultados: se halló una relación directa y significativa entre desarrollo moral, la sensibilidad ética y la mayor empatía. Se detectó un incremento de razonamiento moral y sensibilidad ética entre los alumnos de 1.° y 3.°, sin incremento entre 3.° y cursos superiores. No se encontraron diferencias significativas entre estas variables y el género. Conclusiones: en este estudio se ha hallado una correlación entre razonamiento moral, sensibilidad ética y empatía, así como una falta de progresión de las 2 primeras variables en los últimos cursos del grado de medicina

High-quality clinical practice includes not only improving clinicians' expertise in scientific and technical aspects but also managing values, ethical sensitivity and skills for assessing and dealing with ethical conflicts. The reviewed literature suggests the presence of an "ethical erosion", according to which ethical competence and empathy decrease or do not progress during medical training. The aim of this study was to determine the relationship between ethics (moral reasoning and ethical sensitivity) and empathy in a group of medical students and to determine the relationship with other variables such as academic year and sex. Material and method: a cross-sectional observational study was conducted with 193 medical students from different academic years, who were administered a sociodemographic questionnaire, the Rest sociomoral dilemma test, clinical vignettes to measure ethical sensitivity (Problem Identification Test [PIT]) and a cognitive and emotional empathy test (test de empatía cognitiva y afectiva, TECA). Results: we found a direct and significant relationship between moral development, ethical sensitivity and greater empathy. We detected an increase in moral reasoning and ethical sensitivity among first and third-year students, with no increase between the third year and later academic years. There were no significant differences between these variables and sex. Conclusions: this study found a correlation between moral reasoning, ethical sensitivity and empathy and a lack of progression of the first 2 variables in the last years of the medical degree

Ethics and empathy: The relationship between moral reasoning, ethical sensitivity and empathy in medical students. / Ética y empatía: relación entre razonamiento moral, sensibilidad ética y empatía en estudiantes de medicina.

High-quality clinical practice includes not only improving clinicians' expertise in scientific and technical aspects but also managing values, ethical sensitivity and skills for assessing and dealing with ethical conflicts. The reviewed literature suggests the presence of an "ethical erosion", according to which ethical competence and empathy decrease or do not progress during medical training. The aim of this study was to determine the relationship between ethics (moral reasoning and ethical sensitivity) and empathy in a group of medical students and to determine the relationship with other variables such as academic year and sex. MATERIAL AND METHOD: A cross-sectional observational study was conducted with 193 medical students from different academic years, who were administered a sociodemographic questionnaire, the Rest sociomoral dilemma test, clinical vignettes to measure ethical sensitivity (Problem Identification Test [PIT]) and a cognitive and emotional empathy test (test de empatía cognitiva y afectiva, TECA). RESULTS: We found a direct and significant relationship between moral development, ethical sensitivity and greater empathy. We detected an increase in moral reasoning and ethical sensitivity among first and third-year students, with no increase between the third year and later academic years. There were no significant differences between these variables and sex. CONCLUSIONS: This study found a correlation between moral reasoning, ethical sensitivity and empathy and a lack of progression of the first 2 variables in the last years of the medical degree.

La equidad en la consulta clínica. Propuestas a pacientes, profesionales, gestores y políticos para limitar la discriminación / Equality in clinical practice. Proposals for patients, professionals and managers and policies to limit discrimination

Objetivo: Realizar propuestas que mejoren la equidad de la atención clínica. Métodos: Diseño: Grupo de discusión con enfoque cualitativo realizado desde la perspectiva de la equidad en la consulta. Entorno: Debate realizado en 2013 en España, centrado en la equidad en el trabajo clínico. Participantes: 98 profesionales de atención primaria de varios países. Instrumentos: El análisis de las respuestas fue realizado por los firmantes del presente trabajo agrupadas por temas, interpretadas y reestructuradas por los analistas para dar consistencia. Se diseñó un instrumento de recogida de datos con respuestas abiertas, que permitía responder de forma libre a 3 cuestiones generales que abordaban la mejora de la equidad desde la vertiente del propio profesional, del paciente, y del gestor y del político sanitario. No se fijó como horizonte analítico la saturación de los discursos, por entender que desde esta perspectiva subjetiva de priorización no existía posibilidad de que los discursos llegaran a saturarse. Resultados: Se agregaron las respuestas en los 3 ejes principales recomendando a los profesionales que fueran conscientes de su posibilidad discriminatoria. A los pacientes se les propuso confiar en sus profesionales de salud, exigir la asignación de un profesional de referencia, y a los gestores facilitar los sistemas de información, contribuir a disminuir las desigualdades en salud y fomentar la autonomía del trabajador. Conclusiones: El trabajo presenta propuestas concretas para fomentar una mejora en la equidad en la consulta, durante la prestación de servicios (AU)

Objective: To make feasible and practical proposals to improve equality in the course of clinical care during the patient-provider encounter. Methods: Design: A focus group study was conducted with a qualitative approach from the perspective of reducing health inequalities in the clinic. Setting: A classroom discussion focused on equality in clinical work. Subjects: 98 professionals from several countries. Measurement tools: An analysis of the responses was performed, grouped by themes interpreted by analysts, and restructured to provide consistency and uniformity to responses given. Data were collected using a questionnaire with open answers, allowing free-form answers to three general questions that addressed improving equality from the perspective of the professional themselves, patients, and health policy managers. No saturation horizon of analytical discourses was set, to understand that from this subjective prioritization of opinion there is no possibility that discourses reached saturation. Results: Responses were added to the 3 principal axes, recommending that professionals be aware of their discriminatory ability. Patients were asked to trust their health professionals and that they should be assigned to a professional. It was also proposed that managers provide information systems, help reduce health inequalities, and encourage professional freedom. Conclusions: The paper presents concrete measures to promote improved equality in clinics during the delivery of health care (AU)

[Equality in clinical practice. Proposals for patients, professionals and managers and policies to limit discrimination]. / La equidad en la consulta clínica. Propuestas a pacientes, profesionales, gestores y políticos para limitar la discriminación.

OBJECTIVE: To make feasible and practical proposals to improve equality in the course of clinical care during the patient-provider encounter. METHODS: Design: A focus group study was conducted with a qualitative approach from the perspective of reducing health inequalities in the clinic. Setting: A classroom discussion focused on equality in clinical work. Subjects: 98 professionals from several countries. Measurement tools: An analysis of the responses was performed, grouped by themes interpreted by analysts, and restructured to provide consistency and uniformity to responses given. Data were collected using a questionnaire with open answers, allowing free-form answers to three general questions that addressed improving equality from the perspective of the professional themselves, patients, and health policy managers. No saturation horizon of analytical discourses was set, to understand that from this subjective prioritization of opinion there is no possibility that discourses reached saturation. RESULTS: Responses were added to the 3 principal axes, recommending that professionals be aware of their discriminatory ability. Patients were asked to trust their health professionals and that they should be assigned to a professional. It was also proposed that managers provide information systems, help reduce health inequalities, and encourage professional freedom. CONCLUSIONS: The paper presents concrete measures to promote improved equality in clinics during the delivery of health care.

The profile of general practitioners (GPs) who publish in selected family practice journals.

BACKGROUND: Providing support for research is one of the key issues in the ongoing attempts to improve Primary Care. However, when patient care takes up a significant part of a GP's time, conducting research is difficult. In this study we examine the working conditions and profile of GPs who publish in three leading medical journals and propose possible remedial policy actions. FINDINGS: The authors of all articles published in 2006 and 2007 in three international Family Medicine journals - Annals of Family Medicine, Family Practice, and Journal of Family Practice - were contacted by E-mail. They were asked to complete a questionnaire investigating the following variables: availability of specific time for research, time devoted to research, number of patients attended, and university affiliation. Only GPs were included in the study. Three hundred and ten relevant articles published between 2006 and 2007 were identified and the authors contacted using a survey tool. 124 researchers responded to our questionnaire; 45% of respondents who were not GPs were excluded. On average GPs spent 2.52 days per week and 6.9 hours per day on patient care, seeing 45 patients per week. Seventy-five per cent of GPs had specific time assigned to research, on average 13 hours per week; 79% were affiliated to a university and 69% held teaching positions. CONCLUSIONS: Most GPs who publish original articles in leading journals have time specifically assigned to research as part of their normal working schedule. They see a relatively small number of patients. Improving the working conditions of family physicians who intend to investigate is likely to lead to better research results.

Hipernatremia grave, hiperfosforemia, acidosis metabólica y fracaso renal secundarios a la administración de enemas de limpieza / No disponible

No disponible

Quiste pericárdico / Pericardial cyst

Los quistes pericárdicos son raros, habitualmente asintomáticos y su descubrimiento suele ser casual. Presentamos el caso de un paciente con un quiste pericárdico que fue encontrado casualmente en una radiografía de tórax como una lesión radiopaca en el ángulo cardiofrénico derecho (AU)

Pericardial cysts are rare, are usually asymptomatic and their discovery is generally incidental. We report the case of a male patient with a pericardial cyst that was found incidentally on a chest X-ray as a radio-opaque lesion in right cardiophrenic angle (AU)

Extraña causa de anemia en mujer joven / Uncommon cause of anemia in a young woman

Se presenta el caso de una paciente joven con anemia ferropénica que no era debida a una alteración ginecológica, sino a una causa digestiva poco habitual como es el cáncer gastrointestinal estromal de estómago. Este cáncer, raro en gente joven, tiene un origen celular poco claro y el diagnóstico se confirma mediante inmunohistoquímica

The case of a young female patient with iron-deficiency anemia is presented. It was not due to a gynecological alteration, but rather to a not very common digestive cause such as gastrointestinal stromal cancer of the stomach. This cancer, rare in young people, does not have a not very clear cellular origin and immunohistochemistry confirms the diagnosis

Un portal docente en Atención Primaria: proyecto Fotomedica / Educational portal site in Primary CarepPhotomedical Project

INTRODUCCIÓN. La fotografía digital, la formación continuada a distancia y la universalización de internet son campos de gran proyección en la práctica habitual del médico de familia. OBJETIVO. Creación de una página web de acceso gratuito que ofrezca imágenes médicas de calidad en formato digital. MÉTODO. Se seleccionaron todas aquellas imágenes de la consulta susceptibles de ser de interés docente para el médico de familia. Se diseñó un circuito para la realización de fotografías digitales en dos Áreas Básicas de Salud y un hospital de referencia. Una vez obtenida una casuística importante de imágenes en formato JPEG, se diseñó la forma de la página, la política de privacidad, se buscó un servidor, se registró un dominio, y finalmente se colgó la página en red. RESULTADOS. Se ha creado una página con 1.200 imágenes médicas. Se han recibido más de 600.000 peticiones al servidor en un año, con visitas procedentes de España y varios países de habla hispana. Ha habido una transferencia media diaria de 17,15 megabytes. La mayor afluencia se realiza de martes a viernes (63% del total de visitas), siendo de 10 a 13 y de 15 a 19 las horas de más entradas. CONCLUSIONES. Se ha conseguido crear una página dinámica e interactiva que ofrece libremente múltiples imágenes de interés docente para el médico de familia

INTRODUCTION. Digital photography, correspondence continuous education and universalization of Internet are fields having great projection in the usual practice of the family doctor. OBJECTIVE. Creation of a free access web page that offers medical images of quality in digital format. METHOD. All those images of medical consultation that may have teaching interest for the family doctor were selected. A circuit to perform digital photographs in two basic health areas and a reference hospital were selected. Once an important casuistry of the images in JPEG format was obtained, the page form and privacy policy were designed, a server sought, a domain was registered and finally the page was up-loaded in the net. RESULTS. A page with 1200 medical images has been created. More than 600,000 requests have been received by the server in one year, with visits from Spain and several Spanish speaking countries. There has been a mean daily transference of 17.15 megabytes. The greatest number of visits is from Tuesday to Friday (63% of all the visits), 10 a.m. and 1 p.m. and 3 p.m. to 7 p.m. having the most visits. CONCLUSIONS. It has been possible to create a dynamic and interactive page that freely offers multiple images of teaching interest for the family doctor

Uso de tacrolimus tópico y sus efectos adversos / Use of topical tacrolimus and its side-effects

No disponible

Autorización para usar imágenes fotográficas en el modelo educativo de atención primaria / Authorisation for use of photographic images in the educational model of primary care

No disponible

¿Puede ser una buena herramienta docente el uso de la cámara digital en un centro de atención primaria? / Can digital cameras in a primary care centre be a good teaching tool?

No disponible