Rodrigo Moreno B

Mejoría en el desempeño académico de estudiantes de medicina en tiempos de reforma curricular

Background: During the last decade, academic life at the medical school of the Pontificia Universidad Catolica de Chile has been thoroughly affected by a curricular reform process. Changes started in 1993 and have continued up until now. This reform did not have an experimental design to allow for a scientific evaluation of its effects. However, it seems interesting to study the evolution of indices of academic performance of our students during this period. Aim: To evaluate the academic performance of medical students between 1989 and 1999. Subjects and Methods: All undergraduate students enrolled between 1989 and 1999. Academic performance was evaluated by 1) failure to pass one or more courses, 2) delay to complete the third year of studies, 3) withdrawal from school and 4) medical school grades. Results: All indices of academic performance changed during the period of study. Failure to pass, delay and withdrawal from school significantly decreased, whereas medical school grades improved, particularly in basic and pre-clinical subjects. Conclusions: Academic performance of medical students improved consistently between 1989 and 1999. While specific causal relationships cannot be established, we believe that this improvement is likely related to the curricular reform. This reform included horizontal and vertical integration of academic contents, greater emphasis in problem-based learning and additional instances of evaluation such as the repetition exam (Rev Med Chile 2002; 130: 437-445)

Espirometría: Manual de procedimientos. Sociedad Chilena de Enfermedades Respiratorias, 2006

La espirometria es una prueba fundamental en la evaluacion funcional respiratoria. Este test es utilizado frecuentemente en la practica clinica y en estudios de poblaciones. Entre los diversos indices derivados de una espiracion forzada, el VEF1 y la CVF son los mas usados debido a su buena reproducibilidad, facilidad de su medicion, y su grado de correlacion con la etapa de la enfermedad, condicion funcional, morbilidad y mortalidad. Considerando la importancia de aplicar procedimientos estandarizados para realizar espirometrias, un comite de especialistas en funcion pulmonar de la Sociedad Chilena de Enfermedades Respiratorias, elaboro este manual de procedimientos para realizar espirometrias. El objetivo de este manual es comunicar las normas internacionales para realizar espirometrias, a fin de promover su aplicacion en la practica clinica y de laboratorio. Ademas se propone una manera consensuada para informar e interpretar los valores espirometricos tanto en la practica clinica como en el trabajo de laboratorio

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana

Objetivos: Establecer la etiologia de la neumonia y comparar el rendimiento de diferentes tecnicas para el diagnostico de las infecciones por Pneumocystis jiroveci y Mycobacterium tuberculosis en pacientes con infeccion por virus de inmunodeficiencia humana (VIH). Material y Metodos: De cada paciente se obtuvo esputo inducido y se efectuo LBA. A las muestras obtenidas se les realizo tinciones de Gram, Ziehl-Neelsen, plata e inmunofluores-cencia (IF) para P. jiroveci y M. tuberculosis; reaccion de polimerasa en cadena (RPC) para ambos microorganismos; cultivos aerobicos, fungicos, para micobacterias, virus respiratorios y citomegalovirus. Tambien se realizo determinacion de IgM de Mycoplasma pneumoniae y Chlamydophyla pneumoniae y antigeno urinario de Legionella pneumophila. Resultados: Se incluyeron 60 pacientes, lograndose diagnostico etiologico en 97% de los casos. Pneumocystis jiroveci fue la etiologia mas frecuente (58%), seguida por Streptococcus pneumoniae (12%) y Mycobacterium avium complex (MAC) (12%). Mycobacterium tuberculosis fue encontrado en 5%. Conclusiones: La comparacion de los metodos diagnosticos para P. jiroveci mostro una mayor sensibilidad de la IF y tincion de plata en LBA que en esputo; sin embargo, la RPC fue igualmente sensible en ambos tipos de muestras. Con esta estrategia se logro establecer etiologia en la gran mayoria de los pacientes. La etiologia mas comun fue P. jiroveci. IF en LBA sigue siendo el estandar para el diagnostico de la neumonia por P. jiroveci.

Etiología de la neumonía adquirida en la comunidad en el adulto inmunocompetente

En la situacion clinica ideal, el tratamiento antimicrobiano empirico prescrito en la neumonia del adulto adquirida en la comunidad (NAC) deberia estar basado en el resultado de los estudios microbiologicos realizados en el medio nacional. La informacion disponible sobre la etiologia en el medio ambulatorio y la UCI es relativamente escasa, en comparacion con la referida al medio intrahospitalario. En los estudios disenados especificamente para estudiar los agentes causales, en 40-50% de los casos no se identifica el patogeno respiratorio, lo que pone de manifiesto las dificultades de los metodos diagnosticos. En todos los escenarios de atencion, Streptococcus pneumoniae es el principal patogeno respiratorio aislado en la NAC del adulto, siendo responsable de 16% de los casos tratados en el medio ambulatorio y de alrededor de 22% de los casos admitidos al hospital y la UCI. Aproximadamente un tercio de los casos son causados por un conjunto de varios microorganismos: Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, virus respiratorios, Staphylococcus aureus, bacilos gramnegativos y Legionella sp, siendo cada uno responsable de menos de 10% de los casos. En general, la distribucion de los microorganismos varia escasamente en los tres entornos de atencion: ambulatorio, sala de cuidados generales y UCI. Entre las excepciones destaca una mayor frecuencia de infeccion por bacilos gramnegativos, S. aureus y Legionella sp en la UCI, y de C. pneumoniae en el medio ambulatorio. En Chile, la etiologia de la NAC en el adulto hospitalizado es similar a la comunicada en estudios extranjeros, y no se dispone de informacion especifica sobre la NAC de manejo ambulatorio y de la que cursa en forma grave

Etiology of community-acquired pneumonia in immunocompetent adults

In an ideal clinical setting, empiric antimicrobial treatment prescribed in adult community acquired pneumonia (CAP) should be based on national etiological surveillance and in vitro susceptibility assays. Available information about etiology in ambulatory patients and intensive care unit (ICU) patients is scarce, compared to information obtained in hospitalized patients. In studies designed to explore the etiology of pneumonia, no microorganism is detected in 40-50% of patients, a fact that represents limited yields in diagnostic methods. In all settings, Streptococcus pneumoniae is the main respiratory pathogen recovered in adults CAP, being responsible of about 16% of cases among ambulatory patients and about 22% of those admitted to hospital and ICU. About one third of cases are caused by a small group of microorganisms: Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, respiratory viruses, Staphylococcus aureus, gramnegative bacillus, Legionella sp; each one is isolated in less than 10% of cases. In general, microorganism distribution varies scarcely in the following attending settings: ambulatory patients, common wards and ICU. An exception is represented by a higher frequency of gram negative bacillus, S. aureus and Legionella sp in ICU, and of C. pneumoniae in the ambulatory setting. In Chile, CAP etiology in hospitalized adult patients is similar to foreign reports; no systematic information has been collected about the etiology in neither ambulatory patients nor in severe CAP.

Seroprevalencia de Legionella pneumophila en Santiago: evidencias de exposición durante la infancia

Evidence of past exposure to i. pneumcphila was evaluated in a 1 20 chiiean subjects less than 20 yeais old stratified by socioeconomic background and age. Serum samples were analyzed for /. pneumophila antibodies by indirect immunofluorescence using serogroup 1 to 6 antigens; tilers equal or greatci than 1:64 were considered positive. Overall, 1 2 out of 1 20 samples (10%) were positive for (. pneumcphila antibodies and different prevalence rates were recorded among individuals of low [0/40], middle (2/40; 5%} and high j 10/40; 25%) socioeconomic groups. The highest liters observed in this heallhy population based survey were 1:128. High socioeconomic background is associated with highest prevalence of anfi-i. pneumophila antibodies in chilean population.

Descripción de los Procesos de Evaluación en la Escuela de Medicina de la Pontificia Universidad Católica de Chile: Experiencia de 10 años

Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Catolica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comite Nacional de Acreditacion de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.