Statistics and Epidemiology are crucial both in clinical decision-making and clinical research. Teaching these disciplines in a Bachelor's Degree in Medicine is a significant challenge. In this ...paper, we aim to describe two participatory teaching methods used in a yearlong second-year course that includes both Epidemiology and Statistics, and to analyze how these two methodologies affect the students' perception of the course and their abilities related to these subjects. Both methodologies consist in carrying out a specific practical activity. The first practical activity is carried out using a website and aims to help students understand concepts and interpret information; the second involves analyzing a database using a statistical package and, subsequently, producing a scientific report. In addition, we prepared a questionnaire to find out the students' perception of these issues. The nine questionnaire items were assessed using a rating scale and adapted to characteristics of the course, which covers Epidemiology and Statistics in an integrated manner. Then we assessed the differences in perception before and after the activities were carried out. The results show that the students' perception improved significantly in the following items: "importance of Statistics and Epidemiology in Medicine"; "usefulness in clinical practice"; "understanding concepts"; "ability to perform a statistical analysis"; and "ability to sort data". The difference was not significant in the remaining four items. In conclusion, the students' perception of their ability in Statistics and Epidemiology significantly improved after completing the practical activities, and their perception of importance and usefulness of these subjects also improved.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Este trabajo aborda la inmigración española a Argentina de la segunda mitad del siglo XX, décadas después. En el nuevo siglo, encontramos a algunos de aquellos inmigrantes y a sus descendientes ...trabajando en sus asociaciones y federaciones en la tarea de mantener vivo el recuerdo de su tierra de origen y estableciendo una red densa de contactos con las instituciones en España, en un momento en que la colectividad se ha asimilado a la sociedad argentina. Lejos de resultar paradójico, el caso de los castellanos y leoneses en Buenos Aires muestra cómo el transnacionalismo de determinadas prácticas culturales convive en un escenario de asimilación.
Antecedentes: la falta de adherencia de los pacientes a sus tratamientos tiene un gran impacto tanto clínico como económico. Aunque existen diferentes métodos para medir la adherencia, los estudios ...retrospectivos son cada vez más utilizados por ser objetivos y menos sensibles a la percepción del paciente, interfiriendo menos en su vida. El sistema de receta electrónica proporciona a la farmacia comunitaria una herramienta útil para llevar a cabo esta investigación. Objetivos: utilizar el sistema de receta electrónica para medir la adherencia de los pacientes a su medicación crónica, analizando diferentes grupos terapéuticos y la salud mental de los pacientes. Métodos: se desarrolló un estudio observacional, ambispectivo y longitudinal. La adherencia se evaluó mediante la Proportion of Days Covered (PDC) por paciente y por tratamiento y con el test de Morisky Green Levine. A través del sistema de receta electrónica se obtuvieron datos sobre los medicamentos dispensados a los pacientes durante los últimos 12 meses. Los datos sobre la salud mental de los pacientes se recogieron mediante el cuestionario PHQ-2. Resultados: se reclutaron un total de 300 pacientes, pero sólo 290 se incluyeron en el análisis. El 25,5 % (IC: 20,6-30,9) se clasificó como polimedicado. El PDC por paciente tuvo una mediana de 0,90 (AI: 0,73-1). Según el cuestionario de Morisky Green Levine, el 57,9 % de los pacientes (IC: 52,0-63,6) eran adherentes a sus tratamientos. La concordancia entre el test de Morisky Green Levine y el PDC fue de kappa=0,086. Conclusiones: la receta electrónica resultó ser una herramienta útil para conocer la adherencia de la población a sus tratamientos crónicos medida con el PDC.
Objetivo: conocer la satisfacción y percepción de los pacientes con el sistema de receta electrónica. Métodos: se realizó un corte transversal en 290 pacientes que contestaron el cuestionario ...PERSA-RE. Se recogieron las variables sociodemográficas de los pacientes e información sobre su adherencia a través del cuestionario Morisky Green Levine. Se analizaron las diferencias en las puntuaciones del cuestionario según las variables sociodemográficas y la adherencia de los pacientes. Resultados: la puntuación total media del cuestionario fue de 63,42 (DE 7,02) sobre una puntuación total de 85. El atributo mejor valorado del cuestionario fue “Satisfacción” con una puntuación de 4,32, mostrando los pacientes su preferencia por la receta electrónica frente a la receta de papel. El 96 % de los pacientes afirmó poder recoger su medicación sin problema con la tarjeta sanitaria. El atributo peor valorado fue “Comprensión”, que puntuó 3,45. Los pacientes más jóvenes puntuaron más alto los atributos “Satisfacción” y “Gasto”. El 70 % de los pacientes dijo estar “totalmente en desacuerdo” o “en desacuerdo” con la afirmación de que el sistema de receta electrónica les ha incrementado su gasto en medicamentos. Los pacientes cumplidores según el Morisky Green Levine presentaron una mayor comprensión del sistema de receta electrónica Conclusión: los usuarios de la receta electrónica tienen un alto grado de satisfacción con este sistema de prescripción y dispensación. El nivel de estudios, la edad y la adherencia fueron las variables con mayor influencia en la puntuación del cuestionario.
Society demands a university education grounded on ethical principles. Education in ethics values is responsibility of universities but will not be viable unless also adopted by directly responsible ...agents, the teachers who work with the students. For this reason, our primary research objective was to conduct an in-depth analysis of how Health Sciences students self-perceive the ethical dimension.
A mixed research methodology with two phases, qualitative and quantitative, allowed us to address our research question from two complementary viewpoints. Conversational interviews were conducted in an intentional and purposive sample to identify a wide range of discursive representations. A questionnaire was designed based on previous studies and the topics of qualitative research. The response format for the questionnaire followed a Likert scale and modulators such as sex, age, degree and the score of a social desirability test were examined.
After 24 conversational interviews, three main thematic blocks (coinciding with the three subscales of the questionnaire) were identified: "attitudes for harmony in human relations", "construction of the self" and "rules and regulations". A total of 246 students completed a questionnaire with 39 items. The total scores ranged from 93 to 152 points, with an average score of 122.72 ± 10.64 points. Responsibility, the basic rules of education and respect were perceived as the two most important values, whereas solidarity and social participation as the least important. Results showed a significant positive linear correlation between total score on the questionnaire and age and social desirability. Age was also a significant predictor for the total score and the subscale score "rules and regulations". The students´ responses seemed to be conditioned by the degree of social desirability that they present.
The ad-hoc questionnaire captured the maintenance of high ethical values in our college undergraduate students, which may be directly related to enhanced social desirability. The scores obtained on the questionnaire were correlated with the students' age, which may indicate that values might tend to acquire progressively more importance as students grow older. Further research is warranted to delve deeper on the determinants of professionalism and ethical decision-making in college students.
Objetivo: diseñar un cuestionario para conocer la satisfacción y percepciones de los pacientes con el sistema de prescripción de receta electrónica. Métodos: el cuestionario se desarrolló en tres ...fases. Primera, búsqueda y selección de los atributos del cuestionario. Segunda, análisis del cuestionario por expertos mediante grupo focal multidisciplinar con farmacéuticos, médicos y enfermeros. Tercera, estudio piloto, observacional en 50 pacientes usuarios de receta electrónica durante al menos un año. Se valoró la consistencia interna del cuestionario, la fiabilidad intraobservador y la validez. Resultados: de la primera y segunda fase resultó un cuestionario que incluye 5 atributos y 17 ítems. En el estudio psicométrico, el alfa de Cronbach fue de 0,77 (IC 95 %: 0,66-0,85), siendo el atributo de “satisfacción” el más valorado. La fiabilidad intraobservador tuvo un coeficiente de correlación de 0,96 (IC 95 %: 0,91-0,98). La validez de criterio quedó confirmada a través de la correlación de Spearman con una escala EVA. La validez convergente fue estadísticamente significativa (p=0,04) para el nivel de estudios y no mostró relación con el número de tratamientos prescritos. Conclusión: el cuestionario diseñado presenta adecuada fiabilidad y validez, y puede ser una herramienta útil para el trabajo en la farmacia comunitaria y para su uso en otras comunidades autónomas.
Abstract
Background
In the ART-PRO pilot trial there were no virological failures through 48 weeks of treatment with dolutegravir plus lamivudine in suppressed individuals with and without archived ...lamivudine resistance-associated mutations (RAMs) detected through next-generation sequencing (NGS) but without evidence of lamivudine RAMs in baseline proviral DNA population sequencing.
Objectives
To present 96 week results from ART-PRO.
Methods
Open-label, single-arm pilot trial. At baseline, all participants switched to dolutegravir plus lamivudine. Participants were excluded if proviral DNA population genotyping detected lamivudine RAMs. To detect resistance minority variants, proviral DNA NGS was retrospectively performed from baseline samples. For this analysis the efficacy endpoint was the proportion of participants with <50 HIV-1 RNA copies/mL at week 96. Safety and tolerability outcomes were incidence of adverse events and treatment discontinuations.
Results
Forty-one participants were included, 21 with lamivudine RAMs in historical plasma RNA genotypes. Baseline proviral DNA NGS detected lamivudine RAMs (M184V/I and/or K65R/E/N) above a 5% threshold in 71.4% (15/21) and 15% (3/20) of participants with and without history of lamivudine resistance, respectively. At 96 weeks, 90.2% of participants achieved the efficacy endpoint. Between week 48 and 96 there was one discontinuation due to consent withdrawal and no discontinuations related to adverse events. Two participants had a transient viral rebound, both re-suppressed on dolutegravir plus lamivudine. Through week 96, there were no virological failures.
Conclusions
In this pilot trial, dolutegravir plus lamivudine maintained virological suppression at 96 weeks despite historical lamivudine resistance and persisting archived minority lamivudine RAMs.
Real-life cohorts have shown that the effectiveness of all-oral, direct-acting antivirals (DAA) for HCV treatment is > 90%. We aimed to explore the predictive factors of DAA success in HIV ...coinfection. This is an observational prospective study within the cohort “VIH-DOC”, Madrid, Spain. HIV/HCV-coinfected patients were included if they had been treated with DAAs between 9 January 2015 and 31 August 2016. The sustained virological response (SVR) was analysed in the intention-to-treat population. Binary logistic regression was used to study the impact of cirrhosis, anti-HCV therapy experience and the IL28B polymorphism on SVR, besides factors with a
p
value < 0.15 from the univariate analysis. DAA were prescribed to 423 patients. SVR was confirmed in 92.9%. The univariate analysis showed higher proportion of patients with SVR among those with DAA adherence ≥ 95% (difference + 10.3%, 95% CI 3.5–19.6) and a baseline CD4+ cell count ≥ 200/μL (difference + 14.7%, 95% CI 4.1–31.0). Logistic regression evinced that both DAA adherence and baseline CD4+ cell counts predicted the SVR (OR 3.9, 95% CI 1.8–8.8, and OR 5.2, 95% CI 1.9–13.9, respectively). Moreover, men who reported having sex with other men (MSM) were less likely to achieve SVR (OR 4.2, 95% CI 1.1–16.1). Among MSM, three of three patients without SVR were suspected to have experienced HCV reinfection. DAA for HCV in HIV-coinfected patients is highly effective. DAA adherence ≥ 95% and a baseline CD4+ count ≥ 200/μL predicted a higher probability of SVR. A lower rate of SVR was found in MSM, presumably due to a higher frequency of HCV reinfection.
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