Patients with chronic kidney disease (CKD) have an increased risk of premature mortality, mainly due to cardiovascular causes. The association between hemodialysis and accelerated atherosclerosis has ...long been described. The ankle-brachial index (ABI) is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. The clinical implications of ABI cut-points are not well defined in patients with CKD. Echocardiography is the most widely used imaging method for cardiac evaluation. Structural and functional myocardial abnormalities are common in patients with CKD due to pressure and volume overload as well as non-hemodynamic factors associated with CKD. Our study aimed to identify markers of subclinical cardiovascular risk assessed using ABI and 2D and 3D echocardiographic parameters evaluating left ventricular (LV) structure and function in patients with end-stage renal disease (ESRD) (patients undergoing dialysis), patients after kidney transplantation and non-ESRD patients (control). In ESRD, particularly in hemodialysis patients, changes in cardiac structure, rather than function, seems to be more pronounced. 3D echocardiography appears to be more sensitive than 2D echocardiography in the assessment of myocardial structure and function in CKD patients. Particularly 3D derived end-diastolic volume and 3D derived LV mass indexed for body surface appears to deteriorate in dialyzed and transplanted patients. In 2D echocardiography, myocardial mass represented by left ventricular mass/body surface area index (LVMI) appears to be a more sensitive marker of cardiac structural changes, compared to relative wall thickness (RWT), left ventricle and diastolic diameter index (LVEDDI) and left atrial volume index (LAVI). We observed a generally favorable impact of kidney transplantation on cardiac structure and function; however, the differences were non-significant. The improvement seems to be more pronounced in cardiac function parameters, peak early diastolic velocity/average peak early diastolic velocity of mitral valve annulus (E/e´), 3D left ventricle ejection fraction (LV EF) and global longitudinal strain (GLS). We conclude that ABI is not an appropriate screening test to determine the cardiovascular risk in patients with ESRD.
Objective
To compare the perceptions of students and teachers of the “Educational Climate” (EC) in Spanish public dental schools.
Methods
A group of 1064 students and 354 teachers from six Spanish ...public dental schools responded to the DREEM questionnaire. This has 50 items grouped into five subscales: perception of learning (Learning); perception of teachers (Teachers); academic self‐perceptions (Academic); perception of the atmosphere in the faculty (Atmosphere); and social self‐perceptions (Social). The DREEM scale provides results for each item, each subscale and the overall EC.
Results
The EC scores were 123.2 (61.6%) for the students and 134.1 (67.0%) for the teachers (P<.001). The scores of the students and teachers for the subscales were, respectively: 27.9 (58.1%) and 30.2 (63.0 %) for Learning (P<.001); 26.8 (60.9%) and 32.6 (74.1%) for Teachers (P<.001); 20.7 (64.7%) and 20.5 (64.0%) for Academic (P=.333); 29.9 (62.3%) and 33.7 (70.3%) for Atmosphere (P<.001); and 17.9 (64.0%) and 16.9 (60.5%) for Social (P<.001). The students identified six problematic items (12.0 %) compared to only two (4.0 %) highlighted by the teachers.
Conclusion
The students and teachers considered the EC to be “more positive than negative” in Spanish public dental schools; and the different subscales to be “positive and acceptable.” The teachers did, however, evaluate the EC, and specifically the learning‐teaching process, more positively than their students, identifying fewer problematic educational aspects. Both groups agreed on the need to: improve support systems for students who suffer from stress and reduce teaching based on “factual learning.”
Aim
To carry out a psychometric evaluation of the Spanish‐language version of the Dundee Ready Education Environment Measure (DREEM) applied to dental students.
Methods
A total of 1,391 students from ...nine Spanish public schools of dentistry responded to the DREEM questionnaire. To analyse the reliability of the DREEM questionnaire, the internal consistency was assessed and a ‘test‐retest’ carried out. Validity was evaluated through analysis of item response rate, floor and ceiling effects, corrected item‐total and item‐subscale correlations and factor structure. A confirmatory factor analysis was performed to analyse the structure of the original DREEM scale.
Results
Cronbach's alpha coefficient for the ‘Educational Climate’ (EC) global scale was 0.92. In the subscales, the ‘observed’ Cronbach's alpha coefficients ranged between 0.57 and 0.79 and were higher than the ‘expected’ ones; except for the Social subscale. In the DREEM questionnaire, all of the corrected correlation coefficients between the items and the EC global scale, and the items and their corresponding subscales, were >0.2; except for items 50 and 17. All goodness‐of‐fit indices of confirmatory factor analysis showed acceptable values (close to one or zero, depending on the case), and there was consistency in the results.
Conclusions
The Spanish‐language version of the DREEM questionnaire is a reliable and valid instrument for analysing the EC for dental students and its factor structure is supported by the data. Although our findings indicate that the DREEM may be as culturally independent as was originally stated, more research should be directed at verifying the factor structure in various languages and cultural environments.
Uncontrolled resistant hypertension (RH) defined by the mean 24-hour ambulatory blood pressure (ABPM) represents an independent risk factor in hypertensive patients. Predictors of blood pressure (BP) ...control in RH are not yet clearly defined.
To evaluate the predictors of BP control in RH patients with repeated ABPM measurements.
114 consecutive patients from outpatient cardiology office fulfilling criteria for RH (office BP ≥ 140 and/or 90 mmHg, with treatment of ≥ 3 antihypertensive drugs, including diuretic, or controlled BP with > 3 drugs), with two consecutive ABPM studies were compared in clinical characteristics according to BP control assessed by ABPM RESULTS: After the second ABPM, BP was controlled in 25.4 % of patients; the remaining 74.6 % were classified as uncontrolled. In the uncontrolled BP group, systolic office BP was 140.91±16.71 mmHg, diastolic 81.26 ± 10.92 mmHg. In ABPM, systolic was 145.11 ± 13.65 mmHg, diastolic 81.26 ± 10.92 mmHg. Compared to the controlled BP group, in the uncontrolled group the age was higher 72.32 ±10.89 years (p = 0.047), baseline average real variability of systolic BP was lower 12.66 ± 3.08 vs. 14.52 ± 3.53 (p = 0.013), no significant difference in baseline standard deviation of systolic BP changes was found.
Higher office BP, older age, and increased short term BP variability were associated with an uncontrolled hypertension. Stronger association was found with baseline average real variability rather than standard deviation. No significant differences were found in the dipping status and other clinical characteristics (Tab. 6, Fig. 1, Ref. 28).
Aim
To analyse the ‘Educational Climate’ (EC) of dental students in Spain.
Methods
The study group consisted of 1391 students from nine Spanish Public Schools of Dentistry, who responded to the ...questionnaire based on ‘Dundee Ready Education Environment Measure’ (DREEM). This questionnaire has 50 items that are grouped into five domains: Learning, Teachers, Academic, Atmosphere and Social.
Results
The global score on the EC was 123.1 (interpretation: ‘EC more positive than negative’). The scores obtained in the different domains were: 28.0 in Learning (interpretation: ‘a generally positive perception of learning’), 26.8 in Teachers (interpretation: ‘teachers are going in the right direction’), 20.8 in Academic (interpretation: ‘feeling more on the positive side’), 29.7 in Atmosphere (interpretation: ‘a generally positive atmosphere’) and 17.7 in Social (interpretation: ‘social perception acceptable’). In seven items (14%), an average of <2 was detected, showing that there are some educational problem areas. Regarding the EC in the different Schools of Dentistry, an average of >100 was achieved in all of them, although there were two centres that showed significantly higher values of EC.
Conclusions
Spanish dental students felt that their EC was more positive than negative and considered that the different domains were positive and acceptable. However, they pointed out the existence of several educational problem areas associated with the development of a traditional curriculum. Accordingly, and in parallel with the implementation of an innovative curriculum in all Spanish Dental Schools in the coming years, immediate educational goals must address the problem areas identified, thereby further promoting a more positive perception of EC.
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