{"title":"[High Level Commission on Mental Health and COVID-19: An evaluation agenda].","authors":"Miguel Gallegos, Tomás Caycho-Rodríguez","doi":"10.4067/S0034-98872022000400566","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400566","url":null,"abstract":"","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodrigo A Sepúlveda, Javier Romero, Sebastián Sepúlveda, Cristián Juanet
{"title":"[Severe respiratory alkalosis due to psychogenic hyperventilation. Report of one case].","authors":"Rodrigo A Sepúlveda, Javier Romero, Sebastián Sepúlveda, Cristián Juanet","doi":"10.4067/S0034-98872022000400554","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400554","url":null,"abstract":"<p><p>Severe respiratory alkalosis is a life-threatening condition, as it induces hypo- calcaemia and extreme adrenergic sensitivity leading to cerebral and myocardial vasoconstriction. We report a 37-year-old woman with previous consultations for a conversion disorder. While she was infected with SARS-CoV-2 (without pulmonary involvement), she consulted in the emergency room due to panic attacks. On admission, she developed a new conversion crisis with progressive clinical deterioration, hyperventilation, and severe respiratory alkalosis (pH 7.68, Bicarbonate 11.8 mEq/L and PaCO2 10 mmHg). Clinically, she was in a coma, with respiratory and heart rates 55 and 180 per min, a blood pressure of 140/90 mmHg, impaired perfusion (generalized lividity, distal coldness, and severe skin mottling) and tetany. She also had electrocardiographic changes and high troponin levels suggestive of ischemia, and hyperlactatemia. She was managed in the hospital with intravenous benzodiazepines. The clinical and laboratory manifestations resolved quickly, without the need for invasive measures and without systemic repercussions.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Monitoring decongestion in acute heart failure].","authors":"Franco Appiani","doi":"10.4067/S0034-98872022000400493","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400493","url":null,"abstract":"<p><p>Persistent congestion following an episode of acute heart failure is associated with higher morbidity and mortality. Monitoring diuretic therapy is essential to guide effective decongestion before patient discharge. Unfortunately, there are no markers which can predict on their own, the exact point in which euvolemia is achieved. Cardiothoracic and extra thoracic ultrasound are other tools to consider when evaluating hemodynamic and interstitial components of congestion. However, the question of which and how many parameters must be used for this purpose, is still unanswered.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33481504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aintzane Gallastegui-Braña, Denisse Parra-Giordano, Pedro Pérez-Cruz
{"title":"[Training in palliative care in nursing and medical schools in Chile].","authors":"Aintzane Gallastegui-Braña, Denisse Parra-Giordano, Pedro Pérez-Cruz","doi":"10.4067/S0034-98872022000400541","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400541","url":null,"abstract":"<p><p>Training in Palliative Care (PC) at the undergraduate level has proven to be an effective strategy to expand access to this type of services. In Chile, the increase in magnitude of serious health-related suffering and the recently approved Law that guarantees universal access to Palliative Care, requires the extension of PC undergraduate training in medical and nursing schools. Therefore, this study assessed and described the characteristics of current PC training in the Schools of Medicine and Nursing of Chile through an online survey of their directors. Nursing schools report higher frequency of mandatory training hours and access to clinical training, while Medicine schools report higher frequency of elective internships. However, gaps persist in the number of teaching hours and the teaching methods used, which may be due to the scarcity of qualified professionals in PC, limited access to clinical fields and disciplinary differences. Strengthening and expanding PC training at the undergraduate level with practical and interdisciplinary methodologies are fundamental steps so that future medical and nursing professionals can provide adequate care and relief of serious health-related suffering to an aging population until the end of their life.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fabián Elgueta, Pamela Wurmann, Macarena Mac-Namara, Juan Grandjean, Leopoldo Ardiles
{"title":"[Pulmonary manifestations of anti-neutrophil cytoplasmic antibody associated vasculitis].","authors":"Fabián Elgueta, Pamela Wurmann, Macarena Mac-Namara, Juan Grandjean, Leopoldo Ardiles","doi":"10.4067/S0034-98872022000400505","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400505","url":null,"abstract":"<p><p>This article reviews the pulmonary manifestations of anti-neutrophil cytoplasmic antibody associated vasculitis (AAV). Its frequency in the different phenotypes of the disease, clinical manifestations and updated therapeutic recommendations are reviewed, aiming to alert the medical community about the existence of these diseases. We pretend to stimulate a timely suspicion, diagnostic precision, and the implementation of effective therapies, to reduce the eventual sequelae derived from a diagnostic omission or an inappropriate treatment for the different clinical scenarios in which these diseases appear.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33481505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[A systematic review of standardized instruments to measure the doctor-patient relationship].","authors":"Mariana Lazzaro-Salazar, Lucas Pujol-Cols","doi":"10.4067/S0034-98872022000400512","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400512","url":null,"abstract":"<p><p>The current health situation caused by the COVID-19 pandemic has prompted a reconfiguration of the doctor-patient relationship. We performed a systematic review to comparatively evaluate the instruments most used to study communication in the doctor-patient relationship. We identified 43 instruments assessing different aspects of the doctor-patient relationship, of which 34 correspond to Anglo-Saxon literature and nine to Latin American texts. The psychometric evidence for many of these instruments is incipient. Most of these instruments contemplate a unidirectional design and address similar dimensions of the doctor-patient relationship, particularly in the Latin American context where the relationship is mostly studied in a unidimensional way. We propose recommendations for the development, revision, or refinement of instruments that measure communication in the doctor-patient relationship.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33481506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Constanza Caneo-Robles, Pedro Letelier-Camus, María Ignacia Arteaga, Matías González-Tugas, Jorge Calderón, Nicolás Hayes, Felipe León, Pablo Toro-Espinoza
{"title":"[Implementation of a protocol for neuropsychiatric disease surveillance in a general hospital].","authors":"Constanza Caneo-Robles, Pedro Letelier-Camus, María Ignacia Arteaga, Matías González-Tugas, Jorge Calderón, Nicolás Hayes, Felipe León, Pablo Toro-Espinoza","doi":"10.4067/S0034-98872022000400415","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400415","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital.</p><p><strong>Aim: </strong>To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice.</p><p><strong>Material and methods: </strong>Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team.</p><p><strong>Results: </strong>A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals.</p><p><strong>Conclusions: </strong>The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33481086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolás Ortiz-López, Carolina Olea-Gangas, Sofía Ponce-Arancibia, Sara Arancibia-Carvajal, Jonathan Rodríguez-Cabello, Felipe Cortés-Chau, Iván Solís
{"title":"Assessing student perceptions of the clinical teachers' performance during early clinical exposure.","authors":"Nicolás Ortiz-López, Carolina Olea-Gangas, Sofía Ponce-Arancibia, Sara Arancibia-Carvajal, Jonathan Rodríguez-Cabello, Felipe Cortés-Chau, Iván Solís","doi":"10.4067/S0034-98872022000400439","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400439","url":null,"abstract":"<p><strong>Background: </strong>The clinical teachers' attributes can be grouped into physician competencies, teacher competencies, and personal characteristics. Global performance is considered the clinical teacher's capacity to facilitate an active and stimulating learning process for medical students and a warm, supportive, and pleasant environment.</p><p><strong>Aim: </strong>To determine which attributes of the clinical teacher influence their global performance from the students' point of view.</p><p><strong>Material and methods: </strong>The Role Model Apperception Tool questionnaire (RoMAT) was answered by 133 second-year medical students at the University of Chile during 2018.</p><p><strong>Results: </strong>The students assessed 37 clinical teachers. Teaching competencies had the higher influence in global performance. Personal characteristics also had a significant influence. Physician competencies had an indirect influence on teaching competencies. The model obtained 88% of the explained variance of the teacher's global performance.</p><p><strong>Conclusions: </strong>This study showed that teacher competencies, personal characteristics, and physician competencies are qualities that influence the perception of the global performance of clinical teachers.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33481089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marcelo A Crockett, Vania Martínez, Jorge L Ordóñez-Carrasco
{"title":"[Psychometric properties of the Generalized Anxiety Disorder 7-item (GAD-7) scale in Chilean adolescents].","authors":"Marcelo A Crockett, Vania Martínez, Jorge L Ordóñez-Carrasco","doi":"10.4067/S0034-98872022000400458","DOIUrl":"https://doi.org/10.4067/S0034-98872022000400458","url":null,"abstract":"<p><strong>Background: </strong>The Generalized Anxiety Disorder 7-item (GAD-7) scale is widely used for the assessment of generalized anxiety disorder.</p><p><strong>Aim: </strong>To adapt the GAD-7 to the Chilean adolescent population and to evaluate its psychometric properties.</p><p><strong>Material and methods: </strong>The GAD-7 was adapted and administered to 2,022 adolescents between 13 and 19 years of age, recruited from eight schools in the northern area of Santiago, Chile. Other self-report instruments were used to assess depressive symptoms and health-related quality of life. The one factor structure and invariance by sex were examined using Confirmatory Factor Analysis. Its reliability and validity based on its relationship with other variables were assessed.</p><p><strong>Results: </strong>The one-factor structure and invariance by sex were confirmed. The results showed an adequate internal reliability (Cronbach's alpha = 0.86, Spearman-Brown coefficient = 0.82). As expected, significant correlations were observed with measures of depressive symptoms and health-related quality of life. Higher scores were observed in women than in men.</p><p><strong>Conclusions: </strong>The Chilean version adapted for adolescents of the GAD-7 has good psychometric properties. Thus, it may be a useful and valid instrument for the assessment of generalized anxiety disorder in adolescents in Chile.</p>","PeriodicalId":21360,"journal":{"name":"Revista medica de Chile","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33481500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}