Revista medica de Chile最新文献

Aim: This study evaluates regional disparities in access to treatment and preventive screenings for high-mortality non-communicable diseases (NCDs) -specifically cancer and diabetes- in Chile, using data from the 2022-2023 National Health, Sexuality, and Gender Survey (ENSSEX).

Methods: Four key indicators were analyzed: mammography (MAM), Pap smear (PAP), prostate-specific antigen test (PSA), and diabetes treatment (DIA). Disparities were assessed using both general and relative disparity indices (ID) to quantify regional inequalities.

Results: The general disparity index (IDg) revealed substantial differences in access to preventive screenings, with regional gaps reaching up to 20% for PSA tests, mammograms, and Pap smears. In contrast, disparities in diabetes treatment access were notably smaller (<5%). Better performance was observed in the northern and southern macrozones, while regions such as Tarapacá, Maule, and Metropolitana showed significant lags.

Conclusions: The findings underscore persistent regional disparities in preventive healthcare services in Chile. Targeted decentralization policies and subnational prioritization are crucial to reducing these gaps. Addressing these disparities is essential for achieving Sustainable Development Goal 3.4 and lowering premature mortality from NCDs.

Aim: To evaluate and correct the reported sensitivity and specificity values of DART (Diagnóstico Automatizado de Retinografías Telemáticas), an automated Artificial Intelligence based (AI-based) screening tool used for diabetic retinopathy (DR) detection in the Chilean public healthcare system, by employing the appropriate gold standard and conditional probability.

Methods: Data were obtained from the clinical validation of DART. DR detection capabilities were assessed for three methods 1) Fundoscopy, 2) Retinography and 3) AI- DART. To estimate the true sensitivity and specificity of DART, conditional probability was applied using three hypothetical sensitivities level for method 2: A) Optimistic (90%), B) Moderate (80%), and C) Pessimistic (70%). Based on these scenarios, corrected sensitivity and specificity values for DART were calculated, along with false negative/positive rates (%FN/%FP), and predictive values (NPV/PPV).

Results: In all scenarios, corrected sensitivity and specificity values for DART were significantly lower than those reported in the original validation study. Compared to method 3 (AI-based), method 2 (retinography by and ophthalmologist) consistently demonstrated superior performance across all metrics, including FN%, FP%, NPV and PPV values.

Conclusion: While the integration of new AI-based technologies like DART in healthcare offer promise for enhancing patient care, their implementation must be preceded by validation using the correct gold standard. Reliable clinical decision-making depends on trustworthy diagnostic parameters.

The perception of academic mistreatment among medical students is associated with burnout, emotional disorders, and poorer professional performance. Conversely, a positive environment that promotes respectful teaching can enhance empathy, reduce burnout, and increase student satisfaction. This study examines perceptions of respectful teaching and its associations with demographic and academic characteristics among medical students in Chile.

Aim: To evaluate perceptions of respectful teaching among medical students in Chile and their relationship with sociodemographic, academic, and personal satisfaction factors.

Methods: A cross-sectional study was conducted across six Chilean universities, involving 443 medical students. We used the Good Teaching Practices Questionnaire (40 items in 9 dimensions) and tools for sociodemographic characterization and academic satisfaction. Data were analyzed using descriptive statistics, reliability coefficients, Spearman correlations, and ANOVA, with significance set at p<0.05.

Results: Younger students, those in earlier years, or those recently admitted reported better perceptions of respectful teaching (p<0.05). Men perceived greater support in flexible planning, feedback, and concern for students (p<0.01). Theoretical and synchronous courses were associated with better perceptions of class agility and teaching passion (p<0.001). The highest-rated dimension was subject mastery (Md= 4.00), while concern for students received the lowest score (Md= 3.00).

Conclusion: Higher life satisfaction and work-life balance levels are related to respectful teaching. Differences between universities and demographic groups highlight the need for inclusive institutional policies and faculty training to foster equitable and empathetic environments in medical education.

Recently, there has been a surge in technological tools designed to automate tasks across various areas of health sciences, including the identification of evidence used in the development of evidence syntheses that inform clinical practice guideline (CPG) recommendations. Simultaneously, there has been a significant increase in the production of systematic reviews, meaning that much of the relevant evidence is already included in existing reviews.

Aim: To compare the performance of the semi-automated Epistemonikos Evidence Matrix tool with that of a traditional manual literature search in identifying studies for the development of clinical practice guidelines.

Materials and methods: During the development of three CPGs (focused on HIV/AIDS, pediatric asthma management, and stroke management), we compared studies identified through a traditional search strategy in MEDLINE, Embase, and the Cochrane Library with those found using a strategy based on existing systematic reviews, via the Epistemonikos database. The traditional search employed keyword-based strategies and a specific filter for randomized controlled trials. In contrast, the Epistemonikos-based strategy relied on the semi-automated Evidence Matrix tool, which identifies studies shared across two or more systematic reviews.

Results: Across the three guidelines, 8,466 potentially relevant articles were identified using the traditional method, compared to 6,771 using the Epistemonikos-based method. Of these, 155 studies (1.8%) were deemed truly relevant in the traditional search, versus 103 (1.5%) in the Epistemonikos-based approach (p= 0.14). The approach based on existing reviews demonstrated significantly higher precision (94% vs. 78%, p<0.01) but lower sensitivity (58% vs. 88%, p<0.01) compared to the traditional search.

Conclusions: The evidence search strategy based on existing systematic reviews is an efficient and reliable alternative for identifying relevant studies to support evidence-based decision-making.

Pancreatogenic diabetes is a specific form of diabetes secondary to exocrine pancreatic disease. It is often misclassified or confused with other types of diabetes. It is not a single clinical entity but occurs in association with various exocrine pancreatic disorders, through diffe-rent mechanisms of hyperglycemia. This condition is associated with an increased risk of hypoglycemia, making close clinical monitoring essential.

Aim: To review the physiological and pathophysiological aspects of the exocrine-endocrine interplay of the pancreas, as well as the clinical features of this specific type of diabetes, in order to support accurate diagnosis, treatment, and follow-up.

Methodology: Narrative review.

Results: A multidisciplinary overview of pancreatogenic diabetes is presented, covering its definition, pathogenesis, epidemiology, and management, integrating both endocrine and exocrine pancreatic perspectives.

Conclusions: The management of pancreatogenic diabetes should be multidisciplinary and individualized, with a focus on preventing and treating malnutrition, and combining insulin therapy with pancreatic enzyme replacement therapy.

The implementation of the hospitalist model (HM) in public hospitals across Latin America has been scarcely documented. In Chile, the Diagnosis-Related Groups (DRG) system enables standardized analysis of hospital performance; however, its longitudinal behavior in the context of organizational reform remains underexplored.

Aim: To describe historical trends in DRG-based indicators of productivity and morbidity-mortality in the Internal Medicine Service (IMS) of Hospital Las Higueras de Talcahuano (HHT) from 2012 to 2019, during the progressive implementation of the hospitalist model.

Methods: A retrospective, observational, and descriptive study was conducted using the full set of hospital discharges from IMS-HHT coded by DRG. Two operationally defined periods were compared: P1 (2012-2016, traditional care model) and P2 (2016-2019, hospitalist model implementation). Four indicator domains were analyzed: general, process, complexity, and outcomes. Due to the population-based nature of the data, no statistical tests for significance were applied.

Results: IMS accounted for 13.8% to 17.5% of total HHT discharges. During P2, an increase in the average DRG weight and in the proportion of severe cases was observed. The adjusted length-of-stay index (ALOSi) initially rose and then steadily declined from the third year onward. Urgent readmissions and hospital mortality rates consistently decreased starting from the beginning of P2.

Conclusions: The temporal evolution of DRG indicators suggests a pattern of sustained improvement in clinical and administrative performance during the implementation of the hospitalist model, without inferring causal relationships.

The use of alternative medicine treatments, such as Schisandra chinensis, has a long-standing history. While numerous active compounds are available on the market, with various benefits attributed to their use, reports of adverse events remain limited. However, significant interactions have been documented between these compounds and the CYP3A enzymatic system, which plays a key role in the metabolism of xenobiotics and endogenous substances. Inactivation of this system has the potential to disrupt coagulation processes, posing serious health risks. Clinical Case: We report the case of a patient who developed spontaneous subdural and subarachnoid hemorrhage and de novo immune thrombocytopenia following the initiation of a multi-component tablet containing Schisandra chinensis. Conclusions: The indiscriminate use of alternative medicine therapies may result in severe, acute, and disabling adverse effects, even in the absence of prior reports of such reactions. Increased awareness and further research are essential to better understand the potential risks associated with these treatments.

Intestinal obstruction (IO) during pregnancy is a rare and serious complication, with sigmoid volvulus (SV) being the most common cause. We present the case of a 28-year-old primigravida at 33+4 weeks of gestation who presented with abdominal pain, nausea, and four days of no bowel movements. IO was diagnosed via computed tomography. A cesarean section was performed, followed by a sigmoidectomy and rectosigmoid anastomosis for ischemic SV. Both the mother and newborn had favorable outcomes. Diagnosing SV in pregnancy is challenging due to symptom overlap with normal pregnancy. Imaging is crucial for timely diagnosis, though radiation exposure must be carefully considered. Prompt management is essential to reduce maternal and fetal mortality, which can reach 50% in cases complicated by perforation.

Graphic medicine is defined as the intersection between comics, Ilustration and the field of medicine. The concept was introduced by British physician Ian Williams in 2007 and has since evolved, offering a wide range of applications that have influenced both healthcare delivery and the education of health professionals. Today, this form of visual literature is experiencing a global rise, closely tied to the development of the medical humanities since the late 1990s. In particular, narrative medicine -the most recent branch of the medical humanities- has embraced graphic medicine as a powerful tool to better understand the human condition and patient subjectivity.

Aim: To describe the current educational applications of graphic medicine in health professions training, and to highlight selected examples from Chile.

Methods: A narrative review was conducted, focusing on literature and documented experiences regarding the use of graphic medicine in health education, with special attention to its implementation in Chile.

Results: The review revealed a growing interest in the use of graphic medicine as an educational resource, emphasizing its potential to represent non-biomedical aspects of illness, such as emotional experiences, subjectivity, and social determinants of health. In Chile, several initiatives have employed graphic novels, comic strips, and visual narratives as pedagogical tools in the training of healthcare professionals, showing promising outcomes in fostering empathy, critical reflection, and a holistic understanding of patient care.

Conclusions: The intentional use of graphic medicine in health education offers an effective approach to developing more well-rounded professionals-those who are not only scientifically competent but also skilled in humanistic dimensions of care. These visual tools serve as meaningful educational resources that support a more humanized, socially engaged, and ethically grounded approach to healthcare.