Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720110011&lang=pt vol. 139 num. 11 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Acute myocardial infarction mortality in Chile: Thrombolysis or angioplasty]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100001&lng=pt&nrm=iso&tlng=pt During recent decades, acute myocardial infarction short-term mortality has decreased to one digit levels, in the United States. Data from Chilean registries give figures around 11% for patients receiving thrombolysis, and 5 to 6 % for patients treated with angioplasty. The decrease in mortality in Chile is related to the implementation of the AUGE program at a national level, initiative than gives patients the opportunity to receive at least thrombolytic therapy as well as a standardized and rapid diagnosis and treatment for this condition. There is a lack of Outcome Research studies in Chile, that would guide public health decisions such as the use of fibrin-specific agents for early presentation and high risk cases, and a rational system providing better access to primary angioplasty. <![CDATA[Angioplasty compared to thrombolysis as the initial reperfusion therapy in acute myocardial infarction]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100002&lng=pt&nrm=iso&tlng=pt Background: Primary angioplasty is superior to intravenous thrombolysis as reperfusion therapy for acute myocardial infarction. Aim: To compare the results of available reperfusion strategies for initial management of acute myocardial infarction during hospitalization and 5 years follow up. Patients and Methods: Historical cohort study from a prospective registry of patients admitted with acute myocardial infarction to our center. Patients treated with primary angioplasty were identified and were then matched by age, sex and date of event with patients treated with throm-bolysis. The clinical outcomes were compared including hospitalization and 5-years follow-up. Results: From March 1993 to August 2001, 98 patients were treated with primary angioplasty and matched with 98 thrombolyzed patients. The groups were comparable. Compared to thrombolysis, angioplasty had a higher success rate (68 and 91% respectively), resulted in less complications and reduced mortality (11 and 2% respectively), required less revascularization procedures and shorter hospital stay (17 and 13 days, respectively). During the follow-up of survivors, no differences in events or additional mortality were detected at 1 or 5years. Conclusions: Primary angioplasty is superior as treatment in terms of achieving success and reducing mortality during hospitalization. Evolution after hospitalization is independent of initial therapy. <![CDATA[The adaptation methodology of a guideline for the management of adults with community-acquired pneumonia]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100003&lng=pt&nrm=iso&tlng=pt Background: Clinical practice guidelines (CPG) are widely used as tools for improving quality of health care. Guidelines developed elsewhere, can be adapted using a valid and systematic process. Aim: To describe the methodology used in the process of adaptation of a guideline for the management of adults with community-acquired pneumonia (CAP) in a private health care organization. Material and Methods: We used the ADAPTE framework involving three main phases. At the set-up phase a guideline adaptation group integrated by medical specialists from different disciplines, a methodologist and a nurse coordinator was formed. At the adaptation phase, the specific clinical questions to be addressed by the guidelines were identified. Results: Twenty five guidelines were initially retrieved. After their assessment, the number was reduced to only three. Recommendations from these guidelines were 'mapped' and focused searches were carried out where 'evidence gaps' were identified. An initial draft was written and revised by the adaptation group. At the finalization phase, the external review of the guideline was carried out and a process for the regular review and update of the adapted guideline was defined. Conclusions: We developed a guideline for the management of adults with CAP, adapted to the local context of our health care system, using guidelines developed elsewhere. This guideline creation method can be an efficient means of saving professional resources. <![CDATA[Results of gastric bypass for morbid obesity after a follow up of seven to 10 years]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100004&lng=pt&nrm=iso&tlng=pt weight and complications of obesity, seven to 10 years after gastric bypass surgery. Material and Methods: One hundred eighteen subjects with morbid obesity, aged 15 to 66years (103 women), were followed for a mean of 94 months after surgery. Body weight, fasting blood glucose, total cholesterol, triglycerides and hemoglobin were measured before surgery and during follow up. Results: At 24 months of follow up, all patients lost weight and there was a mild weight increase at 94 months, that paralleled the preo-perative body mass index. Diabetes, hypercholesterolemia and hypertriglyceridemia subsided in 95, 87 and 94% of cases, respectively. Twenty percent of patients had mild anemia and 11% moderate or severe anemia. No patient recovered the preoperative weight. Conclusions: Weight reducing effects of gastric bypass are maintained after 94 months of follow up with the expected health benefits. <![CDATA[Pregnancy and inflammatory bowel disease: Experience in 17 patients]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100005&lng=pt&nrm=iso&tlng=pt Background: Inflammatory bowel disease (IBD) has a peak incidence between 15 and 25 years of age, thereby affecting women of reproductive age. Fertility rates with inactive IBD are similar to the general population, and drugs currently used, with the exception of methotrexate and thalidomide, have a good safety and efficacy profile during pregnancy. Starting a pregnancy with inactive IBD significantly reduces the potential maternal and fetal complications. Aim: To assess the evolution of pregnancy and the underlying disease in women with IBD. Patients and Methods: Retrospective and prospective study of female patients with IBD controlled in our hospital who became pregnant from January 1994 to February, 2011. Results: We followed 17patients with a total of 19 pregnancies. In two patients the onset of IBD occurred during pregnancy and from the remaining, 11 patients became pregnant during remission of IBD. Most of the patients continued the same treatment during pregnancy and the few flares that occurred were treated satisfactorily. Major complications occurred in three patients, all associated with IBD activity. Fifteen patients had full-term deliveries and the majority of the newborns had normal weight and Apgar score. None had malformations. Conclusions: Pregnancies among patients with an inactive IBD, have a good evolution. A multidisciplinary approach and patient education are invaluable to achieve these good results. <![CDATA[Factorial structure and reliability of Fisher, King & Tague's self-directed learning readiness scale in Chilean medical students]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100006&lng=pt&nrm=iso&tlng=pt Background: Continuous education is crucial among physicians. Therefore, medical schools must teach self-directed learning skills to their students. Aim: To evaluate the factorial structure and reliability of the Spanish version of the Self-Directed Learning Readiness Scale of Fisher, King & Tague, applied to medical students. Material and Methods: The survey was answered by 330 students aged between 17 and 26years (58% men, with 10 missing cases). Factorial structure, internal reliability and temporary stability of scale was evaluated. Results: The Exploratory Factorial Analysis, conducted using a principal factor method, identified five factors in the structure of the survey. Internal consistency was adequate with a Cronbach's alpha between 0.66 and 0.88. Test retest reliability, comparing the results of the survey applied six months after the first application, showed Pearson correlation coefficients that fluctuated between 0.399 and 0.68. Conclusions: These results show a defined factorial structure with adequate reliability of the survey. <![CDATA[Normal plasma insulin and HOMA values among chilean children and adolescents]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100007&lng=pt&nrm=iso&tlng=pt Background: Plasma insulin and HOMA (homeostasis model assessment) index, used to determine insulin resistance, do not have local standard values for children and adolescents in Chile. Aim: To establish the normal reference intervals for insulin and HOMA in children and adolescents aged 10-15 years, according to sex and puberal maturation. Material and Methods: A cross-sectional study of 2,153 children and adolescents from Puente Alto County was performed, during 2009 and 2010. Anthropometry and self-report of puberal maturation were assessed. Fasting glucose (hexoquinase) and insulin blood levels (chemiluminiscence), were determined and HOMA index was calculated. Percentile distributions of these variables were calculated. Results: The reference group included only subjects with normal body mass index and fasting blood glucose (n = 1,192). Girls had higher insulin and HOMA values than boys (12.5 ± 6.0 and 9.1 ± 4.9 μϋ/mL (p < 0.01) and 2.7 ± 1.4 and 2.1 ± 1,1 (p < 0.01), respectively). Subjects with Tanner I and IIpuberal stages had lower insulin and HOMA mean values than subjects with Tanner III and IV (9.0 ± 4.3 and 12.5 ± 6.2μϋ/ml (p < 0.01) and2.0 ± 1 and2.8 ± 1.4 (p < 0.01), respectively). Conclusions: The 90th percentile of insulin and HOMA distributions according to sex and maturation, was selected as the upper cut-off point to identify individuals with insulin resistance. HOMA cutoff point for Tanner I and II boys was 3.2, for Tanner I and II girls was 4.1, for Tanner III and IV boys was 4.2 and for Tanner III and IV girls was 5.0. <![CDATA[Plasma fructosamine to evaluate metabolic control among women with gestational diabetes]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100008&lng=pt&nrm=iso&tlng=pt Background: Metabolic control of diabetic pregnant women is assessed using glycated hemoglobin (HbAlc) levels and fasting blood sugar. Another glycated protein, namely fructosamine, can be an indicator of average glucose levels during the last three weeks. Aim: To evaluate plasma fructosamine as an indicator of glycemic control in women with gestational diabetes. Patients and Methods: Prospective cohort study of 41 pregnant women aged 30 to 37 years, with gestational and pre-gestational diabetes. Blood glucose, HbAlc, fructosamine were measured. Newborn weight, and other prenatal and postnatal variables, were used to evaluate the correlation between metabolic control and the presence or absence of macrosomia. Results: The correlation observed between fructosamine and fasting blood glucose (r = 0.627, p < 0.001) was superior to that of HbA1c and blood glucose (r = 0.516, p < 0.001). No association was observed between macrosomia and levels of fructosamine, nor between the other studied variables. Conclusions: Fructosamine levels were not associated with macrosomia, but it could be better for the evaluation of glycemic control in patients with gestational diabetes since it allows short-term monitoring. <![CDATA[Intensity modulated radiotherapy treatment for prostate cancer, first experience in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100009&lng=pt&nrm=iso&tlng=pt Background: Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. Aim: To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. Patients and Methods: From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. Results: Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. Conclusions: IMRTforprostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates. <![CDATA[Prospective assessment of medication errors in critically ill patients in a university hospital]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100010&lng=pt&nrm=iso&tlng=pt Background: Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. Aim: To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. Patients and Methods: During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. Results: In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. Conclusions: We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management. <![CDATA[Analysis of the explicit guarantees of health inclusion criteria for elderly burned patients]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100011&lng=pt&nrm=iso&tlng=pt Background: The guidelines for the treatment of severely burned patients, ineluded in the explicit guarantees in health care (GES), accept having a Garces' index over 70, among others, as an inclusion criterion. This criterion allows elderly patients with small total burn surface area (TBSA) to have access to GES. Aim: To analyze if a universal access to GES for this group of patients is justified. Material and Methods: Revision of medical records of adult patients admitted to a burn service. Causative agent, TBSA, associated illnesses and outcome were compared between 218 subjects aged 65 years or more and 720 subjects aged less than 65 years. Results: Older subjects had smaller TBSA, a lower prevalence of inhalation injury and more associated diseases. Their lethality was three times greater than that of younger subjects and their risk of dying. When adjusting for TBSA, presence of inhalation injury and associated diseases was 11 times greater. Conclusions: The inclusion of older people with lower TBSA in the explicit guarantees in health is fully justified, considering the lethality of burns in this age group. <![CDATA[Primary amyloidosis associated with multiple myeloma and renal failure: Case report]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100012&lng=pt&nrm=iso&tlng=pt We report a 53-year-old female on chronic dialysis, presenting with weight loss, the development of big soft masses in the shoulders ("shoulder pads"), forearms and buttocks, macroglossia and rigidity of hands and lower limbs. Laboratory confirmed the presence of amyloidosis and myeloma with lambda chain restricted plasma cell infiltration of bone marrow. The diagnosis of multiple myeloma associated with primary amyloidosis in a patient with terminal renal failure, was reached. <![CDATA[Multiple paragangliomas associated to a <i>SDHB</i> gene mutation: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100013&lng=pt&nrm=iso&tlng=pt Paragangliomas are tumors arising from sympathetic and parasympathetic tissues. The classic associated syndromes are neurofibromatosis type 1, multiple endocrine neoplasia type 2 and von Hippel-Lindau. Germline mutations of succinate dehydroge-nase subunits genes, are associated with familial paraganglioma syndromes 1,2,3 and 4. We report a 29-year-old woman with a family background of pheochromocytoma and history of paroxysmal headache, nausea, sweating, palpitations, associated with severe hypertension. The patient had elevated plasma noradrenalin and urinary normetanephrines. Imaging studies revealed three retroperitoneal extra-adrenal masses. The clinical and laboratory study of classic syndromes associated with para-ganglioma was negative. The patient was operated and the pathological study of the surgical specimen was consistent with paragangliomas. The genetic study showed a mutation in the SDHB succinate dehydrogenase gen, Exon 2 of CCTCA c.300_304 (p.P56delYfsX5). <![CDATA[Late diagnosis of nodular melanoma of the foot in a 74-year-old Brazilian man]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100014&lng=pt&nrm=iso&tlng=pt The incidence and mortality of malignant melanoma is increasing. Its early diagnosis can contribute to a favorable prognosis. We report a 74-year-old black man with a dark brown mole in the right plantar area, that grew slowly in the last decade. A biopsy of the lesion revealed a nodular malignant melanoma. A wide excision of the tumor was performed 18 months ago, followed by chemotherapy for nine months. At admission, the patient was debilitated, and presented with numerous nodules in the lower limb and suprapubic area. Imaging studies disclosed chest and abdominal nodules. The patient died 13 days after admission.<hr/>Melanoma maligno constituye una importante preocupación debido al incremento de la incidencia y mortalidad. El diagnóstico precoz de esta malignidad puede contribuir para prognósticos favorables. Se describe el diagnóstico tardío de melanoma nodular del pie en un varón afro-brasileño con 74 años de edad. El propósito es aumentar el índice de sospecha acerca de esta infrecuente localización del tumor de la piel, y estimular a los médicos de cuidado primario para realizar examen minucioso del cuerpo entero, contribuyendo a la detección temprana de los cánceres de piel. <![CDATA[Successful rituximab therapy in refractory autoimmune hepatitis and Evans syndrome]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100015&lng=pt&nrm=iso&tlng=pt A 44-year-old woman was found to have elevated aminotransferases, twice the upper limit of normal. Liver biopsy demonstrated a mixed inflammatory process suggestive of both primary biliary cirrhosis and autoimmune hepatitis (AIH). Prednisone and azathioprine were started, with normalization of aminotransferases. Six months later, she returned with worsening pruritus and re-evaluation demonstrated probable reactivation of AIH with acute elevation of liver injury tests. Repeat liver biopsy was suggestive of a flare of AIH which did not respond to prednisone, azathioprine, or mycophenolate mofetil. One month later the patient was hospitalized for sudden onset of anemia and thrombocytopenia, suggestive of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura consistent with Evans syndrome. Rituximab was initiated and mycophenolate mofetil discontinued. After one infusion of rituximab, liver injury tests significantly improved. Within four weeks of rituximab infusion (4 doses) the patient's Evans syndrome completely resolved with normal hemoglobin and platelet levels; aminotransferases also significantly improved to less than twice the upper limit of normal. <![CDATA[Spinal lumbar stenosis: An update]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100016&lng=pt&nrm=iso&tlng=pt Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging discs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI). Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease. <![CDATA[Detection of <i>Salmonella</i> and <i>Mycobacterium</i> species in seagulls captured in Talcahuano, Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100017&lng=pt&nrm=iso&tlng=pt Background: Salmonella can be isolated from the feces of seagulls. Therefore these birds can be a vector for dissemination of this pathogen. Aim: To evaluate the possible role of gulls as vectors of two important human and animal pathogens (My-cobacteria and Salmonella). Material and Methods: One hundred twenty three Kelp gull (Larus dominicanus) and 60 Franklin gulls (Leucophaeus pipixcan) captured off the coast of the seaport of Talcahuano, were analyzed. Using traditional microbiological methods, the presence of Mycobacteria in cloacal swabs and feet lavages, was analyzed in both types of gulls. To detect the presence of Salmonella, feces, fecal and tracheal swabs, and feet lavage were analyzed from Franklin gulls. Feces, feet lavage, intestine, spleen, liver, kidney and lung, were examined in Kelp gulls. Results: All Mycobacteria cultures were negative. Salmonella enterica cultures were positive in 25 % of Kelp gulls and 6.7 % of Franklin gulls. Four serovars were identified by serotyping. Enteritidis and Senfteberg serovars were found in both types of gulls. Anatum and Infantis serovars were found only in Kelp gulls. Feces of gulls captured during the winter had the highest yield of positive cultures (36.1%). Conclusions: Seagulls are an important Salmonella vector in Chile. <![CDATA[A proposal to improve sick leaves granted by physicians]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100018&lng=pt&nrm=iso&tlng=pt From time to time, sick leaves granted by physicians, cause concern among professionals, patients and institutions that administer the funds required to finance the days of work. This document analyzes different aspects of the form that must be filled by the physician to grant the sick leave, reflects on some important difficulties that are faced by health care professionals to complete the document and proposes changes to the form to correct such difficulties. Also, a proposal for a fairest solution for professionals and patients is presented. <![CDATA[Impact of a diploma on medical education in a medical school in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100019&lng=pt&nrm=iso&tlng=pt Background: The medical school of the Pontificia Universidad Católica de Chile offers a Diploma on Medical Education (DME) for its faculty since 2000. However its impact had never been evaluated. Aim: To determine the perception of the graduates of the impact of DME, using the Kirkpatrick model for evaluation of educational outcomes. Material and Methods: A questionnaire containing closed and pre-post retrospective questions that represented Kirkpatrick's four levels of evaluation, was sent to all the graduates in 2009. Results: Eighty two of 91 graduates returned the questionnaire. Ninety one percent had a high level of satisfaction at Kirkpatrick Level 1 (Reaction), and perceived an average of 81.8% completed objectives. Most respondents reported modification of attitudes and perceptions about teaching, at Kirkpatrick Level 2 (Learning). All the differences between the pre and posttest retrospective questionnaire were statistically significant. More than 98% of responded stated that they improved their role as teacher using the skills learned during DME, according to Kirkpatrick Level 3 (Behavior). According to Kirkpatrick Level 4 (Outcomes), 66% stated that the DME contributed to appreciate the value of teaching at an institutional level. Conclusions: According to the perception of the respondents, the DME has had a positive impact at all the levels described in the Kirkpatrick model. <![CDATA[Evaluation of Post Graduate Teaching Programs in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100020&lng=pt&nrm=iso&tlng=pt Background: The medical school of the Pontificia Universidad Católica de Chile offers a Diploma on Medical Education (DME) for its faculty since 2000. However its impact had never been evaluated. Aim: To determine the perception of the graduates of the impact of DME, using the Kirkpatrick model for evaluation of educational outcomes. Material and Methods: A questionnaire containing closed and pre-post retrospective questions that represented Kirkpatrick's four levels of evaluation, was sent to all the graduates in 2009. Results: Eighty two of 91 graduates returned the questionnaire. Ninety one percent had a high level of satisfaction at Kirkpatrick Level 1 (Reaction), and perceived an average of 81.8% completed objectives. Most respondents reported modification of attitudes and perceptions about teaching, at Kirkpatrick Level 2 (Learning). All the differences between the pre and posttest retrospective questionnaire were statistically significant. More than 98% of responded stated that they improved their role as teacher using the skills learned during DME, according to Kirkpatrick Level 3 (Behavior). According to Kirkpatrick Level 4 (Outcomes), 66% stated that the DME contributed to appreciate the value of teaching at an institutional level. Conclusions: According to the perception of the respondents, the DME has had a positive impact at all the levels described in the Kirkpatrick model. <![CDATA[Potentiation of Aripiprazole extrapiramidal adverse effects with the concomitant use of serotonin selective reuptake inhibitors]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100021&lng=pt&nrm=iso&tlng=pt Background: The medical school of the Pontificia Universidad Católica de Chile offers a Diploma on Medical Education (DME) for its faculty since 2000. However its impact had never been evaluated. Aim: To determine the perception of the graduates of the impact of DME, using the Kirkpatrick model for evaluation of educational outcomes. Material and Methods: A questionnaire containing closed and pre-post retrospective questions that represented Kirkpatrick's four levels of evaluation, was sent to all the graduates in 2009. Results: Eighty two of 91 graduates returned the questionnaire. Ninety one percent had a high level of satisfaction at Kirkpatrick Level 1 (Reaction), and perceived an average of 81.8% completed objectives. Most respondents reported modification of attitudes and perceptions about teaching, at Kirkpatrick Level 2 (Learning). All the differences between the pre and posttest retrospective questionnaire were statistically significant. More than 98% of responded stated that they improved their role as teacher using the skills learned during DME, according to Kirkpatrick Level 3 (Behavior). According to Kirkpatrick Level 4 (Outcomes), 66% stated that the DME contributed to appreciate the value of teaching at an institutional level. Conclusions: According to the perception of the respondents, the DME has had a positive impact at all the levels described in the Kirkpatrick model. <![CDATA[A tribute to Professor Luis Vargas Fernández, M.D.]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001100022&lng=pt&nrm=iso&tlng=pt Background: The medical school of the Pontificia Universidad Católica de Chile offers a Diploma on Medical Education (DME) for its faculty since 2000. However its impact had never been evaluated. Aim: To determine the perception of the graduates of the impact of DME, using the Kirkpatrick model for evaluation of educational outcomes. Material and Methods: A questionnaire containing closed and pre-post retrospective questions that represented Kirkpatrick's four levels of evaluation, was sent to all the graduates in 2009. Results: Eighty two of 91 graduates returned the questionnaire. Ninety one percent had a high level of satisfaction at Kirkpatrick Level 1 (Reaction), and perceived an average of 81.8% completed objectives. Most respondents reported modification of attitudes and perceptions about teaching, at Kirkpatrick Level 2 (Learning). All the differences between the pre and posttest retrospective questionnaire were statistically significant. More than 98% of responded stated that they improved their role as teacher using the skills learned during DME, according to Kirkpatrick Level 3 (Behavior). According to Kirkpatrick Level 4 (Outcomes), 66% stated that the DME contributed to appreciate the value of teaching at an institutional level. Conclusions: According to the perception of the respondents, the DME has had a positive impact at all the levels described in the Kirkpatrick model.