Martin Rodriguez

University of Alabama at Birmingham, Birmingham, AL, United States

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Publications (8)18 Total impact

  • Journal of General Internal Medicine 01/2014; · 3.28 Impact Factor
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    ABSTRACT: BACKGROUND:: Current evaluation tools of medical school courses are limited by the scope of questions asked and may not fully engage the student to think on areas to improve. The authors sought to explore whether a technique to study consumer preferences would elicit specific and prioritized information for course evaluation from medical students. METHODS:: Using the nominal group technique (4 sessions), 12 senior medical students prioritized and weighed expectations and topics learned in a 100-hour advanced physical diagnosis course (4-week course; February 2012). Students weighted their top 3 responses (top = 3, middle = 2 and bottom = 1). RESULTS:: Before the course, 12 students identified 23 topics they expected to learn; the top 3 were review sensitivity/specificity and high-yield techniques (percentage of total weight, 18.5%), improving diagnosis (13.8%) and reinforce usual and less well-known techniques (13.8%). After the course, students generated 22 topics learned; the top 3 were practice and reinforce advanced maneuvers (25.4%), gaining confidence (22.5%) and learn the evidence (16.9%). The authors observed no differences in the priority of responses before and after the course (P = 0.07). CONCLUSIONS:: In a physical diagnosis course, medical students elicited specific and prioritized information using the nominal group technique. The course met student expectations regarding education of the evidence-based physical examination, building skills and confidence on the proper techniques and maneuvers and experiential learning. The novel use for curriculum evaluation may be used to evaluate other courses-especially comprehensive and multicomponent courses.
    The American Journal of the Medical Sciences 04/2013; · 1.33 Impact Factor
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    ABSTRACT: Objetivo: Describir las características clínicas y biológicas de sujetos con falla virológica participantes de la Estrategia Sanitaria de Prevención y Control de Infecciones de Transmisión Sexual (ITS) VIH/SIDA de un hospital público del Perú. Materiales y Métodos: Se realizó un estudio descriptivo exploratorio con datos de sujetos mayores de 18 años que iniciaron terapia anti-retroviral de gran actividad (TAlRGA) entre mayo de 2004 y diciembre de 2009 con al menos un control de carga viral luego de 24 semanas de TARGA. Falla virológica fue definida como un valor de carga viral superior a 1.000 copias/mL luego de 24 semanas de TARGA. Resultados: Se analizaron 1.478 registros de sujetos en TAlRGA: la mediana de edad fue 35 años (rango intercuartíl [RIQ] 2941) y 69,6% fueron varones. Se encontró falla virológica en 24%. La proporción de fallecidos fue superior en el grupo con falla virológica (9,5%) respecto al grupo sin falla virológica (1,8%). En el análisis multivariado, la edad, antecedentes de uso de anti-retrovirales antes de iniciar TARGA, cambio de anti-retrovirales por toxicidad, infecciones oportunistas durante TARGA, nivel de linfocitos CD4+ inferior a 100 céls/mL al año de inicio de TARGA, adherencia y estadio clínico se asociaron independientemente a falla virológica. En un sub-análisis limitado al grupo de pacientes sin antecedente de uso de anti-retrovirales antes del inicio de la TARGA, se encontró que adherencia, edad y aparición de infecciones oportunistas tuvieron asociación con falla virológica. Conclusión: Este estudio identificó factores asociados a falla virológica. Se necesitan estudios adicionales para evaluar si el uso de estos factores ayudaría a identificar prospectivamente pacientes en riesgo de fallar y al diseño de intervenciones para disminuir este riesgo.
    Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia 02/2013; 30(1):42-48. · 0.45 Impact Factor
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    ABSTRACT: Objective: To describe clinical and biological characteristics of subjects with virologic failure who participated in the sexually transmitted diseases HIV/AIDS National Program from a Peruvian public hospital. Materials and Methods: An exploratory descriptive study was performed with data from subjects older than 18 who started high activity antiretroviral therapy (HAART) between May 2004 and December 2009 and who had a viral load control after 24 weeks of HAART. Virologic failure was defined as a viral load value above 1000 copies/mL on follow up after 24 weeks on HAART. Results: Of 1478 records of patients on HAART analyzed, the median age was 35 years [IQR, 29-41] and 69.6% were male. Also, virologic failure occurred in 24% and 3.7% died. Of subjects with virologic failure, 9.5% died. On multivariate analysis, age, history of antiretroviral use before starting HAART, change of antiretroviral therapy due to toxicity, opportunistic infections during HAART, level of CD4 + lymphocytes below 100 cells/ml at start of HAART, adherence and clinical stage were independently associated with virologic failure. In the group of patient with no history of antiretroviral use before starting HAART, age, opportunistic infections during HAART were associated with virologic failure. Conclusion: This study identified factors associated with virologic failure. Further studies are needed to evaluate whether the use of these factors can help to identify prospectively patients at high risk of failure, and to design interventions aimed to reduce this risk.
    Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia 02/2013; 30(1):42-8. · 0.45 Impact Factor
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    ABSTRACT: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.
    PLoS ONE 01/2013; 8(10):e76323. · 3.53 Impact Factor
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    ABSTRACT: Gastrointestinal involvement is an uncommon manifestation of cryptococcosis and, consequently, there are very few reports that have described symptomatic duodenal involvement. We present three cases of Cryptococcus-associated duodenitis in HIV-positive patients and review the literature.
    Medical mycology: official publication of the International Society for Human and Animal Mycology 02/2011; 49(7):775-8. · 2.13 Impact Factor
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    Journal of General Internal Medicine 02/2011; 26(5):551-4. · 3.28 Impact Factor
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    ABSTRACT: Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem. To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis. Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months. Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58. A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.
    PLoS ONE 01/2010; 5(8):e12082. · 3.53 Impact Factor