Person: Díaz Schmidt, Joaquín Andrés
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Díaz Schmidt
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Joaquín Andrés
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Publication Simulación remota: Un estudio cualitativo sobre razonamiento clínico y errores cognitivos desde la perspectiva de los estudiantes(2023) Mir Bezanilla, Verónica; González-Bernstein, Antonia; Luer, Maria Ignacia; López-Leiva, Rosario; Díaz Schmidt, Joaquín Andrés; Armijo-Rivera, Soledad; Pérez-Villalobos, CristhianIntroduction: Clinical reasoning is a crucial competency for medical practice and also a complex theory that is susceptible to cognitive errors. It is usually taught with clinical cases, in clinical settings, without technologies and in a practical manner rather than from a conceptual perspective. Given the need to improve its teaching in the undergraduate medical curriculum during the pandemic, we hypothesized that medical students participating in an online simulation and reflective practice course could benefit from a practical and theoretical approach to the clinical reasoning process. Material and Methods: A four-week online course, based on synchronous and asynchronous online simulation and reflective practice, was developed to promote metacognition among participants. The course was delivered to 8 sixth-year medical students as an elective module. A questionnaire consisting of four open-ended questions was designed to explore knowledge about clinical reasoning and cognitive errors, and was administered at the beginning and end of the course. A qualitative analysis of the responses was carried out using Berelson's content analysis method. Results: At the end of the course, students changed their understanding of the concept of clinical reasoning, considering it more as a process and identifying the dual nature described in one of the theories of clinical decision making. They also changed their knowledge of cognitive errors, attributing them not only to lack of knowledge, and understanding that they can actively use some strategies to reduce cognitive biases. Discussion: This study confirms that undergraduate students positively change their concept of clinical reasoning and their knowledge about this cognitive process and the cognitive errors that occur in it after a course that includes online simulation and reflectionPublication Integration of T-cell clonality screening using TRBC-1 in lymphoma suspect samples by flow cytometry(2024) Castillo, Felipe; Morales, Constanza; Spralja, Biserka; Díaz Schmidt, Joaquín Andrés; Iruretagoyena, Mirentxu; Ernst, DanielBackground: The diagnosis of T-cell non-Hodgkin lymphomas (NHL) is challenging. The development of a monoclonal antibody specific for T-cell receptor β constant region 1 (TRBC1) provides an alternative to discriminate clonal T cells. The aim of this study was to evaluate the diagnostic potential of an anti-TRBC1 mAb for the identification of T-NHL. Methods: We performed a cross-sectional diagnostic analytic study of samples tested for lymphoma. All samples sent for lymphoma screening were first evaluated using the standard Euroflow LST, to which a second additional custom-designed T-cell clonality assessment tube was added CD45/TRBC1/CD2/CD7/CD4/TCRγδ/CD3. Flow cytometry reports were compared with morphological and molecular tests. Results: Fifty-nine patient samples were evaluated. Within the T-cell population, cut-off percentages in the CD4+ cells were from 29.4 to 54.6% and from 23.9 to 52.1% in CD8+ cells. Cut-off ratios in CD4+ T cells were from 0.33 to 1.1, and in CD8+ cells between 0.22 and 1.0. Using predefined normal cut-off values, 18 of 59 (30.5%) samples showed a restricted expression of TRBC1. A final diagnosis of a T-NHL was confirmed clinically and/or by histopathological studies in 15 of the 18 cases (83.3%). There were no cases of T-NHL by morphology/IHC with normal TRBC1 expression. Non-neoplastic patient samples behaved between predefined TRBC1 cut-off values. Conclusions: Expression of TRBC1 provides a robust method for T-cell clonality assessment, with very high sensitivity and good correlation with complementary methods. TRBC1 can be integrated into routine lymphoma screening strategies via flow cytometry.