Objective. To evaluate the use of an objective structured clinical examinations (OSCE) to assess clinical competency acquired during an off-campus introductory pharmacy practice experience (IPPE). Methods. Third-year pharmacy students completed an IPPE in transitions of care and completed 24 experiential contact hours at one of 17 practice sites. Students were assessed using two OSCEs, the first occurring prior to beginning an off-site IPPE (pre-experience OSCE) and the second occurring after completion of the off-site IPPE (post-experience OSCE). Each OSCE consisted of 10 stations and covered five graded competency domains. The primary outcome was the degree of change in student performance from the pre-experience OSCE to the post-experience OSCE. Secondary outcomes included changes in each graded domain, OSCE pass rate, and failure conversion rate. Results. Of 111 students, 109 completed both the pre-and post-experience OSCE. Significant improvements were observed in overall score and cohort pass rate. Overall scores improved from 80 for the pre-experience OSCE to 87 for the post-experience OSCE. The OSCE pass rate also improved from 47% to 84%. Conclusion. Although preceptor evaluations have traditionally served as the primary summative assessment for IPPE and APPE, this study indicates that OSCEs may be a reliable alternative to assess clinical competency acquired from off-site practice experiences.

SYNOPSIS Twelve patients with active 'juvenile' cirrhosis (active chronic hepatitis, 'lupoid' hepatitis) and six subjects with other types of portal or postnecrotic cirrhosis were submitted to percutaneous renal biopsy. In addition, renal function was assessed in all patients by measurement of the 24-hour endogenous creatinine clearance, maximal urinary osmolality after deprivation of water, 24-hour urinary protein excretion, and routine urine analysis.Renal function was not significantly abnormal in either group of patients, but seven of the 12 patients with active 'juvenile' cirrhosis showed mild histological changes on renal biopsy. These changes are very similar to the lesions described in early 'lupus nephritis'.The significance of these findings in relation to the aetiology of active 'juvenile' cirrhosis is discussed.In recent years a newly recognized syndrome affecting the liver has attracted increasing attention. Since the first description of the syndrome (Waldenstr6m, 1950), a number of cases have been reported

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Se presenta la experiencia en el manejo de 33 pacientes con insuficiencia renal aguda (IRA) por el Servicio de Nefrología del Hospital Dos de Mayo, durante la epidemia de cólera que afectó al Perú en 1991. Desde el 5 de febrero hasta el 15 de mayo, seatendieron 5341 pacientes con diagnóstico clínico de cólera. De ellos, 2932 (55%) requirieron hospitalización y 33 de éstos (21 varones y 12 mujeres, con edades entre 24 y 75 años) presentaron IRA como complicación. Uno de los pacientes tuvo IRA prerenal (funcional), en los restantes 32 la IRA fue consecuencia de una severa depleción del volumen extracelular, producida por diarrea masiva. Las características clínicas y metabólicas relevantes en los pacientes portadores de NTA fueron: marcada hipotensión arterial; acidosis metabólica severa, más pronunciada que la correspondiente al grado de uremia ; hipopotasemia y finalmente, la corta duración del período oligúrico, comparado con el que suele observarse en NTA de otras etiologías. En el paciente con IRA pre-renal la restitución de la diuresis normal se logró con la sola administración de solución salina normal para reemplazar el déficit de volumen. De los 32 pacientes con insuficiencia renal intrínseca 25 respondieron al tratamiento conservador; 2 necesitaron diálisis y 5 fallecieron por complicaciones intercurrentes