Background: The current cure rates with triple therapy combining a proton-pump inhibitor, amoxicillin and clarithromycin are unacceptably low. Aims: To evaluate the efficacy of a 14-day concomitant therapy as an empirical first-line treatment for curing Helicobacter pylori (Hp) infection in primary care. Methods: Patients from six primary care centers in Catalonia -Spain- were included consecutively. Hp status pre and post treatment was assessed according to local clinical practice protocol. A 14-day concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus omeprazole 20 mg, all drugs administered twice daily) was prescribed. Adherence to therapy and adverse events were assessed by personal interview. Results: 112 patients were enrolled. Mean age was 46.7 ± 16.1 years. Main indication for treatment was non-investigated dyspepsia (83%). Hp eradication was achieved in 100 of the 112 patients. Eradication rates were 89.3% (95% CI: 81.7–94.1) by intention-to-treat (ITT) analysis and 91.7% (95% CI; 84.6–95.9) per protocol (PP). No major side effects were reported; 104 (92.8%) patients complete the treatment. Forty-seven patients (42%) complained of mild side effects (metallic taste, nausea). Low adherence to treatment (p = 0.004) and significant adverse events (p = 0.004) were the variables associated with treatment failure. Conclusions: In primary care, a 14-day concomitant therapy is highly effective and well tolerated.

Evaluation of clinical communication skills in medical students with simulated patients Background: Communication skills are not learnt innately. It is therefore necessary to both train and evaluate medical students in this area. Aim: To evaluate communication skills of fourth-year medical students with the use of a simulated patient (SP). Material and Methods: Four clinical scenarios (CS) for clinical interviews with simulated patients were designed: chronic and acute diseases, difficult and functional patients. Each student performed the four CS, and his communication skills were evaluated using our own questionnaire as agreed with the SP. The questionnaire included items on verbal and nonverbal communication, warmth, respect, specificity, assertiveness and empathy (rated from 0 to 10). The response variable was the arithmetic mean of the scores on each item. All students received a detailed evaluation report. Results: Sixty one students (32 men) performing 244 interviews, were evaluated. The overall mean score was 7.87 (4.62 to 9.03). The highest scores were for respect and specificity (7.57 and 7.15 respectively). The lowest were for empathy and nonverbal communication (6.44 and 6.84 respectively). The CS evaluations were 7.87 (chronic disease), 7.02 (difficult patient), 6.46 (acute disease) and 6.14 (functional pathology). Women had higher overall scores compared to men (7.26 and 6.51 respectively; p < 0.01) and a significantly higher score in all communication variables (p < 0.01). Conclusions: The overall assessment in clinical communication with SP is satisfactory although there is room for improvement, especially in empathy and nonverbal communication. Women had significantly higher scores than men.

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