RESUMO
BACKGROUND: Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. METHODS: This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen's Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. RESULTS: Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81-0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. CONCLUSION: This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.
Assuntos
Assistência Perinatal , Consulta Remota/métodos , Desenvolvimento de Pessoal , Telemedicina/métodos , Ultrassonografia Pré-Natal , Diagnóstico Precoce , Intervenção Médica Precoce/normas , Feminino , Humanos , Obstetrícia/educação , Assistência Perinatal/métodos , Assistência Perinatal/normas , Peru/epidemiologia , Testes Imediatos/organização & administração , Gravidez , Trimestres da Gravidez , Melhoria de Qualidade/organização & administração , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/tendências , Enfermagem Rural/métodos , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/organização & administração , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/normasRESUMO
Introducción: La enfermería cubana es una profesión que ha experimentado cambios trascendentales en sus funciones como prestadora de servicios de salud, así como en el proceso de formación que ha realizado de forma acelerada, por etapas y niveles, lo que conllevó a ajustar los modelos de formación. Los programas de estudio son perfeccionados en correspondencia con el encargo social y desarrollo científico técnico, lo que permite dar respuesta oportuna a la salud universal. Objetivo: Exponer experiencias en la formación de recursos humanos de enfermería en el contexto cubano, logros alcanzados y principales desafíos ante la salud universal. Métodos: Ensayo cualitativo teórico-reflexivo, realizado en enero a mayo de 2020, basado en literatura nacional e internacional. Para buscar los estudios se utilizaron descriptores controlados "Recursos humanos", "Enfermería", "Salud", en bases de datos latinoamericanas e internacionales. Los datos se procesaron a través del análisis de contenido. Conclusión: Cuba ha conseguido desarrollar la formación de los recursos humanos en enfermería y alcanzar adecuada cobertura de salud, lo que resulta un logro que garantiza atención sin exclusión de las personas que requieran sus servicios(AU)
Introduction: Nursing, as a profession, has undergone transcendental changes in Cuba regarding its functions as provider of healthcare services; as well as in the training process, which has undergone accelerated transformations, by stages and levels, and thus led to adjustments in the training model. The study programs are improved in correspondence with the social order and technical-scientific development, which allows a timely response to universal health. Objective: To present experiences regarding the training of nursing human resources in the Cuban context, as well as achievements and main challenges concerning universal health. Methods: Theoretical-reflective and qualitative essay carried out from January to May 2020, supported by national and international literature. To identify the studies, controlled descriptors were used (Recursos humanos [human resources], Enfermería [nursing], Salud [health]), searching in Latin-American and international databases. The data was processed through content analysis. Conclusion: Cuba has managed to develop the training of human resources in nursing and achieve adequate health coverage, an achievement that guarantees care without exclusion of the people who require such services(AU)
Assuntos
Humanos , Enfermagem em Saúde Pública/métodos , Desenvolvimento de Pessoal/métodos , Qualidade da Assistência à SaúdeRESUMO
Resumo: Introdução: As competências relevantes ao ensino médico atual são divididas em sete dimensões: cognitiva, técnica, contextual, integrativa, afetiva, relacional e hábitos da mente. No presente estudo, um instrumento de aprendizagem nomeado Registro Clínico Baseado em Problemas (RBP), composto por uma lista de problemas on-line dos pacientes com suas respectivas investigações e intervenções, foi desenvolvido e aplicado em um programa de residência médica em clínica médica. Objetivo: Este estudo teve como objetivo investigar a percepção dos médicos residentes e preceptores sobre a utilização do RBP no processo ensino-aprendizagem e no desenvolvimento de competências em suas várias dimensões. Método: Participaram do estudo 21 residentes e oito preceptores de uma enfermaria de clínica médica, distribuídos em três grupos focais, em que dialogaram sobre a utilização do RBP no serviço. Para a interpretação da fala dos participantes, utilizou-se a análise de conteúdo de Bardin. Resultados: Na percepção dos residentes, o RBP influenciou na organização do conhecimento e na motivação dentro da dimensão cognitiva. A dimensão integrativa foi a mais citada pelos participantes, visto que o RBP levou à reflexão e à estruturação do raciocínio por problemas, atuando positivamente na organização do conhecimento e na definição dos problemas mais relevantes. Na dimensão contextual, não houve consenso entre os residentes sobre o impacto na solicitação racional de exames, e os preceptores relacionaram a falta de impacto do RBP à falta de feedback. Na dimensão relacional, preceptores e residentes relataram que o RBP trabalhou a síntese e organização do pensamento. No discurso dos residentes, o RBP influenciou os hábitos da mente relacionados à capacidade do médico de autoavaliação e reflexão sobre sua prática. Conclusão: O RBP atuou como instrumento de aprendizagem, principalmente por estar associado a fatores psicopedagógicos relacionados à facilitação da aprendizagem. As dimensões de competências cognitiva, integrativa, contextual, relacional e hábitos da mente foram desenvolvidas pelo RBP. A visão dos residentes e preceptores sobre a relevância do RBP para a aprendizagem de competências foi divergente. As dimensões cognitiva, integrativa e hábitos da mente tiveram maior diferença entre os participantes. Para que o RBP gere um aprendizado mais eficaz, os preceptores precisam interagir mais com o instrumento e realizar regularmente o feedback com os residentes.
Abstract: Introduction: Competencies relevant to current medical education are classified into cognitive, technical, contextual, integrative, affective, relational, and habits of mind. In the present study, a learning instrument, called Problem-Based Clinical Record (RBP), composed of a list of patients' online problems with their respective investigations and interventions was developed and applied in a Medical Residency Program in internal medicine. Objectives: To investigate the perception of resident physicians and tutors on the use of RBP in the teaching-learning process and the development of skills in its various dimensions. Method: 21 residents and 8 preceptors of a Medical Clinic ward participated in the study, distributed into 3 focus groups, where they discussed the use of RBP in the service. The participants' oral accounts were interpreted using Bardin's content analysis. Results: In the residents' view, RBP influenced the organization of knowledge and motivation within the cognitive dimension. The integrative dimension was the most cited by the participants, since RBP led to reflection and the structuring of reasoning by problems, acting positively in the organization of knowledge and definition of relevant problems. In the contextual dimension, no consensus was found among residents regarding impact on the rational request for exams and the preceptors related to the lack of impact of RBP to the lack of feedback. In the relational dimension, preceptors and residents reported that RBP worked on the synthesis and organization of thought. The residents argued that RBP influenced habits of the mind, related to the physician's ability to self-assess and reflect on his practice. Conclusion: RBP acted as a learning tool, mainly because it is associated with psycho-pedagogical factors related to the facilitation of learning. The dimensions of cognitive, integrative, contextual, relational, and habits of the mind were developed by the RBP. The view of residents and tutors on the relevance of RBP for learning skills was divergent. The cognitive, integrative, and habits of the mind dimensions had a greater difference between the participants. For RBP to generate more effective learning, preceptors need to interact more with the instrument and regularly provide feedback to residents.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Desenvolvimento de Pessoal/métodos , Aprendizagem Baseada em Problemas/métodos , Educação Médica/métodos , Mentores , Avaliação de Programas e Projetos de Saúde , Prontuários Médicos , Estudos Transversais , Feedback Formativo , Capacitação de Professores , Internato e ResidênciaRESUMO
Introducción: Florence Nightingale contribuyó a la mejora y desarrollo de la salud. Hoy en día, todavía representa una fuente de inspiración y un tema de investigación para académicos. Objetivo: Analizar la obra de Florence Nightingale en la formación de recursos humanos de Enfermería. Resultados: Se insistió en algunos tópicos dentro del tema, como los enfoques del modelo educativo de Florence Nigthingale y sus características. Su sistema fue la base para la creación de muchas de las primeras escuelas de formación de Enfermería en el mundo y abogó por la independencia de la escuela de los hospitales para que los estudiantes no se consideraran trabajadores del mismo durante su formación. Conclusiones: Florence Nightingale vio en la formación una herramienta esencial para mejorar y evolucionar, creando para ello una escuela con la que formó personas en torno a un modelo firmemente establecido(AU)
Introduction: Florence Nightingale contributed to the improvement and development of health services. Today, she still represents a source of inspiration, and is a common research topic for academics. Objective: To analyze the Florence Nightingale´s method used in the apprenticeship preparation of nurses. Results: Related topics were the most reviewed; referring, for instance, to Florence Nightingale´s teaching model and its characteristics. Her teaching system was the foundation of most of the early nursing schools, and she also defended the idea of separating school from hospitals, so that students would not be considered as workers in hospitals during their training. Conclusions: Florence Nightingale saw in teaching an essential tool to improve and make progress, creating school standards in which she trained people under strict established model(AU)
Assuntos
Humanos , Feminino , Desenvolvimento de Pessoal/métodos , Modelos Educacionais , Educação em Enfermagem , Pessoas FamosasRESUMO
CONTEXT: A key component of the improvement of public health infrastructure in the United States revolves around public health workforce development and training. Workforce challenges faced by the public health system have long been recognized, but there are additional challenges facing any region-wide or cross-jurisdictional effort to accurately assess priority workforce training needs and develop training resources to address those needs. These challenges include structural variability of public health organizations; diverse population health contexts; capturing both topic-specific skill sets and foundational competencies among public health workers; and reaching/representing the target population despite suspicion, disinterest, and/or assessment "fatigue" among employees asked to participate in workforce development surveys. OBJECTIVE: The purpose of this article is to describe the challenges, strategies to meet those challenges, and lessons learned conducting public health workforce training needs assessments by academic and practice partners of the Region 2 Public Health Training Center (R2/PHTC). SETTING AND PARTICIPANTS: The R2/PHTC is hosted by the Mailman School of Public Health at Columbia University and serves New York, New Jersey, Puerto Rico, and the US Virgin Islands within its jurisdiction. RESULTS: Strategies for responding to diverse organizational structures and population health contexts across the region; defining training priorities that address both foundational competencies for public health professionals and content-specific training to address local public health needs; reaching/representing target populations of public health workers; and analysis and report writing to encourage rapid response to identified needs and comprehensive workforce development planning are discussed. Lessons learned are likely instructive to other workforce training needs assessments in complex and ever-changing public health environments.
Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Avaliação das Necessidades/estatística & dados numéricos , Saúde Pública/educação , Recursos Humanos/tendências , Assistência à Saúde Culturalmente Competente/tendências , Humanos , New Jersey , New York , Saúde Pública/métodos , Saúde Pública/tendências , Porto Rico , Desenvolvimento de Pessoal/métodos , Inquéritos e Questionários , Ilhas Virgens AmericanasAssuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Dengue Grave/complicações , Dengue/terapia , Atenção Primária à Saúde , Desenvolvimento de Pessoal/métodosRESUMO
RESUMEN Introducción: la formación doctoral es el núcleo integrador no solo de los procesos sustantivos universitarios (docencia, investigación y extensión) sino de las diferentes formas de postgrado y garante de la calidad universitaria y, especialmente, de los egresados de la educación superior. Objetivos: identificar los factores que limitan la gestión del proceso de formación doctoral en la Universidad de Ciencias Médicas de Matanzas. Material y métodos: se realizó la presente investigación en el área de postgrado y Ciencia e Innovación Tecnológica con un enfoque cualitativo. Se emplearon métodos empíricos y teóricos de investigación, así como integración de métodos cuantitativos-cualitativos y técnicas (grupos de especialistas, lluvia de ideas, matriz de ponderación de impactos), cuyos resultados fueron triangulados para realizar las valoraciones finales. Resultados: se identificaron las principales barreras que limitan la gestión del proceso de formación doctoral en la Universidad de Ciencias Médicas de Matanzas determinando como tal: inadecuado funcionamiento de los Consejos Científicos, deficiente claustro de profesores, pobre disponibilidad de los tutores necesarios para el desarrollo de la actividad, insuficiente organización de la Ciencia y Técnica, poca importancia conferida por los directivos a la obtención de la categoría científica. Conclusiones: las principales barreras que limitan la gestión del proceso de formación doctoral en la Universidad de Ciencias Médicas de Matanzas fueron identificadas.
ABSTRACT Introduction: The doctorate training is not only the integrating kernel of the substantive university processes (teaching, research and extension) but also of the different postgraduate activities and guaranty of the university quality, especially of the high education graduates. Objective: to identify the factors affecting the management process of the doctorate training at the University of Medical Sciences of Matanzas. Materials and methods: the following qualitative research was made in the area of Postgraduate Studies and Science and Technology Innovation. Research empiric and theoretical methods were used, and also the integration of the quantitative-qualitative methods and techniques (groups of specialists, brain storm, and impact ranking matrix), with triangulation of results for the final valuations. Results: there were identified the main barriers limiting the management of the doctoral training at the University of Medical Sciences of Matanzas. They were: 1. inadequate performance of the Scientific Councils; 2. deficient teaching staff; 3. poor availability of the necessary tutors for the development of the activity; 4. insufficient organization of the Science and Technique; 5. the management staff confers few importance to obtaining the scientific category. Conclusions: the main barriers limiting the management process of the doctoral training at the University of Medical Sciences of Matanzas were identified.
Assuntos
Humanos , Tomada de Decisões Gerenciais , Causalidade , Política Organizacional , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/organização & administração , Epidemiologia Descritiva , Eficiência Organizacional , Administração Financeira , Recursos Humanos/organização & administração , Estudos de Avaliação como Assunto , Tecnologia da Informação/provisão & distribuiçãoRESUMO
La formación profesional universitaria es compleja, pero el resultado final de este proceso debe satisfacer las expectativas sociales relacionadas con la competencia de los egresados, por lo cual las ciencias pedagógicas deben mantener una búsqueda constante en cuanto a métodos, procedimientos y estrategias que permitan satisfacer el encargo social. Teniendo en cuenta lo anterior se realizó el presente estudio con vistas a contribuir a la implementación de las estrategias curriculares, desde una óptica didáctico-metodológica, y su cumplimiento de manera objetiva a través de un proceso que pueda ser medido y controlado, donde se incorporen los contenidos previstos en cada asignatura y disciplina.
The university vocational training is complex, but the final result of this process should satisfy the social expectative related to the competence of those graduated, reason why the pedagogic sciences should maintain a constant search as for methods, procedures and strategies that allow to satisfy the social responsibility. Keeping in mind the above-mentioned statement the present study was carried out aimed at contributing to the implementation of the curricular strategies, from a didactic-methodological view, and their fulfillment in an objective way through a process that can be measured and controlled, and the foreseen contents are included in each subject and discipline.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Competência Profissional , Capacitação Profissional , Desenvolvimento de Pessoal/métodos , Estratégias de SaúdeRESUMO
OBJECTIVE: To evaluate the scientific production, generation of patents and researchers training among Brazilian Collective Health professors who were awarded a Pq/CNPq productivity scholarship from 2000 to 2012 and to verify the existence of an association between these production modalities and the characteristics of the professors, such as gender, training and origin. METHOD: An analytical cross-sectional study was carried out from 2000 to 2012, and the Prevalence Ratio was calculated using Poisson regression. For the statistical analyzes, the SPSS® program was used. RESULTS: Of particular note are regional and institutional concentration, consistent scientific output, important researchers training, and a primordial but still timid generation of patents. We found an association between the "scientific production", "researchers training" outcomes, and the gender characteristics, such as the formation and origin of the Pq professor. CONCLUSION: These findings can guide the decision-making aimed at the deconcentration of scientific production and researchers training in the Brazilian Collective Health.
Assuntos
Eficiência , Docentes/normas , Bolsas de Estudo/tendências , Pesquisadores/normas , Adulto , Brasil , Estudos Transversais , Escolaridade , Docentes/estatística & dados numéricos , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Patentes como Assunto/estatística & dados numéricos , Distribuição de Poisson , Saúde Pública/educação , Pesquisadores/estatística & dados numéricos , Fatores Sexuais , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/tendênciasRESUMO
ABSTRACT Objective: To evaluate the scientific production, generation of patents and researchers training among Brazilian Collective Health professors who were awarded a Pq/CNPq productivity scholarship from 2000 to 2012 and to verify the existence of an association between these production modalities and the characteristics of the professors, such as gender, training and origin. Method: An analytical cross-sectional study was carried out from 2000 to 2012, and the Prevalence Ratio was calculated using Poisson regression. For the statistical analyzes, the SPSS® program was used. Results: Of particular note are regional and institutional concentration, consistent scientific output, important researchers training, and a primordial but still timid generation of patents. We found an association between the "scientific production", "researchers training" outcomes, and the gender characteristics, such as the formation and origin of the Pq professor. Conclusion: These findings can guide the decision-making aimed at the deconcentration of scientific production and researchers training in the Brazilian Collective Health.
RESUMEN El objetivo del trabajo fue evaluar la producción científica, la generación de patentes y la formación de investigadores entre docentes de la Salud Colectiva brasileña que fueron contemplados con becas de productividad Pq/CNPq en el período de verano y verificar la existencia de la asociación entre estas modalidades de producción; y las características de los docentes, como el género, la formación y el origen. Método: Se realizó un estudio transversal analítico en el período de referencia y se calculó la razón de prevalencia por medio de la regresión de Poisson. Para los análisis estadísticos se utilizó el programa SPSS®. Resultados: Se destacan la concentración regional e institucional, la consistente producción científica, la importante formación de investigadores; y la significativa, pero aún tímida, generación de patentes. Se encontró una asociación entre los resultados de la producción científica, la formación de investigadores y las características género, formación y origen del docente Pq. Conclusión: Esos hallazgos pueden orientar la toma de decisiones dirigidas a la desconcentración de la producción científica y la formación de investigadores en Salud Colectiva en Brasil.
RESUMO Objetivo: Avaliar a produção científica, geração de patentes e formação de pesquisadores entre docentes da Saúde Coletiva brasileira que foram contemplados com bolsas de produtividade Pq/CNPq no período 2000-2012 e verificar a existência de associação entre estas modalidades de produção e características dos docentes, como gênero, formação e origem. Método: Foi realizado um estudo transversal analítico no período 2000-2012 e foi calculada a razão de prevalência por meio da regressão de Poisson. Para as análises estatísticas, utilizou-se o programa SPSS®. Resultados: Destacam-se a concentração regional e institucional, consistente produção científica, importante formação de pesquisadores e primordial, mas ainda tímida geração de patentes. Foi encontrada associação entre os desfechos "produção científica", "formação de pesquisadores", e as características de gênero, como formação e origem do docente Pq. Conclusão: Estes achados podem orientar a tomada de decisões voltadas para a desconcentração da produção científica e formação de pesquisadores em Saúde Coletiva no Brasil.