RESUMO
Resumen: A partir del año 2017, la Facultad de Medicina de la Universidad de la República (UdelaR) incorpora la enseñanza en reanimación cardíaca avanzada como actividad curricular obligatoria durante el Ciclo Internado Rotatorio (CIR). Esto se justifica dada la relevancia que presenta en términos de morbilidad y mortalidad la patología cardiovascular, en particular los paros cardiorrespiratorios y específicamente la muerte súbita. Los cursos de reanimación permiten la adquisición de habilidades técnicas y no técnicas para dar respuesta tanto a esta patología tan prevalente como a la falta de estos cursos en la formación médica. Los objetivos del trabajo son comunicar y evaluar la primera experiencia durante el CIR 2017-2018. Para dichos objetivos se realizó un estudio transversal donde se analizaron los números de participantes y el porcentaje de aprobados. Además, se realizó una encuesta de valoración de autopercepción de habilidades previas y posteriores al curso y una evaluación de conformidad con éste. De los resultados se desprende la amplia aprobación en una primera instancia del curso y la valoración positiva que se realiza. También es positiva la mejora en la autopercepción de habilidades identificadas por los internos. Como debilidad se desprende el uso de un cuestionario no validado y que la evaluación no fue completada por todos los internos, ambos aspectos a mejorar en futuras evaluaciones. Como conclusión, se logró comunicar la experiencia, los cursos de Resucitación cardíaca avanzda (RCA) son una fortaleza en sí mismos y han sido un avance significativo en la formación profesional del futuro médico.
Summary: In 2017 the School of Medicine of the University of the Republic included advanced cardiopulmonary resuscitation as a mandatory curricular activity during the rotating internship. The decision is justified by morbility and mortality rates of heart disease, in particular cardiopulmonary arrests and sudden death. Resuscitation courses enable the acquisition of technical and non- technical skills to respond to a prevalent condition and to compensate the absence of this specific training in the training of medical doctors. The study aimed to communicate and evaluate the first experience during the 2017-2018 rotating internship. A transversal study was conducted to analyse the number of participants and the percentage of successful candidates. Likewise, a survey was designed to assess self-perception of skills prior to the course and skills acquired during the course, as well as a course satisfaction. Results revealed the high acceptance rate of this first instance of the course and its positive assessment. Similarly, interns evidenced improvement in their self-perception of identified skills. As to a weaknesses found, the questionnaire used had not been validated and not all Interns completed the assessment, both aspects that will be improved in future assessments. To conclude, we managed to inform about the experience, advanced cardiopulmonary resuscitation courses are an advantage in itself, and it has been a significant advance in the professional training of future medical doctors.
Resumo: A partir de 2017, a Faculdade de Medicina da Universidad de la República (UdelaR) incorporou o ensino de ressuscitação cardíaca avançada como atividade curricular obrigatória durante o ciclo de estágio rotativo (CIR). Isso se justifica dada a relevância das doenças cardiovasculares em termos de morbimortalidade, em especial a parada cardiorrespiratória e especificamente a morte súbita. Os cursos de reanimação permitem a aquisição de competências técnicas e não técnicas para responder, tanto a esta patologia prevalente, como à falta destes cursos na formação médica. Os objetivos deste trabalho são comunicar e avaliar a primeira experiência durante o Ciclo de Estágios Rotativo 2017-2018. Com esse fim foi realizado um estudo transversal onde foram analisados o número de participantes e o percentual de aprovação. Além disso, foi realizada uma pesquisa para avaliar a autopercepção de habilidades antes e depois do curso, bem como uma avaliação da adesão ao curso. Os resultados mostram a ampla aprovação na primeira instância do curso e a avaliação positiva que se faz do mesmo. A melhora na autopercepção das habilidades identificadas pelos estagiários também é positiva. Como fragilidade, surge a utilização de um questionário não validado e que a avaliação não foi respondida por todos os internos, aspectos que devem ser melhorados em avaliações futuras. Como conclusão foi possível comunicar a experiência, os cursos RCA são uma força em si e têm sido um avanço significativo na formação profissional do futuro médico.
Assuntos
Reanimação Cardiopulmonar/educação , Internato e Residência , Medicina Clínica/métodos , Educação MédicaRESUMO
Introducción: El cuestionamiento del carácter científico de la medicina clínica se incluye entre los problemas epistemológicos de las ciencias. Objetivo: Revisar la contribución de la medicina clínica como ciencia aplicada, con énfasis en la metódica que le distingue: el método clínico. Métodos: Se revisó la bibliografía especializada, complementada con el empleo de procedimientos de investigación cualitativa que incluyeron: entrevistas a profesionales de reconocida experiencia, trabajo con grupos focales y sesiones en profundidad. Desarrollo: El desarrollo histórico del pensamiento científico tuvo impacto en la medicina clínica, la cientificidad del método clínico explicada desde diferentes enfoques, la respuesta a las críticas del positivismo y la manera en que la medicina clínica cumple con los requerimientos para su aceptación como ciencia aplicada. Conclusiones: Se fundamentó la cientificidad de la medicina clínica desde un enfoque dialéctico distinguida por su carácter interdisciplinar, su condición de ciencia aplicada y por una metódica científica que posibilita el desempeño profesional del médico con el enfermo, el individuo en riesgo de enfermar y el hombre aparentemente sano: el método clínico(AU)
Introduction: The questioning the scientific character of clinical medicine is included among the epistemological problems of science. Objective: To review the contribution of clinical medicine as an applied science, with emphasis on the method that distinguishes it: the clinical method. Methods: The specialized bibliography was reviewed, complemented with the use of qualitative research procedures that included interviews with professionals with proven experience, working with focus groups and in-depth sessions. Findings: The historical development of scientific thought had an impact on clinical medicine, the scientificity of the clinical method explained from different approaches, the response to the criticisms of positivism and the way in which clinical medicine meets the requirements for its acceptance as applied science. Conclusions: The scientificity of clinical medicine was founded from a dialectical approach distinguished by its interdisciplinary nature, its condition of applied science and by a scientific method that enables the professional performance of the physician with the patient, the individual at risk of becoming ill and apparently healthy man: the clinical method(AU)
Assuntos
Humanos , Masculino , Feminino , Medicina Clínica/métodos , Técnicas de Laboratório Clínico/métodos , Domínios CientíficosRESUMO
Introducción: La comorbilidad es un fenómeno que complejiza el cumplimiento de las funciones del médico generalista en la atención a pacientes en salas de medicina interna. Objetivo: Fundamentar las bases de la comorbilidad como variable, en tanto se define en lo conceptual, lo operacional y relaciones esenciales internas y externas con el enfoque en sistema de las funciones del médico clínico en las salas de Medicina Interna de los hospitales. Material y Métodos: Se realizó una revisión bibliográfica que abordasen la comorbilidad y que facilitaran cumplir el objetivo de la investigación. Desarrollo: En el plano conceptual se define la comorbilidad como la asociación de enfermedades donde una tiene carácter protagonista Se presenta la definición conceptual de la comorbilidad. La relación entre enfermedades comórbidas puede estar explicada por asociaciones de clara dependencia patogénica o por coincidencia en el paciente sin relación patogénica directa. Existen numerosos y diversos instrumentos para operacionalizarla disponibles para su aplicación en investigación y la práctica clínica. Conclusiones: Las relaciones entre las diferentes enfermedades son multilaterales y requieren de una interpretación etiopatogénica y fisiopatológica profunda para ser comprendida y analizada en el cumplimiento de las funciones asistenciales, investigativa, docentes y administrativas del médico en salas de Medicina Interna(AU)
Introduction: The comorbidity is a phenomenon that complicates general doctor´s fulfillment of their functions regarding the care of patients at Internal Medicine Wards. Objective: To base the bases of comorbidity as a variable, insofar it is defined in the conceptual, the operational and essential internal-external relationships with a systemic approach of the functions of the clinical physician in the hospital´s Internal Medicine wards. Material and Methods: A bibliographic revision that take into account comorbidity and allow to satisfy the objective was performed. Development: Conceptually, comorbidity is defined as the association of diseases in which one has a leading role character. The conceptual definition of comorbidity is presented. The relationship between comorbid diseases can be explained by associations of a clear pathogenic dependence or by coincidence in the patient without direct pathogenic relationship. There are numerous and diverse instruments available to make it operable for its application in research and clinical practice. Conclusions: The relations between different diseases are multilateral and need a deep etiopathogenic and fisiopathological interpretation to be understood and examined in the fulfillment of its asitencials, investigative, teaching and administrative functions of the doctor at Internal Medicine wards(AU)
Assuntos
Humanos , Masculino , Medicina Clínica/métodos , Comorbidade , Múltiplas Afecções Crônicas/terapiaRESUMO
BACKGROUND: Our previous work has shown that type 2 diabetes mellitus is a problem in the school-aged population of Trinidad, West Indies. The current study evaluated the prevalence in this population of selected risk factors for diabetes, viz: obesity, family history of diabetes and acanthosis nigricans. OBJECTIVE: To assess the prevalence of the following risk factors for type 2 diabetes (T2DM) in school children in Trinidad: obesity, family history of diabetes in first- or second-degree relatives and the presence of acanthosis nigricans (AN). METHODS: A cross-sectional survey was performed among school children aged 7-18 years from September 2009 to June 2010. A convenience sample was selected from a random sample of 32 schools drawn from all educational districts. A self-administered questionnaire was employed to record family history, gender and ethnicity. AN was assessed and scored clinically at the neck and obesity was measured by anthropometry and bio-impedance. RESULTS: There were 2130 participants in the study. Fifteen per cent were obese and 17% were overweight. Primary school children had a higher prevalence of obesity (22·9% vs 11·0%) and overweight (20·0% vs 15·6%) than secondary school children (P<0·05). A greater proportion of males than females had combined overweight/obesity as measured by BMI for age (35·8 vs 29·4%, P<0·05). The overall prevalence of AN was 43·4%. However, just over 18% of all school children have a degree of AN greater than grade 2, which clinically is readily recognisable. Females displayed this physical sign more commonly than males (P<0·05). The prevalences of a family history of diabetes in first- and second-degrees relatives were 11·0% and 1·1%, respectively. Forty-three per cent had one risk factor for diabetes, 23·1% had two and 2·9% had three. CONCLUSION: Risk factors for T2DM are very common among school children in Trinidad. More than 40% had at least one risk factor. Strategies aimed at reducing risk factors for T2DM, especially obesity, among Trinidadian school children are urgently warranted.
Assuntos
Acantose Nigricans/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Obesidade/epidemiologia , Acantose Nigricans/complicações , Adolescente , Antropometria , Criança , Medicina Clínica/métodos , Estudos Transversais , Demografia , Saúde da Família , Feminino , Humanos , Masculino , Anamnese , Obesidade/complicações , Prevalência , Distribuição Aleatória , Fatores de Risco , Inquéritos e Questionários , Trinidad e Tobago/epidemiologiaRESUMO
In a retrospective cohort of 494 children with meningitis in Sao Paulo, Brazil, the Bacterial Meningitis Score identified all the children with bacterial meningitis (sensitivity 100%, 95% confidence interval: 92-100% and negative predictive value 100%, 95% confidence interval: 98-100%). Addition of cerebrospinal fluid lactate to the score did not improve clinical prediction rule performance.
Assuntos
Técnicas de Laboratório Clínico/métodos , Medicina Clínica/métodos , Técnicas de Apoio para a Decisão , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/patologia , Adolescente , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Meningite Asséptica/diagnóstico , Meningite Asséptica/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Dengue and malaria are two major public health concerns in tropical settings. Although the pathogeneses of these two arthropod-borne diseases differ, their clinical and biological presentations are unspecific. During dengue epidemics, several hundred patients with fever and diffuse pain are weekly admitted at the emergency room. It is difficult to discriminate them from patients presenting malaria attacks. Furthermore, it may be impossible to provide a parasitological microscopic examination for all patients. This study aimed to establish a diagnostic algorithm for communities where dengue fever and malaria occur at some frequency in adults. METHODOLOGY/PRINCIPAL FINDINGS: A sub-study using the control groups of a case-control study in French Guiana--originally designed to compare dengue and malaria co-infected cases to single infected cases--was performed between 2004 and 2010. In brief, 208 patients with malaria matched to 208 patients with dengue fever were compared in the present study. A predictive score of malaria versus dengue was established using .632 bootstrap procedures. Multivariate analysis showed that male gender, age, tachycardia, anemia, thrombocytopenia, and CRP>5 mg/l were independently associated with malaria. The predictive score using those variables had an AUC of 0.86 (95%CI: 0.82-0.89), and the CRP was the preponderant predictive factor. The sensitivity and specificity of CRP>5 mg/L to discriminate malaria from dengue were of 0.995 (95%CI: 0.991-1) and 0.35 (95%CI 0.32-0.39), respectively. CONCLUSIONS/SIGNIFICANCE: The clinical and biological score performed relatively well for discriminating cases of dengue versus malaria. Moreover, using only the CRP level turned to be a useful biomarker to discriminate feverish patients at low risk of malaria in an area where both infections exist. It would avoid more than 33% of unnecessary parasitological examinations with a very low risk of missing a malaria attack.
Assuntos
Proteína C-Reativa/análise , Medicina Clínica/métodos , Dengue/diagnóstico , Dengue/patologia , Testes Diagnósticos de Rotina/métodos , Malária/diagnóstico , Malária/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Guiana Francesa , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Dengue, a mosquito-borne viral illness, is a major public health problem worldwide, and its incidence continues to increase. In 2009, the World Health Organization published guidelines that included a revision of the dengue case definition. Compared to the traditional definition, the revised case definition relies more on signs than on symptoms, making it more applicable to young children. We evaluated the diagnostic utility of both case definitions in two studies of pediatric dengue in Managua, Nicaragua. In a community-based cohort study, we included data from 3,407 suspected dengue cases, of which 476 were laboratory-confirmed. In the second study, we collected information from 1,160 participants recruited at the national pediatric reference hospital (723 laboratory-confirmed). In the cohort study, the traditional definition had 89.3% sensitivity and 43.1% specificity, while the revised definition yielded similar sensitivity (86.6%) and higher specificity (55.2%, p<0.001). In the hospital study, the traditional case definition yielded 96.7% sensitivity and 22.0% specificity, whereas the revised case definition had higher sensitivity (99.3%, p<0.001) but lower specificity (8.5%, p<0.001). We then evaluated the performance of two diagnostic models based on the signs/symptoms included in each definition by analyzing the effect of increasing numbers of signs/symptoms on the sensitivity and specificity of case capture. Receiver operating characteristic analysis showed a slightly better performance for the revised model in both studies. Interestingly, despite containing less symptoms that cannot be readily expressed by children aged less than 4 years, the revised definition did not perform better in this age group. Overall, our results indicate that both case definitions have similar capacity to diagnose dengue. Owing to their high sensitivity and low specificity, they should be primarily used for screening purposes. However, in a primary care setting, neither of the case definitions performed well as a screening test in younger children.
Assuntos
Medicina Clínica/métodos , Medicina Clínica/normas , Dengue/diagnóstico , Dengue/patologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Guias como Assunto , Humanos , Lactente , Masculino , Nicarágua , Sensibilidade e Especificidade , Organização Mundial da SaúdeRESUMO
We evaluated the accuracy and interobserver variation of 3 clinical decision rules for streptoccocal pharyngitis diagnosis. Oropharyngeal swab culture was the reference. The Abu Reesh rule had the highest sensitivity and the World Health Organization rule showed the highest specificity. The interobserver variation of those rules indicates the need for better training of clinicians.