ABSTRACT
Este artigo relata a experiência de aplicação de metodologias ativas na disciplina "Programa de Interação Serviço Ensino e Comunidade" (PISEC) do curso de Medicina da Universidade Vila Velha (UVV). Utilizou-se a metodologia da problematização, que consiste em cinco passos: observação da realidade; definição de pontos-chave; teorização; hipótese de solução e aplicação à realidade. A problematização oportuniza a reflexão mediada pelo professor sobre atividades de interação, sendo um elemento chave para a satisfação pessoal dos alunos e para a melhoria do processo de aprendizagem.
This article reports the experience of applying active methodologies in the module"Learning, Services and Community Interaction Program" (PISEC) of the medicine course of Vila Velha University (UVV). We used the problematization methodology, which consists of five steps: observation of reality; defining key points; theorizing; hypothesis of solution and application to reality. The problematization provides reflective opportunities for teacher-mediated interaction activities, which are a key element to students' personal satisfaction and improvements in learning process.
Este artículo presenta la experiencia de aplicación de metodologías activas en la disciplina "Programa Interactivo de Aprendizaje, Servicio y Comunidad" (PISEC) del curso de Medicina de la Universidad Vila Velha (UVV). Se utilizó la metodología de problematización, que consiste en cinco pasos: observación de la realidad; definición de puntos claves; teorización; hipótesis de solución y aplicación a la realidad. La problematización ofrece oportunidades de reflexión sobre las actividades de interacción mediadas por el profesor, siendo un elemento clave para la satisfacción personal de los estudiantes y para mejorar el proceso de aprendizaje.
Subject(s)
Humans , Problem-Based Learning , Education, Medical , Community IntegrationABSTRACT
Introducción Los grandes cambios producidos en las dos últimas décadas en las reglas laborales en salud, los estilos de trabajo, la organización sanitaria, el uso y la importancia de la tecnología y en la consideración social acerca del profesional médico tienen causas complejas y multifactoriales; las mismas presentan elementos comunes como el empeoramiento de la remuneración que perciben los médicos, la disminución absoluta y relativa de los honorarios profesionales y la percepción del médico respecto de su propia profesión y marcan una realidad que exige reconsiderar el lugar del médico en sus nuevos escenarios de trabajo. Objetivos Definimos como "problemática médica" a toda vivencia o situación problemática que experimenta el médico durante el ejercicio de su actividad. Sobre el tema existen abundantes datos y opiniones en los últimos años referidos a la insalubre situación laboral del médico y a la propia percepción negativa sobre su tarea. El objetivo de presente trabajo fue explorar si la problemática médica era tratada en el Congreso Argentino de Cardiología. Material y métodos Estudio observacional, descriptivo, sobre la existencia de temas libres y mesas sobre problemática médica en los últimos tres Congresos Argentinos de Cardiología y su ubicación temática. Algunas de las palabras clave fueron: realidad laboral, trabajo médico, burn out, bioética, ética, condiciones de trabajo y otras. Resultados Hubo en total 2254 temas libres en los tres años, de los cuales 8 (0,35%) trataron sobre elementos de problemática médica. Los temas libres se ubicaron en las categorías "miscelánea", psicosociales, educación médica o salud pública. Hubo 13 mesas, organizadas por el Comité de Bioética, el Área de Investigación de la Sociedad Argentina de Cardiología, CONAREC y la Fundación Cardiológica Argentina. Conclusiones En el período estudiado hubo una proporción muy escasa de mesas y temas libres dirigidos a la problemática médica, estos últimos sin un marco conceptual preestablecido adecuado. Así, la problemática médica no es considerada un objeto de estudio relevante. Es conveniente la discusión e investigación para la búsqueda de planteos y soluciones a múltiples niveles, o no podrá hacerse un diagnóstico y tratamiento del tema, con las eventuales y enormes implicaciones futuras potenciales.
Background The big changes produced during the last two decades have produced a reality that requires physicians to reconsider the role they play in their new working scenario. These changes include regulations in health care working, work styles, health organization, use and importance of technology and how the physician is socially considered. The causes are complex and multifactorial, yet they share common elements as worse payment to physicians, an absolute and relative reduction in professional fees and physicians' perception about their own profession. Objectives A "medical problem" is defined as any problematic experience or situation felt by a physician during his/her practice. In the last years, there are plenty of information and several opinions about this matter, in reference to the working conditions of physicians and to their negative self-perception about medical practice. The goal of the present study was to explore if the Argentine Congress of Cardiology dealt with the medical problem. Material and Methods Observational and descriptive study about open-topic sessions and roundtable sessions dealing with the medical problem -and under which field the medical problem was considered- during the past/latest three Argentine Congresses of Cardiology. The following key words were used: working reality, medical practice, burnout, bioethics, ethics and working conditions, among others. Results Of 2254 open topics presented in the three years, 8 (0.35%) dealt with the medical problem. The open topics were considered under "miscellany", psychosocial, medical education or public health fields. Thirteen roundtable sessions were identified and organized by the Committee on Bioethics, the Research Area of the Argentine Society of Cardiology, the CONAREC and the Argentine Cardiology Foundation. Conclusions We found very few roundtable sessions and opened-topic sessions -and without an adequate preestablished conceptual framework- focused on the medical problem. Thus, the medical problem is not considered an important topic of study. Discussion and investigation are convenient to search for arguments and solutions at multiple levels, otherwise it will not be possible to make a diagnosis and treatment of the topic, with the eventual and important future implications.
ABSTRACT
Alcohol abuse is related to diverse medical problems including neuropsychiatric problems, malignant neoplasms, cardiovascular diseases and liver diseases. The liver is the organ most severely affected by alcoholism. Alcoholic liver disease (ALD) remains a major cause of morbidity and mortality world wide. The spectrum of ALD is not uniform including steatosis, alcoholic hepatitis and cirrhosis with increasing severity. Recent research has elucidated the mechanisms of alcohol-induced liver injury, offers the prospect of advances in the management of alcoholic liver disease. Interactions between acetaldehyde, reactive oxygen species, inflammatory mediators and genetic factors appear to play important roles in the development of ALD. The mainstay of therapy for ALD is cessation of drinking. Nutritional support has been shown to play a positive role in ALD. In this article, the most recent data on the efficacy of treatment of ALD including corticosteroid, anti-inflammatory agents and antioxidant were reviewed.
Subject(s)
Humans , Acetaldehyde , Alcoholics , Alcoholism , Anti-Inflammatory Agents , Cardiovascular Diseases , Drinking , Fibrosis , Hepatitis, Alcoholic , Liver , Liver Diseases , Liver Diseases, Alcoholic , Mortality , Nutritional Support , Reactive Oxygen SpeciesABSTRACT
OBJECTIVE: Improvements in microsurgical and neuroanesthesiological techniques have resulted in an increasing number of operation for aneurysmal clipping in elderly patients.The authors evaluated surgical outcome of elderly patients, considering neurologic grade on admission, amount of subarachnoid hemorrhage (SAH) on computerized tomographic findings and timing of surgery. METHODS: The subjects of present study are 91 patients who were admitted to department of neurosurgery and treated surgically between May, 1983. and December, 1999. in Yeungnam University Hospital. The patients were classified by age into two groups: 65 to 69 years (59 cases), 70 years or older (32 cases). On admission, the clinical condition of patients was graded according to the scales of Hunt & Hess and the amount of SAH was graded according to grading system of Fisher. The timing of operation was dvided into two groups: 1-3 days (63 cases) & more than 3days (28 cases). The surgical morbidity & mortality according to Hunt & Hess grade, grading system of Fisher and timing of operation was analized. RESULTS: Overall 32 of the 91 patients were poor prognosis. And 10 of the 32 patients died, for a mortality rate 11%. There was close relationship between the preoperative Hunt & Hess grade, initial Fisher grade, operative timing & outcome. The most common causes of poor or death outcome were medical problems, i.e pulmonary dysfunction, cardiovascular disease and sepsis. The clinical factors of unfavorable outcome in the elderly patients were poor neurological grade on admission, symptomatic cerebral vasospasm, rebleeding and pre-existing medical conditions such as DM, hypertension, cardiopulmonary disease. CONCLUSION: In recent years, with improvement in surgical technique and neuroanasthesia, the number of operation for ruptured aneurysm has increased in elderly patients. We conclude that factors that most affects the clinical outcome of surgery in elderly patients were based on the neurosurgeon's technique and the patients neurological grade and concominant disease, not just on the patients age.