Preferencia de especialidades médicas en estudiantes de medicina de una universidad chilena / Preference of medical specialties among medical students in a Chilean university

En este trabajo se describen las preferencias de elección de especialidad médica que manifiestan los estudiantes de la carrera de medicina de una universidad regional del norte de Chile. Se trata de un estudio descriptivo basado en información primaria con una muestra de 266 respuestas válidas, con una tasa de respuesta de 58,7%. La información se recogió a través de un cuestionario disponible en Google Forms, previo consentimiento voluntario de participación, durante los meses de mayo a julio de 2022. Se encontró que las especialidades médicas preferidas por los estudiantes de la Universidad Católica del Norte fueron las especialidades clínicas como medicina interna y las médico-quirúrgicas como medicina de urgencias y ginecología-obstetricia. Además, existen especialidades con un claro predominio femenino como psiquiatría infanto-adolescente, ginecología-obstetricia, cirugía pediátrica, pediatría y medicina familiar, mientras que el predominio masculino destaca en radiología y anestesiología, ambas asociadas a un trato indirecto con el paciente. Se observó que las especialidades quirúrgicas, tradicionalmente preferidas por hombres, podrían estar en proceso de cambio generacional, aumentando la presencia femenina en ellas, sobre todo en cirugía general.

This study describes medical specialty preferences expressed by medical students at a regional university in northern Chile. This descriptive study is based on primary information with a sample of 266 valid responses and a response rate of 58.7%. The information was collected through a Google Forms questionnaire before voluntary consent of participation from May to July 2022. We found that the medical specialties preferred by the Universidad Católica del Norte students were clinical specialties, including internal medicine, and medical-surgical specialties, including emergency medicine and gynecology-obstetrics. Women markedly predominated in child and adolescent psychiatry, gynecology-obstetrics, pediatric surgery, pediatrics, and family medicine, while men predominated in radiology and anesthesiology, both associated with indirect patient interaction. We also found that surgical specialties, traditionally preferred by men, could be in the process of generational change, as there is an increase in the presence of women, especially in general surgery.

Variables, indicadores y criterios de evaluación del servicio médico como escenario de formación de especialistas

La calidad de la educación de posgrado concebida estratégicamente como la integración de la pertinencia social y la excelencia académica, deviene esencial en la gestión de las instituciones docente-asistenciales del sector salud. Sus múltiples dimensiones deben ser contextualizadas y son susceptibles de análisis y perfeccionamiento en cada servicio médico donde se desarrolla el proceso de formación de especialistas. Se utilizaron métodos teóricos y empíricos, para la identificación de las dificultades y la elaboración de la nueva propuesta. Se obtuvieron criterios sobre los servicios médicos como escenarios de formación, en los que se identificaron los problemas relativos a la actividad de posgrado. La propuesta consideró las directrices estratégicas, la población objeto de atención y los diferentes ámbitos temporales y espaciales identificados, con lo que pretende el fortalecimiento y desarrollo de la formación de posgrado en las Universidades de Ciencias Médicas en Cuba.

The quality of postgraduate education, strategically conceived as the integration of social relevance and academic excellence, becomes essential in the management of teaching-assistance institutions in the health sector. Its multiple dimensions must be contextualized and are susceptible to analysis and improvement in each medical service where the specialist formation process takes place. Theoretical and empirical methods were used, for the identification of the difficulties and the elaboration of the new proposal. Criteria on medical services were obtained as training scenarios, in which problems related to postgraduate activity were identified. The objective of the work is to expose a proposal of variables, indicators and evaluation criteria in the service as a scenario the specialist's formation. The proposal was considered the strategic guidelines, the target population and the different temporal and spatial areas identified, with which it intends to strengthen and develop postgraduate training in the Medical Sciences Universities in Cuba.

A Case for Horizontal Distribution of Activities between General Surgery and Surgical Super Specialties

Under the current practice in organizing surgical services, proportionate representation of disciplines is provided in the curricular planning and in corresponding clinical functions. This is based on the level of competence expected by the end of training period. The disciplines as a “whole” are placed in general surgery or super specialty. The system of vertical arrangement has some serious concerns. Paradoxically, patients with diseases of simple and routine nature of discipline categorized as super specialty are neglected. Super specialist is unable to attend on account of preoccupation with serious challenging problems. The general surgeon hesitates because of privileging issues, fear of allegations of negligence and litigation. The system of vertical division is based on premise that some disciplines deal with complex procedures and others with only simple and routine nature. This premise is incorrect. Each discipline is a mix of simple and complex cases requiring specialized treatment. Alternate modified organization of surgical service is proposed. Activities of all disciplines are scrutinized according to the level of expected competence by the end of training. Categorization is shifted from the “discipline' to “activities.” Criteria applied for classification of activities are as follows: on completion, the trainee is capable to assume full responsibility-category 1; has gained sufficient experience-category 2; and is conversant with broad understanding of management-category 3. Activities of category 1 from all disciplines are assigned to general surgery and those of category 3 from all disciplines are assigned to respective super specialty. Those in the middle, comprising difficult cases but not requiring specialized training or heavy inputs in equipment, are in category 2. They are assigned to general surgery as additional/optional items, or super specialty, guided by local factors. The scope and practice of general surgery are broadened with a shift from “residual” to “comprehensive” discipline. Advantages, concerns, collateral issues of horizontal distribution of activities, its positive impact on research and education are discussed. It is concluded that the proposed organization of surgical services is a rational, logical, and practical strategy for good-quality surgical care in the society. The super specialists need to be convinced that “taking load off” is good for the specialty.

Analysis of Otorhinolaryngology Practices-Challenges of Specialists and Facilties-in sub-Saharan Africa

Background: More than 95% of the population in sub-Saharan Africa (S.S.A.) does not have ready access to safe, affordable surgical care, and there is a desperate need for E.N.T. (ear, nose, and throat), audiology, and speech therapy services. Therefore, from an international outlook, the most significant challenge confronting hearing and cancer care delivery is not high-technology and high-cost medicine but the lack of access to even the most elementary E.N.T. care Materials and Methods: A literature search for studies on the analysis of trends and outcomes of otorhinolaryngology practices in sub-Saharan Africa was performed using Google Scholar search database, PubMed, Medline, and ScienceDirect. The bibliographies of included studies were also searched for additional references. About 95 articles were identified. Twenty-one articles were considered suitable for the review. The whole residents of the 22Results: countries illustrated in a study reviewed were 720,500,000; this symbolizes 75% of the population of sub-Saharan Africa. Among the 22 countries that were tested, 847 ENT surgeons, 580 audiologists, 906 speech therapists, 264 ENT clinical officers, and 320 oncologists were reported. When data have combined the sample, the regional ratio was 1.2 million people per E.N.T. surgeon, 0.8 million people per audiologist, and 1.3 million people per speech therapist. Conclusion: Basic E.N.T. and airway-related interventions are possible in most countries that responded; life-saving procedures such as tracheostomy (and tracheostomy tubes), bronchoscopy, and balloon dilatation were not readily available in all countries. Access to hearing screening was very poor in most countries, highlighting the undocumented burden of disease of hearing loss in Africa and other LMICs, estimated at 5% of the world's population

Propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología / A proposal of specific professional competences for the training of gastroenterology specialists

Introducción: La formación con calidad del capital humano en el sector salud constituye un reto para la educación médica cubana contemporánea. La formación académica, en particular la especialidad, tiene el cometido de formar un profesional con alta competencia y avanzadas capacidades para el desempeño especializado, solidez de los principios ético-morales y elevada calificación científico-técnica, por lo que el desarrollo de competencias profesionales resulta una prioridad para la formación de los especialistas biomédicos. Objetivo: Elaborar una propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología. Métodos: Se realizó un estudio educacional, de investigación aplicativa, bajo el enfoque general dialéctico-materialista, con fundamento en teorías y enfoques filosóficos, psicológicos y legales de las leyes de la educación, y de la educación médica en particular. Asimismo, se utilizaron métodos teóricos, empíricos y estadístico-matemáticos. Resultados: Se elaboró una definición operativa de competencias profesionales específicas en gastroenterología, a partir del estudio del sistema de competencias y de la sistematización de los documentos rectores en dicha formación. También se identificaron y definieron las competencias profesionales específicas en las áreas asistencial, docente, investigativa y de dirección, que posibilitaron la mejora en el desempeño profesional de los futuros especialistas. Conclusiones: La formación basada en el desarrollo de competencias profesionales específicas constituye una prioridad para la educación médica y la salud pública cubana contemporánea, en aras de elevar la calidad del proceso formativo en la especialidad de gastroenterología y la atención médica que brindan estos galenos en los niveles de atención en salud(AU)

Introduction: The quality training of human capital in the health sector is a challenge for contemporary Cuban medical education. Academic training, particularly the residence, has the task of training a professional with high competence and advanced capabilities for specialized performance, solid ethical-moral principles and high scientific-technical qualification; therefore, the development of professional competences is a priority for the training of biomedical specialists. Objective: To elaborate a proposal of specific professional competences for the training of gastroenterology specialists. Methods: An educational study of applicative research was carried out under the general dialectical-materialistic approach and based on philosophical, psychological and legal theories and approaches of the laws of education and, particularly, of medical education. Theoretical, empirical and statistical-mathematical methods were also used. Results: An operational definition of specific professional competences in gastroenterology was elaborated, based on the study of the system of competences and the systematization of the guiding documents for such training. Specific professional competences were also identified and defined in the care, teaching, research and management areas, which allowed to improve the professional performance of future specialists. Conclusions: Training based on the development of specific professional competences is a priority for contemporary Cuban public health and medical education, in view of raising the quality of the training process in the specialty of gastroenterology and the medical care provided by these physicians at the levels of healthcare(AU)

Intenções de graduandos de Medicina em face dos preditores de fixação: Programa Mais Médicos na Bahia / Medicine graduates intentions in the face of establishment predictors: Bahia's Mais Médicos Program

Resumo: Introdução: O déficit quantitativo e as desigualdades na distribuição de médicos agravam a crise global da força de trabalho em saúde. Muitas políticas têm sido adotadas para enfrentamento do problema, destacando-se pela sua abrangência o Programa Mais Médicos. Objetivo: Este estudo objetivou caracterizar, entre graduandos de Medicina do estado da Bahia, as intenções de especialidade médica futura e de fixação em áreas prioritárias definidas pelo Programa Mais Médicos, conforme os preditores apontados na literatura. Método: Trata-se de um estudo de corte transversal com caráter exploratório, realizado com estudantes dos cursos de Medicina de quatro universidades federais da Bahia. Resultado: Predominaram estudantes de 20 a 24 anos, com perfil socioeconômico mais baixo em relação aos estudos anteriores, naturais dos pequenos e médios municípios baianos, que afirmaram, em sua maioria, a opção pela residência médica em especialidades de outras áreas, que não as áreas básicas, após a graduação. Verificou-se uma disparidade entre o percentual de estudantes com intenção de trabalhar na atenção primária à saúde e aqueles que desejaram especialidades básicas, sendo ainda consideravelmente menor a opção pela medicina de família e comunidade. As estudantes do sexo feminino predominaram de modo evidente entre aqueles que desejaram as especialidades de áreas básicas e que vislumbraram um futuro trabalho na atenção primária à saúde, nesse estado. De modo contrário, os estudantes do sexo masculino escolheram, na sua maioria, especialidades de outras áreas, especialmente aqueles que tiveram os aspectos financeiros como motivação principal para escolha de carreira. Conclusão: O estudo acrescentou conhecimento ao corpo de literatura sobre as mudanças na formação médica no país e os efeitos de políticas indutoras de um perfil profissional generalista que atenda às necessidades sociais da população.

Abstract: Introduction: The quantitative deficit and inequalities in the distribution of doctors exacerbate the global health workforce crisis. Many policies have been adopted to face the problem, with the 'Mais Médicos' Program standing out due to its scope. Objective: This study aimed to characterize, among undergraduate medical students in the state of Bahia, the intentions of future medical specialty and professional retention in priority areas defined by the More Doctors Program (PMM), according to the predictors indicated in the literature. Methods: This is a cross-sectional exploratory study conducted with medical students from four federal universities in the state of Bahia. Results: The study predominantly included students aged 20 to 24 years, with a lower socioeconomic profile in relation to previous studies, born in small and medium-sized municipalities in the state of Bahia, who mostly stated their option for medical residency in specialties other than the basic areas after graduation. An inequality was observed between the percentage of students who intended to work in Primary Care and those who wanted basic specialties, with the option for Family and Community Medicine being even lower. Female students clearly predominated among those who desired basic specialties and who envisioned a future employment in Primary Care in this state. Conversely, male students mostly chose specialties in other areas, especially those who had financial aspects as the main motivation for career choice. Final considerations: The study added knowledge to the body of literature on changes in medical training in the country and the effects of policies leading to a generalist professional profile that meets the social needs of the population.

Preliminary construction of a core index system of job responsibilities for specialist trauma nurses / 中华创伤杂志

Objective:To construct a core index system of job responsibilities for specialist trauma nurses tailored to the current trauma care system in China and provide a reference for trauma centers to set up specialist trauma nurses.Methods:Literature review and group discussion were used to develop the first draft of the core index system of job responsibilities for specialist trauma nurses. The Delphi method was used to conduct two rounds of consultation among 15 experts from 7 provinces or cities in China to determine the final draft. The two rounds of expert active coefficient, expert authority coefficient ( Cr), Kendal coefficient (Kendall′s W), and average value of the importance and variation coefficient ( CV) of each indicator were calculated. Results:In both rounds of consultations, the expert active coefficient was 100%, and the Cr was 0.953. In the second round of consultation, the Kendall′s W was 0.188 ( χ2 =155.29, P<0.001), and the average value of the importance of each indicator ranged from 4.27-5.00 points with the CV of less than 0.25 points. The final index system consisted of 7 first-level indicators and 49 second-level indicators. Conclusion:The core index system of job responsibilities for specialist trauma nurses is reasonable and comprehensive, which can provide guidance for setting up positions of specialist trauma nurses in China.

Exploration and practice of physician-pharmacist joint clinic service / 中华医院管理杂志

In order to expand the breadth and depth of pharmaceutical services, in March 2022, a tertiary hospital opened a physician-pharmacist joint clinic based on clinical specialty clinics. The hospital formulated a fixed outpatient scheduling system, clarified service targets, established outpatient treatment processes and quality management systems, and standardized pharmacist communication models, to provide patients with " one-stop" standardized pharmaceutical services. As of December 2022, the pharmaceutical joint outpatient service had opened more than 100 consultations and served 1 709 patients. This practice provided reference for promoting the high-quality development of pharmaceutical services in medical institutions in China.

Specialized Dental Care in the Brazilian Unified National Health System (SUS)

ABSTRACT Objective: To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO. Material and Methods: Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination. Results: The total of 932 CEO's were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO's had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases. Conclusion: Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO's actions was evidenced, mainly related to the work processes.

Vivencias y experiencias en las relaciones sociales durante la formación académica de médicos especialistas

Introducción: La formación académica en las especialidades médicas es un proceso continuo de entrenamiento teórico y práctico en el que las y los residentes interactúan constantemente con los coordinadores del programa, con residentes de diferentes programas y las y los trabajadores de los escenarios de prácticas. Se investigó por medio de entrevistas las relaciones que se presentan en diferentes especialidades. Objetivo: Conocer las vivencias y experiencias de la jerarquía de las y los residentes durante su proceso de formación en los escenarios de prácticas. Método: Estudio cualitativo de corte fenomenológico que aplicó entrevistas semi-estructuradas a 42 estudiantes de especialidades médico-quirúrgicas como: cirugía plástica, ginecología, medicina crítica, medicina interna, neurología, pediatría y psiquiatría, revisando de la batería de riesgo psicosocial el dominio de relaciones sociales y liderazgo. Resultados: Las y los entrevistados expresaron 195 referencias relacionadas con sus experiencias en las que el liderazgo de los coordinadores del programa es descrito como una interacción significativa que genera malestar psicológico o protección, junto con 158 referencias de estilo de retroalimentación en algunas vivencias, escaso o centrado en una nota cuantitativa, y 156 referencias de cómo veían la relación con sus residentes mayores desde una perspectiva jerárquica. Conclusiones: Las características de la jerarquía durante la residencia están determinadas por el estilo de liderazgo del coordinador del programa y los residentes replican el mismo modelo con sus compañeros de mismo año, superiores y residentes menores.

Introduction: Academic training in medical specialties is a continuous process of theoretical and practical training where residents constantly interact with program coordinators, residents of different programs and workers in internship scenarios; the relationships that occur in different residences were investigated through interviews. Objective: To know the life experiences of the hierarchy of resident doctors during their training process in the practice settings. Method: Qualitative phenomenological study that uses semi-structured interviews with 42 students of medical-surgical specialties such as: plastic surgery, gynecology, critical medicine, internal medicine, neurology, pediatrics and psychiatry, reviewing the psychosocial risk battery domain of social relations and leadership. Results: The interviewees expressed 195 references related to their experiences where the leadership of the program coordinators is described as a significant interaction generating psychological or protective discomfort, along with 158 references of feedback style in some experiences, scarce or focused on a quantitative note and 156 references of how they saw the relationship with their older residents from a hierarchical perspective. Conclusions: The characteristics of the hierarchy in the residence are determined by the leadership style of the program coordinator and the residents replicate the same model with their peers of the same year, superiors and minor residents.

Inteligencia artificial en medicina y procedimientos quirúrgicos: impacto en la toma de decisiones y la salud / Artificial Intelligence in Medicine and Surgical Procedures: Impact on Decision Making and Health

Introducción: Las revisiones sistemáticas de la literatura constituyen una herramienta metodológica práctica para la búsqueda de información sobre investigaciones clínicas, aplicaciones tecnológicas y la toma de decisiones de impacto en la salud. Objetivo: Describir cómo influye la inteligencia artificial en la toma de decisiones médicas según el grado de concordancia entre estas evidencias y los sistemas expertos aplicados en las especialidades clínicas y quirúrgicas de impacto en la salud, según reportes entre 2010 y 2019. Métodos: Se realizó una revisión sistemática con el uso de un modelo de bases de datos relacional y un modelo de entidad relación para garantizar la entidad referencial de la que hacen parte las bases de datos y los artículos, así como la calidad de cada uno de los artículos mediante clasificación por grados de concordancia entre muy concordante o no concordante con la temática de interés y la toma de decisiones de impacto en la salud. Conclusiones: Las aplicaciones como los sistemas expertos, los aprendizajes de máquinas y la robótica aportan innovación a las instituciones y un cambio revolucionario en lo académico, clínico y epidemiológico(AU)

Introduction: Systematic reviews of the literature constitute a practical methodological tool for the search of information on clinical research, technological applications and health impact decision-making. Objectives: To describe how artificial intelligence influences medical decision-making according to the degree of agreement between this evidence and the expert systems applied in clinical and surgical specialties with an impact on health, according to reports from 2010 to 2019. Methods: A systematic review was conducted with the use of a relational database model and a relationship entity model to guarantee the referential entity of which the databases and articles are part, as well as the quality of each of the articles classified by degrees of agreement between very concordant or not concordant with the topic of interest and the decision making of impact on health. Conclusions: Applications such as expert systems, machine learning and robotics bring innovation to institutions and a revolutionary change in academic, clinical and epidemiological areas(AU)

Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas / Care models at the second level: Experience of the Medical Specialties Unit

Resumen Objetivo: Reportar la implementación y los beneficios del Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas, su utilidad en el manejo y seguimiento de los pacientes con enfermedades crónicas. Material y métodos: Se lograron implementar 9 consultorios de atención médica de la siguiente forma, 2 de Endocrinología, 3 consultorios de Clínica de Enfermedades Crónicas, uno de educación en diabetes e hipertensión, así como 3 de apoyo nutricional. Se midió valores absolutos del número de consultas durante los años 2017, 2018, 2019 y parte del 2020. Así mismo se buscó identificar las patologías más prevalentes con la idea en tener un mejor control y seguimiento de los pacientes, con una mejor organización de personal de atención médico y de enfermería. Resultados y discusión: Se lograron incrementar los números de consulta, con un control y seguimiento más estricto de los pacientes, además de los beneficios en cuanto a la formación y capacitación de médicos residentes, generales tanto militares como profesionales de la salud civiles para enfrentar estos padecimientos prevalentes en nuestro país.

Abstract Objective: To report the implementation as well as the benefits of the Comprehensive Care Model at the second level: Experience of the Medical Specialties Unit, and assess its usefulness in the management and monitoring of patients with chronic diseases. Material and methods: 9 medical care clinics were implemented as follows, 2 for Endocrinology, 3 Clinics for Chronic Diseases, one for education in diabetes and hypertension, as well as 3 for nutritional support. Absolute values of the number of consultations were measured during the years 2017, 2018, 2019 and part of 2020. Likewise, it was sought to identify the most prevalent pathologies with the idea of having a better control and monitoring of patients, with a better organization of medical and nursing care personnel. Results and discussion: It was possible to increase the consultation numbers, with a stricter control and monitoring of patients, in addition to the benefits in terms of training and training of resident doctors, both military generals and civilian health professionals to face these prevalent conditions in our country.

Valoraciones sobre el procesamiento de información en investigaciones asociadas a especialidades médicas / Assessments on the processing of information in research associated with medical specialties

RESUMEN El presente trabajo tiene como objetivo valorar las regularidades de los principales problemas que se evidencian en el uso y empleo de la dinámica del procesamiento de la información en investigaciones asociadas a especialidades médicas, a partir de una selección de tesis vinculadas a la especialidad de Medicina General Integral y de otras especialidades médicas defendidas en los últimos 5 años en la Universidad de Ciencias Médicas de Camagüey. Los principales resultados de la revisión documental se centran en deficiencias en la presentación e interpretación de la naturaleza de las relaciones entre las variables del diseño metodológico y las técnicas estadísticas que se utilizan desde el diseño, ejecución y presentación del resultado científico.

SUMMARY The present work aims to assess the regularities of the main problems that are evidenced in the use and employment of the dynamics of information processing in research associated with medical specialties, from a selection of theses linked to the specialty of Comprehensive General Medicine and other medical specialties defended in the last 5 years at the University of Medical Sciences of Camagüey. The main results of the documentary review focus on deficiencies in the presentation and interpretation of the nature of the relationships between the variables of the methodological design and the statistical techniques that are used from the design, execution and presentation of the scientific result.

Posicionamiento conceptual metodológico para el examen estatal en anatomía humana / A conceptual-methodological stance for the state examination of human anatomy

Introducción: El examen estatal en las especialidades médicas cubanas es un garante de calidad en las competencias y el desempeño profesional. Su calidad técnica y metodológica debe ser objeto de perfeccionamiento permanente como acción responsable hacia la excelencia académica. Objetivo: Promover un posicionamiento conceptual metodológico para el perfeccionamiento del examen teórico práctico de la especialidad anatomía humana. Métodos: Se emplearon el analítico sintético, la observación participativa y la revisión documental. Resultados: Se obtuvo una propuesta valorativa en el contexto de la especialización en anatomía humana, con acciones específicas para el perfeccionamiento del examen práctico y teórico de esta especialidad. Conclusiones: Los fundamentos teóricos y prácticos presentados son pertinentes para superar debilidades en los exámenes estatales anteriores, y favorecer en el residente de anatomía humana el desarrollo de un pensamiento holístico durante su proceso de formación, con beneficio de mayores competencias y mejor desempeño docente e investigativo(AU)

Introduction: The state examination in Cuban medical specialties ensure quality in competences and professional performance. Its technical and methodological quality should be subjected to permanent improvement as a responsible action towards academic excellence. Objective: To promote a conceptual-methodological stance for the improvement of the practical-theoretical examination of the Human Anatomy specialty. Methods: The methods of analysis-synthesis, participative observation and documental review were used. Results: An assessment proposal was obtained in the context of the specialization in Human Anatomy, with specific actions for the improvement of the practical and theoretical examination of this specialty. Conclusions: The theoretical and practical foundations presented are pertinent to overcome weaknesses of previous state examinations, as well as to favor, in the Human Anatomy resident, the development of a holistic thinking during her or his training process, with the benefit of greater competences and better teaching and research performance(AU)

Fatores associados ao desenvolvimento de lesões por pressão em cirurgia eletiva: revisão integrativa / Factors associated with the development of pressure injuries in elective surgery: integrative review / Factores asociados al desarrollo de lesiones por presión en cirugía electiva: revisión integrativa

Objetivo: Identificar os fatores associados ao desenvolvimento de lesão por pressão (LP) no período perioperatório em indivíduos submetidos a cirurgia eletiva. Método: Revisão integrativa da literatura realizada, em 2021, com o auxílio da Biblioteca Virtual em Saúde (BVS). Resultados: Identificaram-se 135 artigos na base de dados, dos quais 19 foram selecionados para extração dos resultados. Os critérios de inclusão dos artigos foram: serem originais, responderem à pergunta de pesquisa, publicados em português, inglês ou espanhol, apresentarem como população: pacientes cirúrgicos; como exposição: fatores de risco no pré-operatório, intraoperatório ou pós-operatório; e como resultado: desenvolvimento de LP. Dos artigos incluídos, 15,8% foram realizados no Brasil, com predominância do nível de evidência NE=2 (n = 15; 68,2%). Conclusão: Associaram-se ao desenvolvimento de lesão fatores intrínsecos e extrínsecos relacionados com cirurgia, medicamentos em uso, comorbidades, estado clínico pré-cirúrgico, sexo, idade, ser admitido de um outro local que não sua residência, cirurgias abertas, tipo de cirurgia, tipo de anestesia, episódios hipotensivos, transfusão, tempo cirúrgico, uso de coxim, condições da pele, aumento da pressão no intraoperatório, temperatura da pele, hipotermia

Objective: To identify factors associated with the development of pressure injuries (PI) in the perioperative period in individuals undergoing elective surgery. Method: Integrative literature review carried out in 2021 with the help of Biblioteca Virtual em Saúde (BVS). Results: 135 articles were identified in the database, of which 19 were selected for extraction of results. The inclusion criteria of the articles were: being original, answering the research question, published in Portuguese, English or Spanish, presenting as a population: surgical patients; as exposure: preoperative, intraoperative or postoperative risk factors; and as a result: LP development. Of the articles included, 15.8% were carried out in Brazil, with a predominance of the level of evidence LE=2 (n = 15; 68.2%). Conclusion: Intrinsic and extrinsic factors related to surgery, medications in use, comorbidities, pre-surgical clinical status, sex, age, being admitted from a place other than their residence, open surgeries, type of surgery were associated with the development of injury. , type of anesthesia, hypotensive episodes, transfusion, surgical time, use of cushion, skin conditions, increased intraoperative pressure, skin temperature, hypothermia.

Objetivo: Identificar factores asociados al desarrollo de lesiones por presión (LP) en el perioperatorio en sujetos sometidos a cirugía electiva. Método: Revisión integrativa de la literatura realizada en la Biblioteca Virtual en Salud (BVS) en 2021. Resultados: 135 artículos fueron identificados en la base de datos y 19 fueron seleccionados para la extracción de resultados. Los criterios de inclusión de los artículos fueron: ser originales, responder a la pregunta de investigación, publicados en portugués, inglés o español, con la siguiente población: pacientes quirúrgicos; como exposición: factores de riesgo preoperatorios, intraoperatorios o postoperatorios; y como resultado: desarrollo de LP. De los artículos incluidos, 15,8% fueron realizados en Brasil con predominio del nivel de evidencia NE=2 (n = 15; 68,2%). Conclusión: Asociados con el desarrollo de lesiones, están: Factores intrínsecos y extrínsecos relacionados con la cirugía, medicamentos en uso, comorbilidades, estado clínico prequirúrgico, sexo, edad, ser ingresado de lugar diferente al de residencia, cirugías abiertas, tipo de cirugía, tipo de anestesia, episodios de hipotensión, transfusión, tiempo quirúrgico, uso de almohadillas, afecciones de la piel, aumento de la presión intraoperatoria, temperatura de la piel, hipotermia.

Application of a new double-headed endoscopic cleaning brush to soft endoscope cleaning / 中华消化内镜杂志

In order to clean the endoscopic tube more effectively, a new double-headed endoscopic cleaning brush was used in this study. A total of 130 colonoscopies were selected from the Digestive Endoscopy Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2019 to August 2020. The colonoscopy cleaning sequence was marked with odd and even number. Colonoscopies marked with the odd number were assigned to the conventional group ( n=65) which received back and forth cleaning with the single-headed endoscope cleaning brush. Colonoscopies marked with the even number were assigned to the experimental group ( n=65) which received one-way cleaning with a nylon brush at the head and a dense non-woven brush at the tail. The cleaning methods for endoscopes were in accordance with Flexible Endoscopic Cleaning and Disinfection Technical Specification WS507—2016. ATP bioluminescence tests and bacterial quantitative cultures were applied to evaluate the cleaning effects of the two methods. The results showed that ATP relative light unit (RLU) decreased in both the experimental group and the conventional group [530.63 RLU (26-3 559 RLU) VS 270.87 RLU (20-1 415 RLU)] before and after cleaning the endoscope tube, showing significant difference between the two groups ( Z=-2.894, P<0.05). After scrubbing, the positive rate of bacterial culture on the brush head was 86.2% (56/65) for the double-headed non-woven brush head, 46.2% (30/65) for the double-headed nylon brush head and 32.3% (21/65) for the single-headed nylon brush head with significant differences among the three groups ( χ 2=41.046, P<0.05). The cleaning effect of the new double-headed endoscopic cleaning brush is better than that of the conventional single-headed endoscopic cleaning brush for soft endoscope cleaning. Non-woven brush is better than nylon brush in eliminating bacteria.

Actitudes ante la muerte en cirujanos e internistas

RESUMEN Introducción: La muerte en el contexto hospitalario, es un estresor crítico que para el médico en su asistencia es parte del rol profesional, lo cual produce diferentes actitudes de afrontamiento. Objetivo: Comparar las actitudes ante la muerte en médicos cirujanos e internistas de un hospital clínico quirúrgico. Método: Investigación cuantitativa, descriptiva y transversal, realizada en agosto del 2019, en una muestra intencional de 30 cirujanos y 33 internistas. Se empleó el Cuestionario de Actitudes ante la Muerte - 2, compuesto por 32 ítems distribuidos en 6 subescalas. Resultados: Hubo desacuerdos con tener actitudes religiosas tanto en cirujanos como en internistas. No se manifestaron actitudes de ansiedad ante la muerte ni actitudes proeutanasia. Se identificaron posiciones no definidas con relación a las actitudes de distanciamiento profesional. Se mostró ambigüedad con respecto a las actitudes de vulnerabilidad afectiva y de evasión ante la muerte. No hubo asociación entre la edad y la experiencia profesional con respecto a las actitudes caracterizadas. Conclusiones: Las actitudes ante la muerte entre internistas y cirujanos se caracterizaron por ser predominantemente homogéneas. No se halla ningún tipo de relación entre las variables sociodemográficas edad y experiencia laboral, con respecto a las actitudes ante la muerte.

ABSTRACT Introduction: Death in the hospital context is a critical stressor; for the doctor in his care, is part of the professional role, producing different coping attitudes. Objective: To compare the attitudes to death in surgeons and internists of clinical-surgical hospital. Methods: Quantitative, descriptive and cross-sectional research conducted in August 2019, in an intentional sample of 30 surgeons and 33 internists. The Attitudes to Death Questionnare-2 was used, composed of 32 items distributed in 6 subscales. Results: There were disagreements with having religious attitudes both surgeons and internists. There were no anxiety attitudes towards death as well as pro-euthanasia attitudes. Undefined positions were identified in relation to professional distancing attitudes. There was ambiguity regarding attitudes of affective vulnerability and evasion before death. There was no association between age and professional experience with respect to the attitudes characterized. Conclusions: The attitudes to death between surgeons and internists were characterized by being predominantly homogeneous. No type of relationship was found between the sociodemographic variables age and work experience with respect to attitudes towards death.

Historia de la anestesiología / History of Anesthesiology

Resumen: El arte de la medicina es tan antiguo como el origen mismo de la vida, ha estado implícita en muchas culturas en todo el mundo, iniciando en cada una de ellas como un concepto mágico - religioso, y evolucionando con el paso de los siglos, y la presencia de grandes personajes en los diferentes momentos y culturas, con la aportación de conocimientos y técnicas que hoy han consolidado a la medicina como una ciencia que trasciende y se ha perfeccionado a través de los siglos, para dar lugar a cada una de las especialidades que actualmente conocemos, todas ellas igual de importantes e imprescindibles entre ellas mismas.

Abstract: The art of medicine is as old as the very origin of life, it has been implicit in many cultures around the world, beginning in each of them as a magical-religious concept, and evolving over the centuries, and the presence of great characters in different moments and cultures, with the contribution of knowledge and techniques that today have consolidated medicine as a science that has transcended and has been perfected over the centuries to give rise to each of the specialties that we currently know, all of them equally important and essential among themselves.

Relação médico-paciente nas especialidades médicas: um breve panorama da realidade brasileira / Doctor-patient relationship in medical specialties: a brief overview of the Brazilian reality

Introdução: A humanização do cuidado responde por um grande ganho à saúde do enfermo, haja vista que a relação médico-paciente, quando bem estabelecida, favorece a aceitação do tratamento pelo doente. Apesar disso, observa-se uma variação de postura entre os médicos generalistas e os especialistas, no tocante à priorização da empatia ao longo das atividades. Dessa forma, o presente artigo busca apresentar uma breve descrição a respeito da relevância da relação médico-paciente junto da prática clínica e abordar diferenças de conduta profissional identificadas entre médicos generalistas e especialistas no quesito empatia. Métodos: Foram colhidos dados secundários obtidos de uma revisão bibliográfica de caráter qualitativo, na qual foram incluídos oito trabalhos científicos publicados entre 2008 e 2018 em plataformas digitais, no idioma português. Resultados: O estudo acerca do tema permitiu observar a existência de falhas no exercício da relação médico-paciente tanto entre médicos generalistas quanto entre especialistas, o que pode ser explicado pela influência da formação acadêmica, bem como pelos entraves estruturais e administrativos incidentes sobre a atuação médica; a respeito das variações de conduta analisadas entre médicos especialistas, a busca pareceu indicar que a prática clínica se aproxima mais do processo de humanização em comparação à prática cirúrgica. Conclusão: Portanto, tem-se que a relação médico-paciente consiste em uma prática indispensável na assistência ao enfermo, principalmente no que concerne ao tratamento integrativo; ao mesmo tempo, são necessários mais estudos que delimitem perfis de comportamento dentro de cada especialidade médica.

Introduction: The humanization of care accounts for a great gain in patient health, given that the doctor-patient relationship, when well established, favors the acceptance of treatment by the patient. Nevertheless, there is a variation in attitude between general practitioners and specialists regarding the prioritization of empathy throughout the activities. Thus, this article seeks to present a brief description of the relevance of the doctor-patient relationship in clinical practice and to address differences in professional conduct identified between general practitioners and specialists in terms of empathy. Method: Secondary data were collected from a qualitative literature review, which included 8 scientific papers published between 2008 and 2018 on digital platforms, in Portuguese. Results: The study on the subject allowed observing the existence of flaws in the exercise of the doctor-patient relationship, both among general practitioners and among specialists, which can be explained by the influence of academic training, as well as by the structural and administrative obstacles inherent in the doctor's activity; regarding the variations in conduct analyzed among specialist physicians, the search seemed to indicate that clinical practice is closer to the humanization process as compared to surgical practice. Conclusion: Therefore, the doctor-patient relationship is an indispensable practice in the care of the sick, especially with regard to integrative treatment; at the same time, further studies are needed to define behavior profiles within each medical specialty.

Effects of the COVID-19 on the public interest in medical specialties in Brazil

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of the COVID-19 pandemic and the social isolation on the interest rates of different medical specialties in Brazil. METHODS: The research was performed using the terms "Médico" (Doctor), "Infectologista" (Infectologist), "Cirurgião" (Surgeon), "Geriatra" (Geriatrician), "Otorrinolaringologista" (Otolaryngologist), and "Oftalmologista" (Ophthalmologist), related to several medical specialties, and "COVID-19," which represented the public interest for the disease, utilizing the Brazilian version of Google Trends, where the data were acquired. The time range of this analysis was from 29 September, 2019 to 20 September, 2020. The data were tabulated in Microsoft Excel, exported to the Statistical Package for the Social Sciences software, and correlated with searches for the term "COVID-19" using Pearson's correlation. 95% confidence interval was used for all analyses. RESULTS: "Geriatra" (72.26±16.42) and "Cirurgião" (72.15±12.53) remained with the higher means among the evaluated specialties. In terms of standard deviation, "Oftalmologista" (64.71±16.72) and "Infectologista" (22.03±16.60) presented the most significant changes. After utilizing the Pearson's analysis to identify the correlation between each medical specialty and the term "COVID-19," all the evaluated specialties presented significant statistical correlations. "Oftalmologista" (r= -0.607) was notoriously the most negatively affected, while "Infectologista" (r=0.504) was pointed to have the highest positive correlation with the term. CONCLUSIONS: Several changes in the interest rates of different medical specialties in Brazil were found during the time range of the COVID-19 pandemic.