Is the symptom of pain adequately addressed in hospitalization at Internal Medicine? Cross-sectional study / O sintoma dor é abordado adequadamente em internação hospitalar de Clínica Médica? Estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the main reasons for seeking medical care. Thus, the objective of the present study was to evaluate the treatment of pain complaints in a medical clinic ward. METHODS: Cross-sectional and descriptive study at the Santa Lucinda Hospital (Hospital Santa Lucinda - HSL) and Sorocaba Hospital Complex (Conjunto Hospitalar de Sorocaba - CHS). Data was collected by: (1) interviewing the participants using a structured questionnaire drawn up by the researchers, and (2) accessing information such as pain records and drug prescriptions in the medical records. RESULTS: The sample consisted of 85 patients, 11.8% in the HSL and 88.2% in the CHS. More than 80% of patients had already experienced pain at some point in their lives, whether chronic or acute. Forty-one percent of patients had pain during hospitalization, regardless of the reason for admission. A minority of pain events had the complaint recorded in their medical records. Drugs were prescribed for 73.0% of the patients, mostly on demand. There was a mismatch between the type of drug prescribed and the intensity of the pain in 80% of prescriptions. CONCLUSION: The complaint of pain is prevalent in Internal Medicine hospitalizations. In this study, 41.2% of the pain was musculoskeletal, followed by abdominal pain, regardless of the reason for hospitalization. The complaint of pain was medicated in most of the patients' pain reports, but around 23% of the patients complaining of pain did not receive drugs. Most patients (80%) with pain received drugs that were inconsistent with the intensity of the pain; however, the recording of the complaint of pain in the medical records remains insufficient.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dor é um dos principais motivos por assistência ao serviço médico-hospitalar. Desta forma, o objetivo deste estudo foi avaliar o atendimento de queixas dolorosas em enfermaria de clínica médica. MÉTODOS: Estudo transversal e descritivo nos hospitais Santa Lucinda (HSL) e Conjunto Hospitalar de Sorocaba (CHS). A coleta de dados foi realizada por: (1) entrevista com os participantes direcionada por um questionário estruturado elaborado pelos pesquisadores, e (2) acesso a informações como registro de dor e prescrição de fármacos no prontuário. RESULTADOS: A amostra foi composta por 85 pacientes, sendo 11.8% no HSL e 88,2% no CHS. Mais de 80% dos participantes relataram experiência prévia de dor aguda ou crônica em algum momento da vida. Quarenta e um por cento dos participantes relatou dor durante a internação independente da causa da internação. A minoria dos eventos de dor constava nos registros da queixa em seu prontuário. Houve fármaco prescrito para 73% dos pacientes, sendo em sua maioria, por demanda. Houve uma inadequação entre o tipo de fármaco prescrito e a intensidade da dor em 80% das prescrições. CONCLUSÃO: A queixa de dor é um sintoma prevalente entre pacientes internados de Clínica Médica. Neste estudo, 41,2%; das dores foram musculoesqueléticas, seguida de dores abdominais, independente do motivo da internação. A queixa de dor foi medicada na maior parte dos relatos de dor dos pacientes, porém cerca de 23% dos pacientes com queixa de dor não receberam fármacos. A maior parte dos pacientes (80%) com dor recebeu fármacos incoerentes à intensidade da dor; porém o registro da queixa de dor nas evoluções dos prontuários permanece insuficiente.

Concepções sobre clínica na formação médica: análise de um curso derivado do programa Mais Médicos / Conceptions about clinical practice in medical education: analysis of a course derived from the Mais Médicos Program / Concepciones sobre la clínica en la educación médica: análisis de un curso derivado del Programa Más Médicos

Introdução: Principalmente após a instituição das Diretrizes Curriculares Nacionais dos cursos de graduação em Medicina, espera-se que seja predominante na formação médica a clínica ampliada, ou seja, aquela que tem como foco central o sujeito e suas particularidades. Objetivo: Buscou-se compreender as concepções sobre clínica presentes no imaginário de estudantes e professores de um curso de graduação em Medicina de uma universidade federal localizada no Sul do país. Métodos: Trata-se de estudo de caráter exploratório e qualitativo aprovado pelo Comitê de Ética em Pesquisa de uma universidade federal, sob o Parecer nº 2.950.932, de 9 de outubro de 2018. A coleta de dados deu-se com base em entrevistas com docentes médicos (n=21) e grupos focais com acadêmicos (n=43) que, posteriormente, foram tratados pela análise de conteúdo de Bardin. Resultados: Aspectos inerentes à clínica ampliada foram levantados, sobretudo no que diz respeito ao estabelecimento de uma boa relação médico-paciente, à necessidade de desenvolver habilidades comunicativas e de haver um equilíbrio entre os componentes técnico, ético e humanístico. Contudo, alguns discursos característicos da clínica tradicional foram notados, principalmente relacionados à clínica focada no diagnóstico e tratamento de doenças. Conclusões: Com esses resultados é possível concluir que, apesar de a clínica ampliada estar presente no curso em questão, isso ainda não se efetivou completamente.

Introduction: After the institution of National Curriculum Guidelines for Medicine undergraduate courses, it is expected that the extended clinical practice will predominate in medical training, that is, one that has as its central focus individuals and their particularities. Objective: Through this study, we sought to comprehend the conceptions about clinical practice in the minds of students and professor of an undergraduate course in Medicine at a federal university located in the south of the country. Methods: This is an exploratory and qualitative study approved by the Research Ethics Committee of a federal university, under the opinion No. 2.950.932, of October 9th, 2018. Data collection was based on interviews with medical professors (n=21) and academics focal groups (n=43) that, subsequently, were processed by Bardin's content analysis. Results: Aspects inherent to the extended clinical practice were brought up, mainly those regarding a good doctor-patient relationship, the need to develop communication skills, and the balance between the humanistic, ethical and technical components. However, some statements aligned to the traditional clinical practice have been noticed, mostly related to the practice focused on diagnosis and treatment. Conclusions: Through these results, it is possible to conclude that, despite the presence of the extended clinical practice in the medical degree, it has not yet been fully implemented.

Introducción: Después del establecimiento de las Directrices Curriculares Nacionales (DCN) de los cursos de Medicina en Brasil, se espera que la clínica tradicional deje de ser predominante en la formación médica para que se priorice la clínica ampliada, es decir, la que tiene como enfoque central la persona y sus particularidades. Objetivo: A través de este estudio se buscó comprender las concepciones sobre clínica presentes en la carrera de pregrado en medicina de una universidad federal ubicada en el sur del país. Métodos: Se trata de un estudio exploratorio y cualitativo aprobado por el Comité de Ética en Investigación de una universidad federal, bajo el número 2.950.932, del 9 de octubre de 2018. La recolección de datos se realizó a partir de entrevistas con profesores de medicina (n=21) y grupos focales con académicos (n=43), que posteriormente fueron tratados por el análisis de contenido de Bardin. Resultados: Se plantearon aspectos inherentes a la clínica ampliada, especialmente en lo que respecta al establecimiento de una buena relación médico-paciente, la necesidad de desarrollar habilidades comunicativas y el equilibrio entre los componentes técnico, ético y humanístico. Sin embargo, se notaron algunos discursos característicos de la clínica tradicional, principalmente relacionados con una clínica enfocada al diagnóstico y tratamiento de enfermedades. Conclusiones: A través de esos resultados es posible concluir que la clínica ampliada está presente en el curso en cuestión, aún no se ha implementado en su totalidad.

Homeopatía: una breve descripción de esta especialidad médica / Homeopathy: a brief description of this medical specialty

La homeopatía es una forma de medicina con 200 años de historia. A lo largo de este tiempo, ha demostrado su capacidad para resolver problemas, a bajo costo, con un amplio alcance y con una aceptación social incuestionable. Según las estimaciones, aproximadamente 500 millones de personas utilizan la homeopatía en todo el mundo, lo que corresponde a alrededor del 7% de la población mundial. Sin embargo, aún existen obstáculos para su integración en la medicina convencional, los cuales deben ser puestos en perspectiva y eliminados. El propósito del presente artículo es contextualizar la homeopatía como una ciencia y un arte tanto en Brasil como en el resto del mundo. Analizamos algunos aspectos relevantes, como el perfil de sus usuarios, las razones para elegir la homeopatía, así como los contextos históricos y sociales para su inclusión en los sistemas educativos y de atención médica. Concluimos que la homeopatía es un sistema medico ético que ofrece un tratamiento sistémico y seguro a los pacientes, con una optima relación costo-beneficio. La homeopatía debe incluirse en las universidades, escuelas de medicina, así como en todos los niveles del sistema de atención médica, asegurando así su naturaleza histórica como especialidad médica.

Homeopathy is a medical approach with 200 years of history. Along this time it demonstrated its ability to solve problems, with low cost, broad scope and unquestionable social acceptance. According to estimates, approximately 500 million people use homeopathy worldwide, corresponding to about 7% of the world population. However, there are still hindrances to its integration into conventional medicine which need to be put into perspective and removed. The aim of the present article is to contextualize homeopathy as a science and an art in Brazil and worldwide. We analyzed some relevant aspects, such as the profile of users, their reasons to choose homeopathy, and historical and social contexts for the inclusion of homeopathy into health care and educational systems. We conclude that homeopathy is an ethical medical system that provides systemic and safe treatment to patients with optimal costbenefit ratio. Homeopathy should be included in universities, schools of medicine and at all levels of the healthcare system, thus ensuring its historical nature as a medical specialty.

Rediscovering the relevance of clinical medicine with a case of Chilaiditi’s syndrome

Chilaiditi’s sign is a rare radiological diagnosis characterized by colonic interposition between the diaphragm and the liver, and when symptomatic it is known as Chilaiditi’s syndrome. We report that the case of a 55-years-old male, who was referred to our institution as a case of colitis, with the symptoms of recurrent vomiting, pain abdomen, and altered bowel habit, was eventually diagnosed to have Chilaiditi’s syndrome with non-specific colitis, after carefully taking the history and clinically examining the patient

Practice and exploration of online teaching in clinical medicine education in military teaching hospitals / 中华医学教育探索杂志

With the rapid development of information technology and the change in military education policy in the new era, online teaching has gradually become one of the main approaches to implement the clinical medical education in military teaching hospitals. In this study, the online teaching was performed mainly by pre-recorded teaching, supplemented by online live teaching. Massive open online courses (MOOCs) and the seminar-style teaching were advocated to be used in advanced disciplines. The quality of online teaching was guaranteed through infrastructure provision, teacher arrangement, teaching preparation, teaching interactivity, after-class test, teaching evaluation, supervision, and summary of teaching, which ultimately achieved a good effect. The results of the two-way questionnaires of 26 teachers and 129 students showed that 23.26% (30/129) of students and 65.38% (17/26) of teachers believed that students' learning ability was insufficient. 34.88% (45/129) of students and 23.08% (6/26) of teachers thought that the existing technology could not meet the requirements of online teaching. 55.04% (71/129) of students and 69.23% (18/26) of teachers held the view that the effect of online teaching was inferior to face-to-face teaching. 28.68% (37/129) of students and 57.69% (15/26) of faculty asked for the return of face-to-face education. Therefore, it is necessary to strengthen the construction of smart classroom platforms, establish a well-developed online teaching quality evaluation system, and integrate various innovative teaching modes with the online teaching. In these ways, it is expected to optimize the online teaching of clinical medicine and achieve the goal of online teaching.

Analyses on employment of clinical medical students of eight-year program and its implications to talent cultivation / 中华医学教育探索杂志

Objective:To analyze employment status and its tendency of eight-year program clinical medical graduates and explore its implications to talent cultivation using employment data from a university in Beijing.Methods:Descriptive analysis was used in this study. Indicators that were analyzed included quantity of employment, employment rate, employment region and specialty.Results:Between 2009 and 2021, a total of 2 281 eight-year clinical medical students graduated in the university. Among them, 2 188 (96.0%) of them were employed in the year of graduation. On average, 90.8% (2 034/2 241) of them were employed by medical institutions although the percentage decreased over years. A majority of them chose to work in economically developed provinces of eastern China. Those chose to work in Beijing accounted for 78.7% (1 723/2 188), the highest percentage among all provinces. The top two specialties of choice were surgery and internal medicine, which respectively accounted for 33.0% (753/2 281) and 24.4% (557/2 281). Only a few of them chose to study some specialties that were challenged by a serious shortage of physicians, including pediatrics, mental diseases and mental health.Conclusion:Although the employment status of eight-year clinical medical graduates are good, it is still necessary to pay attention to the new tendency of employment, and further improve training scheme. Meanwhile, more guidance on choice of secondary specialties are needed to build a competent talent team for specialty development. Finally, education of curriculum iedology and politics should be strengthened to encourage them to work in specialties and remote provinces that face a serious shortage of physicians.

The exploration and practice on postgraduate education model of professional degree in clinical medicine based on the background of medical education collaboration / 中华医学教育探索杂志

Based on the background of medical education collaboration, postgraduate education of professional degree in clinical medicine needs to be combined with social needs to reform and to carry on the exploration of high-level talents cultivation mode of clinical medicine. The article states the exploration and practice to establish the cultivation mode of clinical medicine as an organic integration of multi-module curriculum system, multi-level clinical practice and multi-directional scientific research training. Then it gives some thoughts and suggestions based on the practice, including potent teaching function of clinical medical college, reasonable clinical teaching incentive mechanism and favorable conditions for clinical research, in order to provide theoretical basis and practice experiences of high-level talents cultivation mode of clinical medicine.

Analysis of the effects of the teaching reform to strengthen the integration of basic medicine and clinical medicine through the National Medical Licensing Examination scores / 中华医学教育探索杂志

Objective:To investigate the effects of teaching reform to strengthen the integration of basic medicine and clinical medicine by analyzing the scores of the National Medical Licensing Examination from 2014 to 2018.Methods:Through the improvement of the training program, the establishment of subject integration courses, the standardization of case teaching mode and the establishment of comprehensive medical experiment courses, the teaching reform of the combination of basic medicine and clinical medicine was carried out. The differences in the scores of the National Medical Licensing Examination between the students from Dalian University and those from the whole country were compared, including the average total scores, the passing rates, the average mastery rates of the basic medicine, and the average mastery rates of the cognitive level of the basic medicine.Results:In 2014, 2015 and 2016, the average total scores of the students from Dalian University were 384.70±53.62, 395.45±50.49, and 401.43±50.88, respectively, which were lower than those from the whole country (396.15±58.85, 400.78±56.88, and 405.15±58.06). The average mastery rates of the basic medicine of the students from Dalian University were 56.28%, 62.45%, and 64.92%, respectively, lower than those from the whole country (58.41%, 62.46%, and 65.36%). The average mastery rates of the basic medicine of the students form Dalian University from 2014 to 2016 were lower than those from the whole country, and those were higher in 2017 to 2018 than the whole country. The average total scores of the students form Dalian University in 2017 and 2018 were 397.11 and 400.26 ± 61.15, respectively, higher than those from the whole country (388.91 and 397.01±58.35). The average mastery rates of the basic medicine of the students form Dalian University were 61.53% and 59.85%, respectively, higher than those from the whole country (58.64% and 58.38%). The total passing rates of the students from Dalian University in 2014 and 2016 were 91.11% and 72.73%, respectively, lower than those from the whole country (91.18% and 73.75%), while in 2015, 2017 and 2018 those were 76.47%, 77.78%, and 77.59%, respectively, all higher than those from the whole country (73.59%, 74.29%, and 76.89%). All the data showed a trend of increase with the teaching reform process.Conclusion:Strengthening the teaching reform of the combination of basic medicine and clinical medicine during the learning stage of basic medicine could improve students' learning interest and attention to the basic medical knowledge, strengthen the understanding of the relevance of basic medicine to clinical medicine, and play a positive role in the cultivation of medical students' post competency and the achievement of the goal of training applied medical talents.

Construction of the post competency model of clinical medicine students in military medical universities / 中华医学教育探索杂志

Objective:To establish a post competency model for clinical medical students in military medical universities to explore the qualities most needed by outstanding graduates.Methods:Through behavioral event interview (BEI) method, the complete interview data of 82 graduates (40 students in excellent group and 42 students in normal group) from a military medical university were obtained. The respondents were asked to recall the three most successful and unsuccessful cases in their past work, and fill in the checklist. The interview data were coded, marked and classified, the interview recording data were analyzed, and the comparison was made between the frequency of competency characteristics and the collection points of excellent graduates.Results:Top 9 competency features with the highest frequency and no difference between the two groups were respectively internal quality (82 students, 100%), clinical medical service capacity (52 students, 63.4%), continuous learning ability (36 students, 43.9%), teamwork ability (38 students, 46.3%), career (66 students, 80.5%), enterprise (46 students, 56.1%), sense of responsibility (42 students, 51.2%), execution (42 students, 51.2%), and coordination of team members (36 students, 44.0%). The proportions of excellent graduates to mention the ability to apply information tools ( χ2=6.80, P=0.009),; master English literature ( χ2=4.42, P=0.036), and be self-disciplined and fame and fortune-weakened ( χ2=6.90, P=0.009) were higher than those of the ordinary ones. Conclusion:This study has scientifically constructed a post competency model for clinical medicine students in military medical universities, including the benchmark competency model (9 characteristics with the highest frequency and non-differentiated between two groups) and the identification competency model (3 characteristics of excellent graduates higher than those of ordinary ones).

Clinical observation of post-chronic pancreatitis diabetes mellitus patients and type 2 diabetes mellitus patients / 中华胰腺病杂志

Objective:To observe and compare the clinical characteristics between post-chronic pancreatitis diabetes mellitus(PPDM-C)patients and type 2 diabetes mellitus(T2DM).Methods:Data of 142 cases of CP patients confirmed in Shanghai Pudong New Area Gongli Hospital from January 2018 to December 2021 were collected, all the patients were divided into CP group without diabetes mellitus ( n=60) and PPDM-C group with diabetes mellitus ( n=82) based on whether with or without diabetes mellitus. And 82 cases T2DM without CP (T2DM group, n=82) hospitalized simultaneously were collected as control group. The age, sex, body mass index, onset characteristics, laboratory examination indicators at admission (fasting blood glucose, glycosylated hemoglobin, blood creatinine, and alanine transaminase), imaging characteristics of the pancreas (pancreatic atrophy, multiple calcifications of the pancreas, pancreatic duct stones, pancreatic duct dilation, and pancreatic duct obstruction), and treatments and efficacy of diabetes were recorded. Results:Compared with T2DM group, PPDM-C group had lower body mass index (22.2 kg/m 2vs 24.6 kg/m 2), and glycosylated hemoglobin levels (7.34% vs 9.20%) (all P values <0.001), higher alanine transaminase levels (33.00 U/L vs 18.65 U/L, P =0.021). And they had more upper abdominal pain, nausea, vomiting, weight loss and diarrhea symptoms. In addition, they had less use of combination of insulin and hypoglycemic drugs to control blood glucose. And compared with CP group, PPDM-C group had higher body mass index (22.06 kg/m 2vs 21.18 kg/m 2), higher glycosylated hemoglobin levels (7.34% vs 5.70%), higher fasting blood-glucose levels (7.91 mmol/l vs 5.31 mmol/l), higher alanine transaminase levels (33.00 U/L vs 26.50U/L), and their differences were statistically significant (all P values <0.05). And they had higher incidence of pancreatic atrophy, multiple calcifications in the pancreatic duct and pancreatic duct obstruction (all P values <0.05). Conclusions:PPDM-C patients are more likely to experience digestive system symptoms such as abdominal pain than T2DM patients, while their pancreatic malfunction is more likely to occur compared to CP patients. More attentions to PPDM-C associated clinical manifestations, biochemical and imaging changes could identify patients at potential risk for early diagnosis and treatment earlier.

Practice and reflection on the constructional path of the Proof-of-Concept Center in clinical medicine / 中华医学科研管理杂志

Objective:To study the operation pattern and valuable experiences of the internationally renowned Proof-of-Concept Center(PoCC), and to improve the construction and management of PoCC in clinical medicine of our country.Methods:The data of basic structure, operation model, and performance in the health field of major PoCCs in the United States and Europe were compiled by literature review, policy combing, and official website search, and analyzed and summarized in combination with the basic national conditions and our practical experience.Results:The fundamental function of a PoCC consists of research and development support, science and technology evaluation, and communication services. The key points of building a PoCC include clear targets of service, widely opened resources, diversified operation patterns, and professional personnel.Conclusions:In China, PoCCs in the clinical medicine field could be built upon public hospitals with the full participation of physicians. Interdisciplinary cooperation, flexible mechanism, and versatile talents in technical management are also essential.

All for clinical purposes / 中华神经科杂志

Since its inception over 60 years ago, the Chinese Journal of Neurology has published many readable and usable high-level clinical papers, including many of the first reported cases of neurological diseases in China, the results of large sample clinical studies, practical and authoritative guidelines for the diagnosis and treatment of diseases or techniques, consensus, standards and norms (hereinafter referred to as guidelines/consensus). Through reading these articles, clinicians have increased their new understanding of nervous system diseases, standardized the diagnosis and treatment of nervous system diseases, and improved the level of diagnosis and treatment. However, there is still a gap between the articles received and some clinical papers published in the journal in recent years and the high standard and standard clinical requirements. Therefore, we propose that complete and standard case data be the cornerstone; authenticity of case data be the bottom line; high-level authoritative guidelines/consensus be published; precision education, active promotion of guidelines/consensus be couducted. Hope we can continue to work hard in the New Year to do a better job with the magazine.

Value of ocular trauma score and ocular structural parameters in the assessment of healing visual acuity from ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the value of ocular trauma score(OTS), initial visual acuity, and ocular structural parameters in the assessment of healing visual acuity from ocular trauma.METHOD: A total of 302 cases(302 eyes)of ocular trauma were selected as subjects, which were accepted and issued clear appraisal opinions by the Academy of Forensic Science from June 2015 to June 2021. The subjects were grouped according to the healing best corrected visual acuity(BCVA)from ocular trauma. Group Ⅰ included 63 cases(63 eyes)with BCVA &#x0026;#x003C;3.7; Group Ⅱ included 70 cases(70 eyes)with 3.7≤ BCVA &#x0026;#x003C;4.5; Group Ⅲ included 78 cases(78 eyes)with 4.5≤ BCVA &#x0026;#x003C;4.9; Group Ⅳ included 91 cases(91 eyes)with BCVA≥4.9. In addition, 77 cases(77 healthy eyes)of ocular trauma were selected as the control group, namely Group Ⅴ. The healing BCVA and ocular structural parameters from ocular trauma and theirs correlation were analyzed, and the random forest(RF)and support vector machine(SVM)model of healing visual acuity was established by the IBM SPSS Modeler 18.0.RESULTS: The initial visual acuity, OTS, the grading of corneas, lenses, and fundus, and the thickness of the retinal never fiber layer of ocular trauma patients were correlated with the healing BCVA(P&#x0026;#x003C;0.01). There were significant differences in ocular structural parameters among groups, except the central subfield thickness(P&#x0026;#x003C;0.001). The SVM model had higher accuracy of predicting healing visual acuity than the RF model, and the accuracy rate was over 80% when the error was within 0.15.CONCLUSION:OTS and ocular structural examination can provide effective information for the clinical forensic medicine appraisal of visual dysfunction after ocular trauma, and they are valuable in discriminating camouflage of visual dysfunction.

Clinical management of COVID-19: living guideline - 15 September 2022

The WHO COVID-19 Clinical management: living guidance contains the Organization's most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the 'Download' button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version. This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes: strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training

Formación Interprofesional en salud mental: un reto posible / Interprofessional training in mental health: a possible challenge

RESUMEN: Introducción: El abordaje de la salud mental requiere acciones interprofesionales, sin embargo, su enseñanza es tradicionalmente uniprofesional y en escenarios especializados, reforzando la creencia que la salud mental es cuestión de especialistas. Es por esto que se diseña la primera rotación interprofesional en salud mental de la que se tenga conocimiento en Colombia, en la cual rotan estudiantes de medicina y psicología. El objetivo del presente artículo es describir este proceso y la rotación. Material y método: Se describe cuáles fueron los pasos para el diseño y la implementación de la rotación interprofesional en salud mental. Resultados: Se describe la rotación, la cual cuenta con elementos clínicos y simulados y diversas metodologías de aprendizaje y evaluación. Conclusiones: La rotación interprofesional es una estrategia útil en el proceso de aprendizaje de competencias en salud mental y habilidades para el trabajo interprofesional.

ABSTRACT Background: Mental health approaches require interprofessional actions. However, education on mental health is traditionally uniprofessional and is performed in specialized scenarios which reinforces the belief that mental health is only a concern for specialists. This is the reason why the first interprofessional mental health rotation in Colombia was designed and launched. The aim of this paper is to describe that process and the rotation itself. Material and method: This work describes the steps for the design and implementation of an interprofessional rotation on mental health. which involve medicine and psychology students. Results: The structure of the rotation is detailed. It contains both a clinical component and a simulated one, and diverse methodologies for learning and assessment. Conclusions: This interprofessional rotation is a useful strategy in the learning process of specific competences in mental health, and it facilitates acquisition of skills for teamwork.

Aspectos neurobiológicos en la toma de decisiones afectivas y sociales e influencia del estrés: posibles implicancias en la toma de decisiones clínicas / Neurobiological aspects in affective and social decision-making: possible implications on clinical decision-making

RESUMEN: La toma de decisiones está influenciada por múltiples factores muchas veces no conscientes. En este artículo se sintetizan algunos correlatos neurobiológicos del componente afectivo y social sobre la toma de decisiones, incluyendo el impacto del estrés agudo y crónico y la perspectiva cognitiva de las heurísticas y los sesgos en la práctica clínica. A nivel afectivo, la hipótesis del marcador somático ha asociado la respuesta corporal periférica con estructuras nerviosas centrales en la configuración de las decisiones; intervienen estructuras como la corteza orbitofrontal y el hipocampo. En la toma de decisiones sociales se involucran las dimensiones recompensa y motivación. En este tipo de decisiones es crucial la capacidad de mentalizar a otro e integrar su perspectiva en la toma de decisiones. Esta función se ha relacionado con el surco temporal posterosuperior, la unión temporoparietal, la corteza cingulada anterior y la corteza prefrontal medial. No obstante, en la toma de decisiones sociales también se integra el cumplimiento de normas socialmente establecidas. El estrés agudo o crónico puede afectar la toma de decisiones, positiva o negativamente. En estos procesos se han involucrado al eje hipotálamo-hipófiso-adrenal junto con circuitos corticoestriados, prefrontales, amigdalinos e hipocampales. En la toma de decisiones clínicas se conjugan factores "prerreflexivos" emocionales, sociales y cognitivos que influyen directamente en las conductas adoptadas con los pacientes. Recomendamos enfatizar la investigación en esta área y fortalecer su enseñanza para reconocerlos adecuadamente.

ABSTRACT Decision-making is influenced by multiple unaware factors. We synthesize some neurobiological correlates of the affective and social components on decision-making, including the impact of acute and chronic stress. We also address the impact of heuristics and biases on clinical practice from the cognitive perspective. At an affective level, the hypothesis of the somatic marker has associated the peripheral body response with central nervous structures in the configuration of decisions; structures such as the orbitofrontal cortex and the hippocampus intervene. The reward and motivation dimensions are involved in social decision-making. In these types of decisions, the ability to mentally engage others and integrate their perspective into decision making is crucial. This function has been related to the posterior superior temporal sulcus, the temporoparietal junction, the anterior cingulate cortex, and the medial prefrontal cortex. However, compliance with socially established norms is also integrated into social decision-making. Acute or chronic stress may affect decision-making, positively or negatively. The hypothalamic-pituitary-adrenal axis has been involved in these processes together with corticostriatal, prefrontal, amygdala and hippocampal circuits. In clinical decision-making, "pre-reflective" emotional, social and cognitive factors are combined, influencing the decisions towards patients. We recommend emphasizing research in this field and strengthening education in this area to recognize these aspects adequately.

Practice on the characteristic curriculum construction of undergraduate clinical medicine in Sino-foreign cooperative education program / 中华医学教育探索杂志

As one of the first institutions to carry out integrated education in China, the Shanghai Jiao Tong University School of Medicine has carried out a pilot reform of the organ system centered vertical single cycle integrated curriculum in the undergraduate medical education (five-year English stream) based on the Sino-foreign cooperative education program. The curriculum has been formed with multi-disciplinary single cycle integrated courses, longitudinal integrated courses, and three-dimensional specialized expansion electives. The curriculum focuses on the competency training of medical student. The aim is to highlight the teaching concept of early contact with clinic, attach importance to the cultivation and shaping of medical personality, achieve effective connection with post-graduation education, and realize the intersection and deep integration of social, humanities and medical professional courses through the construction of a series of course modules.

Exploration and practice of clinical medicine "4+4" program for the cultivation model of innovative talents: taking Shanghai Jiao Tong University School of Medicine as an example / 中华医学教育探索杂志

Since the enrollment in 2002, the cultivation model of "4+4" program of clinical medicine in Shanghai Jiao Tong University School of Medicine has been continuously explored and practiced. With the goal of cultivating high-level compound outstanding medical innovative talents with multi-disciplinary cross-capacity, through strengthening the heuristic teaching, establishing the medical-engineering cross-course, emphasizing the training of scientific research ability, and taking teaching reform in the basic clinical single-circulation organ system integration course, we have established a talent training system with the characteristics of Shanghai Jiao Tong University School of Medicine, which is characterized by "thick foundation, strong practice, re-transformation, shaping norms, and international integration", and intend to make further exploration in the field of post-graduation education convergence.

"4+4" Clinical Medicine Program: comparison and thinking on the model of America and Shanghai Jiao Tong University School of Medicine / 中华医学教育探索杂志

Learning from the clinical medicine program of North American medical schools, Shanghai Jiao Tong University School of Medicine (SJTUSM) has taken the lead in carrying out the "4+4" program of clinical medicine specialty in China since 2002, recruiting outstanding non-medical graduates to study for four years of medical courses. After 20 years of practice, SJTUSM has accumulated a series of effective school-running experience with Chinese characteristics, but there are also problems and puzzles. Based on the analysis and comparison of the "4+4" Clinical Medicine Program of SJTUSM with leading medical schools in the United States, such as Harvard Medical College and Stanford University Medical College, this paper discusses the training objectives, enrollment methods and scale, curriculum setting, degree-granting standards, etc. SJTUSM needs to strengthen the educational reform, improve the enrollment methods and curriculum system, strengthen the characteristics of compound talents training, and rationally balance the training of clinical and scientific research ability, so as to help promote the "4+4" clinical medical talents training mode to excellent.

Practice and effect analysis on construction of clinical medical research center of cardiovascular diseases / 中华医学科研管理杂志

Objective:This article takes the practical experience of the construction of the cardiovascular disease clinical medicine research center in Nanjing First Hospital as an example to provide reference for institutions preparing to build a clinical research center.Methods:The center conducts top-level design based on clinical needs, and this study systematically elaborates the construction of the center from management mechanisms, research platforms, collaborative networks, team building and international cooperation.Results:The center has made remarkable progress in clinical research, scientific and technological innovation, transformation and promotion, standard formulation, and technology leading. On the basis of an international perspective, the level of regional diagnosis and treatment has been improved by optimizing the structure of subject talents, and focusing on the clinical needs of cardiovascular subspecialty.Conclusions:Taking the construction of the clinical medicine center as an opportunity, integrating superior resources, improving the level of disease diagnosis, treatment and service and enhancing international academic influence are effective measures to accelerate the development of health services and deepen medical reforms.