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1.
An. Fac. Med. (Perú) ; 82(3): 206-210, jul.-set. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1355607

ABSTRACT

RESUMEN Introducción. Los medicamentos han logrado prolongar y mejorar la calidad de vida de los pacientes, pero no garantizan estar libres de riesgo. La prescripción conjunta de varios medicamentos favorece que existan interacciones farmacológicas, disminuyendo el efecto esperado del medicamento y favoreciendo la aparición de efectos secundarios inesperados que ponen en peligro la vida del paciente. Objetivo. Determinar la prevalencia de interacciones farmacológicas en pacientes hospitalizados en un servicio de medicina interna de un hospital general. Métodos. Estudio observacional, transversal y retrospectivo. Se analizaron las prescripciones farmacológicas, utilizando la herramienta "Interactions Checker" de drugs. com(r) para la detección de posibles interacciones farmacológicas encontradas en los expedientes clínicos de 118 pacientes hospitalizados en un servicio de medicina interna de un hospital público de México. Resultados. El 78% de los pacientes presentaron al menos una interacción farmacológica, se identificaron 459 interacciones en total con una media de 4 interacciones por paciente. El 75% fueron de clasificación moderada, 13,5% leves y 11,5% graves. El omeprazol presentó el mayor número de interacciones y la interacción con mayor frecuencia fue furosemide + omeprazol. Se encontró una relación significativa entre las interacciones farmacológicas y el número de fármacos prescritos (p <0,001). Conclusiones. Existe una alta prevalencia de posibles interacciones farmacológicas en nuestra muestra de estudio, éstas deben ser consideradas para realizar un proceso de prescripción racional, asegurando la relación riesgo-beneficio para obtener un impacto positivo de gran alcance en la salud de los pacientes.


ABSTRACT Introduction. The joint prescription of several medications favors the occurrence of drug interactions, reducing the expected effect of the drug, and also favors the appearance of unexpected side effects. Objective. Document the prevalence of drug interactions in patients hospitalized in an internal medicine department. Methods. Observational, cross-sectional, retrospective study. It analyzed the drug prescriptions using the drugs.com(r) "Interactions Checker" tool to detect possible drug interactions found in the clinical records of 118 patients hospitalized in an internal medicine department of a public hospital in Mexico. Results. 78% of patients presented at least one drug interaction; 459 interactions were identified in total with a mean of 4 interactions per patient. 75% were classified as moderate, 13.5% mild, and 11.5% severe. Omeprazole had the highest number of interactions, and the most frequent interaction was furosemide + omeprazole. There was a significant relationship between drug interactions and the number of drugs prescribed (p <0.001). Conclusions. There is a high prevalence of possible drug interactions in the study sample, which should be considered when performing a rational prescription process, thereby ensuring the risk-benefit ratio to obtain a far-reaching positive impact on the patients' health.

2.
Medisan ; 25(2)mar.-abr. 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1250347

ABSTRACT

Introducción: La gestión formativa y el perfeccionamiento de los programas académicos de posgrado son necesidades impostergables para la formación permanente de los profesionales en las universidades de ciencias médicas cubanas. Objetivo: Socializar las experiencias sistematizadas en los procesos de gestión de la calidad de los programas de posgrado en dos especialidades médicas. Métodos: Se efectuaron un diagnóstico y una evaluación externa de los programas académicos de posgrado de las especialidades en Dermatología y Medicina Interna de la Universidad de Ciencias Médicas de Santiago de Cuba, en los meses de mayo y septiembre del 2019, respectivamente, donde se ponderó la observación de las diferentes actividades de cada programa a través del desarrollo de las seis variables establecidas para ello, lo cual contribuyó a revelar las principales fortalezas y debilidades de dichos programas de estudio. Resultados: El análisis integral de los programas evidenció, durante el proceso de evaluación externa, el cumplimiento de los estándares establecidos en el modelo de calidad, por lo que se decidió por unanimidad, en el Acuerdo de la Sesión 49 de la Junta de Acreditación Nacional de octubre de 2019, otorgarles la categoría superior de acreditación de Programa de Excelencia. Conclusiones: Pudo demostrarse que en la gestión formativa de ambas especialidades, como figuras académicas de posgrado, se han revelado con asertividad los impactos pertinentes para el Sistema Nacional de Salud Pública.


Introduction: The training management and the improvement of the academic postdegree programs are urgency necessities for the permanent training of the professionals in the Cuban universities of medical sciences. Objective: To socialize the systematized experiences in the processes of quality management of the postdegree programs in two medical specialties. Methods: A diagnosis and an external evaluation of the post degree academic programs in the specialties of Internal Medicine and Dermatology were carried out in the Medical Sciences University in Santiago de Cuba, in the months of May and September, 2019 respectively, where the observation of the different activities of each program was considered through the development of the six established variables for it, which contributed to reveal the main strengths and weaknesses of these study programs. Results: The integral analysis of the programs evidenced, during the process of external evaluation, the fulfillment of the established standards in the quality pattern, reason why it was unanimously decided, in the 49 Session Agreement of the National Accreditation Meeting from October, 2019, to grant them the accreditation higher category of Excellency Program. Conclusions: It could be demonstrated that in the training management of both specialties, as academic figures of postdegree, have been revealed with assertiveness the pertinent impacts for the National System of Public Health.


Subject(s)
Program Evaluation , Dermatology , Internal Medicine , Curriculum , Accreditation
3.
Medisan ; 25(2)mar.-abr. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1250354

ABSTRACT

Durante la última década, en numerosos países, entre ellos Cuba, se revisan los enfoques y las metodologías que se han utilizado para formar a los médicos especialistas. Al respecto, en el presente artículo se evalúan los referentes histórico-lógicos que fundamentan el uso de la medicina natural y tradicional para el desempeño profesional del residente de medicina interna. Asimismo, se describen las diferentes etapas por las que ha transitado la implementación de las terapias naturales y tradicionales en Cuba y cómo se ha fortalecido dicho arsenal terapéutico desde el punto de vista teórico-práctico.


During the last decade, diverse countries among them Cuba, are reviewing approaches and methodologies being used to train the specialist doctors. On this regard, historical and logical references which give bases to the natural and traditional medicine are evaluated in this work, for the professional skills of the internal medicine resident. Likewise, the different stages through which the natural and traditional therapies have developed in Cuba, and how this therapeutic group have been strengthen from the theoretical and practical point of view are described.


Subject(s)
Education, Medical/history , Internal Medicine , Medicine, Traditional/trends , Specialization , Medicine, Traditional
4.
Article in Chinese | WPRIM | ID: wpr-908898

ABSTRACT

Objective:To explore the effect of student standardized patients in experimental teaching of Internal Medicine Nursing. Methods:Totally 440 undergraduate students in Batch 2016 from the Nursing Department of Chengdu Medical College were divided into 9 groups with 5-6 students in each group. The situational teaching method of students' standardized patients playing clinical cases was adopted in internal medicine experimental teaching, and the teaching effect was evaluated by the questionnaire survey after the class.Results:More than 90.45% (398/440) of the students thought that this teaching method could enhance the ability of knowledge understanding and memorizing, 91.36% (402/440) of them thought that it could improve their corporation with classmates, 90.23% (397/440) of them thought that various abilities such as clinical thinking could be improved, and 87.27% (384/440) of them were satisfied with it.Conclusion:Applying standardized patients to the experimental teaching of internal medicine nursing is effective and can stimulate students' learning enthusiasm, thus improving the teaching effect.

5.
Article in Chinese | WPRIM | ID: wpr-882218

ABSTRACT

With rapid society development and the constant changes in people's thinking, the medical ethics issue has become more prominent. Medical interns are often facing ethical problems in clinical practice. Due to the lack of understanding of the experience in medical ethics, they often handle the problems poorly, which leads to intensified disputes between doctors and patients. The paper discusses some ethical problems that often appear in the clinical practice of internal medicine, and suggests several methods to improve the medical ethics education of interns in the clinical process.

6.
Rev. bras. educ. méd ; 45(4): e209, 2021. tab
Article in English | LILACS | ID: biblio-1341009

ABSTRACT

Abstract: Introduction: After the residency in Internal Medicine, most graduates choose to undergo a new selection process to obtain a second specialty. The phenomenon of early specialization is encouraged as early as in the undergraduate course. Despite this, the demand for general practitioners is growing. Objective: To investigate the factors that lead the newly graduated clinician to undertake a new residency. Method: This is a cross-sectional study that analyzes the responses of Internal Medicine residency graduates from the state of Pernambuco in 2020, through a questionnaire available online by Google Forms, containing questions about social aspects, undergraduate medical course, Medical Residency and intentions for the future career. Results: There were 81 responses of the 104 possible participants (77.88%). Most of these were female (66.67%), graduated from public universities (69.14%) and had already started the Internal Medicine residency shortly after graduation (50.62%). Regarding the specialty choice, 51.85% answered they had decided in the second year of residency, and 80.25% stated that they had undergone the selection process for the second specialty shortly after completing the Internal Medicine residency. The most often chosen career was Cardiology (20%). The factors most often associated with the choice of specialty were, according to the means on the Likert scale, "work in an outpatient setting", "long-term patient follow-up", and "more contact with patients". Conclusion: As far as it could be investigated in the literature, this was the first Brazilian study on specialty choices after the Internal Medicine residency. It was possible to identify the most important reasons for choosing a second specialty among the graduates of this Medical Residency program in Pernambuco in 2020. More studies are needed to establish correlations between the factors of choice with the chosen specialty.


Resumo: Introdução: Após a residência em clínica médica, a maioria dos concluintes opta por se submeter a um novo processo seletivo para obter uma segunda especialidade. O fenômeno da especialização precoce é incentivado já na graduação. Apesar disso, a demanda por médicos generalistas está em crescimento. Objetivo: Este estudo teve como objetivo investigar os fatores que levam o clínico recém-formado a realizar uma nova residência. Método: Trata-se de um estudo transversal que analisou as respostas dos concluintes do Programa de Residência Médica em Clínica Médica (PRM-CM) realizado em 2020 no estado de Pernambuco. Os concluintes do PRM-CM, por meio de um questionário disponibilizado de forma on-line pelo Google Forms, responderam a perguntas sobre aspectos sociais, a graduação, a residência médica e intenções para a carreira futura. Resultado: Dos 104 participantes possíveis, houve 81 respostas (77,88%). Desse total final, 66,67% eram do sexo feminino, 69,14% tinham se graduado em universidades públicas, e 50,62% já haviam iniciado o PRM-CM logo após a graduação. Quanto à escolha de especialidade, 51,85% responderam ter decidido no segundo ano de residência, e 80,25% afirmaram ter se submetido ao processo seletivo para a segunda especialidade logo após o PRM-CM. A carreira mais escolhida foi cardiologia (20%). Os fatores mais associados à escolha de especialidade foram, de acordo com as médias na escala de Likert, "trabalho em ambiente ambulatorial", "acompanhamento de pacientes por longo período" e "mais contato com pacientes". Conclusão: Até onde se pôde investigar na literatura, este é o primeiro estudo brasileiro a abordar as escolhas de especialidade após o PRM-CM. Foi possível identificar os motivos mais importantes para escolher uma segunda especialidade entre os concluintes desse PRM em Pernambuco, em 2020. Mais estudos são necessários para tecer correlações entre os fatores de escolha com a especialidade escolhida.


Subject(s)
Career Choice , Internship and Residency , Cross-Sectional Studies , Surveys and Questionnaires , Education, Medical, Continuing , Internal Medicine/education
7.
Rev. Nac. (Itauguá) ; 12(2): 47-60, 03 de diciembre 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1140116

ABSTRACT

RESUMEN Introducción: la información obtenida del egresado de un curso permite aplicar mejoras al plan de estudios. Se desconoce el grado de satisfacción de los médicos del postgrado en Medicina Interna de la Universidad Nacional de Itapúa. Objetivos: determinar la satisfacción con la enseñanza de los egresados del postgrado de la Universidad Nacional de Itapúa realizado en el Hospital Nacional de Itauguá y Hospital Regional de Encarnación. Metodología: se aplicó un diseño observacional descriptivo prospectivo. Se realizó en 2020 una encuesta estructurada, anónima, vía internet, a los egresados del postgrado de ambos hospitales. Se solicitaron variables demográficas, de inserción laboral y los relacionados a la satisfacción con los contenidos académicos. Los datos fueron sometidos a estadística descriptiva. El estudio contó con la aprobación del Comité de Ética de la Universidad Nacional de Itapúa. Resultados: la encuesta fue respondida por 68 egresados, con edad media 33 ± 5 años, siendo 37 (54 %) del sexo masculino. El 57 % refirió estar muy satisfecho, 41 % satisfecho y 2 % insatisfecho con la formación académica recibida en el postgrado. Conclusión: la satisfacción global con la enseñanza de los egresados del postgrado en Medicina Interna de la Universidad Nacional de Itapúa fue 98 %.


ABSTRACT Introduction: the information obtained from the graduate of a course allows to apply improvements to the study plan. The degree of satisfaction of the postgraduate doctors in Internal Medicine at the Universidad Nacional de Itapúa is unknown. Objectives: to determine the satisfaction with the teaching of the graduates of the postgraduate course of the Universidad Nacional de Itapúa carried out in the Hospital Nacional de Itauguá and the Hospital Regional de Encarnación. Methodology: a prospective descriptive observational design was applied. In 2020, a structured, anonymous survey was carried out via the internet to the graduate students from both hospitals. Demographic variables, job placement and those related to satisfaction with academic content were requested. The data was subjected to descriptive statistics. The study was approved by the Ethics Committee of the Universidad Nacional de Itapúa. Results: the survey was answered by 68 graduates, with a mean age of 33 ± 5 years, being 37 (54 %) male. 57 % reported being very satisfied, 41 % satisfied and 2 % dissatisfied with the academic training received in postgraduate studies. Conclusion: the overall satisfaction with the teaching of the graduates of the postgraduate course in Internal Medicine of the Universidad Nacional de Itapúa was 98 %.

8.
Medicina (B.Aires) ; 80(supl.6): 56-64, dic. 2020. graf
Article in English | LILACS | ID: biblio-1250320

ABSTRACT

Abstract The clinical features of COVID-19 differ substantially upon the presence (or absence) of viral pneumonia. The aim of this article was to describe the clinical characteristics of COVID-19 patients admitted to the Internal Medicine ward, as divided into those with and without pneumonia. This single-center prospective cohort study was conducted in a tertiary teaching public hospital in Buenos Aires City named Hospital General de Agudos Carlos G. Durand. Baseline data collection was performed within 48 hours of admission and patients were followed until discharge or in-hospital death. Epidemiological, clinical, laboratory, and radiological characteristics together with treatment data were obtained from the medical records. Of the 417 included, 243 (58.3%) had pneumonia. Median age was 43 years (IQR:32-57) and 222 (53.2%) were female. The overall crude case-fatality rate was 3.8%. None of the COVID-19 patients without pneumonia developed critical disease, required invasive mechanical ventilation nor died during hospitalization. However, 7 (4%) developed severe disease during follow-up. Among patients with COVID-19 pneumonia, in-hospital mortality rate was 6.6%, severe disease developed in 81 (33.3%), critical disease in 23 (9.5%), and 22 (9.1%) were admitted to the intensive care unit. A largely good prognosis was observed among COVID-19 patients without pneumonia, still, even among this group, unfavorable clinical progression can develop and should be properly monitored. Critical illness among patients with COVID-19 pneumonia was frequent and observed rates from this cohort provide a sound characterization of COVID-19 clinical features in a major city from South America.


Resumen Las características clínicas del COVID-19 difieren sustancialmente según la presencia (o ausencia) de neumonía viral. El objetivo de este artículo fue describir las características clínicas de los pacientes con COVID-19 internados en el servicio de Clínica Médica, divididos en pacientes con y sin neumonía. Fue un estudio de cohorte prospectivo, con base en un único centro, realizado en un hospital público de la ciudad de Buenos Aires: Hospital General de Agudos Carlos G. Durand. La recolección basal de datos se realizó dentro de las 48 horas del ingreso y los pacientes fueron seguidos hasta el alta o la muerte hospitalaria. Las características epidemiológicas, clínicas, de laboratorio y radiológicas junto con los datos del tratamiento se obtuvieron de la historia clínica. De los 417 incluidos, 243 (58.3%) tenían neumonía. La mediana de edad fue de 43 años (RIC: 32-57) y 222 (53.2%) eran mujeres. La tasa global de letalidad fue del 3.8%. Ninguno de los pacientes con COVID-19 sin neumonía desarrolló enfermedad crítica, requirió ventilación mecánica invasiva ni falleció durante la hospitalización. Sin embargo, 7 (4%) desarrollaron enfermedad grave durante el seguimiento. Entre aquellos con neumonía COVID-19, la tasa de mortalidad hospitalaria fue del 6.6%, se desarrolló enfermedad grave en 81 (33.3%), enfermedad crítica en 23 (9.5%) y 22 (9.1%) fueron trasladados a la unidad de cuidados intensivos. Los pacientes con COVID-19 sin neumonía presentaron buen pronóstico; sin embargo, incluso en este grupo, se observaron algunos con progresión clínica desfavorable, por lo que se requirió seguimiento adecuado. En los pacientes con neumonía por COVID-19, el desarrollo de enfermedad crítica fue frecuente y las tasas observadas en esta cohorte proporcionan una caracterización sólida de las características clínicas de los pacientes con COVID-19 en una importante ciudad de América del Sur.


Subject(s)
Humans , Female , Adult , Middle Aged , COVID-19 , Medicine , Respiration, Artificial , Prospective Studies , SARS-CoV-2 , Hospitalization , Hospitals
9.
Acta méd. colomb ; 45(1): 32-36, Jan.-Mar. 2020.
Article in English | LILACS, COLNAL | ID: biblio-1124067

ABSTRACT

Abstract In Colombia, there is a significant gap between the educational supply of medical specialties and their demand in health care institutions of varying complexity. This is a serious problem in the case of internal medicine, given its importance in the clinical management of complex patients and diseases, its interdependence with a large number of specialties and its impact on morbidity, mortality, quality of life and patient and family satisfaction with care. Thus, this study, using some elements of health economics, develops four topics:i)the introduction, which highlights the importance of internal medicine within the framework of Colombia's healthcare laws and provides a definition which gives specificity and identity to this specialty;ii)an analysis of this specialty's supply and demand;iii)health impacts or outcomes which may be attributed to the presence of internists; andiv)in conclusion, a discussion of elements which vindicate the need to improve the educational supply in this field.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1309).


Resumen En Colombia existe una brecha importante entre la oferta educativa de especializaciones médicas y su demanda en los servicios de salud de diferente complejidad. Esto constituye un grave problema en el caso de la medicina interna, dada su importancia en el manejo clínico de pacientes y enfermedades complejas, su interdependencia con un gran número de especializaciones y sus impactos sobre la morbilidad, mortalidad, discapacidad, calidad de vida y satisfacción con la atención de los pacientes y sus familiares. En tal sentido, este estudio, retomando algunos elementos de la economía de la salud, desarrolla cuatro tópicos:i)la introducción que destaca la importancia de la medicina interna en el marco de las leyes en salud de Colombia y precisa una definición que le brinda especificidad e identidad a esta especialización,ii)análisis de la oferta y la demanda de esta especialización,iii)impactos o desenlaces en salud atribuibles a la presencia de médicos internistas yiv)a manera de conclusión, se discuten elementos que vindican la necesidad de mejorar la oferta educativa en este campo.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1309).


Subject(s)
Specialization , Internal Medicine , Law of Supply and Demand
10.
Med. interna (Caracas) ; 36(2): 80-90, 2020. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1140292

ABSTRACT

El síndrome de desgaste profesional o burnout es un fenómeno específico del trabajo que surge como respuesta a estresores crónicos emocionales e interpersonales en el entorno laboral. Considerando las consecuencias que puede tener el síndrome, resulta relevante estudiar cómo la situación de crisis sanitaria en Venezuela, que ha sido documentada ya por años, ha impactado a los profesionales de la salud del país. Objetivos: explorar la relación entre la crisis del sistema sanitario y la salud laboral de una muestra de 82 residentes de medicina interna a nivel nacional. se buscó esclarecer la relación del desabastecimiento de insumos médicos básicos y fallas en el servicio eléctrico con las puntuaciones en burnout obtenidas. Métodos: Se utilizó la versión MBI-HSS versión en español. Se realizo una prueba de correlación de Pearson entre las variables y una prueba de Chi-cuadrado para determinar si existían diferencias en el grado de las dimensiones de burnout según el auto-reporte de desabastecimiento de medicinas y fallas en el servicio eléctrico. Resultados: Se obtuvo una correlación significativa entre las fallas en el servicio eléctrico y el burnout, pero no fue así con el desabastecimiento ni se pudieron establecer diferencias en grado de las dimensiones según autoreporte de deficiencias. Conclusión: Se hacen necesarios más estudios con muestras mayores, más representativas y de mayor experiencia para seguir estudiando los posibles impactos de la crisis sanitaria en Venezuela sobre los profesionales de la salud(AU)


The burnout syndrome is a work-specific phenomenon that arises as a response to chronic emotional and interpersonal stressors at the the workplace. Considering the consequences of this work-related syndrome, it is relevant to study how the health crisis in Venezuela, which has been documented for years now, has impacted health professionals in the country. The present study aimed to explore the relationship between the long-standing Venezuelan health crisis and the work- related health of a sample of 82 internal medicine residents at a national level. More concretely, the goal was to explore the relationship between medical supplies shortages and power system failures and the scores obtained in burnout as measured by the MBI-HSS in its Spanish version. A Pearson correlation test was performed between the variables along with Chi-Square tests for determining if there were differences in degree of burnout dimensions according to self-reports in medical supplies shortages and power outages. A significant relationship was found between power system failures and burnout. However, that was not the case for medicine shortages nor for the differences in degree of burnout dimensions according to self-reported medical supplies shortages and power failures. More studies with larger more representative and experienced samples are needed to keep studying the possible impacts that the health crisis in Venezuela is having on healthcare professionals(AU)


Subject(s)
Humans , Male , Female , Occupational Stress , Burnout, Psychological , Occupational Diseases , Workplace , Occupational Health , Health Personnel
11.
Article in English | WPRIM | ID: wpr-827392

ABSTRACT

According to the fact that many coronavirus disease 2019 (COVID-19) patients are seeking for medical help due to some other possible clinical symptoms, besides respiratory symptoms, all the internal medicine departments (including emergency department) could be involved. Moreover, an increasing number of physician are going to work in fever clinic, isolation wards and supporting the medical work in Hubei Province in the future. For a better medical work implementation of physician against COVID-19 and the interpretation of this viral transmission, the work guide was drawn up by Hunan Medical Association, Internal Medicine Specialized Committee.


Subject(s)
Betacoronavirus , China , Coronavirus Infections , Epidemiology , Humans , Internal Medicine , Pandemics , Physicians , Pneumonia, Viral , Epidemiology , Practice Guidelines as Topic
13.
Arch. méd. Camaguey ; 23(6): 738-747, nov.-dic. 2019. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1088815

ABSTRACT

RESUMEN Fundamento: un evento adverso es un suceso que origina una lesión al paciente, causado por procedimientos sanitarios. La atención en salud conlleva riesgos que se derivan de un sin número de factores que favorecen la aparición de los mismos, entre estos se encuentran los factores intrínsecos, los extrínsecos y los del sistema. De igual manera las consecuencias son diversas: morbilidad, mortalidad, hospitalizaciones prolongadas, atención de alta complejidad, discapacidades y problemas legales institucionales. Es necesario referir que los profesionales de enfermería cumplen un papel importante con la de atención y seguridad del paciente. Objetivo: describir la incidencia de los eventos adversos en los servicios de Cuidados Intensivos y Medicina Interna. Métodos: se realizó un estudio transversal con enfoque cuantitativo observacional, descriptivo en pacientes hospitalizados en la unidad de cuidados intensivos y servicio de medicina interna del Hospital General Dr. Gustavo Domínguez Zambrano de Santo Domingo de los Tsáchilas de junio a julio de 2018. La muestra estuvo constituida por 125 pacientes. Se diseñó una lista de chequeo validado por un grupo de jueces expertos que recogía datos clínicos, factores de riesgo y el evento adverso asociado. Resultados: de los 125 pacientes evaluados, el 63 % presentaron al menos un evento adverso. Medicina Interna fue el área donde se evidenció mayor incidencia de estos; con una estancia hospitalaria mayor a siete días; de igual manera en el mismo servicio la flebitis fue el más reportado. Conclusiones: es notorio la elevada incidencia de eventos adversos encontrados en ambos servicios durante la investigación, lo que hace plantear la necesidad vital de revisar la atención que se brinda a los pacientes con la finalidad de lograr la calidad y calidez.


ABSTRACT Background: an adverse event is an injury acquired by the patient through medical procedure. Health care involves many risks that arises from factors such as intrinsic, extrinsic, and including those of the system. The consequences are diverse: morbidity, mortality, prolonged hospitalization, high complexity care, disability and legal problems for the health institution. Nursing professionals that give importance to quality attention and patient safety play an important role in health institutions. Objective: to describe the occurrence of an adverse event in the intensive care unit and internal medicine unit. Methods: a cross sectional study of quantitative, observational and descriptive type among hospitalized patients in the intensive care unit and internal medicine unit of Dr. Gustavo Domínguez General Hospital in Santo Domingo de los Tsáchilas, from June to July of 2018. The sample of the study was 125 patients. A checklist for collecting clinical data, risk factors and associated adverse event was designed and validated by a group of experts. Results: among the 125 patients evaluated, 63 % presented at least 1 adverse event. Internal Medicine is the unit that showed the highest occurrence of adverse events, specifically, among patients with hospital stay of more than seven days. In the same area, phlebitis was the adverse event most reported. Conclusions: the high incidence of adverse events found in both wards during the research study suggests that there is a need to review the attention given to patients in order to achieve quality healthcare which is the main goal of health professionals in the Ecuador.

14.
Medisur ; 17(6): 833-843, nov.-dic. 2019. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1125157

ABSTRACT

RESUMEN Fundamento: La diabetes mellitus constituye una causa frecuente de ingreso hospitalario. Los autores han elaborado una Guía para el manejo terapéutico farmacológico de diabéticos, la cual propone un conjunto de acciones dirigidas a organizar la asistencia médica a los pacientes diabéticos hospitalizados en el Servicio de Medicina Interna. Objetivo: valorar el proceso de implementación de una Guía para el manejo terapéutico farmacológico de diabéticos hospitalizados con mal control metabólico o estado de hiperglucemia aguda no complicada. Métodos: estudio descriptivo, realizado en el Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, en mayo de 2018. Se analizó el cumplimiento de las acciones generales propuestas en la Guía, así como la introducción del esquema de insulina subcutánea programada; para ello fueron utilizados varios indicadores "de proceso" y "de resultados". Resultados: entre los indicadores con resultados negativos, se situaron los siguientes: registro de la glucemia en la Orden de Ingreso (49 %), estratificación de los enfermos (29 %), calidad de la estratificación (60 %), entre otros. Algunos con resultados positivos, fueron la referencia en la Orden de Ingreso al factor descompensante (82 %), adherencia a la conducta propuesta para cada grupo (86 %), utilización del esquema de insulina subcutánea programada (71 %), consideración del factor de descompensación en el manejo terapéutico (100 %), y cumplimiento global del esquema. El control metabólico se fue logrando progresivamente. Conclusión: se evidenció la factibilidad de aplicación del esquema de insulinoterapia subcutánea programada propuesto en la Guía, y su utilidad para el control metabólico de los pacientes.


ABSTRACT Foundation: Diabetes mellitus is a frequent cause of hospital admission. The authors have developed a Guide for the pharmacological therapeutic management of diabetics, which proposes a set of actions aimed at organizing medical care for diabetic patients in the Internal Medicine Service. Objective: to evaluate the process of implementing a Guide for the pharmacological therapeutic management of admitted diabetic patients with poor metabolic control or uncomplicated acute hyperglycemia status. Methods: a descriptive study, conducted at Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, in May 2018. Compliance with the general actions proposed in the Guide was analyzed, as well as the introduction of the programmed subcutaneous insulin scheme; for this, several "process" and "results" indicators were used. Results: among the negative results indicators, the following were recorded: glycemic registration at the admission order (49%), patients´ stratification (29%), and stratification quality (60%), among others. Some with positive results were at the admission order to the decompensating factor (82%), adherence to the proposed behavior for each group (86%), use of the programmed subcutaneous insulin scheme (71%), consideration of the decompensation factor in therapeutic management (100%), and overall compliance with the scheme. The metabolic control was progressively achieved. Conclusion: the feasibility of applying programmed subcutaneous insulin therapy scheme proposed in the Guide, and its usefulness for the metabolic control of patients was confirmed.

15.
Article | IMSEAR | ID: sea-209223

ABSTRACT

Objective: This study assesses and compares physicians’ communication skills based on their specialties from a patientperspective. We also compare their communication skills considering various dependent and independent variables.Methods: This cross-sectional study used the Arabic version of the communication assessment tool (CAT) questionnaire forpatients who visited family medicine, internal medicine specialty, and surgical specialty clinics in the Outpatient Department ofthe King Fahad Medical Military Complex in Dhahran, Saudi Arabia.Results: Of the prospective 400 participants, 365 agreed to participate, a participation rate of 91.2%. The percentage of“excellent” ratings for all of the CAT questions varies between 80% and 90%. A comparison between specialties according tothe CAT scores showed significant variation, with surgeons showing higher scores, compared with other specialties. Patient’sresponses varied widely when compared with the clinical experience of physicians (P < 0.001). Furthermore, there was astatistically significant difference in the results between physicians who had attended a communication skills course and thosewho did not or did not remember, based on patient’s responses.Conclusion: In general, patients were satisfied with the communication skills of the doctors working at King Fahad MedicalMilitary Complex. Doctors from the surgery department received better feedback regarding their communication skills. Basedon our results, we recommend that the questionnaire items that received the lowest rating from patients need to be improvedto increase patients’ overall satisfaction with physicians’ communication skills

16.
Med. interna Méx ; 35(5): 772-774, sep.-oct. 2019.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1250269

ABSTRACT

Resumen: El médico internista actualmente se enfrenta a grandes retos, entre ellos destaca la gran cantidad de información que se produce todos los días y tener que tomar decisiones en cuanto a la atención de los pacientes con esta gran cantidad de información disponible. La tecnología de la información y comunicación nos permite acercar la información al mismo sitio de la atención, haciendo mejor uso de los recursos de que dispone el médico para beneficio de los pacientes que atiende.


Abstract: The internist is currently facing major challenges, among them the large amount of information produced every day and having to make decisions regarding the care of patients with this large amount of available information. The information and communication technology allows us to bring the information to the same site of care, making better use of the available resources in benefit of patients.

17.
Med. interna Méx ; 35(5): 775-782, sep.-oct. 2019. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1250270

ABSTRACT

Resumen: En medicina, cada especialidad ha considerado padre a determinado personaje por el hecho de sus obras en relación con ella. De tal manera que, partiendo de Hipócrates de Cos (c. 460-370 a.n.e.) como el padre de la medicina en general,1 podemos encontrar a quienes se consideran los padres de la medicina interna; la descripción de sus vidas y obras nos pueden ilustrar el porqué de su consideración.


Abstract: In medicine, each specialty has considered father a certain person because of the fact of his works in relation to it. Thus, starting from Hippocrates de Cos (c. 460-370 bC.) as the father of medicine in general, we can find those who are considered the parents of internal medicine. The description of their lives and works can illustrate the reason for their consideration.

18.
Med. interna Méx ; 35(5): 783-788, sep.-oct. 2019. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1250271

ABSTRACT

Resumen: El término reporte matutino se utiliza para describir un foro de discusión en donde los médicos presentan y discuten uno o más casos clínicos. Las metas educativas del reporte matutino son, entre otras, la enseñanza basada en casos, facilitar las habilidades de presentación de los becarios y promover la capacidad de toma de decisiones. Además, esta actividad permite evaluar la calidad del cuidado otorgado facilitando acciones que podrían reducir la morbilidad y mortalidad hospitalaria. La discusión de los casos clínicos debe ser en un ambiente propicio; será preciso, por tanto, conocer los elementos del proceso de enseñanza para así cumplir los objetivos de programa académico. Se realiza una revisión bibliográfica de los beneficios teóricos del foro denominado reporte matutino.


Abstract: Morning report is a case based conference where physicians present and discuss clinical cases. While its primary goal is medical education (it was design to improve residents knowledge, leadership, presentation and problem-solving skills), the advantages for actual patients are many and include monitoring care and reviewing management decisions in a supportive, intellectually stimulating and controlled environment. Didactic style education, proper case selection and organizational characteristics are of upmost importance in designing a proper morning report. In this paper it is reviewed the theoretical benefits of implementing a morning report conference in an academic or university hospital.

19.
Medisur ; 17(5): 622-632, sept.-oct. 2019. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1091218

ABSTRACT

RESUMEN Fundamento: La asistencia médica de los diabéticos hospitalizados en salas del Servicio de Medicina Interna del hospital Gustavo Aldereguía Lima, de Cienfuegos, se caracteriza por una gran variabilidad en la actuación, determinada por criterios y enfoques muy personales de los facultativos. Objetivo: elaborar una guía para el manejo farmacológico de diabéticos con mal control metabólico o estado de hiperglucemia aguda no complicada, hospitalizados en el Servicio de Medicina Interna. Métodos: estudio que incluyó una revisión bibliográfica, a partir de la cual fue elaborada una primera versión de la guía, posteriormente discutida en el colectivo del Servicio de Medicina Interna del Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos. En las discusiones grupales fueron registradas las críticas y sugerencias a la propuesta. Finalmente, fue elaborado el documento. Resultados: entre las acciones más importantes propuestas por la guía, estuvo la estratificación de los pacientes en cuatro grupos diferentes según el grado de control metabólico al ingreso, o por su condición de debut de la enfermedad. Además, se sugirió una conducta terapéutica farmacológica particular para cada uno de esos cuatro grupos. En el caso de los pacientes que ingresan por mal control metabólico o hiperglucemia aguda no complicada, se introdujo el esquema de "insulinoterapia subcutánea programada". Fueron precisados los objetivos metabólicos a alcanzar, y los aspectos diagnósticos y terapéuticos relacionados con la hipoglucemia. Conclusión: la Guía para la atención al diabético puede ser de gran utilidad en todos aquellos servicios no críticos (incluyendo los quirúrgicos), donde con muy elevada frecuencia son admitidos estos pacientes.


ABSTRACT Foundation: The medical care of diabetics hospitalized in Internal Medicine Service wards of the Gustavo Aldereguía Lima Hospital, Cienfuegos, is characterized by a great variability in the performance, determined by criteria and very personal approaches of the physicians. Objective: to develop a guide for the pharmacological management of diabetics with poor metabolic control or a state of uncomplicated acute hyperglycemia, hospitalized in the Internal Medicine Service. Methods: a study which included a bibliographic review, from which a first version of the guide was elaborated, later discussed in the staff of the Internal Medicine Service of the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos. In the group discussions the criticisms and suggestions to the proposal were registered. Finally, the document was prepared. Results: among the most important actions proposed by the guide, was the patient stratification of into four different groups according to the degree of metabolic control at admission, or due to their condition of disease debut. In addition, a particular pharmacological therapeutic behavior was suggested for each of these four groups. In the case of patients admitted due to poor metabolic control or uncomplicated acute hyperglycemia, the "scheduled subcutaneous insulin therapy" scheme was introduced. The metabolic objectives to be achieved were specified, as well as the diagnostic and therapeutic aspects related to hypoglycemia. Conclusion: the Guide for diabetic care can be very useful in all non-critical services (including surgical ones), where these patients are very frequently admitted.

20.
Arq. bras. cardiol ; 113(1): 87-99, July 2019. graf
Article in English | LILACS | ID: biblio-1011237

ABSTRACT

Abstract The electrocardiogram (ECG) has been reinvigorated by the identification of electrical alterations that were not definitely clarified before. In this context, and mainly regarding the definition of arrhythmogenic substrates, the association of the ECG with the vectorcardiogram (VCG) has gathered much more information about the cardiac electrical phenomena, thus allowing us to differentiate potentially fatal cases from benign ones. Obtaining a VCG concomitantly with the performance of an ECG has led to a significant gain in the definition of extremely sophisticated pathologies, which function suffer some type of structural or dynamic alterations, involving either the reduction or enhancement of ionic channels and currents. The classic aspects of the ECG/VCG association in the differential diagnosis of myocardial infarctions, conduction disorders, atrial and ventricular hypertrophies, and the correlations between these electrical disorders are still valid and assertive. The association of these pathologies is further clarified when they are seen through the ECG/VCG dyad. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the ECG linear form. The modern analysis of the ECG and its respective VCG, simultaneously obtained by the recent technique called electro-vectorcardiogram (ECG/VCG), brought a significant gain for the differential diagnosis of some pathologies. Therefore, we illustrate how this type of analysis can elucidate some of the most important diagnoses found in our daily clinical practice as cardiologists.


Resumo O eletrocardiograma (ECG) foi revigorado com o reconhecimento de alterações elétricas que ainda não haviam sido observadas de maneira definitiva. Nesse contexto, principalmente na definição dos substratos arritmogênicos, a associação do ECG com o vetorcardiograma (VCG) propiciou mais informações sobre os fenômenos elétricos cardíacos, possibilitando distinguir os casos potencialmente fatais dos benignos. A obtenção de um VCG ao mesmo tempo da realização do ECG trouxe um ganho muito importante para definir patologias extremamente sofisticadas, com alterações estruturais ou dinâmicas que envolvem canais e correntes iônicas, cujas funções são diminuídas ou exageradas em razão de mutações genéticas. Os aspectos clássicos da relação ECG/VCG no diagnóstico diferencial das áreas inativas, dos distúrbios de condução, das sobrecargas atriais e ventriculares e das associações entre esses distúrbios elétricos continuam vigentes e assertivos, e ficam mais claros quando vistos pelo binômio ECG/VCG. Além disso, a orientação espacial tridimensional das atividades atrial e ventricular cria uma ferramenta de observação muito mais completa do que o modo linear do ECG. A análise moderna do ECG e do respectivo VCG, obtidos simultaneamente pela técnica recente chamada de eletrovetorcardiograma (ECG/VCG), trouxe um ganho importante no diagnóstico diferencial de algumas patologias. Desse modo, são abordadas aqui as principais utilidades dessa análise na elucidação de diagnósticos importantes da atividade diária na clínica cardiológica.


Subject(s)
Humans , Vectorcardiography , Heart Diseases/diagnosis , Practice Patterns, Physicians' , Diagnosis, Differential , Heart Diseases/physiopathology
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