Development and validation of a questionnaire to assess the knowledge of mechanical ventilation in urgent care among students in their last-year medical course in Brazil

OBJECTIVE: To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS: A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach's alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS: The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach's alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION: The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil.

Outbreaks repored in 2016

In the year 2016, several major out-breaks from emerging and re-emerging diseases including cholera in Somalia and Yemen; MERS-CoV in Saudi Arabia; Chikungunya in Somalia, Pakistan and Crimean– Congo Haemorrhagic fever in Pakistan were reported in the Eastern Mediterranean Region [EMR]

Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad / Predictive value of history and physical examination for the diagnosis of community-acquired pneumonia in adults

Background: Community-acquired pneumonia in adults is a serious health problem in the ambulatory care setting. Aim: To define clinical variables associated with the presence of pneumonia in adult patients presenting with fever or respiratory symptoms to the emergency department. Material and methods: Prospective study carried out in the emergency department from the Catholic University Hospital in Santiago, Chile. Three hundred twenty-five patients (53±22 years) presenting fever or acute respiratory symptoms were included. After obtaining a clinical history and physical examination, the physician established a tentative diagnosis. Subsequently, a definitive diagnosis was made with the chest X rays. Results: Thirty-four percent of the patients had pneumonia. The clinical diagnosis of pneumonia before X-ray examination was variable among emergency physicians (positive likelihood ratio: 1.5-4.8) and showed only moderate sensitivity (79 percent) and specificity (66 percent). The clinical variables significantly associated with the presence of pneumonia were: advanced age (over 75 years), cardiovascular disease, fever, chills, sputum production, orthopnea, altered mental status, cyanosis, dullness on percussion, bronchial breath sounds, crackles, any abnormal vital sign (heart rate ³100 beats/min, respiratory rate ³20 breaths/min or temperature ³38°C) and oxygen saturation below 90 percent breathing air. Conclusions: Clinical judgment prior to observation of chest X rays had moderate sensitivity and specificity for the diagnosis of pneumonia. There were no individual clinical findings, or combination of findings, that could confirm or exclude the diagnosis of pneumonia for a patient suspected of having this illness.

The roles and responsibilities of physicians in Pre-Hospital Emergency Medical Services: A Caribbean perspective

A Pre-hospital Emergency Medical Service (PHEMS) is a vital component of a country's health service because it provides early medical care to critically ill and injured persons in the field There is evidence to show that early care reduces mortality and morbidity and offers the patient the best chance of survival and improved quality of life. Caribbean territories have been developing their PHEMS as part of a programme of health sector reform. In a study of PHEMS in 12 Caribbean countries, the Pan American Health Organization reported that there were no clear guidelines with respect to the roles and responsibilities of the physician in PHEMS in the majority of countries. In fact, a few countries had services where there was no direct physician involvement. We present a brief review of the internationally recognized roles and responsibilities of physicians in PHEMS, and make recommendations with particular reference to the Caribbean. We suggest that there is a need for direct and active involvement of physicians in the development of PHEMS because the Emergency Medical Technician is recognized as an extension of the physician in the field and is supposed to be protected by the physician's licence to deliver medical care.

El servicio médico de emergencia pre-hospitalaria (SMEPH) es un componente vital del servicio de salud de un país, porque provee atención médica temprana y sobre el terreno a personas accidentadas o enfermas en estado crítico. Las evidencias indican que la atención temprana reduce la mortalidad y la morbosidad, a la vez que ofrece al paciente la mejor oportunidad posible de sobrevivir y mejorar la calidad de vida. Los territorios caribeños han estado desarrollando su SMEPH como parte de un programa de reforma del sector de la salud. En un estudio del SMEPH en 12 países caribeños, la Organización Panamericana de la Salud informó que no había directrices claras con respecto a las funciones y responsabilidades del médico en el SMEPH en la mayoría de países. De hecho, unos países tenían servicios en los que no había participación directa del médico. Presentamos aquí una revisión breve de las funciones y responsabilidades reconocidas internacionalmente para los médicos en el SMEPH, y hacemos recomendaciones con referencia particular al Caribe. Sugerimos que hay necesidad de que los médicos participen de manera activa y directa en el desarrollo del SMEPH, porque el técnico médico de emergencia es reconocido como una extensión del médico sobre el terreno, y se supone que esté amparado por una licencia para impartir atención médica.

Time for Change: The State of Emergency Medical Services in South Korea

Trauma is the leading cause of death among people younger than 40 years of age in South Korea. This demographic represents the productive members of Korean society, yet little is being done to correct this growing problem. The preventable death rate in Korea is estimated to be approximately 60%, which is unacceptable given Korea's growing economy and available resources.

Manual para las normas terapéuticas para urgencias médicas: (Infarto del miocardio-Hipertensión arterial) / Serie Desarrollo Científico Hospitalario

Documento elaborado tomando como referencia el Manual de Normas terapéuticas para urgencias médicas por el Dr. Jaime Villavicencio. Los temas elegidos para su presentación obedece a que son las patologías m s frecuentes que se atiendenmen las urgencias médicas en los hospitales a nivel del país. Se presenta el diagnóstico de la enfermedad, la terapia aguda, las complicaciones de cada una de lasd enfermedades enunciadas

O cirurgiäo-dentista face às emergências médicas: caracterizaçäo da área de atuaçäo e avaliaçäo da capacidade profissional nos eventos de risco / The dental surgeon and the medical emergencies: characterization of the area of activity and evaluation of the professional competence in the risk situations

Säo identificados aspectos comuns e similares das profissöes médica e odontológica passíveis de serem praticados por esses profissionais, indistintamente, em especial nas emergências médicas que possam acontecer em clínicas e consultórios do cirurgiäo-dentista e que possam levar a risco de vida e saúde os pacientes em tratamento. Questionários individuais, abrangendo cirurgiöes-dentistas com clínicas no interior do Estado de Säo Paulo, quantificaram e caracterizaram áreas de açäo onde há conflitos à competência legal exclusivamente médica de certos procedimentos. É pressuposto que a maioria dos profissionais vem recebendo rudimentos de conhecimentos teóricos sobre emergências médicas, näo tendo, portanto, condiçöes físicas, materiais e psíquicas para uma açäo firme e segura nos eventos emergenciais, tanto pela insuficiência de conhecimentos, como pela legislaçäo inadequada em vigor. Responderam aos questionários 420 profissionais, confirmando essas pressuposiçöes...

Un sistema de atencion de urgencias / A system for emergency attention

Se estudian los fenomenos que han producido un notorio aumento de las urgencias, y como un numero importante de los pacientes con trauma presentan lesiones de alto riesgo. Se revisan las causas de mortalidad en las diferentes edades. Se plantean estrategias para la atencion de pacientes que sufran accidentes de cualquier orden. Se estudian los niveles de atencion medica y se establecen normas relacionadas con las plantas fisicas de los hospitales, dotacion de los servicios de Urgencias, transporte de paciente y prevencion de accidentes