Beyond ventilatory support: challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection

SUMMARY Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.

RESUMO A síndrome respiratória aguda grave (SRAG) pelo novo coronavirus (SARS-CoV-2) é um novo desafio para todos os países e crianças estão predispostas a adquirir a doença. Alguns estudos demonstraram quadros mais graves em adultos, mas crianças criticamente doentes foram descritas em todas as idades. O envolvimento pulmonar é a principal característica e a necessidade de suporte ventilatório é comum nos casos mais graves. Entretanto, outras abordagens terapêuticas importantes devem ser consideradas. Nesse artigo revisamos extensamente a literature médica até o momento a fim de citar os principais recursos terapêuticos para o manejo dos pacientes pediátricos durante o período de suporte ventilatório. Achados radiológicos, terapia fluídica, terapia antiviral, o uso de corticosteroides, terapia antitrombótica e o uso de imunoglobulinas foram analisados a fim de guiar os profissionais durante o período de hospitalização desses pacientes. Nós reforçamos a importância de uma abordagem multiprofissional para recuperação adequada.

Ciencia médica, ciencia clínica y la formación del médico / Medical and Clinical Sciencies during the Doctor´s formation

Durante los estudios de la Carrera de Medicina el estudiante está construyendo su propio conocimiento a través de los elementos científico-técnicos y artísticos. Esta es una ciencia donde se distinguen, desde el punto de vista didáctico, dos áreas de sistema de conocimientos: Ciencias Preclínicas y Ciencias Clínicas, que no son más que momentos diferentes, pero interrelacionados en el abordaje del proceso salud-enfermedad. Luego de transcurrir los primeros cinco años del pregrado en Cuba, el estudiante se convierte en un agente pre-profesional al iniciarse en el internado de un año de duración en la Atención Primaria y Secundaria como escenarios docente-asistenciales, siempre bajo la supervisión de un tutor. Es pues, en el sexto año o internado donde se consolidan los conocimientos, habilidades y valores en un estudiante con modelación cualitativamente superior, para lograr los modos de actuación del egresado a través de la práctica pre-profesional que se realiza en dicha etapa previa al examen de graduación. Así pues, el encargo social al que responde la universidad del siglo XXI plantea la necesidad de egresar un profesional cada vez más comprometido con la salud pública, y es muy importante tener en cuenta una adecuada, precoz y fructífera motivación por la carrera para prestar un servicio sanitario óptimo (AU).

Scientific, technical and artistic elements are very important during medical studies because through them, the student is building his/her own knowledge. From the didactical point of view, this is a science composed by two areas of the knowledge system: Preclinical and Clinical sciences, meaning no more than different moments, but both interrelated, in approaching the health-disease process. After attending the first five years of the pre-grade in Cuba, the student becomes a pre-professional agent at the beginning of the year-long internship in the Primary and Secondary health care as teaching-health care surrounding, always under the supervision of a tutor. Therefore, it is the sixth year or internship when the student consolidates knowledge, skills and values with qualitatively higher models, to achieve the graduate´s behavioral patterns through the pre-professional practice performed in this stage before the graduation exam. Thus, the social duty of the xxi-century University states the necessity of graduating a professional more and more engaged with public health, and it is very important to take into account an adequate, precocious and fruitful professional motivation to render an optimal medical service (AU).

Caracterización de la educación en el trabajo en la especialidad de Medicina General Integral / Characterization of the education at work in the specialty of General Integral Medicine

Introducción: la educación en el trabajo en la especialidad de Medicina General Integral constituye la principal forma de organización de la enseñanza, donde los tutores desempeñan un papel fundamental. Objetivo: caracterizar la educación en el trabajo en la especialidad de Medicina General Integral. Materiales y Métodos: se realizó un estudio pedagógico, y en su ejecución se emplearon métodos teóricos como: la revisión bibliográfica y documental, que abarcó las principales temáticas: el plan de estudio de la especialidad de Medicina General Integral, el perfil profesional y recursos para el aprendizaje. Resultados: se expusieron los resultados del análisis documental efectuado a partir de: la formación del profesional, educación en el trabajo, así como los valores y la ética médica. Conclusiones: la educación en el trabajo constituye el principal artífice de los procesos de formación profesional, educación en el trabajo propiamente dicho, así como valores y ética médica (AU).

Introduction: the education in the work in the specialty of General Medicine constitutes the main form of organization of the teaching, where the tutors play a fundamental part. Objective: to characterize the education in the work in the specialty of Integral General Medicine. Materials and Methods: a pedagogic study was carried out, and in their execution theoretical methods were used as: the bibliographical and documental revision that embraced the main ones thematic: the plan of study of the specialty of General Medicine, the professional profile and resources for the learning. Results: the results of the documental analysis were exposed made starting from: the professional's formation, education in the work, as well as the values and the medical ethics. Conclusions: the education in the work the main author of the processes of professional formation, education in the properly this work constitutes, as well as you value and medical ethics (AU).

Saúde Mental em Medicina Geral Familiar - obstáculos e expectativas percecionados pelos Médicos de Família / Mental Health in General Family Medicine - obstacles and expectations perceived by Family Physicians

Resumo Pretende-se conhecer as dificuldades sentidas pelos médicos de família (MF) na abordagem dos doentes com transtornos mentais (TM) e conhecer as suas propostas para melhorar os cuidados os cuidados de saúde mental (CSM). Estudo qualitativo. Realizaram-se entrevistas semiestruturadas e audio-gravadas a 10 MF. Com análise de conteúdo identificaram-se oito categorias temáticas: condições de trabalho percecionadas; formação em saúde; terapêuticas usadas para tratamento dos TM; instrumentos de saúde mental usados na consulta; TM abordados na atenção primária (AP) e referenciadas a cuidados hospitalares; reação do doente à referenciação; articulação da atenção primária com a psiquiatria; propostas para melhorar os CSM na AP. A articulação com os serviços de saúde mental é deficiente pela falta de acessibilidade, comunicação unidirecional e atraso na resposta. Para melhorar os MF propõem criação de consultorias; equipes multidisciplinares; plataformas que permitam a comunicação bidirecional; aprendizagem contínua com a discussão de casos. O MF presta CSM, o que exige trabalho em equipe, com elementos da comunidade e dos hospitais. Os serviços devem organizar-se como sistemas aprendentes que permitam a progressiva melhoria dos profissionais e o aperfeiçoamento das interfaces entre os mesmos.

Abstract This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.

La educación en el trabajo y sus actividades de aprendizaje en la medicina general integral militar / Work education and learning activities in military general medicine

La educación en el trabajo es un recurso formativo que incluye actividades para la adquisición de habilidades y hábitos de trabajo en los residentes que contribuye a la solución efectiva de diferentes problemas de salud en la comunidad. El objetivo es caracterizar las actividades que incluye la educación en el trabajo desde la visión de los servicios médicos de las instituciones armadas en sus propios escenarios de actuación. Se realizó un trabajo de revisión, en el cual se emplearon como métodos teóricos el análisis-síntesis, inducción-deducción y el histórico lógico durante la consulta de diversas fuentes bibliográficas sobre la temática objeto de investigación. Se describe la educación en el trabajo como principio educativo en la especialización de Medicina General Integral Militar, así como sus actividades docentes asistenciales, investigativas, educativas y administrativas a desarrollar por el residente en la solución de problemas de salud que acontecen en el individuo, familia y la comunidad. Las actividades docentes que incluyen este recurso formativo favorecen la adquisición de habilidades importantes durante el período de especialización, pero requieren de una estructura adecuada, organización del proceso, análisis de salud objetivos y un pensamiento didáctico en el método de trabajo de los tutores.

Education at work is a training resource that includes activities for the acquisition of skills and work habits in residents. This contributes to the effective resolution of various health problems in the community. Our objective is to characterize the activities including education at work from the perspective of medical services at the armed forces in their own scenarios. A review was performed, in which theoretical analysis-synthesis, induction, deduction and logical historical methods were used when reviewing various literature sources on the subject under investigation. Education at work is described as an educational principle in the specialization of general military medicine, as well as their teaching, researching, educational and administrative activities allowing the resident development in solving health problems that occur in the individual, family and community. The educational activities included in this training resource promote the acquisition of important skills during the period of specialization, but they require an appropriate structure, process organization, analysis health, and tutors' educational thought in this work method.

Prevention of healthcare-associated infections in general practice: Current practice and drivers for change in a French study.

Purpose: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners' (GPs') office and identify barriers to and drivers for better practice. Materials and Methods: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. Results: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%), treat wounds (10%), fit intrauterine devices (18%) or perform injections (18%). The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7), inspection by the health authorities (4.8) and the fear of legal action (4.4). Conclusions: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.

Especialista ou clínico geral? / Specialist or general dentist?

Profissionais falam sobre o seu trabalho e discutem as vantagens e desvantagens de ser Clínico Geral ou Especialistas

Estudo comparativo do atendimento a nivel emergencial entre os Hospitais Universitario de Florianopolis e Clinic i Provincial de Barcelona / Comparative study of emergency care between the University Hospital of Florianopolis and the \"Clinic i Provincial hospital of Barcelona\"

Foram comparados os atendimentos de clinica medica nas emergencias do Hospital Clinic i Provincial de Barcelona (HCP) e do Hospital Universitario (HU) da Universidade Federal de Santa Catarina, em Florianopolis, num periodo de um ano. Durante esse periodo, 38.219 pacientes foram examinados. Houve predominio da faixa etaria situada entre 11 e 25 anos e dos pacientes com mais de 65 anos em ambos os hospitais, sendo que no HU houve uma maior procura por parte dos pacientes idosos que no HCP. Somente 3,5 a 13 por cento dos pacientes examinados foram hospitalizados e uma percentagem significante dos demais poderia ter recebido a atencao necessaria no setor de ambulatorios. Nos dois hospitais, os casos de maior gravidade foram constatados com maior frequencia no sexo masculino, embora houvesse tambem um predominio desse sexo na amostragem global. Ainda que a incidencia de doencas infecciosas agudas tenha sido alta em ambos os hospitais, doencas cronicas como hipertensao arterial sistemica, insuficiencia cardiaca congestiva e doenca pulmonar obstrutiva cronica foram vistas mais frequentemente no HU. E possivel que condicoes culturais e socio-economicas possam ter influido no controle e no tratamento dessas enfermidades.