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2.
Arq. bras. cardiol ; 118(2): 433-434, 2022.
Article in Portuguese | LILACS | ID: biblio-1364329
4.
Rev. colomb. cardiol ; 28(3): 203-206, mayo-jun. 2021.
Article in Spanish | LILACS, COLNAL | ID: biblio-1341287

ABSTRACT

l Dr. Adolfo de Francisco Zea partió dejando en las páginas de la historia una huella indeleble. No solamente sus compañeros de vida profesional y académica nos sentimos anonadados y tristes por su partida, sino que también el país entero le extrañará. Quiero expresar mi agradecimiento a mi amigo el Dr. Guillermo Sánchez Medina, psiquiatra y psicoanalista excelso, quien completó datos importantes sobre el curriculum vitae del Dr. De Francisco. El Dr. Sánchez Medina y el Dr. De Francisco Zea fueron amigos muy cercanos desde su juventud, y su amistad recorrió sus vidas a lo largo de los años. El Dr. Sánchez Medina comenta sobre las reuniones realizadas en forma periódica en su casa, los sábados a las 11 de la mañana, las cuales se prolongaban hasta las 15:30 si el Dr. De Francisco se quedaba para almorzar, y si no lo hacía, terminaban a la 1:30. Eran reuniones en las que trataban asuntos intelectuales, históricos, científicos y académicos, aunque también asuntos personales. Traigo este recuerdo revelador de la personalidad de los actores, la disciplina y la necesidad de intercambiar conceptos para así aclarar sus ideas. El Dr. De Francisco Zea fue uno de esos personajes que es difícil olvidar. Le recuerdo por su gallardía innata, su amabilidad permanente, siempre respetuoso con las ideas de su interlocutor, aunque también agudo y preciso en sus conceptos. Elegante y educado en su vestir y comportamiento, y a su vez sencillo en el trato.


Subject(s)
Humans , Male , Physicians , Biography , Cardiologists , Internal Medicine
6.
Arq. neuropsiquiatr ; 79(1): 15-21, Jan. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153144

ABSTRACT

ABSTRACT Background: The importance of simultaneous 2-lead electrocardiogram (ECG) recording during routine electroencephalogram (EEG) has been reported several times on clinical grounds. Objective: To investigate arrhythmia rates detected by simultaneous 2-lead ECG in our patient sample undergoing routine EEG. Remarkably, we sought to assess the possible expansion of results with a more experienced interpretation of simultaneous ECG. Methods: Simultaneous 2-lead ECG recordings during routine EEG, performed between January and March, 2016, have been retrospectively analyzed by a cardiology specialist. In addition, EEG reports were screened with the keywords 'arrhythmia, tachycardia, bradycardia, atrial fibrillation, extrasystole' to evaluate the neurologist interpretation. Results: Overall, 478 routine EEG recordings were scanned. The mean age of the patients was 42.8±19.8 (16-95), with a sex ratio of 264/214 (F/M). In 80 (17%) patients, findings compatible with arrhythmia were identified on simultaneous ECG after a cardiologist's evaluation. The detected arrhythmia subtypes were: ventricular extrasystole (n=27; 5.6%), supraventricular extrasystole (n=23; 4.8%), tachycardia (n=9; 1.8%), prolonged QRS duration (n=7; 8.7%), atrial fibrillation (n=6; 1.2%), and block (n=6; 1.2%). On the other hand, keywords related to arrhythmia were present in 45 (9.4%) of EEG reports. The reported statements were tachycardia (3.3%), arrhythmia (2.5%), bradycardia (2.1%), and extrasystole (1.5%). Conclusions: A considerably high rate of arrhythmia cases was determined on simultaneous ECG during routine EEG after being interpreted by a cardiologist. However, the screening results of EEG reports revealed relatively low arrhythmia rates. These results suggest that the detection rates of ECG abnormalities during routine EEG may be potentially improved.


RESUMO Introdução: A importância do registro simultâneo de eletrocardiograma (ECG) de duas derivações durante o eletroencefalograma (EEG) de rotina foi relatada várias vezes por motivos clínicos. Objetivos: Investigar as taxas de arritmias detectadas em ECG de duas derivações simultâneas em amostra de pacientes submetidos a EEG de rotina, para avaliar impacto nos resultados pela interpretação do ECG simultâneo por examinador experiente. Métodos: Registros simultâneos de ECG de duas derivações durante EEG de rotina realizados entre janeiro e março de 2016 foram analisados retrospectivamente por cardiologista. Adicionalmente, os relatórios de EEG foram selecionados com palavras-chave de 'arritmia, taquicardia, bradicardia, fibrilação atrial, extrassístole', para avaliar a interpretação dos neurologistas. Resultados: 478 registros de EEG de rotina foram digitalizados. A idade média dos pacientes foi de 42,8±19,8 [16-95] anos com uma proporção de sexo de 264/214 (F/M). Em 80 (17%) dos pacientes, achados compatíveis com arritmia no ECG simultâneo foram determinados após avaliação do cardiologista. Os subtipos de arritmia detectados foram extrassístole ventricular (n=27; 5,6%), extrassístole supraventricular (n=23; 4,8%), taquicardia (n=9; 1,8%), duração QRS prolongada (n=7; 8,7%), fibrilação atrial (n=6; 1,2%) e bloqueio (n=6; 1,2%), respectivamente. Por outro lado, palavras-chave relacionadas à arritmia foram citadas em 45 (9,4%) dos relatórios de EEG. As declarações relatadas foram taquicardia (3,3%), arritmia (2,5%), bradicardia (2,1%) e extrassístole (1,5%), respectivamente. Conclusões: Uma taxa consideravelmente alta de casos de arritmia foi determinada em ECG simultâneo durante EEG de rotina, após interpretação por cardiologista. No entanto, triagem dos relatórios de EEG revelaram taxas de arritmia relativamente baixas. Esses resultados sugerem que as taxas de detecção de anormalidades no ECG durante EEG de rotina podem ser melhoradas.


Subject(s)
Humans , Atrial Fibrillation , Cardiologists , Retrospective Studies , Electrocardiography , Electroencephalography
8.
ABC., imagem cardiovasc ; 34(4): eabc215, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1359166

ABSTRACT

Introdução: O Echo WISELY Trial é um estudo controlado, randomizado, multicêntrico, cego pelo investigador, que avaliou uma intervenção educacional com base nos critérios de uso apropriado para ecocardiografia para redução da proporção de ecocardiogramas raramente apropriados realizados ambulatorialmente. Objetivo: Descrever a prevalência e identificar preditores de responsividade de médicos respondedores submetidos à intervenção educacional no Echo WISELY Trial. Métodos: Médicos do grupo intervenção receberam um programa educacional multifacetado. O médico respondedor foi definido como aquele que apresentou redução >2,5% na média proporcional de exames raramente apropriados solicitados entre o primeiro trimestre (linha de base) e qualquer um dos seguintes trimestres (segundo ao sexto). Foram comparadas as características do médico (sexo, tempo de formação, especialidade médica e local de trabalho) com as classificações dos ecocardiogramas (apropriado, talvez apropriado e raramente apropriado) e razões clínicas para ecocardiogramas solicitados utilizando teste do qui-quadrado. A significância estatística foi indicada por p < 0,05 bicaudal. Resultados: Foram analisados 4.605 exames solicitados nos seis hospitais participantes de Ontário e randomizados para o braço intervenção. Dentre os 36 médicos incluídos, 26 (72%) foram classificados como respondedores. Entre as variáveis analisadas, não houve diferença significativa entre médicos respondedores e não respondedores à intervenção educacional. O número de exames raramente apropriados solicitados pelos respondedores foi significativamente menor que o de não respondedores (234; 8,67% versus 261; 13,8%; p < 0,0001). Conclusão: A prevalência de médicos respondedores é alta, porém não foram identificados preditores de responsividade à intervenção educacional entre as variáveis analisadas. Isso pode decorrer de aspectos psicológicos e características pessoais dos médicos, que não foram incluídos nesta pesquisa.(AU)


Introduction: The Echo WISELY Trial is a controlled randomized multicenter investigator-blinded study that evaluated an educational intervention based on the criteria for appropriate use of echocardiography to reduce the proportion of rarely appropriate outpatient echocardiograms performed. Objective: To describe the prevalence and identify predictors of the responsiveness of responding physicians subjected to an educational intervention in the Echo WISELY Trial. Methods: The intervention group physicians received a multifaceted educational program. A responding physician was defined as one who had a >2.5% reduction in the proportional mean of rarely appropriate tests requested between the first trimester (baseline) and any of the following trimesters (second to sixth). Physician characteristics (sex, time since graduation, medical specialty, and workplace) were compared to the echocardiogram ratings (appropriate, maybe appropriate, and rarely appropriate) and clinical reasons for the requested echocardiograms using the chi-square test. Statistical significance was indicated by a two-tailed p < 0.05. Results: A total of 4,605 tests requested at the six participating hospitals in Ontario were analyzed and randomized for the intervention arm Of the 36 included physicians, 26 (72%) were classified as responders. Of the variables analyzed, there was no significant difference in the outcomes of the responders versus non-responders to the educational intervention. The number of rarely appropriate tests requested by the responders was significantly lower than that of the non-responders (234 [8.67%] versus 261 [13.8%]; p < 0.0001). Conclusion: The prevalence of responder physicians was high, but predictors of responsiveness to educational intervention were not identified among the analyzed variables. This may be a result of the psychological aspects and personal characteristics of the physicians, which were not included in this research. (AU)


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Quality Control , Echocardiography/economics , Echocardiography/statistics & numerical data , Cardiovascular Diseases/diagnostic imaging , Cardiologists/statistics & numerical data , Outpatient Clinics, Hospital , Time Factors , Echocardiography/methods , Prevalence , Data Interpretation, Statistical , Benchmarking/methods , Quality Improvement , Physicians, Primary Care/statistics & numerical data
9.
J. pediatr. (Rio J.) ; 96(5): 614-620, Set.-Dec. 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1135074

ABSTRACT

Abstract Objectives: Functional echocardiography is a valuable tool in the neonatal intensive care unit, but training programs are not standardized. The aim was to report an functional echocardiography training program for neonatologists and to describe the agreement of their measurements with the pediatric cardiologist. Methods: Functional echocardiography training lasted 32 h. After training program, the neonatologists performed functional echocardiography in the neonatal intensive care unit and were required to measure left cardiac chambers dimensions, left ventricle systolic function, right and left ventricular output, ductus arteriosus diameter, and flow pattern. Images were recorded by the equipment and reviewed offline by the pediatric cardiologist. The Bland-Altman test was used for quantitative variables and the kappa test, for qualitative variables. Results: Twenty-two trained neonatologists performed 100 functional echocardiography exams. Ductus arteriosus identification and flow pattern had substantial agreement (kappa = 0.91 and 0.88, respectively), as well as its diameter (mean difference = 0.04 mm). The mean difference for the aortic root was −1.2 mm; left atrium, 0.60 mm; left ventricle diastolic diameter, −0.90 mm; left ventricle systolic diameter, −0.30 mm. Shortening fraction and ejection fraction correlated well with broad limits of agreement, −2.96% (14.88; −20.82%) and −-3.43% (15.54; −22.40%), respectively. Right and left ventricular output had broad limits of agreement, 16.69 mL/kg/min (222.76; −189.37) and 23.57 mL/kg/min (157.88; −110), respectively. There was good agreement between interpretations of normal or low cardiac output (76.7% for right ventricular output; 75.7% for left ventricular output). Conclusion: This functional echocardiography training program enabled neonatologists to obtain adequate skills in performing the images, obtaining good agreement with the cardiologist in simple hemodynamic measurements and ductus arteriosus evaluation.


Resumo Objetivos: A ecocardiografia funcional é uma ferramenta valiosa na unidade de terapia intensiva neonatal, mas os programas de treinamento não são padronizados. Nosso objetivo foi relatar um programa de treinamento em ecocardiografia funcional para neonatologistas e descrever a concordância de suas medidas com o cardiologista pediátrico. Métodos: O treinamento em ecocardiografia funcional durou 32 horas. Após o programa de treinamento, os neonatologistas faziam ecocardiografia funcional na unidade de terapia intensiva neonatal e mediam as dimensões das câmaras cardíacas esquerdas, função sistólica do ventrículo esquerdo, débito cardíaco do ventrículo direito e débito cardíaco do ventrículo esquerdo, diâmetro do canal arterial e o padrão de fluxo. As imagens foram registradas no equipamento e revisadas offline pelo cardiologista pediátrico. O teste de Bland-Altman foi usado para variáveis quantitativas e o teste Kappa para variáveis qualitativas. Resultados: Foram feitas por 22 neonatologistas treinados 100 ecocardiografias funcionais. A identificação do canal arterial e o padrão de fluxo apresentaram concordância substancial (Kappa = 0,91 e 0,88, respectivamente), bem como seu diâmetro (diferença média = 0,04 mm). A diferença média foi de -1,2 mm para a raiz da aorta, 0,60 mm para o átrio esquerdo, -0,90 mm para o diâmetro diastólico do ventrículo esquerdo e de -0,30 mm para o diâmetro sistólico do ventrículo esquerdo. A fração de encurtamento e a fração de ejeção apresentaram boas correlações, com amplos limites de concordância, respectivamente -2,96% (14,88; -20,82%) e -3,43% (15,54; -22,40%). Os débitos cardíacos do ventrículo direito e do ventrículo esquerdo apresentaram amplos limites de concordância, 16,69 mL/kg/min (222,76; -189,37) e 23,57 mL/kg/min (157,88; -110), respectivamente. Houve boa concordância entre a interpretação de débito cardíaco normal ou baixo (76,7% de débito ventricular direito; 75,7% de débito ventricular esquerdo). Conclusão: Esse programa de treinamento em ecocardiografia funcional permitiu aos neonatologistas obter habilidades adequadas na realização das imagens, com boa concordância com o cardiologista em medidas hemodinâmicas simples e avaliação do canal arterial.


Subject(s)
Humans , Infant, Newborn , Child , Cardiologists , Echocardiography , Intensive Care Units, Neonatal , Ductus Arteriosus, Patent
10.
Gac. méd. Méx ; 156(6): 556-562, nov.-dic. 2020. tab
Article in Spanish | LILACS | ID: biblio-1249967

ABSTRACT

Resumen Introducción: La relación médico-industria farmacéutica (IF) se ha identificado como un problema ético por favorecer conflictos de interés derivados de los beneficios que reciben los médicos y que pueden afectar su juicio clínico. Objetivo: Identificar la frecuencia de participación de médicos en actividades financiadas por la IF, las actitudes de estos profesionales hacia los representantes de la IF, su conducta prescriptiva y la asociación de sus características y del trabajo con la participación en actividades financiadas por la IF. Método: Encuesta transversal a médicos internistas y cardiólogos. El cuestionario incluyó características de los médicos y centro de trabajo, participación en actividades financiadas por la IF, actitudes hacia los representantes y conducta de prescripción. Resultados: Se analizaron 455 cuestionarios, 78.5 % de los encuestados tuvo conocimiento de la relación médico-IF, la mayoría respondió reunirse con representantes de la IF, 30 % indicó haber recibido subsidios financieros y 10 % consideró que los obsequios afectan su prescripción. Tener conocimiento previo de la relación médico-IF se asoció con menor participación en actividades educativas financiadas por por la IF. Conclusión: Las prácticas y preferencias hacia la IF muestran la necesidad de diseñar estrategias para evitar la prescripción inapropiada.


Abstract Introduction: The physician-pharmaceutical industry relationship has been identified as an ethical problem, due to conflicts of interest motivated by the benefits that doctors receive and that can affect their clinical judgment. Objective: To identify the frequency of physicians participation in activities financed by the pharmaceutical industry (PI), their attitudes towards PI representatives (PIRs), their prescriptive behavior and the association between their characteristics and their workplace with their participation in activities financed by the PI. Method: Cross-sectional survey to internists and cardiologists. The questionnaire included characteristics of the doctors and their workplace, participation in activities financed by the PI, attitudes towards PIRs, and prescription behavior. Results: 455 questionnaires were analyzed; 78.5 % of surveyed subjects were aware of the physician-PI relationship, the majority acknowledged meeting with PIRs, 30 % indicated having received financial subsidies and 10 % considered that gifts affect their prescription. Having prior knowledge of the physician-PI relationship was associated with less participation in PI-financed educational activities. Conclusion: Practices and preferences towards the PI show the need to design strategies to avoid inappropriate prescription.


Subject(s)
Humans , Male , Female , Physicians/ethics , Drug Prescriptions , Practice Patterns, Physicians' , Attitude of Health Personnel , Conflict of Interest , Drug Industry/ethics , Cross-Sectional Studies , Workplace , Health Care Surveys/statistics & numerical data , Gift Giving/ethics , Inappropriate Prescribing/prevention & control , Cardiologists/ethics , Habits , Internal Medicine/ethics
12.
Rev. colomb. cardiol ; 27(4): 203-204, jul.-ago. 2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1289215

ABSTRACT

En Barranquilla, Colombia, el día 1.° de marzo de 2018, en Asamblea ordinaria de la Asociación Sociedad Colombiana de Cardiología y Cirugía Cardiovascular ­SCC­, se aprobó conformar una veeduría ciudadana según los lineamientos de la Ley 850 de 2003 y Ley 1757 de 2015. Hasta hace dos años, la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular era una entidad con fines puramente académicos y científicos. Hoy contamos con la figura de la Veeduría Ciudadana que es una herramienta activa y permanente para las actuaciones de interés gremial. A principios del año 2019, algunos de los cirujanos cardiovasculares del país tomamos la decisión de constituir una asociación que defendiera los aspectos gremiales de nuestra profesión, dado que la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular era una entidad de carácter científico y no tenía esa potestad. Sin embargo, durante la presidencia del Dr. Adalberto Quintero, fui invitado a participar activamente en la Veeduría Ciudadana en representación de los cirujanos cardiovasculares del país, en compañía de importantes cardiólogos representantes de sus regiones: Dr. Jaime Antonio Smith en representación de la Región Caribe Dr. Fabio Alfonso Flores - Región Suroccidente Dr. Eduardo Ramírez - Región Antioquia Dr. Alfonso Merchán - Región Central Dr. Ángel María Chaves en representación de los Santanderes Abogada Sandra Liliana Correa ­ Asesora en aspectos legales. Luego de conocer el funcionamiento y los alcances legales que tiene la Veeduría Ciudadana de la Sociedad, la constitución de una Asociación, Agremiación o Colegio de Cirujanos, con un funcionamiento paralelo al de la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, solo representaría una duplicación de los esfuerzos, ya que para ello era necesario constituir un grupo de trabajo que representaría un costo económico, con una atomización de los esfuerzos encaminados a evaluar, sugerir, apoyar o rechazar nuevas leyes que pudieran ayudar o perjudicar en nuestro ejercicio profesional. Además, una asociación paralela perdería la fuerza para ejercer presión ante malas propuestas gubernamentales, lo que no ocurriría al tener el respaldo de una entidad tan importante en Colombia, con casi 77 años de trayectoria, como lo es la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular.


Subject(s)
Cardiology , Cardiologists , Unified Health System , Constitution and Bylaws
14.
Rev. colomb. cardiol ; 27(2): 67-68, mar.-abr. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1149803

ABSTRACT

Nunca pensé que algún día escribiría un editorial en memoria de un colega y amigo: Roberto Díaz del Castillo. Lo conocí por allá en 1995, en las juntas cardioquirúrgicas que hacíamos en la clínica Rafael Uribe del Seguro Social, en Cali; él trabajaba en la Clínica Nuestra Señora de los Remedios y yo en la Clínica de Occidente. En esa junta confluíamos los cirujanos de las tres instituciones que en aquella época realizábamos cirugía cardiovascular (las mencionadas previamente más la Fundación Valle del Lili); éramos seis cirujanos y cuatro cardiólogos; casi todos éramos jóvenes y creíamos tener la última palabra. Una vez definido el volumen de pacientes a operar, la remisión era democrática: un tercio para cada servicio. En esas juntas, obviamente, fuera de discusiones médicas y académicas, solíamos contar anécdotas y experiencias de nuestra práctica diaria; además, el sentido del humor colombiano afloraba con facilidad, dado el origen de cada uno: cinco vallunos, un bogotano, un paisa, un costeño, un tolimense y un pastuso. Roberto tenía una memoria fotográfica y siempre una historia nueva para contar; irradiaba optimismo y no le veía problema a nada. A medida que el tiempo avanzaba, nuestra amistad y respeto fueron creciendo. En ese camino profesional nos enteramos de la formación del capítulo (hoy seccional) Suroccidente de Cardiología y Cirugía Cardiovascular; nos llamó la atención pertenecer al mismo, pues era un espacio de integración con los cardiólogos de la región, además fuimos empujados y animados por nuestro amigo cardiólogo Adolfo Vera, quien fue el gestor del capítulo.


Subject(s)
Humans , Male , Cardiologists , Memory , Surgeons , History
16.
Rev. colomb. cardiol ; 26(5): 256-263, sep.-oct. 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1092935

ABSTRACT

Resumen Introducción: el ultrasonido cardiaco enfocado ha sido propuesto como una aproximación útil para mejorar la toma de decisiones clínicas, permitiendo identificar rápidamente signos ultrasonográficos de una lista específica de diagnósticos potenciales. Objetivo: evaluar un programa de entrenamiento para médicos sin experiencia en ecocardiografía a fin de realizar ultrasonido cardiaco enfocado por medio de un dispositivo portátil (ecoscopio). Materiales y métodos: se compararon los resultados obtenidos mediante ecoscopia realizada por los médicos que recibieron el entrenamiento, con los obtenidos mediante ecocardiografía convencional realizada por cardiólogos expertos. Métodos: un total de 5 médicos no cardiólogos incluyendo un estudiante de Medicina de último año, 2 residentes de Medicina Interna y 2 Intensivistas participaron en un curso de entrenamiento de cuatro semanas, dirigido por un Cardiólogo experto de nivel III así: Primera semana: teoría y bases de ecocardiografía (3 horas diarias) Segunda semana: teoría de la adquisición de imágenes. Hallazgos normales y anormales (50 estudios). Tercera semana: manejo del ecoscopio (50 estudios). Cuarta semana: recolección de datos. Se incluyeron pacientes programados para ecocardiografía convencional en el Laboratorio de métodos no invasivos. A cada paciente se le realizaron dos exámenes. El primero consistió en una ecoscopia hecha por médico que recibió el entrenamiento y el segundo consistió en un ecocardiograma realizado por un cardiólogo experto. Los parámetros ecocardiográficos evaluados fueron: fracción de eyección del ventrículo izquierdo, disfunción ventricular derecha, crecimiento auricular izquierdo, hipertensión pulmonar, enfermedad valvular cardiaca y derrame pericárdico. Por medio de análisis de concordancia (índice Kappa) se compararon los resultados encontrados en ecoscopia versus ecocardiografía. Resultados: de 221 estudios se obtuvo concordancia moderada en fracción de eyección del ventrículo izquierdo (к =0,541, p<0,000), función ventricular derecha (к =0,403, p<0,001), dilatación de la aurícula izquierda (к =0,413, p<0,001), valvulopatía mitral (к =0,466, p<0,001) y tricuspídea (к =0,437, p<0,001). La valvulopatía aórtica mostró un acuerdo débil. El derrame pericárdico y la hipertensión pulmonar tuvieron concordancia pobre y débil, respectivamente. Conclusiones: con un tiempo limitado de formación, los participantes sin experiencia previa en técnicas de ultrasonido y utilizando ecoscopia, alcanzaron un acuerdo moderado en la mayoría de las mediciones cuando se comparó con ecocardiografía convencional practicada por ecocardiografistas expertos. Es necesario un estudio con mayor número de participantes que determine el tiempo de formación ideal para obtener resultados comparables con ecocardiografía.


Abstract Introduction: Focused cardiac ultrasound has been proposed as a useful approach for improving clinical decision making, as well as to be able to rapidly identify the ultrasound signs of a specific list of potential diagnoses. Objective: To evaluate a training program for physicians with no experience in cardiac ultrasound with the aim performing focused cardiac ultrasound using a portable device (echoscopy). Materials and methods: The results obtained from echoscopy performed by the physicians that received training were compared with those obtained with conventional cardiac ultrasound carried out by expert cardiologists. A total of 5 non-cardiologist doctors, including 1 medical student, 2 Internal Medicine residents, and 2 from Intensive Medicine, took part in a four-week training course given by a Level III Cardiology specialist. The course included: First week: Theory and basis of cardiac ultrasound (3 hours daily) Second week: Theory of acquiring images. Normal and abnormal findings (50 studies). Third week: handling of the echoscope (50 studies). Fourth week: Data collection. The study included patients scheduled for conventional cardiac ultrasound in the Non-Invasive Methods Laboratory. Two examinations were carried out on each patient. The first consisted of an echoscopy performed by a doctor that had received the training, and the second consisted of a cardiac ultrasound carried out by an expert cardiologist. The ultrasound parameters evaluated were: left ventricular ejection fraction, right ventricular dysfunction, left atrial enlargement, pulmonary hypertension, cardiac valve disease, and pericardial effusion. The results found in echoscopy versus cardiac ultrasound were compared using concordance analysis (Kappa Index). Results: The following results were obtained on the 221 studies performed: moderate agreement in left ventricular ejection fraction (к =0.541, P<.000), right ventricular function (к =0.403, P<.001), left atrial enlargement (к =0.413, P<.001), mitral valve and tricuspid valve disease (к =0.437, P<.001 and (к =0.466, P<.001, respectively). There was weak agreement with aortic valve disease. Pericardiac effusion and the presence of pulmonary hypertension had a poor and week agreement, respectively. Conclusions: With a limited training period, the participants with no previous experience in ultrasound techniques and using echoscopy achieved a moderate agreement in the majority of measurements when compared with conventional cardiac ultrasound performed by experts in the technique. A study with a larger number of participants is required in order to determine the ideal training period to obtain results comparable with cardiac ultrasound.


Subject(s)
Humans , Male , Middle Aged , Echocardiography , Ultrasonography , Mentoring , Cardiologists , Aortic Valve Disease , Internal Medicine
19.
Rev. chil. cardiol ; 38(2): 146-148, ago. 2019.
Article in Spanish | LILACS | ID: biblio-1042608

ABSTRACT

The introduction of digital technology in Medicine has brought enormous diagnostic and therapeutic advances but also has impacted the practitioner's welfare and important aspects of practice such as patient-physician relations. It has been alarming the increasing reports of physicians and nurse's burnout and associated mental disturbances such as depression and suicidal ideation. Increasing administrative burden brought to the practitioners by the need to document by digital technology patients' encounters has reduced the time of patient-physician relation and substituted by a longer time spend by the provider interacting with a computer. This represents probably one of the major causes of frustration and burnout consequences among health providers, as reported by a recent National Academy of Medicine review, a Mayo Clinic Proceedings study published in 2019, several recent Medscapes physicians surveys and by a panel discussion in the 2018 European Congress of Cardiology among many other publications. Many factors are indeed at play in this complex scenario such as government, payers, hospital facilities rules and regulations, and the way to modify them to create a more provider friendly environment may be long and difficult. Nevertheless, a first step to be considered is to reduce the administrative burden of the providers to free more time for them with their patients The future role of using diagnostic and therapeutic algorithms, some of them already available, to develop platforms of patient management with a reduced or minimal medical provider force is still uncertain and likely subject to controversial value and ethical considerations.


Subject(s)
Humans , Physicians/psychology , Mental Health , Medicine/trends , Burnout, Professional , Cardiologists/psychology , Burnout, Psychological
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