ABSTRACT
Background@#Teachers in medicine do not only teach scientific facts about health and disease to their learners but they are also looked up to as role models. Little is known about the qualities of consultant-faculty members who are regarded as role models by Filipino internal medicine residents.@*Objective@#This study aimed to determine the reasons why consultant-faculty members are considered role models by Filipino internal medicine residents.@*Methods@#A cross-sectional survey was conducted among internal medicine residents at a tertiary national university hospital in the Philippines. Participants were asked to give the reasons for citing consultant-faculty members who they consider as role models.@*Results@#There were 81 residents who participated (93% response rate) who gave a total of 332 qualities as reasons for citing them as role models. The most commonly cited quality category was those of personal qualities (35.84% of all responses). This was followed by academic, clinical, teaching, leadership and research qualities. Physical qualities were the least cited (0.30% of all responses). Across the four batches of residents, personal qualities were consistently cited the most number of times, while physical qualities were consistently cited the least.@*Conclusion@#Filipino internal medicine residents identified personal qualities as the most frequent reason for considering their consultant-faculty as role models.
Subject(s)
Internal MedicineABSTRACT
Introducción: El estudio de la comorbilidad requiere de un enfoque multilateral con vistas a mejorar la calidad de la atención de los enfermos por el sistema de atención. Objetivos: Explorar la magnitud de la comorbilidad de enfermedades crónicas en adultos internados en los hospitales. Métodos: Se realizó un estudio prospectivo-observacional-longitudinal-analítico. Se incluyeron pacientes internados en las Salas de Clínica Médica o pacientes clínicos en Salas de Internación Indiscriminada. Se realizó un estudio multicéntrico en 42 centros en un período de 2 años, con un muestreo consecutivo. Para el estudio se tuvo en cuenta la estadística descriptiva, inferencial y de regresión. Resultados: El total de pacientes en el estudio fue de 5925, masculinos con el 50,3 por ciento de edad 60,66 ± 0,25 años. Principal procedencia desde la guardia el 73 por ciento. La estadía hospitalaria de 12,61 ± 0,24 días, mayormente en pacientes quirúrgicos (15,45 ± 0,67 vs 11,76 ± 0,23; p < 0,00001). El 23 por ciento recibió tratamiento quirúrgico. El principal nivel educativo: secundario completo 21,6 por ciento. Dificultades económicas: 20 por ciento, mortalidad 9,26 por ciento; prevalencia de dislipemia, diabetes e hipertensión: 22,53 por ciento; 28,82 por ciento y 51,86 por ciento con 473 nuevos diagnósticos, IMC: 27,88 ± 0,65, Charlson global 2,09 ± 0,02 y en óbitos 3,84 ± 0,11. La media de patologías por paciente fue de 2,14 ± 0,01 y aumentó con la edad (p valor regresión lineal < 0,00001). Conclusiones: La hipertensión, la diabetes y la dislipemia representaron las entidades más prevalentes en Salas de Internación Clínica, Las enfermedades cardiovasculares, respiratorias, infectológicas, oncológicas, neurológicas, metabólicas y nefrológicas fueron predictores independientes de mortalidad(AU)
Introduction: The study of comorbidity requires a multilateral approach with a view to improving the quality of care for these patients by the care system. Objectives: To explore the magnitude of the comorbidity of chronic diseases in adults admitted to hospitals. Methods: Prospective-observational-longitudinal-analytical study. Patients hospitalized in a medical clinic room or clinical patients in indiscriminate hospitalization rooms are included, Multicenter study in 42 centers, with 2 years of recruitment. Consecutive sampling. Descriptive, inferential and regression statistics. Results: 5925 recruited, male gender 50,3percent, age 60,66 ± 0,25 years, main origin from the guard 73percent, stay 12,61 ± 0,24 days, longer in surgical (15,45 ± 0,67 vs 11,76 ± 0,23, p < 0,00001), 23percent received surgical treatment. Main educational level: complete secondary school 21,6%. Economic difficulties: 20percent, mortality 9,26percent, prevalence of dyslipidemia, diabetes and hypertension: 22,53percent, 28,82percent and 51,86percent with 473 new diagnoses in said pathologies, BMI: 27,88 ± 0,65, Global Charlson 2,09 ± 0,02 and in deaths 3,84 ± 0,11. The average number of pathologies per patient was 2,14 ± 0,01 and increased with age (p value for linear regression < 0,00001). Conclusions: Hypertension, diabetes and dyslipidemia represented the most prevalent entities in the clinical hospitalization room, cardiovascular, respiratory, infectious, oncological, neurological, metabolic and nephrological diseases were independent predictors of mortality(AU)
Subject(s)
Humans , Male , Female , Comorbidity , Multimorbidity , Internal Medicine , Prospective Studies , Longitudinal Studies , Observational StudyABSTRACT
SUMMARY: This study investigates the relationship between the second and fourth finger ratio (2D:4D), physicians' propensity to choose an internal or surgical branch, and sex differences. On a voluntary basis, 177 physicians working in Elazig, 122 men and 55 women were enrolled in the study. Their hands were measured for 2D and 4D lengths, and the 2D:4D ratio was computed. In female doctors, the left hand's 2D:4D ratio is 1.01, compared to the right hand's 1.00. Male doctors' right 2D:4D ratio is 0.99, while their left 2D:4D ratio is 1.00. Male physicians' 2D:4D ratios were different from those of men in the general population, whereas female physicians' 2D:4D ratios were comparable to those of women in the general population. As a result, this study was the first to examine the relationship between the ratio of the second and fourth fingers (2D:4D), physicians' tendency to choose an internal medicine or surgical branch, and sex differences. While the 2D:4D ratio was higher than 0.98 in all physicians, it was low in women who disliked their profession and branch. Since there aren't many studies on this subject, data from in-depth studies that will be conducted in the future will help physicians who choose internal medicine and surgery make more informed decisions.
Este estudio investiga la relación entre la proporción de los dedos segundo y cuarto (2D:4D), la propensión de los médicos a elegir una rama interna o quirúrgica y las diferencias de género. De forma voluntaria, se inscribieron en el estudio 177 médicos que trabajaban en Elazig, 122 hombres y 55 mujeres. Sus manos se midieron en longitudes 2D y 4D, y se calculó la relación 2D:4D. En las médicos mujeres, la relación 2D:4D de la mano izquierda es 1,01, en comparación con 1,00 de la mano derecha. La relación 2D:4D derecha de los médicos hombres fue 0,99, mientras que la relación 2D:4D izquierda fye 1,00. Las proporciones 2D:4D de los médicos hombres fueron diferentes de las de los hombres en la población general, mientras que las proporciones 2D:4D de las mujeres médicas fueron comparables a las de las mujeres en la población general. Como resultado, este estudio fue el primero en examinar la relación entre la proporción del segundo y cuarto dedo (2D:4D), la tendencia de los médicos a elegir una rama de medicina interna o quirúrgica y las diferencias de sexo. Mientras que la relación 2D:4D fue superior a 0,98 en todos los médicos, fue baja en las mujeres que no les gustaba su profesión y rama. Dado que no hay muchos estudios sobre este tema, los datos de estudios en profundidad que se realizarán en el futuro ayudarán a los médicos que eligen medicina interna y cirugía a tomar decisiones más informadas.
Subject(s)
Humans , Male , Female , Physicians/psychology , Choice Behavior , Fingers/anatomy & histology , Digit Ratios , General Surgery , Sex Factors , Anthropometry , Sex Characteristics , Internal MedicineABSTRACT
Introduction. The management of patients with chronic noncommunicable diseases, when it follows evidence-based recommendations, improves clinical outcomes and health costs. Despite its importance, little is known about adherence to guidelines and the processes for its monitoring in our environment. The objective of this study was to report the applicability and adherence to a selection of recommendations from clinical practice guidelines for noncommunicable chronic diseases by doctors in Bogotá. Methods. This was a cross-sectional study, the baseline of a cluster experiment that assessed the impact of disseminating recommendations on seven chronic diseases to patients, caregivers, and physicians. A total of 177 physicians from public and private health institutions were invited. Consecutive samples of their medical records were manually reviewed in predefined time ranges (up to 20 patients per physician, with up to two diseases of interest). The proportions of applicability and adherence were calculated according to 40 recommendations. Results. The 177 physicians who participated (out of 266 eligible) were from seven institutions, and 3,747 medical records (21,093 patients/recommendation) were analyzed. The general applicability was 31.9% (95% CI 31.3-32.6%), and it varied considerably by recommendation (range 0.3-100%) and disease (range 10.7-65%). Overall adherence was 42.0% (95% CI 40.8-43.2%), with higher adherence in acute coronary syndrome patients (58.4%) and lower adherence in diabetes mellitus patients (23.7%). Discussion. This is the most up-to-date, exhaustive, and representative measurement of adherence to guideline recommendations by doctors in Bogotá. Conclusions. Adherence to evidence-based recommendations for patients with chronic noncommunicable diseases in Bogotá is poor and highly variable. Keywords: Practice Guideline; Evidence-Based Medicine; Noncommunicable Diseases; Quality of Health Care; Implementation Science; Internal Medicine; Primary Health Care
Introducción. El manejo de pacientes con enfermedades crónicas no transmisibles, cuando se realiza a partir de recomendaciones basadas en la evidencia, mejora los desenlaces clínicos y los costos en salud. Pese a su importancia, poco se conocen la adherencia a las recomendaciones de guías y los procesos para su monitoreo en nuestro medio. El objetivo de este estudio es reportar la aplicabilidad y la adherencia a una selección de recomendaciones de guías de práctica clínica, en enfermedades crónicas no transmisibles, por médicos de Bogotá. Metodología. Estudio de corte MSc.Participaron 177 médicos de instituciones de salud públicas y privadas. Se revisaron manualmente muestras consecutivas de sus historias clínicas en rangos de tiempo predefinidos (meta hasta 20 pacientes por médico, en hasta dos enfermedades de interés). Se calcularon las proporciones de aplicabilidad y adherencia en 40 recomendaciones. Resultados. Participaron 177 médicos (de 266 elegibles), de 7 instituciones, con 3,747 historias clínicas (21,093 pacientes/recomendación) analizadas. La aplicabilidad general fue 31.9% (IC95% 31.3%-32.6%), y varió considerablemente por recomendación (rango 0.3%-100%) y enfermedad (rango 10.7%-65%). La adherencia general fue 42.0% (IC95% 40.8% -43.2%), siendo mayor en síndrome coronario agudo (58.4%) y menor en diabetes mellitus (23.7%). Discusión. Esta es la medición más actualizada, exhaustiva y representativa de la adherencia a las recomendaciones de guías por parte de médicos de Bogotá. Conclusiones. La adherencia a recomendaciones basadas en evidencia, para pacientes con enfermedades crónicas no transmisibles de Bogotá, es deficiente y altamente variable. Palabras clave: Guía de Práctica Clínica; Medicina Basada en la Evidencia; Enfermedades no Transmisibles; Calidad de la Atención de Salud; Ciencia de la Implementación; Medicina Interna; Atención Primaria de Salud
Introdução. O manejo de pacientes com doenças crônicas não transmissíveis, quando realizado com base em recomendações baseadas em evidências, melhora os resultados clínicos e os custos de saúde. Apesar da sua importância, pouco se sabe sobre a adesão às recomendações das diretrizes e os processos para monitorá-la em nosso meio. O objetivo deste estudo é relatar a aplicabilidade e adesão a uma seleção de recomendações das diretrizes de prática clínica, em doenças crônicas não transmissíveis, por médicos em Bogotá. Metodologia. Estudo transversal (linha de base de um experimento cluster que avalia o impacto da divulgação de recomendações sobre sete doenças crônicas a pacientes, cuidadores e médicos). Participaram 177 médicos de instituições de saúde públicas e privadas. Foram revisadas manualmente amostras consecutivas de seus prontuários em intervalos de tempo pré-definidos (alvo de até 20 pacientes por médico, em até duas doenças de interesse). Foram calculadas proporções de aplicabilidade e adesão para 40 recomendações. Resultados. Participaram 177 médicos (de 266 elegíveis), de 7 instituições, com 3,747 prontuários (21,093 pacientes/recomendação) analisados. A aplicabilidade geral foi de 31.9% (IC 95% 31.3%-32.6%) e variou consideravelmente por recomendação (intervalo 0.3%-100%) e doença (intervalo 10.7%-65%). A adesão geral foi de 42.0% (IC 95% 40.8%-43.2%), sendo maior na síndrome coronariana aguda (58.4%) e menor na diabetes mellitus (23.7%). Discussão. Esta é a medição mais atualizada, exaustiva e representativa da adesão às recomendações das diretrizes por médicos em Bogotá. Conclusões. A adesão às recomendações baseadas em evidências para pacientes com doenças crônicas não transmissíveis em Bogotá é fraca e altamente variável. Palavras-chave: Guia de Prática Clínica; Medicina Baseada em Evidências; Doenças não Transmissíveis; Qualidade da Assistência à Saúde; Ciência da Implementação; Medicina Interna; Atenção Primária à Saúde
Subject(s)
Evidence-Based Medicine , Primary Health Care , Quality of Health Care , Practice Guideline , Noncommunicable Diseases , Implementation Science , Internal MedicineABSTRACT
Introducción: El Dr. C. Oscar B. Alonso Chil (1930-2021) formó parte de los médicos que permanecieron en Cuba después del triunfo de la Revolución. Fue fundador de servicios de asistencia en medicina interna y geriatría, y realizó importantes contribuciones a la docencia médica. Objetivo: Exponer la trayectoria de Oscar B. Alonso Chil como médico y docente de la medicina cubana revolucionaria, a través de su historia de vida. Métodos: Se realizó un estudio de tipo descriptivo y de corte cualitativo, donde se utilizó la técnica de la historia de vida, centrada en el aspecto profesional. Para ello se hizo una entrevista semiestructurada al testimoniante como fuente fundamental de información. Se validó el testimonio oral mediante la revisión de la documentación oficial en su expediente docente y la literatura científica existente relacionada con el tema, además de entrevistas a sus alumnos y compañeros de trabajo. Desarrollo: Se constató que fundó servicios; organizó la actividad docente; realizó tutorías, publicaciones y asesorías; y fue miembro de tribunales y consejos científicos. Cada una de sus actividades las desempeñó con gran compromiso e incondicionalidad a su profesión, lo cual le generó mucha satisfacción con la vida. Llegó a ostentar las más altas distinciones por su trabajo: Especialista de Segundo Grado en Medicina Interna, y Profesor Titular, Consultante y de Mérito de la Universidad de Ciencias Médicas de La Habana. Conclusiones: Oscar B. Alonso Chil contribuyó al desarrollo de la medina interna en Cuba en la etapa revolucionaria. Este profesor representa un modelo para los estudiantes de ciencias médicas por su prestigio profesional y científico(AU)
Introduction: Ph.D. Oscar B. Alonso Chil (b. 1930-d. 2021) was one of the physicians who stayed in Cuba after the triumph of the Revolution. He was a founder of the healthcare services for internal medicine and geriatrics, and made important contributions to medical teaching. Objective: To present the professional career of Oscar B. Alonso Chil as a physician and teacher of revolutionary Cuban medicine, through his life history. Methods: A descriptive and qualitative study was carried out, using the life history technique, focused on the professional aspect. For this purpose, a semistructured interview was conducted with the testimony witness as a fundamental source of information. The oral testimony was validated by reviewing the official documentation in his teaching file and the existing scientific literature related to the subject; in addition to interviews with his students and coworkers. Development: It was observed that he founded services, organized the teaching activity, supervised research, made publications and consultancies, and was a member of scientific boards and councils. He performed each of these activities with great commitment and unconditionality to his profession, which gave him great satisfaction with life. He achieved holding the highest distinctions for his work: second-degree specialist in Internal Medicine, as well as Full Professor, Faculty Consultant and Emeritus Professor of the University of Medical Sciences of Havana. Conclusions: Oscar B. Alonso Chil contributed to the development of internal medicine in Cuba during the revolutionary period. This professor represents a role model for students of medical sciences due to his professional and scientific prestige(AU)
Subject(s)
Humans , Physicians , Life , Autobiography , Famous Persons , Publications , Research , Liability, Legal , Education, Medical , Faculty/history , Work Engagement , Geriatrics/education , Internal Medicine/education , Medical AssistanceABSTRACT
BACKGROUND@#Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas.@*METHODS@#This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old).@*RESULTS@#Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention.@*CONCLUSIONS@#Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.
Subject(s)
Middle Aged , Humans , Male , Female , Retrospective Studies , East Asian People , Certification , Physicians , Internal MedicineABSTRACT
Objectives To learn the echocardiography skills of intensivists after receiving a basic critical care echocardiography training course, and investigate factors that may influence their performance. Methods We completed a web-based questionnaire that assessed the skills in ultrasound scanning techniques of intensivists who took a training course on basic critical care echocardiography held in 2019 and 2020. Mann-Whitney test was used to analyze the factors which might affect their performance on image acquisition, recognizing clinical syndrome, and measuring the diameter of inferior vena cava, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral.Results We enrolled 554 physicians from 412 intensive care units across China. Among them, 185 (33.4%) reported that they had 10%-30% chance of being misled by critical care echocardiography when making therapeutic decision, and 34 (6.1%) reported that the chance was greater than 30%. Intensivists who performed echocardiography under the guidance of a mentor and finished ultrasound scanning more than 10 times per week reported significant higher scores in image acquisition, clinical syndrome recognition, and quantitative measurement of inferior vena cava diameter, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral than those without mentor and performing echocardiography 10 times or less per week respectively (all P < 0.05).Conclusion The skills in diagnostic medical echocardiography of Chinese intensivists after a basic echocardiographic training course remain low, and further quality assurance training program is clearly warranted.
Subject(s)
Humans , Clinical Competence , East Asian People , Echocardiography/standards , Stroke Volume , Ventricular Function, Left , Self-Assessment , Physicians/standards , Internal Medicine/standardsABSTRACT
Revista Médica de Chile was founded in 1872 by Sociedad Médica de Santiago (currently Chilean Society of Internal Medicine) and it is one out of twenty five medical journals founded during the XIX Century that still remain active. In monthly issues it presents clinical and biomedical research articles, as well as research and position papers dealing with medical education, public health or medical ethics. Special attention receive the impact on health care given by the emergence of new private medical schools in Chile, the relevance of methodologies to assess clinical competences in graduates, the certification of specialty programs and specialists, the appropiate use of simulators in clinical training, telemedicine, organ transplants, and current issues in medical ethics, such as abortions and euthanasia. Institutional and international collaboration in medical research is clearly reflected in recent years. Articles are subjected to external peer review and ICMJE Recommendations are carefully considered throughout the review process. Most articles are published in Spanish but English abstracts are mandatory and a growing number of articles are currently published in English. An Open Access electronic version is published by SciELO. Revista Médica de Chile is indexed in the most important international data bases and it is a member of the ICMJE ruling committee. The long life and prestige of this journal can be considered a testimony of the cultural heritage and progress in Chilean medicine.
Subject(s)
Humans , History, 19th Century , History, 20th Century , History, 21st Century , Periodicals as Topic/history , Anniversaries and Special Events , Bibliometrics , Chile , Education, Medical , Internal Medicine/historyABSTRACT
Introducción: Cuando se habla del símbolo de las generaciones de especialistas que se dedican a la Medicina Interna es necesario referirse al Doctor Alfredo Darío Espinosa Brito, destacado internista cienfueguero que cuenta con una fecunda trayectoria merecedora del reconocimiento de la comunidad médica. Objetivo: Describir los acontecimientos significativos de su vida y obra. Métodos: Se realizó una investigación de tipo descriptiva, que utiliza la historia de vida para lograr su propósito. Fue empleado el método teórico histórico-lógico; para la recolección de datos, se realizó una revisión documental y el testimonio directo de la voz del profesor como fuente primaria de obtención de la información. Desarrollo: los progenitores le inculcaron nobles principios de honradez que definieron su personalidad. Tuvo una trayectoria estudiantil sobresaliente marcada por ideas progresistas. Cuenta con una brillante carrera profesional merecedora de múltiples condecoraciones, pues su influencia ha sido esencial en la enseñanza del método clínico. Conclusiones: El doctor Espinosa ha contribuido sobremanera al desarrollo de la Medicina Interna, la Terapia Intensiva y la Geriatría en el territorio, además de realizar importantes aportes docentes, investigativos, teóricos y prácticos al avance de la enseñanza y de la Salud Pública en Cuba(AU)
Introduction: When talking about the symbol of the generations of specialists dedicated to Internal Medicine, it is necessary to refer to Dr. Alfredo Darío Espinosa Brito, an outstanding internist from Cienfuegos who has a fruitful career deserving the recognition of the medical community. Objective: To describe the significant events of his life and work. Methods: A descriptive research was carried out, using life history to achieve its purpose. The historical-logical theoretical method was used; for data collection, a document review and the direct testimony of the professor's voice were used as the primary source of information. Development: His parents instilled in him noble principles of honesty that defined his personality. He had an outstanding student career marked by progressive ideas. He has a brilliant professional career deserving of multiple decorations, as his influence has been essential in the teaching of the clinical method. Conclusions: Dr. Espinosa has contributed greatly to the development of Internal Medicine, Intensive Care and Geriatrics in the territory, in addition to making important teaching, research, theoretical and practical contributions to the advancement of teaching and Public Health in Cuba(AU)
Subject(s)
Humans , Famous Persons , Internal Medicine/education , Epidemiology, Descriptive , CubaABSTRACT
BACKGROUND: COVID-19 impacted all areas of our society, and we took advantage of new technologies such as telemedicine to deliver information. Peer education is another tool that can be used. AIM: To report the experience of peer education among residents using a digital platform. MATERIAL AND METHODS: A digital educational program was devised in which third year residents exposed different relevant topics in internal medicine to their first year peers using Zoom. The educational process was evaluated using a Likert scale. RESULTS: A high level of satisfaction was found among the respondents according to the scale. Conclusions: There was a high level of satisfaction with the used methodology among first-year residents. A more exhaustive evaluation of this educational program should be worthwhile.
Subject(s)
Humans , COVID-19 , Internship and Residency , Education, Medical, Graduate , Internal MedicineABSTRACT
Introducción: En la educación médica superior, las opiniones de los estudiantes constituyen valiosas herramientas para justipreciar la calidad del proceso docente educativo. En la asignatura Medicina Interna es importante determinar los recursos de aprendizaje más provechosos y atractivos para los estudiantes, con el propósito de mejorar la calidad del proceso docente educativo. Objetivos: Identificar la utilidad que los estudiantes le atribuyen a los recursos didácticos para el aprendizaje de los contenidos teóricos de la asignatura Medicina Interna. Métodos: Se realizó un estudio observacional descriptivo y transversal en el Hospital Docente Clínico Quirúrgico Joaquín Albarrán Domínguez. La muestra incluyó 483 estudiantes de la asignatura Medicina Interna de los cursos 2016-2017 y 2017-2018, a los que se les aplicó una encuesta para identificar sus opiniones sobre la utilidad que le atribuyen a los recursos para el aprendizaje de los contenidos teóricos de la asignatura Medicina Interna. Resultados: El 67,5 por ciento de los estudiantes prefiere disponer de materiales digitales confeccionados por los profesores con preguntas para su autoevaluación, el 67,3 por ciento considera que puede aprender los contenidos teóricos de la asignatura solo mediante el estudio independiente, el 32,1 por ciento encuentra útil asistir a las conferencias y el 84,1 por ciento prefiere consultar al profesor para aclarar sus dudas. Conclusiones: Para alcanzar mayor eficiencia en el aprendizaje de los contenidos teóricos de la asignatura Medicina Interna, debe potenciarse el desarrollo de modalidades de clases taller que tengan en cuenta las expectativas de los estudiantes y promuevan el empleo de recursos didácticos para el aprendizaje activo(AU)
Introduction: In higher medical education, students´ s opinions are valuable tools to assess the quality of the educational teaching process. In the Internal Medicine subject, it is important to determine the most profitable and attractive learning resources for students, with the purpose of improving the quality of the educational teaching process. Objectives: To identify the usefulness that students attribute to the didactic resources for learning the theoretical contents of Internal Medicine. Methods: A descriptive and cross-sectional observational study was carried out at Joaquín Albarrán Domínguez Clinical-Surgical Teaching Hospital. The sample included 483 students of the Internal Medicine of 2016-2017 and 2017-2018 school years, to whom a survey was applied to identify their opinions on the usefulness they attribute to the resources for learning theoretical contents of Internal Medicine. Results: 67.5 percent of students prefer to have digital materials made by teachers with questions for self-assessment, 67.3 percent consider that they can learn theoretical content of the subject only through independent study, 32.1 percent find it useful to attend the lectures and 84.1 percent prefer to consult the professor to clarify their questions. Conclusions: In order to achieve better efficiency in learning theoretical contents of Internal Medicine, workshop- class modalities should be promoted to take into account the expectations of the students and promote the use of didactic resources for active learning(AU)
Subject(s)
Humans , Male , Female , Young Adult , Education, Medical , Internal Medicine/education , Learning , Epidemiology, Descriptive , Cross-Sectional Studies , Observational StudyABSTRACT
Introduction Les maladies auto-immunes systémiques (MAIS) sont peu connues malgré les progrès diagnostiques et thérapeutiques réalisés ces dernières années. L'objectif de ce travail était de décrire le profil épidémiologique, diagnostique et thérapeutique des MAIS dans les services de Médecine Interne et de Dermatologie du Centre Hospitalier Universitaire de Bouaké (CHU). Méthodes Il s'agissait d'une étude transversale descriptive réalisée dans les services de Médecine Interne et de Dermatologie du CHU de Bouaké, sur une période de 10ans (janvier 2009- décembre 2018). Résultats : Sur 30906 patients, 50 présentaient une MAIS soit une prévalence hospitalière de 0,16%. Les MAIS les plus fréquentes étaient le lupus érythémateux systémique (50%) et la sclérodermie systémique (42%). L'âge moyen était de 39,5ans ±15ans et le sex-ratio de 0,19. Le délai moyen de consultation était de 26,2 mois. Le tableau clinique était dominé par les signes généraux (98%), les manifestations cutanéomuqueuses (96%) et les manifestations articulaires (90%). Chez 37 patients ayant réalisé l'hémogramme, l'anémie représentait 51,3% des cas. Le syndrome inflammatoire était objectivé chez 67% des 12 patients possédant un bilan inflammatoire. Les auto-anticorps réalisés chez 05 patients étaient contributifs chez 03 patients. Les corticoïdes par voie générale étaient prescrits dans 56% des cas et les perdus de vue étaient observés dans 90% des cas. Conclusion : Les MAIS étaient rares dans notre étude, dominées par le lupus érythémateux systémique et la sclérodermie systémique. L'amélioration du plateau technique et l'accessibilité du bilan immunologique et la sensibilisation paraissent indispensables afin d'améliorer la prise en charge des patients.
Introduction: Systemic autoimmune diseases (SAID) are little known despite the diagnostic and therapeutic progress made in recent years. The objective of this work was to describe the epidemiological, diagnostic and therapeutic profile of SAID in Internal Medicine and Dermatology departments of the university hospital of Bouake. Methods: This was a cross-sectional study carried out in the Internal Medicine and Dermatology departments of the university hospital of Bouake, over a period of 10 years (January 2009-December 2018). Results: Of 30,906 patients, 50 presented SAID with a hospital prevalence of 0.16%. The most common SAID were systemic lupus erythematosus (50%) and systemic sclerosis (42%). The mean age was 39.5 ± 15 years, and the sex ratio was 0.19. The average consultation time was 26.2 months. The clinical picture was dominated by general signs (98%), mucocutaneous manifestations (96%) and articular manifestations (90%). In 25 patients who performed the blood count, anemia represented 76% of cases. The inflammatory syndrome was objectified in 67% of the 12 patients with an inflammatory profile. The auto-antibodies made in 05 patients were contributory in 03 patients. Systemic corticosteroids were prescribed in 56% of cases and patients were lost to follow-up in 90% of cases. Conclusion: SAID were rare in our study, dominated by systemic lupus erythematosus and systemic scleroderma. Improvement of the technical platform and accessibility of the immunological assessment appears essential in order to improve patient's care.
Subject(s)
Humans , Male , Female , Scleroderma, Systemic , Autoimmune Diseases , Therapeutics , Dermatology , Internal Medicine , Lupus Erythematosus, SystemicABSTRACT
Introducción: La certificación de la calidad de programas en el posgrado constituye un tema cardinal dentro de los ejes estratégicos de la educación superior a nivel nacional e internacional. Objetivo: Describir las ventajas de la acreditación de la calidad de los programas de las especialidades de posgrado, tomando como ejemplo la de Medicina Interna en Santiago de Cuba. Métodos: Se desarrolló una investigación pedagógica, con enfoque mixto sobre dicha temática, según el subsistema vigente, jerarquizado por la Junta de Acreditación Nacional. Para el proceso de evaluación externa se consideraron las ediciones concluidas 35 y 36 del quinquenio 2014-2019 en Medicina Interna más, las ediciones 37, 38 y 39 en ejecución. Se realizó una minuciosa sistematización de procesos, socialización de experiencias de la autoevaluación y evaluación externa, así como una reflexión histórica acerca de la trascendencia y aspectos conceptuales esenciales de la especialidad. Resultados: Se mostraron fortalezas e impactos fundamentales alcanzados en cada variable del patrón de calidad, lo que demostró reconocido prestigio institucional del programa, eficiencia académica en su ejecución, notable visibilidad del claustro, distinguida gestión en el aseguramiento didáctico y tecnológico, excelente fundamentación teórica y metodológica del currículo junto a una sólida tradición de ambos escenarios laborales. Conclusiones: Propuesta útil de procedimientos organizacionales y de gestión primordiales, que urge generalizar para el mejoramiento continuo de la educación posgraduada, junto a la responsabilidad social universitaria demostrada y lograr que los indicadores de calidad en el rango de excelencia sean sostenibles(AU)
Introduction: The quality certification of postgraduate programs constitutes a cardinal issue within the strategic axes of higher education domestically and worldwide. Objective: To describe the advantages of the quality certification of the programs of the postgraduate specialties, taking as an example the Internal Medicine in Santiago de Cuba. Methods: A pedagogical research was developed with a mixed approach on said subject, according to the current subsystem, ranked by the National Certification Board. For the external evaluation process, we considered the 35th and 36th editions of the 2014-2019 five-year period in Internal Medicine plus, the 37th, 38th and 39th editions in progress. A meticulous systematization of processes, socialization of experiences of self-evaluation and external evaluation was carried out, as well as a historical reflection on the transcendence and essential conceptual aspects of the specialty. Results: The strengths and fundamental impacts achieved in each variable of the quality standard were shown, which demonstrated recognized institutional prestige of the program, academic efficiency in the execution, notable visibility of the faculty, distinguished management in the didactic and technological assurance, excellent theoretical foundation and methodological curriculum together with solid tradition of both work settings. Conclusions: It is a useful proposal of fundamental organizational and management procedures, which is urgent to generalize for the continuous improvement of postgraduate education, together with the demonstrated university social responsibility and to ensure that the quality indicators in the range of excellence are sustainable(AU)
Subject(s)
Humans , Male , Female , Quality Control , Education, Continuing , Internal MedicineABSTRACT
La informatización de la sociedad es una exigencia social que favorece la búsqueda de información y la actualización de contenidos mediante el trabajo colaborativo. Este trabajo se propuso evaluar la efectividad de una intervención educativa para la utilización de las tecnologías de la información y la comunicación en el proceso de enseñanza-aprendizaje de la asignatura Medicina Interna. Se realizó un estudio cuasi experimental en la Sede Universitaria del Municipio Gibara, en el período de septiembre de 2018 a junio del 2019. La población estuvo representada por 29 estudiantes y ocho profesores que cumplieron los criterios de inclusión y de exclusión, a quienes se les aplicaron cuestionarios de entrada y de salida. Entre los medios personales disponibles para el uso de las tecnologías de la información y la comunicación predominó el Smartphone (100 por ciento). La intervención demostró que los conocimientos sobre búsqueda, gestión y procesamiento de la información fueron adecuados en el 94,59 por ciento y reflejó que el 100 por ciento de los casos utilizó los métodos tradicionales en las actividades docentes de Medicina Interna. La evaluación de la alternativa por los profesores y estudiantes fue valorada de adecuada por el 100 por ciento de los participante(AU)
Informatization of society is a social need leading to collaborative information search and content updating. The purpose of the study was to evaluate the effectiveness of an educational intervention fostering the use of information and communications technologies in the teaching-learning process of Internal Medicine undergraduate courses. A quasi-experimental study was conducted at the branch university campus of the Municipality of Gibara from September 2018 to June 2019. The study population was 29 students and eight teachers meeting the inclusion and exclusion criteria, who answered input and output questionnaires. Smartphones prevailed among the personal aids available for the use of information and communications technologies (100percent). The intervention showed that knowledge about the search for, management and processing of information was adequate in 94.59percent, whereas 100percent of the participants use traditional methods in Internal Medicine teaching activities. The alternative method was evaluated as adequate by 100percent of the participant teachers and students(AU)
Subject(s)
Humans , Male , Female , Teaching/standards , Information Technology/trends , Internal MedicineABSTRACT
INTRODUCCIÓN: la resistencia a los antimicrobianos plantea una amenaza para la salud pública a nivel mundial. Las infecciones por bacterias ESKAPE representan mayores problemas de resistencia, debido a que pueden presentar más de un mecanismo de resistencia y además tienen la facultad de transmitirlo. En Bolivia no existen artículos publicados que muestren la multirresistencia de bacterias ESKAPE en hospitales de tercer nivel. OBJETIVO: describir el perfil de sensibilidad y resistencia antimicrobiana de las bacterias ESKAPE aisladas en todas las unidades de internación del Hospital Del Norte durante la gestión 2019. MATERIAL Y MÉTODOS: estudio observacional, descriptivo, incluyó 836 aislamientos obtenidos de enero a diciembre del 2019 provenientes de pacientes internados en todas las unidades del Hospital del Norte. Se empleó el sistema WHONET y las variables estudiadas fueron: edad, género, tipo de muestra, sala de internación, perfil de sensibilidad y resistencia de cada uno de los microorganismos en estudio. RESULTADOS: Se elaboró y describió el perfil de sensibilidad y resistencia antimicrobiana de las bacterias ESKAPE, encontrándose que los Enterobacterales tienen mayor frecuencia, siendo Escherichia coli el patógeno más prevalente; se determinó que existe mayor frecuencia en pacientes adultos, con mayor prevalencia en el género femenino. La frecuencia por tipo de muestra se observa que los tres primeros lugares lo ocupan las muestras de orina, vías respiratorias bajas y abscesos. Los servicios de Terapia intensiva, Medicina Interna y Cirugía son las áreas más críticas. Se obtuvieron los porcentajes de resistencia que presentan cada uno de los microorganismos estudiados según sala de internación. Los principales mecanismos de resistencia fenotípica encontrados en este estudio, son BLEE y MRSA. CONCLUSIONES: los resultados obtenidos demuestran que el mapa epidemiológico de resistencia antimicrobiana del Hospital del Norte, presenta porcentajes más altos en relación a los mapas epidemiológicos similares de otros hospitales en Latinoamérica.
INTRODUCTION: antimicrobial resistance raises a serious threat to health worldwide. Infections by ESKAPE bacteria represent major resistance problems, since they can present more than one resistance mechanism and also have the ability to transmit other bacteria. In Bolivia, unfortunately, there are no Bolivian authors who have published articles explaining the multi-resistance of ESKAPE Bacteria in third level hospitals. OBJECTIVE: To describe the antimicrobial sensitivity and resistance profile of ESKAPE bacteria isolated in all inpatient units of Hospital Del Norte in 2019. MATERIAL AND METHODS: observational, descriptive study, included 836 isolates obtained from January to December 2019 from patients hospitalized in all units of Hospital del Norte. WHONET software was used and the variables studied were: age, gender, type of sample, hospitalization room and resistance profile of each of the microorganisms under study. RESULTS: the antimicrobial sensitivity and resistance profile of each ESKAPE bacteria was elaborated and described, and it was found that Enterobacteriaceae have a higher frequency, with Escherichia coli is being the most prevalent pathogen; it was determined that there is a higher frequency in adult patients, with a higher prevalence in the female gender. The frequency by type of sample shows that the first three places are occupied by urine, lower respiratory tract and abscess samples. Intensive care, internal medicine, and surgery services are the most critical areas. The percentages of resistance were obtained for each of the microorganisms studied according to the hospitalization room. ESBL and MRSA are the main phenotypic resistance mechanism found in the hospital. CONCLUSIONS: the results obtained show that the epidemiological map of antimicrobial resistance at Hospital del Norte presents higher percentages in relation to similar epidemiological maps of other hospitals in Latin America.
Subject(s)
Bacteria , Escherichia coli , Inpatients , Public Health , Internal MedicineABSTRACT
Introducción: México es segundo lugar mundial en obesidad en adultos y los médicos residentes no están exentos de este problema. La dieta inadecuada y la inactividad física son factores asociados. La bioimpedancia tiene mayor precisión que la antropometría. Objetivo: analizar la diferencia entre grado de actividad física, ingesta calórica y composición corporal en residentes de Medicina Interna de acuerdo con su grado de residencia. Material y métodos: estudio transversal. Se incluyeron médicos residentes de ambos sexos de segundo, tercero y cuarto grado, quienes participaron en ayuno. Se les tomaron signos vitales, se les otorgó el cuestionario Rapid Assesment of Physical Activity (RAPA), antropometría, recordatorio de 24 horas y medición de composición corporal por bioimpedancia. Se empleó estadística descriptiva, prueba de Kruskal-Wallis y chi cuadrada. Resultados: se incluyeron 84 médicos residentes, 48 (57.14%) fueron del género masculino. La mediana de edad fue de 27 años (26-28). Se encontró una prevalencia de sobrepeso y obesidad de 46.4% a pesar de la dieta hipocalórica en el 89%. La medición por bioimpedancia indicó que 72.6% tuvo grasa corporal elevada, 71% grado de actividad física subóptimo y 23.7% hipertensión arterial. Conclusiones: se encontró una alta prevalencia de sobrepeso y obesidad con diferencias en la composición corporal y el nivel subóptimo de actividad física. Es importante corregir los malos hábitos alimenticios y mejorar la actividad física para reducir riesgos en esta población.
Background: Mexico is ranked second in obesity in adults worldwide and resident physicians are not exempt from this problem. Inadequate diet and physical inactivity are associated factors. Bioimpedance has greater precision than anthropometry. Objective: To analyze the difference between degree of physical activity, caloric intake and body composition in Internal Medicine residents according to their degree of residence. Material and methods: Cross-sectional study. Resident physicians of both sexes, from second, third and fourth degree of training were included; they were fasting. Vital signs were taken; a Rapid Assessment of Physical Activity (RAPA) questionnaire, anthropometry, a 24-hour reminder, and bioelectrical impedance analysis were administered. Descriptive statistics, Kruskal-Wallis and chi squared tests were used. Results: 84 resident physicians were included, 48 were male. The median age was of 27 years (26-28). There was a prevalence of 46.4% of overweight and obesity, despite the hypocaloric diet in 89%. Bioelectrical impedance analysis showed that 72.6% of residents had elevated body fat, 71% sub-optimal degree of physical activity and 23.7% arterial hypertension. Conclusions: A high prevalence of overweight and obesity was found with differences in body composition and suboptimal level of physical activity. It is important to correct bad eating habits and improve physical activity to reduce risks in this population.
Subject(s)
Humans , Male , Female , Students, Medical , Physical Conditioning, Human , Mexico , Body Composition , Exercise , Cross-Sectional Studies , Overweight , Feeding Behavior , Sedentary Behavior , Hypertension , Internal MedicineABSTRACT
Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.
Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.
Subject(s)
Humans , Critical Illness , Practice Guidelines as Topic , COVID-19 , Internal Medicine , Pathology , Sepsis , Hepatic Insufficiency , Heart Arrest , Hospitals, Public , MexicoABSTRACT
ABSTRACT Introduction: During the last decades, benzodiazepines (BZD) and antidepressants (ADP) have been among the most prescribed therapies in all developed countries. They have side effects, and BZD carry a risk of abuse and dependence disorders. The purpose of this study was to evaluate the prevalence of BZD and ADP among patients who attend a Rheumatology clinic, as well as the indication for these drugs. Methods: The study included patients who were referred for the first time to the Rheumatology clinic. Demographical data, reason for referral, and final diagnosis were recorded. The indication for ADP and/or BZD was recorded, as well as the duration of treatment. Sample size was estimated for a 0.05% alpha risk. Univariate and multivariate analyses were performed in order to study the relationships with the demographical or clinical characteristics. Results: A total of 350 patients were included (women 77.1%, men 22.9%). Most of them (73.4%) had been referred for musculoskeletal pain. More than a third (36.6%) of patients were on BZD and/or ADP. The most frequent reasons for their prescription were anxiety, depression, and insomnia. The final diagnosis in the clinic was a non-inflammatory condition in 82%, and an inflammatory one in 18%. In the univariate analyses, the use of BZD/ADP was associated with female gender (p<.001), unemployment (p<.001) and non-inflammatory final diagnosis (p < .001). In the multivariate analyses, the use of BZD and/or ADP was associated with female sex (p = .002 [OR 3.4, 95% CI; 1.6-7.4]), and a non-inflammatory final diagnosis, specifically fibromyalgia (p = .007 [OR 16.1, 95% CI; 2.2-120.7]). Conclusion: Use of BZD and ADP is high and associated with non-inflammatory disease.
RESUMEN Introducción: Durante las últimas décadas, las benzodiacepinas (BZD) y los antidepresivos (ADP) han estado entre las terapias más prescritas en todos los países desarrollados. Estos fármacos tienen efectos secundarios y las BZD pueden ocasionar abuso y problemas de dependencia. El objetivo de este estudio fue evaluar la prevalencia de consumo de BZD y ADP entre los pacientes que acuden a una consulta de reumatología por primera vez, así como la indicación para ellos. Métodos: Se incluyeron pacientes remitidos por primera vez a la consulta de reumatología. Se registraron los datos demográficos, el motivo de la derivación y el diagnóstico final. Con respecto al tratamiento con ADP y/o BZD, se registraron su duración y la indicación de la prescripción. El tamaño de la muestra se estimó para un riesgo alfa de 0,05%. Se realizaron análisis univariantes y multivariantes para estudiar las asociaciones con características demográficas o clínicas. Resultados: Se incluyeron 350 pacientes (mujeres 77,1%, hombres 22,9%). La mayoría de ellos habían sido remitidos por dolor musculoesquelético (73,4%). Más de un tercio (36,6%) de los pacientes estaban en tratamiento con BZD y/o ADP. Las causas más frecuentes para su prescripción fueron ansiedad, depresión e insomnio. El diagnóstico final fue patología no inflamatoria en el 82% de los casos e inflamatoria en el 18% de estos. En el análisis univariante, el uso de BZD y/o ADP se asoció con el sexo femenino (p< 0,001), el desempleo (p< 0,001) y el diagnóstico de patología no inflamatoria (p< 0,001). En el análisis multivariante, el uso de BZD y/o ADP se asoció con el sexo femenino (p=0,002 [OR 3,4; IC 95% 1,6-7,4]) y el diagnóstico de patología no inflamatoria, específicamente con la fibromyalgia (p = 0,007 [OR 16,1; IC 95% 2,2-120,7]). Conclusión: El consumo de BZD y ADP es frecuente y está asociado con patología no inflamatoria.