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Resumo: Introdução: O raciocínio clínico é considerado uma das principais habilidades que devem ser desenvolvidas pelos estudantes de Medicina, porque permite a elaboração de hipóteses diagnósticas e orienta estratégias investigativas e diagnósticas de forma racional. Embora os educadores tradicionalmente foquem o ensino no modelo hipotético-dedutivo ou analítico, muitos professores de medicina enfrentam no seu dia a dia o desafio de encontrar novas estratégias para ajudar seus estudantes a desenvolver o raciocínio clínico. Objetivo: Este estudo realizou uma revisão integrativa da literatura para identificar as estratégias utilizadas no processo ensino-aprendizagem do raciocínio clínico, nas escolas médicas brasileiras. Método: A metodologia utilizada consistiu em seis etapas: 1. elaboração da pergunta da pesquisa; 2. definição dos critérios de inclusão e exclusão; 3. elenco das informações a serem extraídas; 4. avaliação dos estudos incluídos; 5. interpretação dos resultados; e 6. apresentação da revisão. Resultado: A maioria dos trabalhos apontam que o ensino do raciocínio clínico é realizado por meio de discussões de casos clínicos, de maneira incidental, em diversas disciplinas ou por meio do uso de metodologias ativas, como PBL, TBL e CBL. Apenas três trabalhos apresentados em congressos demonstraram experiências relacionadas à implantação de uma disciplina curricular obrigatória voltada especificamente ao ensino do raciocínio clínico. O ensino do raciocínio clínico é priorizado no internato em relação às fases clínicas e pré-clínicas. Conclusão: Poucos são os estudos que analisam a maneira como se dá o processo ensino-aprendizagem do raciocínio clínico nas escolas médicas brasileiras. Embora mais estudos sejam necessários, podemos verificar a falta de conhecimento teórico sobre raciocínio clínico como uma das principais causas de dificuldade para o desenvolvimento dessa competência pelos estudantes.
Abstract: Introduction: Clinical reasoning is considered one of the main skills that must be developed by medical students, as it allows the establishment of diagnostic hypotheses and directs investigative and diagnostic strategies using a rational approach. Although educators have traditionally focused the teaching method on the analytical model, many medical professors face the challenge in their daily lives of finding new strategies to help their students develop clinical reasoning. Objective: To carry out an integrative literature review to identify the strategies used in the teaching-learning process of clinical reasoning in Brazilian medical schools. Method: The methodology used consists of six steps: 1. creation of the research question; 2. definition of inclusion and exclusion criteria; 3. list of information to be extracted; 4. evaluation of included studies; 5. interpretation of results and 6. presentation of the review. Results: Most studies indicate that the teaching of clinical reasoning is carried out through discussions of clinical cases, incidentally, in different disciplines or through the use of active methodologies such as PBL, TBL and CBL. Only three studies presented at conferences disclosed experiences related to the implementation of a mandatory curricular discipline specifically aimed at teaching clinical reasoning. The teaching of clinical reasoning is prioritized in internships in relation to the clinical and pre-clinical phases. Final considerations: There are few studies that analyze how clinical reasoning is taught to medical students in Brazilian medical schools. Although more studies are needed, we can observe the lack of theoretical knowledge about clinical reasoning as one of the main causes of the students' difficulty in developing clinical reasoning.
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Objective To investigate the significance of digital tomosynthesis (DTS) for suspicions lesions in the physical examination of the chest.Methods Totally 1 000 physical examinees were divided into two groups,with 500 younger ones in one group and the remained 500 ones in the other.The examinees underwent examination with digital X-ray radiography,and then the suspicious cases went through DTS examination to analyze the detection rate of pulmonary positive results.Results There were 110 suspected cases found by digital X-ray radiography,including 8 young ones and 102 old ones.The suspected cases went through DTS examination,and totally 92 nodules were found including 4 ones in the young persons and 88 ones in old persons.CT examination found 89 carcinomatous nodules in the 92 ones.Conclusion DTS examination can detect the lesion of the physical examinee,and lays a foundation for early diagnosis and treatment.
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Objective To investigate the application value of the self-rated health measurement scale (SRHMS) in health check-up.Method A total of 8 083 health check-up receivers frow Fujian Province underwent SRHMS self-assessment,and the results of the assessment were analyzed by Chi-square test.Result The results of the survey showed that the total prevalence rate of chronic disease was 57.8％ top five were stomach/duodenum diseases (14.57％),hypertension (11.58％),mammary gland disease (8.04％),abnormal blood lipid (7.16％) and prostate disease (6.54％).The proportion of these five kinds of illness was 43.38％.A positive correlation between the prevalence rate of chronic disease and age was found.The difference of the prevalence rate of chronic diseases between each age group was statistically significant (x2=863.816,P=0.000).Those with family history of chronic diseases accounted for 69.27％ and those with history of present illness accounted for 57.83％ (4 674/8 083).Bodily pain,dietary preferences,refined grain intake,lack of exercise,and alcohol drinking was found in 75.03％,60.15％,54.84％,46.07％ and 41.50％ participants.Conclusion The SRHMS could reflect the chronic disease incidence and unhealthy daily habits.
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Objective To explore the detection rate and major risk factors of nodular thyroid diseases among adults.Methods A total of 35 495 adults who carried out health checkup during January 1st,2009 and December 31th,2010 in our center were assessed for the occurance of nodular thyroid diseases and the size and number of thyroid nodules by age and gender.Chi-square test,rank sum test and Chi-square trend test were used for data analysis.Results The total detection rate of nodular thyroid diseases was 33.87％ (female vs male:41.76％ vs 29.68％).The prevalence of single thyroid nodule was decreased with age,as opposed to multi-thyroid nodules.Single thyroid nodule was more commonly seen in males,which was reversed in multi-thyroid nodules.Small,middle and large thyroid nodules were found in 77.49％,18.19％ and 4.32％ males or 72.57％,21.59％ and 5.84％ females,respectively.Moreover,thyroid cancer was detected in 0.4‰ of those with nodular thyroid diseases.Conclusions The detection rate of nodular thyroid diseases among adult health checkup receivers was higher,which calls on the needs of intensive monitor and effective prevention of the condition.
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A morte súbita cardíaca em atletas não é um fato novo e nem isolado. Historicamente, ela atinge principalmente atletas jovens, tendo como maior incidência a cardiomiopatia hipertrófica. No ano de 2005, a Sociedade Brasileira de Medicina do Esporte instituiu a Diretriz sobre a Morte Súbita no Exercício e no Esporte. A implementação dessas recomendações por clubes de futebol profissional poderá contribuir para detecção precoce de risco e prevenção de morte súbita nesses atletas. OBJETIVO: Identificar a adoção de protocolos e rotinas por clubes de futebol profissional quanto à avaliação pré-participação dos atletas e sua adequação à Diretriz. MÉTODO: Todos os clubes de futebol profissional do município de São Paulo pertencentes à Federação Paulista de Futebol foram avaliados através de entrevista com o médico responsável pelo Departamento Médico de cada clube, após aprovação do projeto pelo Comitê de Ética em Pesquisa e autorização do sujeito de pesquisa. As respostas foram submetidas à estatística descritiva e comparadas à Diretriz. RESULTADOS: Nenhum clube adota integralmente os exames sugeridos pela Diretriz; contudo, os exames como anamnese completa com enfoque cardiovascular, teste ergométrico e eletrocardiograma de repouso são realizados por todos. O ecocardiograma é realizado por 82,5 por cento dos clubes. CONCLUSÃO: Todos os clubes avaliados seguem um protocolo institucional que contempla parcialmente as recomendações da Diretriz. Sugere-se a integração entre os órgãos responsáveis pelo esporte no Brasil e parcerias privadas com o objetivo de diminuir o custo efetivo dos exames.
Sudden cardiac death in athletes is neither a new nor an isolated phenomenon. Historically, it mainly affects young athletes with a higher incidence as hypertrophic cardiomyopathy. In 2005, the Brazilian Society of Sports Medicine established the Guideline on Sudden Death in Exercise and Sports. The implementation of these recommendations by professional soccer clubs can contribute to early detection of risk and prevention of sudden cardiac death in these athletes. OBJECTIVE: To identify the adoption of protocols and routines by professional soccer clubs concerning the pre-participation evaluation of athletes and their suitability to the Guideline. METHOD: All professional football clubs in São Paulo, members of the São Paulo Soccer Federation, were evaluated through interviews with the doctor in charge of the Medical Department of each club, after the project has been approved by the Ethics in Research Committee and the subject under research provided his authorization. The answers were submitted to descriptive statistics and compared with the Guideline. RESULTS: No club fully adopts the tests suggested by the Guidelines; however, complete history and examination with focus on cardiovascular stress test and resting electrocardiogram are performed by all. Echocardiogram is performed by 82.5 percent of clubs. CONCLUSION: All clubs evaluated follow an institutional protocol that includes part of the recommendations of the Guideline. The integration between agencies responsible for sports in Brazil and private partnerships is suggested with the aim to reduce the effective cost of the examinations.
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Humanos , Masculino , Adulto Joven , Persona de Mediana Edad , Enfermedades Cardiovasculares/prevención & control , Examen Físico/normas , Fútbol/fisiología , Muerte Súbita Cardíaca/prevención & control , Atletas , Recuento de Células Sanguíneas , Electrocardiografía , Ejercicio Físico/fisiología , AnamnesisRESUMEN
Objective To investigate the relationship between fatty liver progress and metabolic changes.Methods A total of 414 patients who had B-mode ultrasonography confirmed fatty liver development during 2 health check-ups within 2 years were enrolled in this study.Paired t and χ2 tests were used to compare body mass index (BMI),alanine aminotransferase (ALT),aspartate aminotransferase (AST),fasting plasma glucose (FPG),serum uric acid (UA),triglycerides (TG),and high-density lipoprotein cholesterol (HDL-C) among the participants.Results BMI,TG,HDL-C,ALT,AST,and UA were significantly increased after fatty liver progressed,although HDL-C was largely decreased.ConclusionsPrevention and treatment of MS as well as early intervention for fatty liver should be important for successful control of fatty liver.
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Objective To explore the use of non-invasive technique for early detection of atherosclerosis in health checkups. Methods A total of 46 824 healthy normotensive volunteers, including 24 879 men and 21 945 women, from 27 physical examination centers were reviewed for their clinical data. Pulse wave velocity (PWV) by age was calculated,and related factors of PWV were analyzed. Results Reference range of PWV was increased with age. Detectable rate of abnormal PWV in men < 60 years was significantly higher than women (P<0.05). Detectable rate of PWV of > 1400 cm/s, > 1700 cm/s or > 2000 cm/s were 34. 5% ,7. 5% and 1.9% Respectively. Correlation analysis showed that PWV was closely related with age and mean systolic blood pressure ( P < 0. 05 ). Conclusion Non-invasive technique for early detection of atherosclerosis and PWV should be useful in physical examinations and cardiovascular disease screening.
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The body mass index, blood pressures and blood profiles of adults, who worked at three colleges in the Daejeon area, were evaluated for use in developing well-balanced menus at their workplace cafeterias and/or in creating nutrition education programs tailored to their health statuses. The data analyzed were from physical examinations performed in 2002 and in 2004 by the National Health Insurance Corporation. Overall, levels of systolic and diastolic blood pressure and serum cholesterol were lower in the 2004 samples than in those of 2002, but most samples in 2004 showed higher levels of SGOT. In 2002, statistical differences occured in the levels of blood pressure and serum cholesterol among age groups, but not in 2004. And in 2004, the older the age group, the higher the BMI. Among subjects in their twenties, three variables (systolic and diastolic blood pressure, and serum cholesterol) showed statistical differences; this increased to four variables (systolic and diastolic blood pressure, blood glucose and serum cholesterol) among subjects in their thirties and to six variables (Hb, SGOT, systolic and diastolic blood pressure, blood glucose and serum cholesterol) among those in their forties, followed by a decline to four variables (systolic and diastolic blood pressure, Hb and serum cholesterol) among subjects in their fifties. In general, the results of physical examinations showed improvements in blood pressure and blood profiles in 2004 in comparison with results in 2002. The level of SGOT was the exception. Despite these improvements, of those employees who had physical examinations in 2004, 5.2% had high blood glucose and 18.1% hypertension, 27.9% hypercholesterolemia, 8.3% registered abnormal liver functions, and 31.3% were classified as overweight and obese. Moreover, because some vulnerable blood profiles were found in the older age groups, various programs, including nutrition education, and/or development of healthful diets as well as excercise activities, may be needed within their workplaces.
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Adulto , Humanos , Aspartato Aminotransferasas , Glucemia , Presión Sanguínea , Índice de Masa Corporal , Colesterol , Dieta , Educación , Hipercolesterolemia , Hipertensión , Hígado , Programas Nacionales de Salud , Sobrepeso , Examen FísicoRESUMEN
OBJECTIVE: This prospective study was done to find out common symptoms and beneficial physical examinations, and to evaluate relations among symptom, pain severity, physical examination method and width of symphysis pubis of symptom-giving pelvic girdle relaxation (PGR) in pregnant women. METHODS: Four hundreds sixty-five pregnant women who complained pelvic pain were asked to fill out a questionnaire. Ninety-six pregnant women were diagnosed as PGR and were examined physically and took the sonogram. Statistical correlation was evaluated among symptoms, pain severity (visual analog scale: VAS), physical examination method and sonogram. RESULTS: The most common complain was difficulty of rolling in bed (100%). The most frequent positive diagnostic physical method was posterior pelvic pain provocative test (PPPT) (85.4%). There was correlation between VAS and symptoms (r= 0.340, P=0.001) but no correlations between VAS or symptoms and numbers of positive physical examination (P>0.05). CONCLUSION: It is suggested that PPPT was most beneficial diagnostic methods of PGR in pregnancy.