Ensino do exame respiratório: o que é história e o que é necessidade? / Teaching the respiratory physical examination: what is history and what is needed?

A semiologia é uma das técnicas mais utilizadas na prática médica há séculos. Ensinada por meio de roteiros sistematizados, estudantes de inúmeras escolas da área de saúde por todo o mundo aprendem as manobras semiológicas como fundamento na avaliação dos pacientes. No entanto, apesar de extremamente difundida, discute-se pouco sobre sua acurácia como manobra diagnóstica. Tendo este ponto em vista, este artigo aborda a precisão das diversas manobras semiológicas do exame físico do aparelho respiratório e a descrição comparativa do seu ensino em diferentes escolas médicas no mundo. Como resultados, tem-se valores de acurácia discordantes, o que pode ser justificado pela qualidade dos estudos ou pelas variáveis analisadas que diferem entre os estudos e propostas de padronização. Em conclusão, a semiologia é a base da avaliação médica, independentemente dos avanços e disponibilidade dos exames de imagens, e cada manobra deve ser ensinada com seu devido valor científico. Conhecer a aplicabilidade e individualizar a prática das etapas do exame respiratório pode ser um caminho possível de adequação aos tempos atuais, sem impor perdas de informações relevantes para o desenvolvimento do raciocínio clínico (AU)

Medical semiology has been one of the most common techniques used in medical practice for centuries. Health science students around the globe learn these techniques through a systematized model as a fundamental skill for patient evaluation. However, though being widespread, little is known about semiology's true accuracy as a diagnostic maneuver. Knowing that, through a literature review, this paper evaluated the precision of the preconized procedures that are used as part of the exam of the respiratory system and the comparative description of its teaching in different medical schools around the world. As a result, disagreement between several papers was found, which can be justified by the poor quality of the studies and the different variables that were studied in each one. However, one thing is still clear: respiratory physical examination continues to be essential in medical practice, independently of the recent advances and availability of imaging exams. Teaching each step should consider available scientific evidence. The knowledge of the applicability and practical individualization of the respiratory examination can be a possible way for the current times without missing relevant information for developing clinical reasoning (AU)

Evaluation of turkish pharmaceutical track and trace system (ITS): perspective of community pharmacists

Abstract Turkish Pharmaceutical Track & Trace System (ITS) is implemented as a system in which drug movements are tracked in order to ensure drug safety. The system is integrated among drug stores, pharmacies and reimbursement institutions. As the pharmacies are the primary users, their evaluations regarding the system are considered important. In this study, it was aimed to evaluate the pharmacies'- a shareholder of ITS in Turkey- satisfaction level for ITS and problems and suggestions encountered in the system. The most expressed contribution of ITS to the pharmacists' work was the ease of medicine tracking and control with 27.1%. The average satisfaction level of pharmacists about ITS was found to be 2.9±1.2. In the research, the most expressed of the regarding the areas of ITS that need to be developed is 'work without interruption' with 37.1%. ITS application has provided advantages for pharmacies in many aspects that facilitate operations. However, continuous development of technology, increasing information resources and diversity, changing expectations, and utilization levels of the users require the constant improvement of the performance of the system.

Monitoreo del impacto en la formación de especialistas en Medicina Intensiva y Emergencias en Matanzas / Monitoring the impact in the formation of specialist in intensive medicine and emergencies, Matanzas

Introducción: la evaluación y acreditación de la calidad en la formación de las especialidades médicas en Cuba, conceptualiza el monitoreo del impacto como el proceso dirigido a evaluar la correspondencia entre los objetivos del programa y los resultados alcanzados por sus participantes en el entorno social donde se desarrollan profesionalmente. Objetivo: aplicar la metodología diseñada para el monitoreo del impacto en la formación de las especialidades médicas en el Programa de Medicina Intensiva y Emergencias. Materiales y métodos: se realizó un estudio de corte pedagógico donde se aplicó la metodología diseñada en la Universidad de Ciencias Médicas de Matanzas, para monitorear el impacto en la formación de la especialidad de Medicina Intensiva y Emergencias, desarrollado en el Hospital Universitario Comandante Faustino Pérez Hernández. Participaron 6 egresados, 11 profesores, 8 tutores y 4 directivos de la última edición concluida (octubre de 2016 a noviembre de 2019). Resultados: se observó un alto impacto en la institución y mediano en el individuo, con contraste entre el diagnóstico inicial y durante la formación: de excelencia en el 100 % de los residentes, pero un diagnóstico final con 33,3 % excelente y 66,6 % bien. No se evaluó la etapa de transferencia o impacto en la sociedad, por el corto de tiempo de experiencia laboral de los egresados. Conclusiones:la metodología aplicada permitió conocer un mediano impacto en la formación de los egresados de Medicina Intensiva y Emergencias, por contrastación entre el diagnóstico inicial y durante la formación, de excelente con un diagnóstico final de bien (AU).

Introduction: the evaluation of the quality in the formation of the medical specialties in Cuba, conceptualize the monitored of the impact like the process directed to evaluate the correspondence among the objectives of the program and the results reached by their participants in the social environment where they are developed professionally, guaranteeing the relevancy of the program. Objective: to apply the methodology designed for the monitored of the impact in the formation of the medical specialties in the program of intensive Medicine and emergencies. Materials and methods: carried out a study of pedagogic court where the methodology was applied designed in the Medical University of Matanzas, for the monitored of the impact in the formation of the specialty of intensive Medicine and emergencies, developed in the university hospital "Faustino Pérez Hernández." They participated six graduate, four directives, 11 professors and tutors of the last concluded edition, from October of the 2016 to November of the one 2019. Results: a high impact was observed in the institution and medium in the individual, with a contrast among the initial diagnosis and during for formation of excellence in 100% of the residents, with a final diagnosis of 33,3% excellent and 66,6% well. It was not evaluated the transfer stage or impact in the society, for the short of time of labor experience of the graduate. Conclusions: the applied methodology allowed to know the medium impact in the formation of graduate in Intensive Medicine and Emergencies in Matanzas, for a contrast among the initial diagnosis and during the formation of excellent with the final diagnosis of well (AU).

Complexity of pediatric chronic disease: cross-sectional study with 16,237 patients followed by multiple medical specialties / Complexidade da doença crônica pediátrica: estudo tranversal com 16.237 pacientes seguidos por múltiplas especialidades médicas

ABSTRACT Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

RESUMO Objetivo: Avaliar dados demográficos e características de crianças e adolescentes com doenças crônicas pediátricas, de acordo com o número de especialidades/paciente. Métodos: Realizou-se um estudo transversal com 16.237 pacientes com doenças crônicas pediátricas durante um ano. A análise foi feita em um sistema eletrônico, de acordo com número de consultas médicas para doenças crônicas pediátricas. Este estudo avaliou dados demográficos, características do seguimento, tipos de especialidades médicas, diagnóstico (10ª Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde - CID-10), número de visitas e complicações agudas. Resultados: Os pacientes acompanhados por três ou mais especialidades simultaneamente tiveram seguimento de maior duração comparados com aqueles seguidos por ≤2 especialidades [2,1 (0,4-16,4) vs. 1,4 (0,1-16,2) anos; p<0,001], bem como maior número de consultas em todas as especialidades. As áreas médicas mais comuns em pacientes acompanhados por ≥3 especialidades foram: psiquiatria (Odds Ratio - OR=8,0; intervalo de confiança de 95% - IC95% 6-10,7; p<0,001); dor/cuidados paliativos (OR=7,4; IC95% 5,7-9,7; p<0,001); doenças infecciosas (OR=7,0; IC95% 6,4-7,8; p<0,001); nutrologia (OR=6,9; IC95% 5,6-8,4; p<0,001). As regressões logísticas mostraram que os pacientes com doenças crônicas pediátricas seguidos por ≥3 especialidades tinham alto risco para: maior número de consultas/paciente (OR=9,2; IC95% 8,0-10,5; p<0,001); atendimentos em hospital-dia (OR=4,8; 95%IC3,8-5,9; p<0,001); atendimentos em pronto-socorro (OR=3,2; IC95% 2,9-3,5; p<0,001); hospitalizações (OR=3,0; IC95%2,7-3,3; p<0,001); internação em terapia intensiva (OR=2,5; IC95% 2,1-3,0; p<0,001); óbitos (OR=2,8; IC95%1,9-4,0; p<0,001). Os diagnósticos de asma, obesidade, dor crônica, transplante e infecção do trato urinário foram mais frequentes nos pacientes seguidos por três ou mais especialidades. Conclusões: O presente estudo mostrou que pacientes com doenças crônicas pediátricas que necessitaram de múltiplas especialidades médicas simultaneamente apresentavam doenças complexas e graves, com diagnósticos específicos.

Usos diversos de los epónimos en Medicina / Various uses of eponyms in Medicine

Los epónimos vienen siendo utilizados desde hace siglos. Su uso habitual constituye una de las características del lenguaje de las ciencias médicas y está extendido a todas las especialidades, formando parte de su cultura y de la historia de la Medicina. Se abordan los epónimos en el campo de varias especialidades médicas, así como el debate científico a favor y en contra de su uso, considerando que no son pocas las voces que apoyan su erradicación total; esto es algo que todavía resulta difícil pensar, ya que se cree que los epónimos aportan más de lo que podrían ofrecer otros recursos lingüísticos. Se reconoce la existencia de epónimos cubanos, que no se han estudiado lo suficiente (AU).

Eponyms have been used during centuries. Their common use is one of the characteristics of the medical sciences language, reaches all the specialties, and is part of the Medicine culture and history. The use of eponyms in the field of several medical specialties is approached and also the scientific dispute in favor or against their use, taking into consideration that no few voices back their total eradication; it is still something difficult to understand because it is believed that eponyms are more fruitful than what is offered by other linguistic resources. The existence of Cuban eponyms that are still not sufficiently studied is recognized (AU).

Control de daño de extremidad pélvica en lesión compleja del pie: Reporte de un caso / Pelvic limb damage control following a complex foot injury: Case report

Las lesiones de la articulación tarsometatarsal (Lisfranc) son producidas en accidentes automovilísticos en más de 20% de los casos, siendo poco común este tipo de trauma y su reducción ha sido reportada en 50% de los casos de manera cerrada. Un paciente masculino de 18 años de edad electricista participa en trauma de alta energía, presentando fractura luxación de Lisfranc expuesta de pie izquierdo grado III B Gustilo y Anderson, siendo sometido a lavado y desbridamiento quirúrgicos, reducción abierta y fijación interna y cobertura cutánea inmediata. Con el tratamiento estricto y los cuidados de las lesiones ortopédicas severas, la proporción de las complicaciones secundarias pueden disminuir. El tratamiento de las lesiones severas de las extremidades incluyendo las óseas combinadas con la de los tejidos blandos (piel, tejido subcutáneo, fascias, uniones músculo-tendinosas, ligamentos, periostio y estructuras neurovasculares), deben seguir un protocolo multidisciplinario: desbridamiento extenso de tejido no viable, erradicación de infecciones y reconstrucción o cobertura de tejidos. Por lo que todo cirujano ortopedista debe tener conocimiento básico del mismo, teniendo vital importancia el manejo adecuado, la técnica precisa para cada caso y el momento preciso para su solución.

More than 20% of the tarsometatarsal joint injuries (Lisfranc injuries) occur during motor vehicle accidents. This kind of trauma is infrequent and in 50% of cases closed reduction is used. A 18 year-old male patient sustained a high-energy trauma resulting in a Gustilo and Anderson III B open Lisfranc fracture dislocation of the left foot. Surgical debridement, open reduction and internal fixation, and immediate skin coverage were performed. The secondary complication rate may decrease with stringent treatment adherence and proper care of severe orthopedic injuries. Treatment of the latter, including bone and soft tissue injuries (skin, subcutaneous tissue, fascias, musculotendinous junctions, ligaments, periosteum, and neurovascular structures) should follow a multidisciplinary protocol: extensive debridement of nonviable tissue, eradication of infections, and tissue reconstruction or coverage. Thus, any orthopedic surgeon should possess basic knowledge of this protocol. Proper management, using the right technique in each case, and the right timing of treatment are of the utmost importance.

Guía práctica para el diagnóstico de muerte encefálica en urgencias del Hospital de San Ignacio (Bogotá, Colombia) / Diagnosis of Brain Death in the Emergency Room of San Ignacio Hospital from Bogota, Colombia: Practical Guideline

En la actualidad, los servicios de urgencias atienden pacientes con daño neurológicograve, especialmente por trauma craneoencefálico, en quienes durante la reanimacióninicial se logra la recuperación de la estabilidad hemodinámica, pero requieren intubacióntraqueal y soporte con ventilación mecánica, sin que con ello se logren recuperar lasfunciones cerebrales y de tallo, lo que lleva a la sospecha de muerte encefálica. No es útilque un paciente con alta probabilidad de certeza para este diagnóstico sea trasladado a unaunidad de cuidado intensivo, pero sí es necesario que los pacientes con este diagnóstico,potencialmente donantes de órganos, puedan ofrecer este último servicio altruista en suexistencia. Los médicos urgenciólogos deben hacer este diagnóstico cuando sea el casoy conocer el ámbito legal que lo rodea...

In currently, emergency services are faced with patients that have severe neurologicaldamage after traumatic brain injury, and especially in those that during the initial resuscitation is achieved hemodynamic stability,required intubation and mechanical ventilationsupport, and were unable to recovery functionalbrain, leading to the suspicion of brain death. Itis futile for those patients with a high probabilityof certainty of this diagnosis need to be hospitalizedto intensive care unit but, it is necessary forthose patients with a diagnosis of brain death,potential organ donor, can offer a last selflessservice in your existence. Emergency physiciansshould make this diagnosis when is appropriate,and know the legal field that surrounds it...

Endoscopist Specialty Is Associated with High-Quality Endoscopy in Korea

PURPOSE: The present study was aimed to determine whether endoscopist specialty is associated with high-quality endoscopy. MATERIALS AND METHODS: We prospectively collected endoscopy quality related data based on the Endoscopy Quality Rating Scale (EQRS) of 277 endoscopy units in a hospital setting from the National Cancer Screening Program of Korea in 2009. Gastroenterology medical professors (n=154) from university hospitals visited each endoscopy unit and graded the unit according to the EQRS. The scores from the EQRS were analyzed and compared in relation to endoscopy training during residency and endoscopy subspecialist certification. RESULTS: After excluding data from 3 endoscopy units, EQRS data from 274 endoscopy units were analyzed: 263 esophagogastroduodenoscopy (EGD) screening units and 90 colonoscopy screening units. There were no significant differences in the scores of EQRS with respect to endoscopy training during residency (p=no significance), except for scores of EGDs for "Facility and Equipment" (p=0.030). However, EQRS scores were significantly higher in the endoscopy units where endoscopy subspecialists performed the endoscopies than those where Endoscopy Subspecialists did not perform the endoscopies (p<0.05, except p=0.08 for the "Process" criteria of EGD). CONCLUSION: Endoscopist specialty is an important determinant of high-quality endoscopy in Korea.

Competencias profesionales de los pasantes de enfermería, medicina y odontología en servicio social en México / Professional competencies of nursing, medical, and dental interns performing social service in Mexico

OBJETIVO: Identificar hasta dónde los pasantes de enfermería, medicina y odontología que están realizando su servicio social en México poseen las competencias profesionales requeridas para ejercer la profesión. MÉTODOS: Se revisaron los resultados de los exámenes generales para el egreso de la licenciatura, aplicados por el Centro Nacional para la Evaluación de la Educación Superior a los egresados de las carreras de enfermería, medicina y odontología entre 2006 y 2008. RESULTADOS: De 39 824 egresados examinados de las tres carreras en el periodo considerado, 12 845 no contaban con las competencias profesionales mínimas. En enfermería, del total de examinandos en los tres años, 3 765 (30,2 por ciento) mostraron desempeño no suficiente; en medicina, 6 704 (32,7 por ciento), y en odontología, 2 376 (34,1 por ciento). A pesar de esto, todos ellos ejercían, o habían ejercido, como profesionistas, con el respaldo de la normatividad correspondiente y formando parte del personal de salud de las instituciones de salud (aproximadamente 11 por ciento de la fuerza de trabajo en esas profesiones, en la Secretaría de Salud). CONCLUSIONES: Los pasantes son la base de la atención de salud de la población rural, pero aproximadamente una tercera parte de ellos no tienen las competencias profesionales mínimas. Es imperativo que demuestren sus competencias profesionales antes de iniciar el servicio social, y que cuenten con una supervisión académica y profesional estrecha durante el término de la pasantía.

OBJECTIVE: Determine the degree to which nursing, medical, and dental interns performing social service in Mexico have the professional competencies required to practice the profession. METHODS: The results of the general examinations for completion of the undergraduate degree, administered between 2006 and 2008 to students in the nursing, medical, and dentistry programs by the National Center for Higher Education Assessment, were reviewed. RESULTS: Of the 39 824 graduates in the three programs who were tested during the period in question, 12 845 did not exhibit the minimum professional competencies. In nursing, out of the total students tested in the three-year period, 3 765 (30.2 percent) performed inadequately; in medicine, the figure was 6 704 (32.7 percent), and in dentistry, 2 376 (34.1 percent). Notwithstanding, backed by the respective regulations, all them were practicing, or had practiced, as professionals, serving as members of the health team in health institutions (approximately 11 percent of the Ministry of Health workforce in those professions). CONCLUSIONS: Interns are the bedrock of health care for the rural population, but approximately one-third of them lack the basic competencies to practice their profession. It is imperative that they demonstrate professional competence before beginning their social service and that they be closely supervised, both academically and professionally, during their internship.

Medicina e direito: atuação na integralidade destes dois saberes

A integração entre as áreas da Medicina e do Direito deve primeiramente assegurar a dignidade dos seres humanos, valorizando sempre os direitos globalmente reconhecidos.A medicina baseada em evidências traz em si um direito humano ao uso universal do reconhecimento científico de melhor qualidade.O Direito Sanitário fazendo uso da Medicina Baseada em Evidências,dinamizará o o processo de relacionamento entre Medicina e Direito.A tomada de decisão jurídica com base nas evidências científicas é a forma mais adequada para a garantia dos direitos humanos.