El desarrollo profesional médico continuo en el Uruguay de cara al siglo XXI / Continuing medical professional development in Uruguay as the country faces the 21st century

This paper outlines the evolution of the concept of continuing medical professional development in Uruguay, as that professional development has progressed from independent and varied efforts that were not coordinated or evaluated to a plan that is aimed at improving the quality of educational activities and programs and making them accessible to all the physicians in the country. In contrast to countries where scientific societies and medical associations preside over continuing professional development, in Uruguay the Graduate School of the School of Medicine of the University of the Republic has taken on managing and developing this process. The key objective of this process is for the Graduate School to work in conjunction with other leading players in professional development to create a national system of continuing medical professional development. This system should be interinstitutional and include both public and private entities. By having the key public institutions (the Graduate School and the Ministry of Public Health) working with private entities (medical associations, scientific societies, and health care institutions), there should be an adequate balance of interests. The national professional development system should work in the most decentralized manner possible and should be based on a network of units distributed around the entire country, but with centralized coordination. The system's interinstitutional character should ensure high technical and ethical standards as well as a balance among the governmental, commercial, professional, and university components. This system should serve as the basis for extending this activity to all health personnel in Uruguay. While the national system is still being finalized, the Graduate School has implemented a process of accrediting institutions that are involved in continuing professional medical development. The aim of this accreditation process is to improve the educational offerings for physicians and to generate practical experience that will serve the future system

Estudio polisomnografico de los efectos de la melatonina sobre el sueño en ancianos con insomnio primario crónico / Polysomonographic recordings of the effects of melatonin on sleep in elderly patients suffering from primary chronic insomnia

Se determinó en el laboratorio para el estudio del sueño el efecto de la melatonina a la dosis de 3 mg, sobre el sueño de ancianos con un insomnio primario crónico. Pudo comprobarse que la melatonina redujo el tiempo de vigilia luego del comienzo del sueño e incrementó el tiempo total de sueño y su eficiencia, durante las dos semanas de tratamiento. El aumento de la duración del sueño fue clínicamente relevante en cinco de los diez pacientes tratados con melatonina. No se observó efectos adversos durante el período de administración del fármaco. En la fase inicial del tratamiento (noches 4 y 5) se comprobó un ligero aumento de la densidad del espectro de potencia en las bandas delta y theta; en cambio, durante la fase final de administración de melatonina (noches 15 y 16) la densidad del espectro tendió a disminuir. No se observó una correlación estricta entre los niveles de 6-sulfatoximelatonina obtenidos antes del comienzo del estudio y la mejoría del sueño observada luego de administrar melatonina. Nuestros resultados indican que la melatonina es beneficiosa en el tratamiento del insomnio primario crónico del anciano