Internal medicine, art and science in the third millennium / Medicina interna, arte y ciencia en el tercer milenio

Internal medicine, art and science in the third millennium is a statement that Medicine is not only science. It acts on the sick individual to reestablish a natural state as a curative art. Medical art, commissioned by an individual or a society, is service. It requires vocation to obtain satisfaction. However due to the incidence of value changes, market globalization, technological and industrial development, the patient/physician relationship is becoming a user/provider relationship. Physician-related factors such as a higher health care demand, resource shortage and a progressive specialization have also influenced this change of paradigm. This is causing dissatisfaction, loss of self-esteem and a lower ethical commitment among professionals. We need to recover a professional repertoire of ideas in the context of a global ethics. Responsibility and co-responsibility are ethical principles addressed to technological civilizations and their collateral effects on people and environment that lead to a "responsible globalization". We also need a scientific futurology to define risks and avoid errors. In this era of progressive specialization, Internal Medicine, with its holistic vision of mankind, may play a fundamental role in the field of bioethics.

Medicina Interna, Arte y Ciencia en el Tercer Milenio", expresa que la medicina no es exclusivamente ciencia. Tiene de sí actuar hábilmente sobre el hombre enfermo, (arte curativo), buscando restablecer un estado natural. El arte médico, comisionado por el enfermo o por la sociedad, es servicio. Requiere vocación, obteniendo su propia satisfacción. Sin embargo, la relación "paciente / médico", se ha visto transformada actualmente en "usuario /prestador", Incidiendo factores generales, tales como cambios valóricos, preeminencia del mercado (globalización), desarrollo de la tecnología e industria, y además factores propiamente médicos: mayor demanda asistencial, escasez de recursos, progresiva especialización, presencia de gestores no médicos, y otros. Ello ha provocado en los médicos insatisfacción, pérdida de autoestima y menor compromiso ético. Necesitamos recuperar un ideario profesional, en el contexto de una "ética global". El "principio de la responsabilidad" (Jonas) o la "corresponsabilidad" (Apel), son éticas destinadas a la civilización tecnológica y a sus efectos colaterales sobre las personas y el medio ambiente, conducentes a una "globalización responsable". Necesitamos, además, estimular el desarrollo de una "futurología científica" que permita definir los riesgos a evitar o los errores a corregir. En esta era de creciente especialización, la Medicina Interna, beneficiaria de la mejor tradición médica por su visión holística del hombre, puede y debe jugar un rol fundamental en el campo de la Bioética.

Una mirada crítica en torno al plan AUGE: algunos aspectos generales y valóricos / A critical appraisal to AUGE health plan in Chile

The health reform in Chile established a health plan callee! AUGE that guarantees an access to diagnosis and treatment of certain specifie diseases within a time frame that must be respected. This article reviews and analyzes the general provisions of this plan and its management of values. Aspects that were implemented by the reform are discussed, especially those that refer to direct care of the population. The positive and negative aspects of the reform are balancea and are contrasted with eventual changes that should be made from an ethicalpointofview.

Reflexiones sobre la evidencia en medicina / Reflections on evidence-based medicine

This is a review of the basic concepts of evidence, medicine, evidence-based medicine and its effects. Evidence-based medicine is a contribution for statistical design and management, that allows the gathering of scientific information, but does not completely exclude bias. Its methodology proceeds with order and caution, generating a highly probable mass of knowledge. The quality of the information obtained from diverse sources such as meta-analysis to expert opinions is classified in different levels according to the «strength¼ of the evidence in which it is based. The best contribution of evidence-based medicine is probably for diseases of incidence and does not replace clinical experience and patients-physician relationship. Basically we treat ill people and not illnesses. Without clinical experience, medical practice can be tyrannized by evidence-based medicine that can become inapplicable or inappropriate. Without evidence-based medicine, medical practice will not be updated, limiting our professional skills.

Desastres: planes de asistencia / Disasters: assistance plans

A disaster is defined as a unseasonable event that provoke such an amount of victims that the health care capacity of the community is exceeded. The aim of this paper is to review the health attention during an emergency period, whose pre-hospital and hospital services are inherent to critical care medicine. The reduction in victim`s morbidity and mortality depends on the opportuneness and efficacy of pre-hospital care. Trained personnel is required to establish command posts, perform the rescue, categorize seriousness of victims to receive priority health care and transport to better equipped health centers. At the hospitals an emergency team must elaborate, publish and periodically review emergency care plans and eventually coordinate actions with other community organizations. The diverse phases of the plan must be specified, including preparatives, emergency situation cases. As complement, the hospital must have security and evacuation plans to face own emergency situations such as fires, explosions and inundations

Estudio funcional respiratorio en ejecutantes de instrumentos musicales de viento / Respiratory functional study in wind instruments players

Se efectuaron diversas pruebas de función pulmonar (espirometría, FEM50, Plmáx,PEmáx) en 108 músicos de una banda instrumental, 90 de los cuales ejecutaban instrumentos de viento y 18 de percusión o de cuerdas. La única diferencia significativa se obtuvo en la prueba de Presión Expiratoria Máxima (PEmáx) que fué mayor en los ejecutantes de instrumentos de viento (p<0.001). Estos resultados no se pueden extrapolar a lo que sucede en los pacientes con Enfermedad Bronquial Obstructiva Crónica que efectúan entrenamiento muscular, por la diferente naturaleza de los sujetos y por el distinto modo de entrenamiento