Human body constitution care medicine under the intervention of sports science / Os cuidados médicos com a constituição do corpo humano sob a intervenção da ciência do esporte / Los cuidados médicos con la constitución del cuerpo humano bajo la intervención de la ciencia del deporte

ABSTRACT Introduction: The shape, physiological function, and physical fitness (exercise ability) of the human body are the main parts of physical fitness. Different sports kinesiology methods have different effects on the human physique. System science-related theories can be applied to the research of the human health system under medical theory. Objective: We researched the human body's physique and formulate relevant sports kinesiology programs for the human body. We could analyze the influence of human body shape and physiological condition on human body constitution. Methods: We conducted research on the human body's physical health and nutrition through methods such as physical tests, anthropometric measurements, diet surveys, and laboratory examinations of the human body. Analyzing the correlation between sports and human body conditioning medicine had a favorable outcome in the study. Results: The sports kinesiology program has apparent effects on improving and enhancing human body shape, physiological functions, and physical fitness. Conclusion: The sports kinesiology program has a significant effect on improving the physical fitness of the human body. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A forma, a função fisiológica e o preparo físico (habilidade da prática de exercícios) do corpo humano são os principais componentes do preparo físico. Diferentes métodos de cinesiologia dos esportes êm diferentes efeitos no físico humano. Teorias cientificas sistemáticas podem ser aplicadas à pesquisa do sistema de saúde humana sob a teoria médica. Objetivo: Pesquisamos o físico do corpo humano e formulamos programas de cinesiologia dos esportes relevantes para o corpo humano. Pudemos analisar a forma corporal e a condição fisiológica na constituição do corpo humano. Métodos: Conduzimos uma pesquisa sobre a saúde e nutrição física do corpo humano com métodos como testes físicos, medidas antropométricas, estudos sobre dietas e exames laboratoriais do corpo humano. A análise da correlação entre esportes a medicina do condicionamento do corpo humano teve resultados positivos neste estudo. Resultados: O programa de cinesiologia do esporte tem efeitos visíveis em melhorar e aprimorar a forma do corpo humano, suas funções fisiológicas e o preparo físico. Conclusão: O programa de cinesiologia do esporte tem um efeito significativo em melhorar o preparo físico do corpo humano. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

Resumen Introducción: La forma, la función fisiológica y la preparación física (habilidad de la práctica de ejercicios) del cuerpo humano son los principales componentes de la preparación física. Diferentes métodos de kinesiología de los deportes pueden aplicarse a la investigación del sistema de salud humana bajo la teoría médica. Objetivo: Investigamos el físico del cuerpo humano y formulamos programas de kinesiología de los deportes relevantes para el cuerpo humano. Pudimos analizar la forma corporal y la condición fisiológica en la constitución del cuerpo humano. Métodos: Conducimos una investigación sobre la salud y nutrición física del cuerpo humano a través de métodos como pruebas físicas, medidas antropométricas, estudios sobre dietas y exámenes laboratoriales del cuerpo humano. El análisis de la correlación entre deportes y la medicina del condicionamiento del cuerpo humano tuvo resultados positivos en este estudio. Resultados: El programa de kinesiología del deporte tiene efectos visibles en mejorar y primorear la forma del cuerpo humano, sus funciones fisiológicas y la preparación física. Conclusión: El programa de kinesiología del deporte tiene un efecto significativo en mejorar la preparación física del cuerpo humano. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Perceptions of a night float system for intern doctors in an internal medicine program: an Asian perspective / 한국의학교육

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.

As tutelas de urgência com pedidos de saúde em sede de plantão judiciário noturno / The emergency relief with health requests in the night court

RESUMO Este ensaio aborda o tratamento dado pelo judiciário fluminense às demandas de saúde que ingressaram, em sede de plantão judicial noturno, nos meses de janeiro e julho, do ano de 2017, considerando que a judicialização da saúde se trata de um fenômeno que tem aumentado estatisticamente e que o plantão judiciário se tronou uma porta de acesso facilitado aos que buscam tutelas de urgência. No âmbito processual civil, abordam-se os prazos e as multas impostas, bem como os pedidos requeridos. Em especial, analisam-se as tutelas de urgência, trazendo informações sobre a tutela antecipada em caráter antecedente, assim como a necessidade de fundamentação precisa por parte do magistrado e o papel da autonomia mé-dica. A metodologia utilizada foi hipotético-dedutiva, em análise qualitativa, por meio da re-visão doutrinária, jurisprudencial e legislativa. Os resultados evidenciam índices elevados de judicialização em questões de saúde pública e privada.

ABSTRACT This essay addresses the treatment given by the Rio de Janeiro Judiciary to the health demands that were filed at the judicial nocturnal duty, in January and July, 2017, con-sidering that the judicialization of health is a phenomenon that has increased statistically, and that the judicial duty has become a way of easy access for those seeking emergency relief. In civil procedural matters, the deadlines and fines imposed, as well as the requests requested are addressed. In particular, we analyze the urgency decisions, bringing information about the anticipated protection in advance, as well as the need for precise justification on the part of the magistrates and the role of medical autonomy. The methodology used was hypothetical-deductive, in qualitative analysis, through doctrinal, jurisprudential and legislative review. The results show high levels of judicialization in public and private health demands.

Funcionamento 24 horas para Unidades de Saúde da Família: uma solução para ampliação de acesso? Um ensaio sobre as "Upinhas" do Recife / 24-hour operation for Family Health Units: a solution for access expansion? An essay on the "Upinhas" of Recife / Funcionamiento 24 horas para las Unidades de Salud de la Familia: ¿Una solución para la ampliación del acceso? Un ensayo sobre las "Upinhas" de Recife

A Atenção Primária à Saúde é via preferencial de acesso ao sistema de saúde, tendo em vista seu papel ordenador, os benefícios da continuidade do cuidado e resolutividade deste nível de atenção. Diversas barreiras de acesso, dentre eles o horário restrito de funcionamento, fazem com que esse primeiro contato não seja facilitado. No Recife, novos equipamentos de Atenção Primária à Saúde vêm sendo implantados desde o ano de 2013: as "Upinhas 24 horas". O objetivo deste trabalho é analisar o modelo "Upinha" apresentado como uma solução para ampliação de acesso. Foi realizada uma revisão da literatura sobre diversas estratégias existentes de ampliação do acesso, a partir das quais se analisou criticamente o modelo "Upinha 24 horas" às lentes dos modelos vigentes. Horário estendido, acesso avançado e acolhimento à demanda espontânea foram os modelos de ampliação de acesso revisados para embasar a discussão. O impacto do horário estendido na ampliação do acesso pode ser minimizado se outras medidas, como mudanças no modelo de agendamento, priorizando o acesso avançado, não forem concomitantemente implantadas. O modelo "Upinha 24 horas", da forma como se apresenta, parece ser baseado na concepção de uma Atenção Primária à Saúde que funciona como complemento para "desafogar" os serviços de atendimento às urgências já existentes e não como ordenadora do serviço de atenção às urgências. Apesar de apontar numa direção inicialmente acertada, a implantação das "Upinhas 24 horas" parece ainda ser uma proposta incipiente na garantia de acesso.

Primary Health Care is a preferential route of access to the health system, considering its ordering role, the benefits of continuity of care and the effectiveness of this level of care. Several access barriers, including restricted hours of operation, make this first contact difficult. In Recife, new equipment for Primary Health Care has been implemented since 2013: the "Upinhas 24 horas". The objective of this essay is to analyze the "Upinha" model presented as a solution to increase access. A review of the literature on several existing strategies of access expansion was carried out, from which the "Upinha 24 horas" model was analyzed critically through the lenses of the current models. Extended hours, advanced access and welcoming of the spontaneous demand were the models of access expansion revised to support the discussion. The impact of extended hours on increased access can be minimized if other measures, such as changes to the scheduling model prioritizing advanced access, are not implemented concurrently. The "Upinha 24 horas" model, as presented, seems to be based on the conception of a Primary Health Care system that works as a complement to "unload" the services of attendance to emergency services and not as ordering of the system emergency attention. Despite pointing in an initially correct direction, the implementation of the "Upinhas 24 horas" still seems to be an incipient proposal in the guarantee of access.

La Atención Primaria es la vía preferencial de acceso al sistema de salud, teniendo en cuenta su papel ordenador, los beneficios de la continuidad del cuidado y resolución de este nivel de atención. Diversas barreras en el acceso, dentro de ellas, el horario restringido de funcionamiento, hacen que ese primer contacto sea difícil. En Recife, nuevos equipos de Atención Primaria vienen siendo implementados desde el año 2013: las "Upinhas 24 horas". El objetivo de este trabajo es analizar el modelo "Upinha" presentado como una solución que amplía el acceso. Fue realizada una revisión de la literatura sobre diversas estrategias existentes de ampliación del acceso, a partir de las cuales se analizó críticamente el modelo "Upinha 24 horas" a la vista de los modelos vigentes. Horario extendido, acceso avanzado y acogimiento de la demanda espontanea, fueron los modelos de ampliación del acceso revisados para sustentar la discusión. El impacto del horario extendido en cuanto a la ampliación del acceso puede ser minimizado si otras medidas, como cambios en el modelo de turnos priorizando el acceso avanzado, no fueran concomitantemente implementadas. El modelo "Upinha 24 horas" de la forma que se presenta, parece basado en la concepción de una Atención Primaria que funciona como complemento para "desahogar" los servicios de atención de urgencias. A pesar de apuntar en una dirección inicialmente correcta, la implementación de las "Upinhas 24 horas" parece ser todavía una propuesta incipiente en la garantía del acceso.

After-hours care models in leading countries

After-hours care (AHC) provides medical care after the regular weekday work hours of clinics. In Korea, data from the National Emergency Department Information System showed that approximately 40% of the pediatric patients need AHC. To meet this need, many countries have different models of AHC. In this article, the authors tried to summarize and emphasize the advantages and disadvantages of AHC models in several leading countries. This article can be useful in designing AHC models in Korea because the proportions of potential patients requiring AHC are substantial, and the adoption of AHC models should be seriously considered.

A plan for strengthening pediatric emergency care: establishment of pediatric certified emergency center

Pediatric patients (younger than 19 years) account for approximately 25% of all emergency patients. Pediatric patients have large proportions of toddlers (aged 1–5 years), low severity, illness (rather than injury), and after-hours visits. Considering these features, the authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, suggest the establishment of the pediatric certified emergency center (PCEC) to stratify Korean pediatric emergency medical system according to the Korean Acuity and Triage Scale (KTAS). The PCEC is a facility dedicated to the emergency care for a large population of KTAS 3–4 patients (i.e., mildly ill). In addition, the PCEC may perform early stabilization and transfer to the pediatric emergency centers for pediatric patients having KTAS 1–2 illnesses and injuries. To facilitate the application of emergency centers for the PCEC, the designation criteria should be flexible in terms of manpower, facility, and equipment. Financial support from the government is essential for sustainable PCEC.

Non-emergency department models for pediatric after-hours care

After-hours care (AHC) provides urgent primary care at nighttime, weekends, and holidays. In Korea, individual primary care physicians seldom participate in AHC and many parents have difficulty in receiving primary care during non-office hours without going to an emergency department (ED). The ED is currently the only place to access a full range of services at any time. However, the ED is not optimized for AHC, and using it for AHC is not an efficient use of resources. Therefore, many countries are seeking a safe, efficient non-ED AHC model which provides the best care considering the limitations. Different models for AHC exist worldwide, varying from family doctor-based to hospital-based models, and some countries use several different models including 24-hr telephone triage and advice services (TTA). Common problems of AHC include the inaccessibility to primary care, discontinuity of care, expensive healthcare costs, and work dissatisfaction among health care professionals. These are the major reasons for the recent changes made to the AHC system in many countries, such as the integration into one single national TTA in the United Kingdom, support for group practices in Canada, reorganization of small practice rotation groups into large scaled, general practitioner cooperatives in the Netherlands, and rapid expansion of the urgent care industry in the United States. This review presents a brief overview of the current AHC in Korea and the need for an effective non-ED AHC model. An effective AHC system will improve the quality of care, financial saving, and job satisfaction of the health care professionals.

Use of the complete Rockall score and the Forrest classification to assess outcome in patients with non-variceal upper gastrointestinal bleeding subject to after-hours endoscopy: a retrospective cohort study / El uso de la puntuación de Rockall completa y la clasificación de Forrest para evaluar resultados en pacientes con hemorragia gastrointestinal alta no varicosa sometidos a endoscopía de urgencia: un estudio de cohorte retrospectivo

OBJECTIVES: To evaluate the usefulness of the Forrest classification and the complete Rockall score with customary cut-off values for assessing the risk of adverse events in patients with upper gastrointestinal bleeding (UGI-B) subject to after-hours emergency oesophago-gastro-duodenoscopy (E-EGD) within six hours after admission. METHODS: The medical records of patients with non-variceal UGI-B proven by after-hours endoscopy were analysed. For 'high risk' situations (Forrest stage Ia-IIb/complete Rockall score > 2), univariate analysis was conducted to evaluate odds ratio for reaching the study endpoints (30-day and one-year mortality, re-bleeding, hospital stay > 3 days). RESULTS: During the study period (75 months), 86 cases (85 patients) met the inclusion criteria. Patients' age was 66.36 ± 14.38 years; 60.5% were male. Mean duration of hospital stay was 15.21 ± 19.24 days. Mortality rate was 16.7% (30 days) and 32.9% (one year); 14% of patients re-bled. Univariate analysis of post-endoscopic Rockall score > 2 showed an odds ratio of 6.09 for death within 30 days (p = 0.04). No other significant correlations were found. CONCLUSION: In patients with UGI-B subject to after-hours endoscopy, a 'high-risk'Rockall score permits an estimation of the risk of death within 30 days but not of re-bleeding. A 'high-risk'Forrest score is not significantly associated with the study endpoints.

OBJETIVOS: Evaluar la utilidad de la clasificación de Forrest y la puntuación de Rockall completa con los valores límites habituales a fin de evaluar el riesgo de eventos adversos en los pacientes con hemorragia gastrointestinal alta (HGIA) sometidos a una esofagogastroduodenoscopia (EGD) de urgencia dentro de seis horas después del ingreso. MÉTODOS: Se analizaron las historias clínicas de pacientes con HGIA de origen no varicoso comprobada por endoscopia de urgencia. Para las situaciones de 'alto riesgo' (etapa Forrest Ia- IIb/puntuación de Rockall completa >2), se realizó un análisis univariado para evaluar las probabilidades de riesgo (oddsratio) y llegar a los criterios de valoración del estudio (mortalidad de 30 días y un año, resangrado, estancia hospitalaria > 3 días). RESULTADOS: Durante el periodo de estudio (75 meses), 86 casos (85 pacientes) cumplieron los criterios de inclusión. La edad de los pacientes fue de 66.36 ± 14.38 años; 60.5% eran varones. La duración promedio de estancia hospitalaria fue de 15.21 ± 19.24 días. La tasa de mortalidad fue de 16.7% (30 días) y 32.9% (1 año); el 14% de los pacientes volvió a tener sangramiento. El análisis univariado de la puntuación Rockall postendoscópica > 2 mostró un odds-ratio de 6.09 por muerte en 30 días (p = 0.04). No se encontraron otras correlaciones significativas. CONCLUSIÓN: En pacientes con HGIA sometidos a endoscopía de urgencia, una puntuación Rockall de 'alto riesgo'permite una estimación del riesgo de muerte dentro de 30 días, pero no de resangrado. Una puntuación Forrest de 'alto riesgo' no es significativa con respecto a los criterios de valoración del estudio.

O trabalho do médico recém-formado em serviços de urgência / The work of recently graduated physicians in emergency services

JUSTIFICATIVA E OBJETIVO: A superlotação dos serviços de urgência, causada por vários fatores, associada ao fato de o médico que lá está ser, muitas vezes, um inexperiente recém-formado, transforma essa área numa das mais problemáticas do sistema de saúde brasileiro. Este estudo teve por objetivo quantificar e avaliar a inserção do médico recém-formado nos serviços de urgência em uma parcela de formandos em 2011 de uma escola privada. MÉTODOS: Foi utilizado um questionário estruturado e perguntado ao egresso se ele estava ou não cursando residência médica, se estava trabalhando em serviço de urgência (não vinculado à residência médica cursada), especificando-o (unidades de pronto atendimento, de emergência ou pré-hospitalar móvel), e se era público ou privado. RESULTADOS: Da turma de 101 ex-alunos, 50 responderam ao questionário. Destes, 31 (62,0%) estavam cursando residência médica e 19 (38,0%) não estavam. Trabalhavam em serviços de urgência 20 (64,5%) estudantes do primeiro grupo e 12 (63,2%) do segundo. Prevaleceu a empregabilidade no setor privado. Não houve diferença significante se o egresso estava cursando ou não residência médica. CONCLUSÃO: O trabalho em serviços de urgência mostrou ser opção relevante para os egressos, independentemente da residência médica. Isso reforça a importância do ensino/aprendizagem de urgências durante a graduação e aponta para a possível sobrecarga de trabalho durante a residência médica...

BACKGROUND AND OBJECTIVE: Emergency services overcrowding, due to a variety of factors, associated with the fact that the physician in charge may often be an inexperienced recently graduated person, has turned this sector into one of the most problematic in Brazilian health system. This study aimed at quantifying and assessing the insertion of recently graduated physicians from a group of graduated students of year 2011 of a private institution in emergency services. METHODS: A structured questionnaire was used; graduates were asked whether they were attending medical residency, and to specify the type of emergency service (not connected to the medical residency attended) they were working at, if any (first care units, emergency units or mobile pre-hospital units), and whether public or private. RESULTS: Out of 101 former students, 50 answered the questionnaire. Out of these, 31 (62.0%) were attending medical residency and 19 (38.0%) were not. Twenty in the former group (64.5%) and 12 in the latter group have been working at emergency units. Jobs in the private sector prevailed. No significant difference was seen between graduates attending/not attending residency. CONCLUSION: Jobs at emergency services have proven to be a relevant option for graduates, regardless of the medical residency. This reinforces the importance of the teaching/learning of emergencies during graduation course and shows possible work overload during medical residency...