Atenção humanizada às mulheres em situação de abortamento e violência sexual: movimentos e ações de um coletivo de trabalho em um hospital de ensino / Humanized care for women in situations of abortion and sexual violence: movements and actions of a work collective in a teaching hospital

O aborto legal e a violência sexual são temas importantes para a saúde das mulheres no país. Porém, o acesso e a qualidade dos serviços prestados a estas demandas estão aquém do ideal. Lançada em 2011, a Rede Cegonha tem entre suas ações vinculadas o ApiceON ­ Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia ­, projeto que congrega cerca de cem hospitais com atividade de ensino no país e se volta a qualificação da atenção, gestão e ensino, considerando-os componentes indissociáveis. Em Belo Horizonte, o projeto conta em com o Hospital Risoleta Tolentino Neves (HRTN) como um destes serviços. OBJETIVO: Demarcar os movimentos e ações disparadas, planejadas e/ou implementadas por um coletivo de trabalho de uma maternidade participante do projeto ApiceON na humanização do cuidado às mulheres em situação de violência sexual e abortamento, considerando seu desenho de acompanhamento avaliativo. MÉTODOS: Pesquisa qualitativa, do tipo estudo de caso, recorte de um estudo maior intitulado "Avaliação para a qualificação da atenção obstétrica e neonatal em hospitais com atividades de ensino". Foi escolhido como unidade de análise o grupo estratégico local (GEL-HRTN). Participaram deste estudo 10 trabalhadores que integravam o GEL de forma ativa no período da pesquisa. A coleta de dados ocorreu entre out./2019 e jan./2020, por meio de análise documental, observação participante e entrevista. A análise dos dados ocorreu mediante a metodologia do acompanhamento avaliativo transversal proposta pelo Projeto. RESULTADOS: O GEL realizou movimentos e ações que proporcionaram a construção do serviço de atendimento à vítima de violência sexual, assim como possibilitou o reconhecimento do trabalho coletivo como importante ferramenta para a mudança. Porém, observase que ações de gestão e formação ainda apontam como incipientes. CONCLUSÕES: Reconhece-se que este coletivo avançou nos aspectos relativos ao componente atenção. Contudo, apresentou dificuldades próprias de uma instância colegiada, em especial aquelas referentes à gestão e participação dos estudantes. Novos estudos devem ser conduzidos a fim de elucidar questões não esclarecidas neste trabalho.

Legal abortion and sexual violence are important issues for the health of women in the country. However, the access and quality of services provided to these demands are less than ideal. Launched in 2011, the Cegonha Network has among its related actions ApiceON ­ Improvement and Innovation in Care and Education in Obstetrics and Neonatology ­, a project that brings together about one hundred hospitals with teaching activity in the country, aimed at qualifying care, management and teaching, considering them inseparable components. The project in Belo Horizonte has the Hospital Risoleta Tolentino Neves (HRTN) as one of these services. OBJECTIVE: To demarcated the movements and actions triggered, planned and / or implemented by a working group from a maternity hospital participating in the ApiceON project in the humanization of care for women in situations of sexual violence and abortion, considering its evaluative follow-up design METHODS: Qualitative research , of the case study type, part of a larger study entitled "Evaluation for the qualification of obstetric and neonatal care in hospitals with teaching activities." As a unit of analysis, the local strategic group (GEL-HRTN) was chosen. They participated in this study 10 workers who actively integrated the GEL during the research period. The data collection took place between Oct / 2019 and Jan / 2020, through document analysis, participant observation and interview. The data analysis took place using the evaluation monitoring methodology transversal proposal proposed by the Project RESULTS: GEL made arrangements, and movements provided the construction of the service to victims of sexual violence, as well as making it possible to recognize collective work as an important tool for change. However, it is observed that management and training actions still point out as incipient. CONCLUSIONS: It is recognized that this group has advanced in the aspects related to the attention component, however, it presented difficulties specific to a collegiate body, especially those related to the management and participation of students. New studies should be conducted in order to elucidate issues not revealed in this work.

Potenciais interações medicamentosas em prescrições de um hospital-escola de Porto Alegre / Potential drug interactions among prescriptions of a teaching hospital in Porto Alegre

Introdução: Relatos das prevalências de interações medicamentosas em hospitais brasileiros são escassos. Objetivos: Descrever a prevalência de interações medicamentosas potenciais entre os fármacos prescritos nas enfermarias clínicas e cirúrgicas de um hospital-escola. secundariamente, descrever as características dessas interações e relacionar a sua ocorrência com o número de medicamentos prescritos e a idade dos pacientes. Pacientes e Métodos: Os dados foram coletados durante uma semana de out/2007, de 2a a 6a feira, a partir da última ficha de prescrição encontrada nos prontuários, envolvendo 128 fichas de prescrição com 10,5±4,1 fármacos. Os pacientes tinham 58,6±16,9 anos e 51,2% eram homens. A doença cardiovascular foi a enfermidade principal (23,4%) e a comorbidade (42,5%) mais frequentemente encontrada. A análise das interações foi feita através de consulta a um sistema interativo (Micromedex®). Resultados: 485 interações foram encontradas, estando presentes em 79,7% (IC95%: 72,6-86,8) das fichas de prescrição (média 3,8). A interação mais frequente foi captopril/dipirona (9,7%), seguida por dipirona/furosemida (4,5%), e os fármacos mais envolvidos foram dipirona (29,3%) e captopril (21,2%). A maioria das interações tinha mecanismo farmacodinâmico (65,5%), gravidade moderada (55,5%), começo tardio (61,3%) e bom embasamento científico (71,1%). A prevalência de interações esteve associada fortemente com o número de fármacos prescritos (r=0,65, p<0,001) e fracamente com a idade do paciente.

Introduction: Reports of the prevalence of drug interactions in Brazilian hospitals are scarce. Aims: To describe the prevalence of potential drug interactions among the medical drugs prescribed in the clinical and surgical units of a teaching hospital. Secondarily, to describe the characteristics of drug interactions and relate their occurrence to the number of prescribed medications and patient age. Patients and Methods: The data were collected from Monday to Friday of a week in Oct 2007, starting from the last prescription form found in the medical charts, and involved 128 prescription forms with 10.5±4.1 drugs. The patients’ mean age was 58.6±16.9 years and 51.2% were males. Cardiovascular disease was the main disease (23.4%) and the most frequently found comorbidity (42.5%). The analysis of interactions was done through consultation with an interactive system (Micromedex®). Results: 485 cases of drug interactions were found, being present in 79.7% (CI95%: 72.686.8) of the prescription forms (mean 3.8). The most frequent interaction was captopril/dipyrone (9.7%), followed by ipyrone/furosemide (4,5%), and the most frequently involved drugs were dipyrone (29.3%) and captopril (21.2%). Most of the interactions had a pharmacodynamic mechanism (65.5%), moderate severity (55.5%), late onset (61.3%), and a good scientific basis (71.1%). The prevalence of interactions was strongly associated with the number of drugs prescribed (r=0.65, p<0.001) and weakly associated with patient age.

La enseñanza de la bioética y su relación con la enseñanza de la clínica. Experiencia de la Escuela de Medicina de la Universidad de Chile / The teaching of the bioethics and its relation with the education of the clinic. Experience of the Medicine School of the University of Chile

This article is intended to describe to clinicians what the Department of Education in Health Sciences means to pre graduation teaching of bioethics, through its historical development,its educational objectives and its contents. There is yet no consensus among different Schools about the methods used to teach the discipline and its purpose, so discussion provokesreflection and alternative decisions. The concept and significance of the “hidden curriculum”, derived from the afore explicit terminology with polisemic interpretation, adds to the debateas it produces new entrances to the pool of meanings, varying from knowledge and culture increments to deliberated and malicious imposition of information. It seems mandatory to all the clinical tutors to assume direct responsibility in students ethics problems analysis, as part of their general competences and reflecting the usual clinical exposure to these situations and the importance that knowing to handle these events has in the medical setting.

Utilidad de la evaluación de 10 grupos clínicos obstétricos para la reducción de la tasa de cesárea en un hospital docente / Utility of the evaluation of 10 clinical obstetric groups for the reduction of the cesarean sections rate in an educational hospital

La tasa de cesárea es uno de los indicadores que evalúa la calidad de la atención perinatal. En Chile, su sostenida alza ha sido motivo de permanente debate. Se realizó un estudio observacional retrospectivo clasificando la población obstétrica en 10 grupos clínicos con el objeto de pesquisar aquellos en donde intervenciones clínicas sean potencialmente relevantes para disminuir la tasa de cesárea. Se compararon los resultados perinatales de dos años consecutivos durante los cuales la tasa de cesárea aumentó de 23,9 por ciento a 30 por ciento. Las pacientes con cicatriz de cesárea constituyeron el grupo de mayor contribución a la tasa de cesárea; sin embargo, las nulíparas con gestación de término única en presentación cefálica y trabajo de parto espontáneo, representaron el mayor aumento en la tasa de cesárea. La evaluación de las indicaciones de cesárea en este último grupo deja abierta la posibilidad de disminuir la tasa de cesárea con intervenciones clínicas específicas.

Maternal mortality in Ramathibodi Hospital: a 28-year comparative study.

A comparative review of maternal mortality rates at Ramathibodi Hospital from 1969 through 1996 including 176, 161 live births is presented. The data are divided into two time periods, both of 14 years, for comparison. A significant decrease in direct obstetric deaths secondary to infection and toxemia (P < 0.05). The rate of deaths due to indirect causes in unchanged. Deaths due to malignancies have increased. This study of maternal mortality demonstrates the need for increased contraceptive services, voluntary sterilization, patient education and preconceptional identification of high-risk patients for further reduction of the maternal mortality rate.

¿Por qué los hospitales? Ideas para mirar / Why do we work in public hospitals? Some ideas to have in mind

Why do we work in public hospitals, what do we look for and what do we find working at these places? There are several answers. The beritage, the places where we learnt, the places where medicine is practiced. A model that feeds us. They cannot be improved and it is difficult to accept their limitations. However, many factors such as teaching, research and group work, encourage us to continue working in them. Variation and simultaneity, they are places with many variables, a living organism. The myth, the mother, that transmits its principles and behaviors, gives us a sense of life, feeds us and allows us to feed others Ecomical reasons and performance. When performance of physicians is analyzed positive values such as contact with patients, hours of discussion ans study, quality of care, risks dedication and training difficulties must be taken into consideration. Hospitals are not a patient assembly line. Fantasies and representations. We are participating in a health community and hospitals become a place for personal growth. Respect towards poverty. Helping the less fortunate. Knowledge and learning. Experiencing values. Forgotten words. Bioethics brought back several principles that are present in hospitals such as compassion, empathy, sweetness, service, humility, gratitude

Duas vertentes da educacao medica e o modelo da Faculdade de Medicina da Universidade de Sao Paulo / Medical educational conceptions at S. Paulo University Medical School

O autor analisa conceitualmente o modelo educacional desenvolvido no curso de graduacao da Faculdade de Medicina da Universidade de Sao Paulo. Embora a proposta institucional volte-se a formacao do medico generalista, o autor considera patente a influencia de um modelo educacional reducionista, calcado quase exclusivamente no componente biologico. Conclui que e fundamental resgatar o significado multidimensional da saude e da enfermidade