La educación de posgrado en el policlínico Juan José Apolinaire Pennini de Cienfuegos

Fundamento: la educación de posgrado constituye la etapa superior del ciclo educativo y responde a la necesidad de formar recursos humanos del más alto nivel, tanto en lo profesional, como en la docencia y la investigación. Objetivo: describir la educación de posgrado de los egresados de la carrera de medicina en el policlínico Juan José Apolinaire Pennini, de Cienfuegos. Métodos: investigación descriptiva de corte transversal desarrollada en el período de enero a mayo del 2022. Se analizaron las variables: formación académica, años de graduados, especialización, categoría docente, categoría de investigador y superación profesional. Resultados: el 69,76 % de los egresados son especialistas de primer grado; prevalecieron los egresados con más de 11 años de experiencia (51,16 %), los especialistas de segundo grado representaron el 4,65 % y los másteres el 16,27 %. Predominaron los especialistas en Medicina General Integral (54,65 %). El 100 % de los egresados recibieron cursos de superación, 20,93 % tienen categoría docente y 3,8 % tienen categoría de investigador. Conclusiones: se desarrolla la educación de posgrado de manera continua. Se identificaron fortalezas como el predominio de especialistas en Medicina General Integral con más de 11 años de graduados y el completamiento del grupo básico de trabajo con profesores categorizados que participan en la formación académica y superación profesional que se desarrolla satisfactoriamente. Existen insuficiencias en la formación de especialistas de segundo grado, másteres y doctores en ciencias; además, no existe correspondencia entre la cantidad de egresados y las categorías docentes y de investigador.

Background: postgraduate education constitutes the upper stage of the educational cycle and responds to the need to train human resources of the highest level, both professionally, as well as in teaching and research. Objective to describe the medical graduates' postgraduate education at the Juan José Apolinaire Pennini polyclinic, in Cienfuegos. Methods: descriptive cross-sectional research carried out from January to May 2022. The analyzed variables were: academic training, years of graduation, specialization, teaching category, scientific category and professional improvement. Results 69.76% of the graduates are first degree specialists; Graduates with more than 11 years of experience prevailed (51.16%), second degree specialists represented 4.65% and master's degrees 16.27%. Comprehensive General Medicine specialists predominated (54.65%). 100% of the graduates received improvement courses, 20.93% have a teaching category and 3.8% have a scientific researcher category. Conclusions: postgraduate education is developed continuously. Strengths were identified such as the prevalence of specialists in Comprehensive General Medicine with more than 11 years of graduation, the basic work group completion with categorized professors who participate in academic training and professional improvement that is developed satisfactorily. There are insufficiencies in the second degree specialists training, masters and doctors of science; In addition, there is no correspondence between the number of graduates and the teaching research categories.

[Percutaneous implantation of an aortic prosthetic valve on a degenerated mitral bioprosthesis. Report of one case]. / Implantación percutánea transeptal de válvula protésica aórtica sobre bioprótesis mitral degenerada.

Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.

Implantación percutánea transeptal de válvula protésica aórtica sobre bioprótesis mitral degenerada / Percutaneous implantation of an aortic prosthetic valve on a degenerated mitral bioprosthesis. Report of one case

Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.

Características clínicas y epidemiológicas de los pacientes amputados en el Hospital General de Ciego de Ávila / Clinical and epidemiological characteristics of the patients amputated in the General Hospital of Ciego de Ávila

Introducción: la amputación es el procedimiento quirúrgico más antiguo y a nivel mundial constituye un problema de salud con alta frecuencia de complicaciones.Objetivo: describir las características clínicas y epidemiológicas de los pacientes amputados de miembros inferiores.Método: se realizó un estudio transversal descriptivo en una población de 145 pacientes con amputaciones mayores y menores ingresados durante el período 2014-2015 en el Hospital General Provincial Docente de Ciego de Ávila.Resultados: la mayoría de los pacientes fueron mayores de 60 años y del sexo masculino. La hipertensión arterial, el hábito de fumar y el descontrol metabólico fueron los principales factores de riesgo identificados. Predominaron las amputaciones mayores y mutilantes. Las complicaciones locales con mayor frecuencia de presentación fueron: el hematoma, la isquemia de la herida, y la sepsis; en las complicaciones generales: la bronconeumonía, el infarto de miocardio y la anemia.Conclusiones: la enfermedad arterial periférica y el pie diabético son las enfermedades con mayor índice de amputaciones mayores y menores, la invalidez total es el principal problema para los pacientes. El control inadecuado de los factores de riesgo, y las complicaciones locales y generales se presentan con frecuencia(AU)

Introduction: amputation is the oldest surgical procedure and worldwide is a health problem with high frequency of complications.Objective: to describe the clinical and epidemiological characteristics of patients with amputated lower extremities.Method: a descriptive cross-sectional study was carried out in a population of 145 patients with major and minor amputations admitted during the 2014-2015 period in the General Provincial Teaching Hospital of Ciego de Ávila.Results: the majority of patients were over 60 years old and male. High blood pressure, smoking habit and metabolic decontrol were the main risk factors identified. Major and mutilating amputations predominated. The local complications with greater frequency of presentation were: the hematoma, the ischemia of the wound, and the sepsis; in the general complications: bronchopneumonia, myocardial infarction and anemia.Conclusions: the peripheral arterial disease and the diabetic foot are the diseases with greater index of major and minor amputations, the total disability is the main problem for the patients. Inadequate control of risk factors, and local and general complications frequently occur(AU)

Embolectomía tardía en isquemia aguda de miembros inferiores / Late embolectomy in acute lower limb ischemia

La isquemia aguda es la interrupción brusca del aporte sanguíneo a un determinado territorio del organismo. Su causa más frecuente, la embolia arterial, consiste en la oclusión también brusca de una arteria sana por material trombótico formado en un territorio proximal al del accidente y que desencadena un cuadro que, de no diagnosticarse y tratarse adecuadamente, puede comprometer la vida del paciente. Existe una estrecha relación entre la gravedad del cuadro isquémico y el tiempo transcurrido de manera que si no se toman medidas agresivas a tiempo raramente se resuelve de manera satisfactoria. La revascularización es considerada menos efectiva después de 8 a 10 h de isquemia, tiempo después del cual muchos se abstienen de operar debido al temido síndrome de reperfusión; sin embargo, algunos refieren éxitos con embolectomías tardías. Se presenta un caso de embolismo arterial a miembro inferior derecho por arritmia cardiaca, que llegó al servicio de Cirugía Vascular del Hospital Provincial "Dr. Antonio Luaces Iraola", con 72 h de evolución. Se le realizó embolectomía femoral con catéter de Fogarty con resultados satisfactorios, lo que apoya la hipótesis de que se debe intentar reperfundir la extremidad siempre que se demuestre viabilidad de los tejidos y no exista gangrena, independientemente del tiempo transcurrido(AU)

Acute ischemia is the sudden interruption of the blood flow in a specific area of the body. Its most common cause is arterial embolism consisting of abrupt occlusion of a healthy artery by thrombotic residues formed in an area near the stroke and unleashing a clinical picture that should be adequately diagnosed and treated to avoid death. There is close relationship between the severity of ischemia and the time elapsed because if no aggressive actions are taken in due time, the results are rarely satisfactory. Revascularization is considered less effective 8 to 10 hours after ischemia. After this time many surgeons refrain from performing surgery due to the frightening reperfusion syndrome. However some had documented successful results with late embolectomy. Here is a case of arterial embolism in right lower limb owing to cardiac arrhythmia. The patient arrived to the Vascular Surgery service after 72 hours of the event; he was performed femoral embolectomy with Fogarty catheter and the achieved results were satisfactory, which supports the hypothesis of trying to reperfusing the affected limb whenever tissue viability exists and gangrene is not present, regardless of time elapsed(AU)

Embolectomía tardía en isquemia aguda de miembros inferiores / Late embolectomy in acute lower limb ischemia

La isquemia aguda es la interrupción brusca del aporte sanguíneo a un determinado territorio del organismo. Su causa más frecuente, la embolia arterial, consiste en la oclusión también brusca de una arteria sana por material trombótico formado en un territorio proximal al del accidente y que desencadena un cuadro que, de no diagnosticarse y tratarse adecuadamente, puede comprometer la vida del paciente. Existe una estrecha relación entre la gravedad del cuadro isquémico y el tiempo transcurrido de manera que si no se toman medidas agresivas a tiempo raramente se resuelve de manera satisfactoria. La revascularización es considerada menos efectiva después de 8 a 10 h de isquemia, tiempo después del cual muchos se abstienen de operar debido al temido síndrome de reperfusión; sin embargo, algunos refieren éxitos con embolectomías tardías. Se presenta un caso de embolismo arterial a miembro inferior derecho por arritmia cardiaca, que llegó al servicio de Cirugía Vascular del Hospital Provincial "Dr. Antonio Luaces Iraola", con 72 h de evolución. Se le realizó embolectomía femoral con catéter de Fogarty con resultados satisfactorios, lo que apoya la hipótesis de que se debe intentar reperfundir la extremidad siempre que se demuestre viabilidad de los tejidos y no exista gangrena, independientemente del tiempo transcurrido(AU)

Acute ischemia is the sudden interruption of the blood flow in a specific area of the body. Its most common cause is arterial embolism consisting of abrupt occlusion of a healthy artery by thrombotic residues formed in an area near the stroke and unleashing a clinical picture that should be adequately diagnosed and treated to avoid death. There is close relationship between the severity of ischemia and the time elapsed because if no aggressive actions are taken in due time, the results are rarely satisfactory. Revascularization is considered less effective 8 to 10 hours after ischemia. After this time many surgeons refrain from performing surgery due to the frightening reperfusion syndrome. However some had documented successful results with late embolectomy. Here is a case of arterial embolism in right lower limb owing to cardiac arrhythmia. The patient arrived to the Vascular Surgery service after 72 hours of the event; he was performed femoral embolectomy with Fogarty catheter and the achieved results were satisfactory, which supports the hypothesis of trying to reperfusing the affected limb whenever tissue viability exists and gangrene is not present, regardless of time elapsed(AU)

New model for diabetes primary health care based on patient empowerment and the right to preventive health: the MIDE program

Objective. To evaluate Mexico’s national Integrated Management of Diabetes in Stages (Manejo Integral de la Diabetes por Etapas, MIDE) program using three types of indicators: process, structure, and impact. Methods. A cross-sectional study was conducted using data for 97 452 people with diabetes (PWD) who participated in the MIDE patient empowerment program (PEP) at “MIDE modules” (standardized diabetes health care units) at Mexico’s Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) hospital clinics and family medical clinics nationwide between 2007 and 2014. The program promotes diabetes patient empowerment and self-care through outpatient consultations with a multidisciplinary health care team supported by continuous training. Baseline data were compared with results post-program for the following indicators: process (metabolic control (MetC), based on glycated hemoglobin (HbA1c), triglyceride (TG), and total cholesterol (TC) levels); structure (number of MIDE modules installed at ISSSTE clinics and number of patients/health personnel accredited as diabetes experts/awarded diplomas); and impact (average number of patient illness days (IDs) and hospitalization episodes (HEs) per PWD over a 12-month period). Results. Over the seven-year study period, the proportion of patients with MetC (HbA1c < 7.0%, TG < 150 mg/dL, and TC < 200 mg/dL) increased significantly (from 35.4% to 60% (with a peak level of 62% in 2013); P < 0.001); average HbA1c, triglycerides, and total cholesterol per PWD dropped by 25%, 31%, and 11% respectively; average number of IDs and HEs per PWD over a 12-month period dropped by 38% and 41% respectively; a total of 140 MIDE modules were installed at ISSSTE clinics; and a total of 1 117 diplomas were awarded to 826 health professionals, and 2 613 PWD were accredited as “patient experts in diabetes.” Conclusions. The MIDE PEP is feasible, usable, and acceptable to PWD. The program improves MetC; reduces the frequency of IDs and HEs; and facilitates patient participation, the involvement of health personnel, and shared decision-making.

Objetivo: Evaluar el programa nacional mexicano “Manejo Integral de la Diabetes por Etapas” (MIDE) usando tres tipos de indicadores: proceso, estructura e impacto. Métodos. Se realizó un estudio transversal con los datos de 97 452 personas con diabetes que participaron entre el 2007 y el 2014 en el programa de empoderamiento de pacientes de MIDE que se llevó a cabo en los “módulos del MIDE” (unidades estandarizadas de atención de salud de diabetes) en el Instituto de Servicios y de Seguridad Sociales de los Trabajadores del Estado (ISSSTE) de México, además de en consultorios de hospitales y centros de medicina familiar de todo el país. El programa promueve el empoderamiento y el autocuidado en los pacientes con diabetes mediante consultas ambulatorias con un equipo de atención de salud multidisciplinario complementadas con talleres de capacitación continua. Se compararon los datos iniciales y los resultados al final del programa con respecto a los siguientes indicadores: proceso (control metabólico basado en análisis de los niveles de glucohemoglobina [HbA1c], triglicéridos y colesterol total); estructura (número de módulos del MIDE instalados en clínicas del ISSSTE y número de pacientes y personal de salud acreditado como experto en diabetes o que ha obtenido un certificado); e impacto (número promedio de días enfermos de los pacientes y número de hospitalizaciones por persona con diabetes durante un período de 12 meses). Resultados. En el período de estudio de siete años, la proporción de pacientes con control metabólico (HbA1c < 7,0%, triglicéridos < 150 mg/dL y colesterol total < 200 mg/dL) aumentó significativamente (de 35,4% a 60%, con un nivel máximo de 62% en 2013; P < 0,001); el nivel promedio de HbA1c, triglicéridos y colesterol total por persona con diabetes descendió en 25%, 31% y 11% respectivamente; el número promedio de días enfermos y número de hospitalizaciones por persona con diabetes durante un período de 12 meses descendió en 38% y en 41% respectivamente; se instalaron un total de 140 módulos del MIDE en clínicas del ISSSTE, y se otorgaron un total de 1117 certificados a 826 profesionales de la salud y 2613 personas con diabetes fueron acreditados como “paciente experto en diabetes”. Conclusiones. El programa de empoderamiento de pacientes del MIDE es un programa factible y aceptable para utilizarse con las personas con diabetes. El programa mejora los valores del control metabólico; reduce la frecuencia de días enfermos y número de hospitalizaciones; y facilita la participación tanto de los pacientes como del personal de salud, así como la toma de decisiones compartida.

Objetivo. Avaliar o Programa de manejo integral de diabetes por etapas (MIDE) no México segundo três tipos de indicadores: processo, estrutura e impacto. Métodos. Estudo transversal realizado com dados de 97.452 pessoas com diabetes (PD) que participaram do Programa MIDE de empoderamento do paciente em “módulos” designados (unidades de saúde que prestam atenção padronizada à diabetes) de ambulatórios hospitalares e centros de medicina da família do Instituto de Serviços e Seguridade Social dos Trabalhadores do Estado (ISSSTE) entre 2007 e 2014. O programa promove o empoderamento e o autocuidado dos pacientes com diabetes realizando consultas ambulatoriais com uma equipe de saúde multidisciplinar que recebe capacitação contínua. Os dados de referência foram comparados aos resultados pós-programa para os seguintes indicadores: processo (controle metabólico segundo os níveis de hemoglobina glicada [HbA1c], triglicerídeos [TG] e colesterol total [CT]); estrutura (número de módulos do MIDE instalados nos ambulatórios do ISSSTE e número de pacientes/pessoal de saúde credenciados como especialistas/diplomados em diabetes) e impacto (número médio de dias de doença do paciente [DD] e internações hospitalares (IH) por PD por um período de 12 meses). Resultados. No período de estudo de sete anos, o percentual de pacientes com controle metabólico (HbA1c <7,0%, TG <150 mg/dl e CT <200 mg/dl) aumentou significativamente (de 35,4% a 60%, atingindo o ponto mais alto de 62% em 2013; P < 0,001). Houve redução dos níveis médios de HbA1c, TG e CT por PD de 25%, 31% e 11%, respectivamente. O número médio de DD e IH por PD em um período de 12 meses teve queda de 38% e 41%, respectivamente. Ao todo, foram instalados 140 módulos do Programa MIDE nos ambulatórios do ISSSTE, 1.117 diplomas foram concedidos a 826 profissionais da saúde e 2.613 PD foram credenciados como “pacientes especialistas em diabetes”. Conclusões. O programa MIDE de empoderamento do paciente é viável, utilizável e aceitável às PD. Promove melhor controle metabólico da diabetes, reduz o número de DD e IH e facilita a participação de pacientes, o envolvimento do pessoal da saúde e a tomada de decisão conjunta.

New model for diabetes primary health care based on patient empowerment and the right to preventive health: the MIDE program.

OBJECTIVE: To evaluate Mexico's national Integrated Management of Diabetes in Stages (Manejo Integral de la Diabetes por Etapas, MIDE) program using three types of indicators: process, structure, and impact. METHODS: A cross-sectional study was conducted using data for 97 452 people with diabetes (PWD) who participated in the MIDE patient empowerment program (PEP) at "MIDE modules" (standardized diabetes health care units) at Mexico's Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) hospital clinics and family medical clinics nationwide between 2007 and 2014. The program promotes diabetes patient empowerment and self-care through outpatient consultations with a multidisciplinary health care team supported by continuous training. Baseline data were compared with results post-program for the following indicators: process (metabolic control (MetC), based on glycated hemoglobin (HbA1c), triglyceride (TG), and total cholesterol (TC) levels); structure (number of MIDE modules installed at ISSSTE clinics and number of patients/health personnel accredited as diabetes experts/awarded diplomas); and impact (average number of patient illness days (IDs) and hospitalization episodes (HEs) per PWD over a 12-month period). RESULTS: Over the seven-year study period, the proportion of patients with MetC (HbA1c < 7.0%, TG < 150 mg/dL, and TC < 200 mg/dL) increased significantly (from 35.4% to 60% (with a peak level of 62% in 2013); P < 0.001); average HbA1c, triglycerides, and total cholesterol per PWD dropped by 25%, 31%, and 11% respectively; average number of IDs and HEs per PWD over a 12-month period dropped by 38% and 41% respectively; a total of 140 MIDE modules were installed at ISSSTE clinics; and a total of 1 117 diplomas were awarded to 826 health professionals, and 2 613 PWD were accredited as "patient experts in diabetes." CONCLUSIONS: The MIDE PEP is feasible, usable, and acceptable to PWD. The program improves MetC; reduces the frequency of IDs and HEs; and facilitates patient participation, the involvement of health personnel, and shared decision-making.

New model for diabetes primary health care based on patient empowerment and the right to preventive health: the MIDE program / El programa MIDE: un nuevo modelo de atención primaria para la diabetes basado en el empoderamiento de los pacientes y el derecho a la salud preventiva / Novo modelo de atenção primária à saúde de diabetes baseado no empoderamento e no direito à saúde preventiva do paciente: Programa MIDE

ABSTRACT Objective To evaluate Mexico's national Integrated Management of Diabetes in Stages (Manejo Integral de la Diabetes por Etapas, MIDE) program using three types of indicators: process, structure, and impact. Methods A cross-sectional study was conducted using data for 97 452 people with diabetes (PWD) who participated in the MIDE patient empowerment program (PEP) at "MIDE modules" (standardized diabetes health care units) at Mexico's Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) hospital clinics and family medical clinics nationwide between 2007 and 2014. The program promotes diabetes patient empowerment and self-care through outpatient consultations with a multidisciplinary health care team supported by continuous training. Baseline data were compared with results post-program for the following indicators: process (metabolic control (MetC), based on glycated hemoglobin (HbA1c), triglyceride (TG), and total cholesterol (TC) levels); structure (number of MIDE modules installed at ISSSTE clinics and number of patients/health personnel accredited as diabetes experts/awarded diplomas); and impact (average number of patient illness days (IDs) and hospitalization episodes (HEs) per PWD over a 12-month period). Results Over the seven-year study period, the proportion of patients with MetC (HbA1c < 7.0%, TG < 150 mg/dL, and TC < 200 mg/dL) increased significantly (from 35.4% to 60% (with a peak level of 62% in 2013); P < 0.001); average HbA1c, triglycerides, and total cholesterol per PWD dropped by 25%, 31%, and 11% respectively; average number of IDs and HEs per PWD over a 12-month period dropped by 38% and 41% respectively; a total of 140 MIDE modules were installed at ISSSTE clinics; and a total of 1 117 diplomas were awarded to 826 health professionals, and 2 613 PWD were accredited as "patient experts in diabetes." Conclusions The MIDE PEP is feasible, usable, and acceptable to PWD. The program improves MetC; reduces the frequency of IDs and HEs; and facilitates patient participation, the involvement of health personnel, and shared decision-making.

RESUMEN Objetivo: Evaluar el programa nacional mexicano "Manejo Integral de la Diabetes por Etapas" (MIDE) usando tres tipos de indicadores: proceso, estructura e impacto. Métodos Se realizó un estudio transversal con los datos de 97 452 personas con diabetes que participaron entre el 2007 y el 2014 en el programa de empoderamiento de pacientes de MIDE que se llevó a cabo en los "módulos del MIDE" (unidades estandarizadas de atención de salud de diabetes) en el Instituto de Servicios y de Seguridad Sociales de los Trabajadores del Estado (ISSSTE) de México, además de en consultorios de hospitales y centros de medicina familiar de todo el país. El programa promueve el empoderamiento y el autocuidado en los pacientes con diabetes mediante consultas ambulatorias con un equipo de atención de salud multidisciplinario complementadas con talleres de capacitación continua. Se compararon los datos iniciales y los resultados al final del programa con respecto a los siguientes indicadores: proceso (control metabólico basado en análisis de los niveles de glucohemoglobina [HbA1c], triglicéridos y colesterol total); estructura (número de módulos del MIDE instalados en clínicas del ISSSTE y número de pacientes y personal de salud acreditado como experto en diabetes o que ha obtenido un certificado); e impacto (número promedio de días enfermos de los pacientes y número de hospitalizaciones por persona con diabetes durante un período de 12 meses). Resultados En el período de estudio de siete años, la proporción de pacientes con control metabólico (HbA1c < 7,0%, triglicéridos < 150 mg/dL y colesterol total < 200 mg/dL) aumentó significativamente (de 35,4% a 60%, con un nivel máximo de 62% en 2013; P < 0,001); el nivel promedio de HbA1c, triglicéridos y colesterol total por persona con diabetes descendió en 25%, 31% y 11% respectivamente; el número promedio de días enfermos y número de hospitalizaciones por persona con diabetes durante un período de 12 meses descendió en 38% y en 41% respectivamente; se instalaron un total de 140 módulos del MIDE en clínicas del ISSSTE, y se otorgaron un total de 1117 certificados a 826 profesionales de la salud y 2613 personas con diabetes fueron acreditados como "paciente experto en diabetes". Conclusiones El programa de empoderamiento de pacientes del MIDE es un programa factible y aceptable para utilizarse con las personas con diabetes. El programa mejora los valores del control metabólico; reduce la frecuencia de días enfermos y número de hospitalizaciones; y facilita la participación tanto de los pacientes como del personal de salud, así como la toma de decisiones compartida.

RESUMO Objetivo Avaliar o Programa de manejo integral de diabetes por etapas (MIDE) no México segundo três tipos de indicadores: processo, estrutura e impacto. Métodos Estudo transversal realizado com dados de 97.452 pessoas com diabetes (PD) que participaram do Programa MIDE de empoderamento do paciente em "módulos" designados (unidades de saúde que prestam atenção padronizada à diabetes) de ambulatórios hospitalares e centros de medicina da família do Instituto de Serviços e Seguridade Social dos Trabalhadores do Estado (ISSSTE) entre 2007 e 2014. O programa promove o empoderamento e o autocuidado dos pacientes com diabetes realizando consultas ambulatoriais com uma equipe de saúde multidisciplinar que recebe capacitação contínua. Os dados de referência foram comparados aos resultados pós-programa para os seguintes indicadores: processo (controle metabólico segundo os níveis de hemoglobina glicada [HbA1c], triglicerídeos [TG] e colesterol total [CT]); estrutura (número de módulos do MIDE instalados nos ambulatórios do ISSSTE e número de pacientes/pessoal de saúde credenciados como especialistas/diplomados em diabetes) e impacto (número médio de dias de doença do paciente [DD] e internações hospitalares (IH) por PD por um período de 12 meses). Resultados No período de estudo de sete anos, o percentual de pacientes com controle metabólico (HbA1c <7,0%, TG <150 mg/dl e CT <200 mg/dl) aumentou significativamente (de 35,4% a 60%, atingindo o ponto mais alto de 62% em 2013; P < 0,001). Houve redução dos níveis médios de HbA1c, TG e CT por PD de 25%, 31% e 11%, respectivamente. O número médio de DD e IH por PD em um período de 12 meses teve queda de 38% e 41%, respectivamente. Ao todo, foram instalados 140 módulos do Programa MIDE nos ambulatórios do ISSSTE, 1.117 diplomas foram concedidos a 826 profissionais da saúde e 2.613 PD foram credenciados como "pacientes especialistas em diabetes". Conclusões O programa MIDE de empoderamento do paciente é viável, utilizável e aceitável às PD. Promove melhor controle metabólico da diabetes, reduz o número de DD e IH e facilita a participação de pacientes, o envolvimento do pessoal da saúde e a tomada de decisão conjunta.

Miocardiopatía periparto: caso clínico / Per partum cardiomyopathy: case report

Se presenta el caso clínico de una mujer de 20 años que presenta insuficiencia cardíaca de rápida instalación, asociada a síntomas de infección respiratoria viral, 9 semanas post parto. Previamente había presentado hipertensión en el puerperio precoz. Se demostró una severa disfunción sistólica (FE 12 por ciento). Se recuperó con medidas convencionales del tratamiento de Insuficiencia cardíaca y finalmente recibió bromocriptina basado en reportes favorables de la literatura respecto del uso de este fármaco. En el control al año de su alta, se mantenía asintomática pero persistía severa disminución de la FE (18 por ciento) y dilatación de cavidades izquierdas. Se revisa la información acerca de esta patología.

A 20 year old woman developed rapidly progressive heart failure 9 weeks after delivery. For a few weeks she was hypertensive. A severe systolic dysfunction with an EF of 12 percent was shown on echocardiography. She recovered on conventional treatment of congestive heart failure. Eventually she received bromocriptine con the basis of favorable literature reports. A follow up control at one year showed an asymptomatic patient, however severe systolic dysfunction with EF 18 percent was still present.

[Adverse events identified in medical complaints]. / Eventos adversos identificables en las quejas médicas.

BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.

Eventos adversos identificables en las quejas médicas / Adverse events identified in medical complaints

BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.

[Exploratory study of ethics, norms and communication skills in medical residents]. / Estudio exploratorio de los conocimientos sobre ética, normativa y comunicación en los aspirantes a residencias médicas.

Medical schools teach technical-scientific knowledge more than social abilities. Confidence in the doctor-patient relationship is obtained through appropriate communication. The predominant medical education model assumes that communication abilities are acquired by the experienced physician in clinical practice. The present study presents a first approach and exploration of three central subjects for the development of a suitable doctor-patient relationship. We observed that the integration of evaluated knowledge was low: communication 21.1%, ethics 40.5%, legal issues 0.1% and doctor-patient conflicts 1.5%. In the analysis of communication models by genre, we found that women were more paternalist and men were more deliberative; the predominant model of communication is paternalism (40.2%). Physicians between 21 and 25 years of age integrated the knowledge better (communication, ethics and doctor-patient conflicts) than at other ages. Physicians between 41 and 45 years of age integrated ethical concepts with significantly less frequency. Parental education was associated with models of communication and integration of knowledge (p <0.001). The results demonstrate the lack of knowledge related to these topics.

[Complaints for treatment of uterine myomatosis]. / Inconformidades por tratamiento de miomatosis uterina.

Complaints related to uterine myomatosis treatments received by the National Commission of Medical Arbitration (Conamed) between 2001 and 2005 were analyzed. Complaints were from patients affiliated to social security institutions (51.7 %), private providers (34.5 %) and public health care services (13.8 %). A medical doctor suggested to fill in the complaint in 10.3 % of cases. Perception of inadequate treatment was the most frequent cause (69 %), incomplete medical charts were 60.3 % and only 24 % included the informed consent form. Medical information given to patients and relatives was inadequate (48.2 %). Hysterectomy was performed to 84.5 % of patients. The most frequent surgical complications were hemorrhage (25.7 %), urologic injuries (25.7 %) and surgical infections (12.7 %). 36.4 % of cases had no surgical complication. Main sequelae were: elapsed length of hospital stay (15 %) and loss of an organ (other than uterus) or function (not reproductive) (13.8 %). There was one death (1.7 %). Medical malpractice was found in 29.3 % of cases. Principal deviations: communication problems (29.6 %), unjustified delayed surgery (29.4 %) and delayed diagnosis of complications due to poor post-surgical care or premature hospital discharge (29.4 %).

[Medical attitude regarding the negative of receiving blood transfusions by Jehovah's Witness patients]. / Actitud médica ante la negativa de recibir hemotransfusión por pacientes Testigos de Jehová.

BACKGROUND: Hemoderivative and blood transfusions without proper medical indication bring uncertain benefits, increase health risks and adverse effects. It is necessary to also consider the patient's values and preferences and the denial to receive transfusions. A deficient medical evaluation and an unnecessary transfusion can generate untoward effects regarding patients' health and safety. MATERIAL AND METHODS: A retrospective, observational, and transverse study of 767 complaints for alleged denial of medical attention presented by Jehovah's Witness patients was undertaken, coupled with their denial to receive blood transfusions and their perception of the problem. RESULTS: It was established that 95.6% of cases studied involved adult patients, while 4.4% involved underage patients, with a mean of 43 years. The majority of complaints appeared at the secondary level of medical attention, 64.5% came from social security institutions and 19% from private institutions. The motive for medical consultation was surgical in 91.9% cases. 98.7% of the complaints were due to a perceived denial of medical attention, associated to religious conviction. 1.3% of complaints were filed after having received blood transfusions, without proper patient consent. The major health problems were solved in different medical units from the beginning in 500 cases (65.2%). Medical care was provided in 450 cases, in private clinics, while 50 cases were cared for in public institutions without the need for transfusion. CONCLUSIONS: Several studies coincide on the high number of unnecessary or unjustified blood transfusions. To improve the quality of transfusion medicine steps should be taken to install specialized hospital committees, update the use of guidelines based on the best scientific evidence, as well as to respect patient autonomy.

[Defensive medicine in Mexico: an explorative survey of its characteristics]. / Medicina defensiva en México: una encuesta exploratoria para su caracterización.

INTRODUCTION: defensive medicine, has been recognized as a problem for health services in several countries of the world. It is defined as the application of treatments, tests and procedures with the main intention to defend the doctor of critic's and to avoid controversies, regarding diagnosis or patient's treatment. There are multiple causes of the defensive medicine: the fundamental is patient doctor relationship without the necessary trust. MATERIAL AND METHODS: the present reports it is a observational, cross-sectional and descriptive study of exploratory nature, with the objective to consider the dimension of the defensive medicine (MD) in Mexico. A survey was designed to pilot an application with Likert scale in a representative sample. 613 doctors participated to national level, with index of confidence of 95% and maximum error of 5% (p < 0.05). The questions explore the level in agreement or disagreement with perceptions, specific attitudes and conducts that are related to the MD practice. RESULTS: categories and degrees in the defensive practices of the interviewed doctors settled down, 38,7% were nondefensive, whereas 61,3% presented association with some MD degree (p < 0.05). CONCLUSIONS: The defensive attitude of the participant doctors is high, it emphasizes the importance of establishing measures that stimulate their containment and fights, which will allow to improve the quality of the medical practice and the doctor-patient relationship. The instrument maintained a degree of confidence and sensitivity (p < 0.05), that its future use allows.

Revision de los documentos de estandarización de las curriculas de residencia médica anestesiologia; ginecología y obstetricia; pediatria; cirugia general; medicina interna / Es

Pretende constituirse en un plan único de formación postgradual que involucre las funciones de desempeño de cada una y uno de los especialistas, tales como la prestación de atención médica especializada, desarrollo de la investigación y gestión de los servicios de salud, además de un componente educativo como herramienta de comunicación en la práctica cotidiana