ABSTRACT
BACKGROUND: Around the world, it is very expensive to become a physician. Although public medical schools are less expensive than private medical schools, tuition fees are charged at public medical schools in the majority of countries. In Brazil, public medical schools, with the exception of municipal schools, are free. There has been little investigation of any differences in conditions offered by paid or free medical schools or what occurs in public and private clerkships in Brazil. We investigated the clerkship conditions offered to the students in both public and private Brazilian medical schools by gathering the opinions of clerkship coordinators and others responsible for clerkships. METHODS: A cross-sectional, descriptive, analytical study using an electronic questionnaire was answered by clerkship coordinators to compare the clerkships of 30 public and 38 private Brazilian medical schools from all regions of the country. The questionnaires covered various aspects of the clinical environments, student supervision, faculty development, student assessments, rotation evaluations and extracurricular activities developed by students. RESULTS: We observed significant differences between public and private medical schools in several aspects investigated. Based on the opinions of the clerkship coordinators, with the exception of access to university hospitals, which was predominantly offered by public medical schools, private medical schools offer better clerkship conditions. The main differences were related to the number of positions, infrastructure, clinical learning environments, faculty development, student assessments, rotation evaluations and students' extracurricular activities. CONCLUSION: This is the first study comparing Brazilian medical clerkships in private and public medical schools and provides a general vision of these programmes. It is necessary to further investigate clerkship development in the Brazilian medical school system and to study the differences between private and public medical schools globally.
Subject(s)
Clinical Clerkship , Students, Medical , Brazil , Cross-Sectional Studies , Humans , Schools, MedicalABSTRACT
INTRODUCTION: The most commonly used technique of arteriovenous fistula cannulation for hemodialysis is the rope-ladder technique with alternation of the cannulation site. An alternative technique, the buttonhole (BH) technique, has become popular because its constant cannulation sites are advantageous for patients with special characteristics. OBJECTIVE: To assess the initial experience of our service with the BH technique and determine its usefulness. PATIENTS AND METHODS: Twenty-one patients with short, tortuous, painful fistulae of difficult cannulation were submitted to the BH technique for the first time using appropriate needles. RESULTS: Neither bleeding nor hematoma were observed during or after hemodialysis. Some patients (15%) reported little or no pain. Two (9.5%) arteriovenous fistulae were lost, and 47.6% of the patients developed fistula clotting at some point in the study, both situations related to change in cannulators. One patient had a paravertebral abscess, possibly originating from the arteriovenous fistula. DISCUSSION AND CONCLUSION: The advantages of reducing pain, miscannulation, and hematoma incidence were counterbalanced by an increased risk of infection and loss of vascular access, due to noncompliance with the technique or involvement of more than one cannulator. The BH technique is useful for selected patients.
Subject(s)
Arteriovenous Shunt, Surgical/methods , Catheterization/methods , Renal Dialysis/methods , Adult , Aged , Brazil , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
INTRODUÇÃO: A técnica de punção de fístulas arteriovenosas para hemodiálise mais comumente utilizada é a de alternância de sítios de punção. Uma técnica opcional (buttonhole) vem-se popularizando, pois os sítios de punção são constantes, oferecendo vantagens para pacientes com características especiais. OBJETIVO: Avaliar experiência inicial do serviço com a técnica de buttonhole e determinar sua utilidade. PACIENTES E MÉTODOS: 21 pacientes com fístulas curtas, tortuosas, de difícil punção ou dolorosas foram puncionados pela primeira vez utilizando-se agulhas apropriadas para a técnica buttonhole. RESULTADOS: Não foram observados sangramentos intra- ou pós-hemodiálise, assim como não houve hematomas. Observou-se dor de intensidade leve e mesmo ausência de dor em alguns pacientes (15 por cento). Houve perda de duas fístulas arteriovenosas (9,5 por cento) e 47,6 por cento dos pacientes apresentaram coágulos em algum momento, situações essas relacionadas com a troca de puncionador. Um paciente apresentou abscesso paravertebral, admitindo-se a disseminação via fístula arteriovenosa. DISCUSSÃO E CONCLUSÃO: As vantagens de menor dor, menor erro de punção e hematoma são contrabalançadas por aumento do risco de infecção e perda do acesso quando ocorre quebra da técnica ou mais de um puncionador está envolvido. É técnica útil para pacientes selecionados.
INTRODUCTION: The most commonly used technique of arteriovenous fistula cannulation for hemodialysis is the rope-ladder technique with alternation of the cannulation site. An alternative technique, the buttonhole (BH) technique, has become popular because its constant cannulation sites are advantageous for patients with special characteristics. OBJECTIVE: To assess the initial experience of our service with the BH technique and determine its usefulness. PATIENTS AND METHODS: Twenty-one patients with short, tortuous, painful fistulae of difficult cannulation were submitted to the BH technique for the first time using appropriate needles. RESULTS: Neither bleeding nor hematoma were observed during or after hemodialysis. Some patients (15 percent) reported little or no pain. Two (9.5 percent) arteriovenous fistulae were lost, and 47.6 percent of the patients developed fistula clotting at some point in the study, both situations related to change in cannulators. One patient had a paravertebral abscess, possibly originating from the arteriovenous fistula. DISCUSSION AND CONCLUSION: The advantages of reducing pain, miscannulation, and hematoma incidence were counterbalanced by an increased risk of infection and loss of vascular access, due to noncompliance with the technique or involvement of more than one cannulator. The BH technique is useful for selected patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Renal Dialysis , Arteriovenous Fistula/therapy , Vascular Fistula/therapyABSTRACT
Introdução: A Síndrome Branquio-Otorrenal é uma doença autossômica dominante de expressividade variável e alta, porém provavelmente de penetrância incompleta. Manifesta-se através de anormalidades do segundo arco branquial (fossetas pré-auriculares, fístulas ou cistos branquiais, entre outras) associadoa anormalidades renais (desde hipoplasia até agenesia renal). Objetivo: Nosso objetivo com o presente relato de caso é estimular a investigação precoce nas alterações renais em pacientes com defeitos otorrinolaringológicos, o que implica melhor prognóstico e qualidade de vida para os acometidos. Relatode caso: Relatamos a evolução de um caso de Síndrome Branquio-Otorrenal em paciente acompanhada há13 anos no ambulatório de nefrologia da Faculdade de Medicina de Marília. A paciente em questão apresenta anormalidades como fístula pré-auricular e fenda branquial, além de hipoacusia do tipo mista,com a concomitância de anormalidades renais. Discussão: Discutimos o diagnóstico a partir da pacienterelatada, bem como as manifestações da síndrome e o tratamento apropriado. Conclusão: Concluímos que o diagnóstico é simples de ser realizado, e sua detecção precoce propicia menor morbi-mortalidade.
Introduction: Branchiootorenal Syndrome (BOR) is an autosomal dominant disease with a high and variable expression, but probably with an incomplete penetrance. It manifests itself through the second branchial arch abnormalities (pre-auricular pits, branchial fistulae or cysts) associated with renal abnormalities (ranging from renal agenesis to hypoplasia). Objective: Our goal is to stimulate early investigation of renal changes in patients with ear and neck defects implying in a better prognosis and quality of life for those affected by BOR. Case report: We report a case of branchiootorenal syndrome development in a patient followed up for 13 years at the nephrology outpatient clinic of the Faculdade de Medicina de Marília). The patient presented with abnormalities that consisted in pre-auricular andbranchial clefts, mixed hearing loss, and renal defect. Discussion: We discuss the diagnosis as well as the manifestations of the syndrome and the appropriate treatment. Conclusion: We conclude that the diagnosis is simple to perform, and its early detection provides less morbidity and mortality.
Subject(s)
Humans , Female , Adult , Branchio-Oto-Renal Syndrome , Chromosome Aberrations , Clinical EvolutionABSTRACT
A formação ética dos médicos envolve as relações profissionais que fazem parte de seu cotidiano e, neste sentido, a Faculdade de Medicina de Marília (Famema) propicia aos estudantes de medicina vivenciar desde o início do curso, na Unidade Educacional de Prática Profissional (UPP), a reflexão sobre a prática e sobre a ética das ações em saúde na Atenção Básica em Saúde (ABS) junto à comunidade. Analisou-se, nesta pesquisa, a percepção dos acadêmicos de medicina das 1ª e 2ª séries acerca das relações éticas envolvidas nas ações em saúde junto à comunidade. A abordagem qualitativa foi a opção de análise desta investigação que permitiu a construção de três categorias empíricas comuns às duas séries: A formação ética e profissional na realidade da ABS; Confidencialidade da informação no desenvolvimento do sigilo profissional médico; As relações interpessoais na formação ética do estudante de medicina, com maior predominância da segunda categoria entre os da 1ª série. Portanto, as relações éticas são mais significativas aos estudantes quando vivenciadas, desde o início, em práticas como estas.
The ethical formation of doctors involves professional relationships that are part of their daily routine, and in this context, Faculdade de Medicina de Marília (Famema) provides the medical students to live deeply since the beginning of the course at the Education Unit of Professional Practice, the ethical reflection of the actions in health when developing abilities in the Primary Health Care (PHC) together with the community. This scientific research analyzed the perception of academics of medicine on the first and second years concerning ethical actions in health developed together with the community. The qualitative approach was the option of analysis of this study that allowed the construction of three empirical categories common to the two years: The ethical and professional training in PHC's reality; Confidentiality of information on the development of medical professional secrecy; interpersonal relationships on ethical formation of medicine students, with more predominance of the second category among the first years students. Therefore, the ethical relations are more significant to the students when lived deeply, since the beginning in practices like these.
Subject(s)
Humans , Interpersonal Relations , Primary Health Care , Students, Medical , Brazil , Ethics, MedicalABSTRACT
The ethical formation of doctors involves professional relationships that are part of their daily routine, and in this context, Faculdade de Medicina de Marília (Famema) provides the medical students to live deeply since the beginning of the course at the Education Unit of Professional Practice, the ethical reflection of the actions in health when developing abilities in the Primary Health Care (PHC) together with the community. This scientific research analyzed the perception of academics of medicine on the first and second years concerning ethical actions in health developed together with the community. The qualitative approach was the option of analysis of this study that allowed the construction of three empirical categories common to the two years: The ethical and professional training in PHC's reality; Confidentiality of information on the development of medical professional secrecy; interpersonal relationships on ethical formation of medicine students, with more predominance of the second category among the first years students. Therefore, the ethical relations are more significant to the students when lived deeply, since the beginning in practices like these.
Subject(s)
Interpersonal Relations , Primary Health Care/ethics , Students, Medical , Brazil , Ethics, Medical , HumansABSTRACT
Introdução: A hipofosfatemia é definida como fósforo plasmático menor que 2,5 mg/dl podendo ser severa se inferior a 1,0 mg/dl. Ocorre em 2 a 5 pacientes hospitalizados, sendo descrita em pacientes com insuficiência renal crônica (IRC) submetidos a tratamento dialítico intenso. O quadro clínico decorre da diminuição de 2,3-difosfoglicerato e de outros compostos energéticos do metabolismo celular (ATP), podendo resultar em diminuição da contratilidade diafragmática, rabdomiólise, disfunção hematológica, miocárdica e da parte central do sistema nervoso. Metodologia: Este trabalho é um estudo retrospectivo realizado por meio de pesquisa do prontuário do paciente em programa regular de hemodiálise na Santa Casa de Misericórdia de Marília, no período de janeiro de 2003 a março de 2004, analisando-se os exames clínicos e laboratoriais apresentados pelo paciente, bem como o resultado das intervenções de suplementação efetuadas. Discussão: Num estudo retrospectivo de três anos em 149 pacientes sob hemodiálise com bicarbonato, baixos níveis de fosfato foram encontrados em 11 (7,3).
Subject(s)
Humans , Male , Middle Aged , Renal Dialysis/adverse effects , Phosphorus/deficiency , Hypophosphatemia/diagnosis , Renal Insufficiency, Chronic/physiopathologyABSTRACT
Objetívo: Verificar o perfil dos pacientes diabéticos com insuficiência renal crônica (IRC) e analisar os fatores de morbídade e mortalidade relacionados a esta afecção em relação aos pacientes não diabéticos. Metodologia: No presente trabalho foram pesqui- sados 46 pacientes com diagnóstico de DM e IRC e uma amostragem de 175 pacientes com IRC sem DM no período de 01 de janeiro de 1996 a 31 de dezembro de 1997. Resultados: A faixa etária dos pacientes diabéticos era mais elevada em relação ao grupo sem DM (p<0,01) e cerca de 63por cento dos pacientes com DM era do sexo feminino (p<0,0001). Foi notada uma relação estatisticamente significativa entre HAS e DM (P<0,05), bem como uma associação deste grupo com insuficiência cardíaca congestiva (p<0,01). A história familiar HAS e DM no grupo diabético também foi significativa em relação aos pacientes não diabéticos (p
Subject(s)
Humans , Male , Female , Diabetes Mellitus , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/etiology , Kidney DiseasesABSTRACT
Relato de um caso de paciente jovem, do sexo masculino, com queixas de hemoptise, dispnéia e perda rápida da função renal. O paciente apresentou curso fulminante com hemorragia pulmonar severa e glomerulonefrite difusa proliferativa extracapilar, rapidamente progressiva com depósitos lineares de IgG em alças capilares glomerulares. A pesquisa positiva de autoanticorpos anti-rnembrana basal na biópsia renal confirmou o diagnóstico de Doença por anticorpo anti-membrana basal e síndrome de Goodpasture.
Subject(s)
Humans , Male , Adult , Glomerulonephritis , Hemorrhage , Anti-Glomerular Basement Membrane Disease/diagnosisABSTRACT
INTRODUCTION: There are few published studies that address the problem of dysfunctional tutorial groups. Most studies are restricted to student or faculty opinions separately and to specific aspects affecting the tutorial group function. This study examined teacher and student perceptions of frequency and importance of problems observed in tutorial groups in a new PBL program. METHODS: Tutors (n=30) and students in the second (n=75) and third (n=53) year completed a questionnaire at the beginning of the 1999 academic year. The questionnaire had 33 items grouped as seven "factors" related to tutor performance, feedback, assessment, educational resources, student performance, educational problems and external factors RESULTS: The most important problems identified were related to tutors (mainly in training aspects) and students (mainly in problem discussion). Students and feedback (quality) were the most frequent. There were statistically significant differences between tutors' and students' (higher) and between second and third year (higher) students' perceptions of different factors. CONCLUSIONS: (1) Marilia Medical School (FAMEMA) has problems in the tutorial group function mainly related to contributions of students and tutors. (2) Students' and tutors' opinions, as well as those of second and third year students, differ and therefore all need to be consulted to solve tutorial group problems. (3) It is necessary to develop a better student training program and also to improve the tutors training program. (4) There is a need for continued evaluation of problem-based learning at FAMEMA. We must look at perceptions of students from all years.
