Residentes, guardias en el servicio de Urgencias y síndrome de Burnout / Residents, shifts in the Emergency department and Burnout syndrome

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Defining the concept of primary care in South Korea using a Delphi method.

BACKGROUNDS AND OBJECTIVES: There is no consensus on the definition of primary care in South Korea. This study's objective was to define the concept of primary care using a Delphi method. METHODS: Three expert panels were formed, consisting of 16 primary care policy researchers, 45 stakeholders, and 16 primary care physicians. Three rounds of voting, using 9-point appropriateness scales, were conducted. The first round involved rating the appropriateness of 20 previously established attributes of primary care. In round 2, panelists received a summary of the first-round results and were asked to once again vote on the 10 undetermined attributes and the provisional definition. The final round involved voting on the appropriateness of the revised definition. The Korean Language Society reviewed the revised definition. RESULTS: Four core (first-contact care, comprehensiveness, coordination, and longitudinality) and three ancillary (personalized care, family and community context, and community base) attributes were selected. The Korean definition of primary care was accomplished with all three panel groups arriving at a "very good" level of consensus. CONCLUSIONS: The Korean definition of primary care will provide a framework for evaluating performance of primary care in South Korea. It will also contribute to resolving confusion about the concept of primary care.

A taxonomy of community-based medical education.

The authors propose a classification of community-based education (CBE) as it is implemented all over the world. To create this taxonomy, they used reports in the literature of 31 active programs in many locations. A CBE program is an instructional program carried out in a community context, outside the academic hospital. The authors distinguish between programs that are developed primarily to provide services to an underserved community; programs that have a research focus; and programs that have as their primary goal the (clinical) training of students. These three major types can be subdivided in six minor types, among them community development programs, health intervention programs, and simple community-exposure programs. The ultimate goal of creating the taxonomy is to contribute to the development of a theory of CBE and provide a more systematic way to study CBE. In addition, the proposed taxonomy clearly demonstrates the various ways in which medical schools, their staffs, and their students can become involved with the communities served. CBE is not a unitary concept but a set of attempts to contribute to the quality of life in a particular community and, at the same time, create conditions for students to acquire hands-on understanding of the nature of the problems to be faced in future professional practice, and to develop relevant skills. The taxonomy also enables those involved in the development of CBE programs in their medical schools to see alternative approaches, which will help them choose the approaches that fit their particular educational goals. Last, it demonstrates the intricacies involved in the implementation of CBE, in particular the complexity of building a learning environment that is productive for students and, at the same time, responsive to community needs.

The spectrum of beta-thalassaemia mutations in the Lebanon.

We screened 110 DNA samples from carriers of beta-thalassaemia, using the ARMS-PCR technique with primers for common Mediterranean mutations. Unidentified samples were subjected to a heteroduplex analysis with Universal Heteroduplex Generators covering the beta-globin gene, followed by DNA sequencing. In total, 16 different mutations were detected, the most frequent being IVSI-110 (40%), followed by other common Mediterranean mutations (IVSI-1, IVSII-1, IVSI-6). Other mutations detected were of Lebanese, Turkish, Iranian, Kurdish, Bulgarian and Asian Indian origin. The most heterogeneous religious group seems to be the Sunni Muslims, with 13 mutations, while only 2 mutations were detected among the Christian Maronites. Results from this study are compared with those from other Mediterranean and neighbouring countries.