Differences in clerkship development between public and private Brazilian medical schools: an overview.

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.

Initial experience with the buttonhole technique in a Brazilian hemodialysis center.

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.

Initial experience with the Buttonhole technique in a Brazilian hemodialysis center / Experiência inicial com a técnica de Buttonhole em um centro de hemodiálise Brasileiro

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.

Relações éticas na Atenção Básica em Saúde: a vivência dos estudantes de medicina / Ethical relationship in Primary Health Care: the experience of medical students

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.

[Ethical relationship in Primary Health Care: the experience of medical students]. / Relações éticas na Atenção Básica em Saúde: a vivência dos estudantes de medicina.

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.

Nefropatia em pacientes diabéticos x nefropatia em pacientes não diabéticos. Análise de 221 pacientes tratados no Hospital das Clíniacs da Faculdade de Medicina de Marília / Nephropthy in diabetic patients x nephropathy in nom-diabetic patients. Analysis on 221 patients treated in Maília Medical School Hospital

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 (p0,05) e a sobrevida renal foi semelhante em ambos os grupos. No entanto, 45,5por cento dos pacientes diabéticos e 46,5por cento dos pacientes não diabéticos estavam em programa dialítico um ano após feito o diagnóstico de IRC e cerca de 54,5por cento e 60,6por cento, respectivamente, antes de dois anos. Conclusões: O grupo de pacien- tes com DM possui uma faixa etária de acometimento renal mais tardia. Sendo que a alta prevalência de HAS e ICC encontradas neste estudo, associada a baixo tempo de sobre- vida renal, demonstra a necessidade do controle rigoroso e precoce da glicemía sangüínea e níveis pressóricos.