RESUMO
Otitis media is a prevalent condition that can be diagnosed and treated by primary care providers skilled in otoscopy. Previous analysis demonstrated that brief, intensive instruction at one site in rural Mexico improved the test scores of health care providers and changed long-term practices (Eavey R, et al. Otolaryngol Head Neck Surg 1993; 109:895-8). We wanted to confirm these test score findings at other sites. A didactic course on otitis media with a practical otoscopy workshop was conducted at six Mexican locations and in one Venezuelan city by an interdisciplinary group of physicians. The same coded test was given immediately before and after the course. The Wilcoxon test for significance of intrasubject performance before and after intervention was used as a nonparametric assessment. At all seven sites (n = 190 subjects), test scores demonstrated statistically significant improvement (range = p < 0.001 to p < 0.0001). We conclude that this educational method consistently improved short-term knowledge of otitis media and that further teaching efforts and a longer term practice-impact study are warranted.
Assuntos
Educação Médica Continuada , Medicina de Família e Comunidade/educação , Internato e Residência , Otite Média , Pediatria/educação , Criança , Avaliação Educacional , Endoscopia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , México , Otite Média/diagnóstico , Otite Média/terapia , Estudos Prospectivos , Estatísticas não Paramétricas , VenezuelaRESUMO
The World Health Organization has designated the teaching of otitis media management skills a "priority" status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary-care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% (p < 0.001) over baseline scores before the sessions. To evaluate long-term impact on clinical practice, a follow-up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary-care providers in rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.
Assuntos
Educação Médica Continuada/organização & administração , Modelos Educacionais , Otite Média/diagnóstico , Otite Média/terapia , Otolaringologia/educação , Médicos de Família/educação , Competência Clínica , Currículo , Educação Médica Continuada/normas , Avaliação Educacional , Humanos , México , Otolaringologia/instrumentação , Otolaringologia/métodos , Padrões de Prática Médica , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , População RuralRESUMO
Chronic parotitis is a disorder characterized by recurrent painful swelling of the gland with purulent sialorrhea. Occasionally, the condition fails to respond to medical management and definitive surgical therapy is necessary. Sialolithiasis is the usual etiology in cases of parotitis, although occasionally severe recurrent parotid infections are superimposed on underlying Sjögren's disease. Total parotidectomy with facial nerve dissection has been used in such cases in our department and has proved to be an excellent way to manage this disease. A summary of our results indicate that the recurring infections were eradicated and that the complication rate is tolerable, considering the magnitude of the problem. We feel that it is better to use surgical management early rather than wait for the formation of fistulae or abscesses.
Assuntos
Parotidite/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/patologia , Parotidite/diagnóstico por imagem , Parotidite/patologia , Complicações Pós-Operatórias , Radiografia , Recidiva , Estudos RetrospectivosRESUMO
Labial pits are usually described as blind epidermal invaginations of lip mucosa with occasional drainage of minor salivary gland secretions. A case of an aberrant parotid duct in communication with both a unilateral, commissural labial pit and an interposed salivary cyst is presented. A 7-year-old boy who had experienced lifelong clear drainage from a congenital pit at his right oral commissure developed fever, pain, and a submucosal mass of the right cheek over a 6-week period. A preoperative sialogram through the pit demonstrated a communication between the oral commissure fistula, an intervening salivary cyst, and a proximal tract from the cyst to the parotid gland. An en bloc resection of the pit, fistula tract, and cyst was performed through a transoral approach. The dissection was medial to the buccinator muscle. There has been no recurrence of the cyst after 1 year follow-up. A description of labial pits and parotid duct anomalies is presented; however, to our knowledge, this combination of anomalies has not been previously described.
Assuntos
Cistos/congênito , Lábio/anormalidades , Doenças Parotídeas/congênito , Doenças das Glândulas Salivares/congênito , Fístula das Glândulas Salivares/congênito , Criança , Humanos , MasculinoRESUMO
Otitis media in Latin America is an important cause of hearing impairment and infectious complications which can be prevented without an inordinate effort or investment of resources. The Latin American Otitis Media Research and Training Program is a multidisciplinary, international project designed to improve the detection an treatment of otitis media in Latin America. Over 200 health care providers have already participated in pilot seminars presented in Brazil, Costa Rica, and Mexico. These sessions were highlighted by audiovisual presentations emphasizing pneumatic otoscopy. We conclude that this focused program of medical education can significantly contribute to improve primary health care in the region.