RESUMO
Introduction: Medical students are poorly prepared in health services management due to the use of traditional teaching methods, developed in theoretical environments with poor active participation. Virtual simulated training is an innovative alternative in the learning process. Objective: This study aimed to determine the knowledge improvement in managerial decision-making amongst medical students at the Universidad Nacional Mayor de San Marcos in Peru, after a virtual simulated training. Methods: A before-after cross-sectional design was undertaken among final year medical students to measure their improvement in management knowledge. The simulation methodology was used as a component of the Medical Externship clinical course in which the administrative dimension of a clinical case such as hypoacusis was considered. Results: Of the 79 participants, 48 (60.8%) were female and the median age was 25 years. There was a median satisfaction level of 3.8 and the performance median score was 17. The median post-test rank scores were higher and statistically significant than pre-test rank scores (p = 0.004); post-test scores for males (p-value = 0.05) and females (p = 0.03) were also statistically higher than pre-test scores. Conclusion: The non-clinical simulation experience improves the knowledge on managerial decision making. It also opens opportunities to work on management issues in clinical courses, providing a comprehensive learning experience. On the other hand, it is an innovative experience where a clinical course adopts a management component.
Introducción: Los estudiantes de medicina están poco preparados en gestión de servicios de salud debido al uso de métodos de enseñanza tradicionales, llevados a cabo en entornos teóricos y poco participativos. La formación virtual simulada es una alternativa innovadora en el proceso de aprendizaje. Objetivo: Determinar la mejora en conocimientos sobre la toma de decisiones gerenciales entre los estudiantes de medicina de la Universidad Nacional Mayor de San Marcos en Perú, tras un entrenamiento simulado virtual. Métodos: Estudio de diseño transversal de antes-después en estudiantes de último año de medicina. La metodología de simulación se utilizó como un componente del curso clínico de externado, en el que se consideró la dimensión administrativa de un caso clínico de hipoacusia. Resultados: De los 79 participantes, 48 (60,8%) eran mujeres y la edad media era de 25 años. La mediana del nivel de satisfacción fue de 3,8 y la mediana del rendimiento fue de 17. La mediana de las puntuaciones del post-test fue mayor y estadísticamente significativa en comparación a la del pre-test (p = 0,004); las puntuaciones post-test fueron más altas que las puntuaciones pre-test para los hombres (p = 0,05) y mujeres (p = 0,03). Conclusiones: La experiencia de simulación no clínica logra una mejora significativa en el conocimiento de los participantes. Además, abre oportunidades para trabajar los temas de gestión en los cursos clínicos, proporcionando una experiencia de aprendizaje integral. Por otro lado, es una experiencia innovadora en la que un curso clínico adopta un componente de gestión.
RESUMO
Los cambios producidos entre los 6 y 9 años de edad a nivel de crecimiento craneofacial y de desarrollo de oclusión se consideran decisivos para lograr una oclusión favorable debido a que la erupción dental determina en gran porcentaje este crecimiento, al ser un estímulo director de la formación ósea maxilar durante estas edades. Es fundamental que el odontólogo general, el odontopediatra y el ortodoncista conozcan los cambios que se dan en este periodo puesto que son las edades adecuadas para prevenir e interceptar diversas maloclusiones. El objetivo de esta revisión fue analizar la cronología y secuencia de erupción en el primer periodo transicional de la dentición mixta. En la revisión se muestra el análisis de varios estudios nacionales e internacionales para lograr un mejor entendimiento de los diversos factores que pueden modificar este proceso de erupción.
The changes that occurred in the craniofacial growth and the occlusion development between 6 and 9 years old are crucial for achieving a favorable occlusion due in a great percentage to tooth eruption, being this process a director of the stimulus in the maxillary bones during these ages. It is essential that the general dentist, pedodontist and orthodontist know the changes that occur in this period because these are the adequate ages to prevent and intercept some malocclusions. The objective of this review was to examine the timing and sequence of eruption in the first transitional period in mixed dentition. In this review, we present an analysis of several national and international studies in order to show a better understanding of the multiple factors that can modify the dental eruption process.
RESUMO
Hepatitis A virus (HAV) infection is the major cause of acute liver failure in paediatric patients. The clinical spectrum of infection is variable, and liver injury is determined by altered hepatic enzyme function and bilirubin concentration. We recently reported differences in cytokine profiles between distinct HAV-induced clinical courses, and bilirubin has been recognized as a potential immune-modulator. However, how bilirubin may affect cytokine profiles underlying the variability in the course of infection has not been determined. Herein, we used a transcription factor (TF) binding site identification approach to retrospectively analyse cytokine expression in HAV-infected children and to predict the entire set of TFs associated with the expression of specific cytokine profiles. The results suggested that modulation of the activity of signal transducers and activators of transcription proteins (STATs) may play a central role during HAV infection. This led us to compare the degree of STAT phosphorylation in peripheral blood lymphoid cells (PBLCs) from paediatric patients with distinct levels of conjugated bilirubin (CB). Low CB levels in sera were associated with increased STAT-1 and STAT-5 phosphorylation. A positive correlation was observed between the serum interleukin-6 (IL-6) content and CB values, whereas higher levels of CB correlated with reduced serum IL-8 values and with a reduction in the proportion of PBLCs positive for STAT-5 phosphorylation. When CB was used to stimulate patients' PBLCs in vitro, the levels of IL-6 and tumour necrosis factor-α were increased. The data showed that bilirubin plays a role in STAT function and affects cytokine profile expression during HAV infection.
Assuntos
Bilirrubina/metabolismo , Citocinas/metabolismo , Vírus da Hepatite A , Hepatite A/metabolismo , Fatores de Transcrição STAT/metabolismo , Bilirrubina/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Análise por Conglomerados , Citocinas/sangue , Feminino , Hepatite A/imunologia , Vírus da Hepatite A/imunologia , Humanos , Leucócitos Mononucleares/metabolismo , Masculino , NF-kappa B/metabolismo , Avaliação de Resultados da Assistência ao Paciente , FosforilaçãoRESUMO
BACKGROUND: Development of a subaortic membrane is not fully understood. Recurrence after surgical removal continues to be high. We sought to assess the differences in aorto-septal angles (AoSA) to possibly explain alterations within the left ventricular outflow tract, hence in subaortic membrane formation. METHODS: A total of 113 patients who underwent subaortic membrane resection were matched by age and sex with 113 controls. The subaortic membrane resection group included isolated subaortic membranes (n = 34, group I), associated with ventricular septal defect (n = 29, group II), or patent ductus arteriosus (n = 50, group III). RESULTS: Mean (± standard deviation) AoSA (in degrees) were not different between subaortic membrane groups I, II, and III but were steeper than their control groups (126.2 ± 9.2 vs 138.6 ± 7.0, 129.2 ± 9.9 vs 137.7 ± 10.0, and 126.2 ± 8.1 vs 135 ± 8.5, respectively; all Ps < .05). Additionally, group II had lower preoperative gradients (28.8 ± 20.7 mm Hg) compared to groups I and III (67.0 ± 32.9 and 66.2 ± 33.1 mm Hg, respectively, P < .001). Follow-up ranged from 3 to 132 months. In 22 (32%) patients, a subaortic membrane recurred. Early postoperative residual gradients and development of aortic regurgutation were associated with the need for reoperation (P < .05). CONCLUSIONS: These findings suggest a contributing role of the AoSA in the development of subaortic membrane. Further rheological experiments are warranted. Whether the steeper the angle the higher the risk of recurrence may be revealed by longer follow-up periods.
Assuntos
Aorta Torácica/patologia , Estenose Subaórtica Fixa/patologia , Cardiopatias Congênitas/patologia , Septos Cardíacos/patologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Estenose Subaórtica Fixa/diagnóstico por imagem , Estenose Subaórtica Fixa/cirurgia , Ecocardiografia , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Resumen
El presente trabajo se realizó con el objetivo de dar a conocer la evolución de la profesión de enfermería durante la época de la Revolución Mexicana. La práctica enfermera se dio de dos formas: en la primera, la mujer brinda el cuidado de forma empírica a hijos, esposos, madres y heridos en del campo de batalla durante la revolución, son las llamadas Adelitas o soldaderas, por otra parte, con la inauguración de la primera escuela de enfermería se tuvo la oportunidad de formar personal para dar cuidados específicos de la práctica de enfermería en esa época.
Summary
This work was conducted with the aim of raising awareness of the evolution of the nursing profession during the time of the Mexican Revolution. The practice of nursing was in two forms: first, the woman provides care in an empirical way to sons, husbands, mothers and wounded soldiers in the battlefield of the revolution, called "Adelitas or soldaderas" and the other with the opening of the first school of nursing. The staff had the objective to structure an advance program tha allowed special care of the practice of nursing according with the time.
Assuntos
Humanos , Escolas de Enfermagem , Guerra , História da Enfermagem , História do Século XX , Recursos Humanos de Enfermagem , México , HumanosRESUMO
A large underserved population of children with congenital cardiac malformation (CCM) exists in many developing countries. In recent years, several strategies have been implemented to supplement this need. These strategies include transferring children to first-world countries for surgical care or the creation of local pediatric cardiovascular surgical programs. In 1997, an effort was made to create a comprehensive pediatric cardiac care program in Guatemala. The objective of this study is to examine the outcome analysis of the Guatemala effort. The goals of our new and first pediatric cardiac care program were to: 1) provide diagnosis and treatment to all children with a CCM in Guatemala; 2) train of local staff surgeons, 3) established a foundation locally and in the United States in 1997 to serve as a fundraising instrument to acquire equipment and remodeling of the pediatric cardiac unit and also to raise funds to pay the hospital for the almost exclusively poor pediatric cardiac patients. The staff now includes 3 surgeons from Guatemala, trained by the senior surgeon (A.R.C.), seven pediatric cardiologists, 3 intensivists, and 2 anesthesiologists, as well as intensive care and ward nurses, respiratory therapists, echocardiography technicians, and support personnel. The cardiovascular program expanded in 2005 to 2 cardiac operating rooms, 1 cardiac catheterization laboratory, 1 cardiac echo lab, 4 outpatients clinics a 6-bed intensive care unit and a 4-bed stepdown unit, a 20 bed general ward (2 beds/room) and a genetics laboratory. Our center has become a referral center for children from Central America. A total of 2,630 surgical procedures were performed between February 1997 and December 2007, increasing the number of operations each year. Postoperative complication occurred in 523 of 2,630 procedures (20%). A late follow-up study was conducted of all the patients operated from 1997 to 2005. Late mortality was 2.7%. Development of a sustainable pediatric cardiac program in emerging countries presents many difficult challenges. Hard work, perseverance, adaptability, and tolerance are useful aptitudes to develop a viable PCP in an "emerging" country. We are not in favor of Medical-Surgical Safari efforts, unless these efforts include training of a local team and eventual unit independence. It helps if an experienced (+/- senior/retired!) surgeon leads this effort on a full-time, pro bono basis. Local and international fund raising is essential to complement vastly insufficient government subsidies.
Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias Congênitas/cirurgia , Programas Nacionais de Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pediatria , Países em Desenvolvimento , Bolsas de Estudo , Guatemala/epidemiologia , Cardiopatias Congênitas/epidemiologia , Humanos , Objetivos Organizacionais , Desenvolvimento de Programas , Avaliação de Programas e Projetos de SaúdeRESUMO
BACKGROUND: In 1997, an effort was made to disseminate US pediatric cardiac surgical practices to create a new comprehensive program in Guatemala. The objective of this study was to describe the improvement of the program by exploring the reduction in risk-adjusted in-hospital mortality. METHODS AND RESULTS: A retrospective cohort study of surgical procedures performed in Guatemala from February 1997 to July 2004 was conducted. Data were divided into 3 time periods (1997 to 1999, 2000 to 2002, and 2003 to 2004) and compared with a US benchmark (2000 Kids' Inpatient Database of 27 states and 313 institutions). The risk adjustment for congenital heart surgery (RACHS-1) method was used to adjust for case mix. Mortality rates, standardized mortality ratios, and 95% confidence intervals were calculated. A total of 1215 surgical procedures were included. Median age was 3.1 years (range, 1 day to 17.9 years). The overall mortality was 10.7% (n=130). The RACHS-1 method showed better discrimination than in prior reports (area under receiver operating characteristic curve=0.854). A decreasing trend in mortality rate was observed in every RACHS-1 risk category over the 3 time periods. When compared against the US benchmark, the reduction in risk-adjusted mortality was noted by a decrease of standardized mortality ratio from 10.0 (95% confidence interval, 7.2 to 13.7) in 1997-1999, to 7.8 (95% confidence interval, 5.9 to 10.0) in 2000-2002, and to 5.7 (95% confidence interval, 3.8 to 8.3) in 2003-2004. CONCLUSIONS: In a short time period, mortality after congenital heart surgery has been reduced substantially in Guatemala. Measurement of risk-adjusted mortality is a useful method to assess pediatric cardiac program improvement in the developing world.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Programas Nacionais de Saúde , Procedimentos Cirúrgicos Cardíacos/mortalidade , Países em Desenvolvimento , Feminino , Guatemala , Mortalidade Hospitalar , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Estados UnidosRESUMO
A bilateral bidirectional cavopulmonary shunt was performed in a cyanotic 14-month-old girl who had tricuspid and pulmonary valve atresia, with right pulmonary artery (RPA) hypoplasia (3 mm), bilateral superior vena cavae and a ductus arteriosus-dependent pulmonary blood flow. Because of 62% postoperative arterial oxygen saturation and a right superior vena cava (RSVC) pressure of 30 mmHg, a 5 mm Gore-Tex tube was interposed to connect the two superior venae cavae. The creation of a 'new-innominate' vein allowed decompression of the right superior vena cava and an increase in arterial oxygen saturation to 86%.
Assuntos
Prótese Vascular , Anormalidades Cardiovasculares/cirurgia , Derivação Cardíaca Direita/métodos , Adolescente , Implante de Prótese Vascular/métodos , Veias Braquiocefálicas/cirurgia , Feminino , Derivação Cardíaca Direita/instrumentação , Humanos , Atresia Pulmonar/cirurgia , Valva Pulmonar/anormalidades , Resultado do Tratamento , Atresia Tricúspide/cirurgiaRESUMO
BACKGROUND: Congenital cardiac disease is the greatest cause of death in patients with Down's syndrome during the first two years of life, with from two-fifths to two-thirds of those with Down's syndrome also having congenital cardiac malformations. The lesions within the heart can be single or multiple. Our objective was to evaluate the frequency and type of such congenital cardiac malformations in patients born with Down's in Guatemala, and to provide baseline information for further research. METHODS: We reviewed all patients with Down's syndrome who underwent a cardiologic screening examination between January, 1997, and December, 2003, in the only department dealing with Paediatric Cardiology in Guatemala. RESULTS: Of the 349 patients reviewed, 189 (54.1 per cent) also had an associated congenital cardiac malformation. The median age at diagnosis was 6 months, with a range from 2 to 13 months. In 152 patients (80.4 per cent), the cardiac lesion was isolated, while 37 patients (19.6 per cent) had multiple defects. The most common single defect was patency of the arterial duct, found in 54 of the 189 patients (28.6 per cent), followed by ventricular septal defect in 27.5 per cent, atrial septal defect in 12.7 per cent, and atrioventricular septal defect with common atrioventricular junction in 9.5 per cent. The most frequent concomitant malformation found co-existing with other congenital cardiac lesions was patency of the arterial duct, found in 17.5 per cent. CONCLUSIONS: As far as we are aware, ours is the first epidemiologic study concerning the frequency and type of congenital cardiac disease found in Guatemalan children with Down's syndrome. The high frequency of patency of the arterial duct, and the differential distribution of the cardiac malformations associated with Down's syndrome among Guatemalan children, differ from what has been reported in the United States of America, Europe, and Asia. This difference warrants further research.
Assuntos
Síndrome de Down/epidemiologia , Cardiopatias Congênitas/epidemiologia , Fatores Etários , Pré-Escolar , Permeabilidade do Canal Arterial/epidemiologia , Comunicação Atrioventricular/epidemiologia , Feminino , Guatemala/epidemiologia , Comunicação Interatrial/epidemiologia , Comunicação Interventricular/epidemiologia , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
Desde hace varias décadas se utiliza el ultrasonido como método diagnóstico. Pese a sus limitaciones sigue siendo una técnica precisa para el diagnóstico por imágenes. Nuestro objetivo es determinar los hallazgos ecográficos pélvicos en 1500 pacientes que fueron evaluadas en el Servicio de Medicina Preventiva del Hospital de Clínicas Caracas en el período 1998-1999, excluyendo pacientes histerectomizadas. De 1082 pacientes, el 79,76 por ciento de los ecosonogramas pélvicos fueron normales y el 20,24 por ciento patológicos, siendo la alteración más frecuente la leiomiomatosis uterina con un 82,2 por ciento y la edad más frecuente de presentación de 40 a 49 años
Assuntos
Humanos , Feminino , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem , Ginecologia , Pelve , Medicina PreventivaRESUMO
La mamografía es la técnica ideal de exploración radiográfica de la mama. Se utiliza esta técnica masivamente desde 1960. En este estudio se evaluaron 500 historias de pacientes femeninas, a las cuales se les practicó la mamografía como método de pesquisa del Servicio de Medicina Preventiva del Hospital de Clínicas Caracas, durante el año de 1998. De estas 229 (45.8 por ciento) se reportaron dentro de los límites normales y 271 (54.2 por ciento) fueron reportadas como alteradas. Estas últimas correspondieron a 258 (95.2 por ciento) alteraciones benignas y 13 (4.8 por ciento) sospechosas. Observándose de esta forma, que más de la mitad de los pacientes presentaron hallazgos mamográficos anormales. Se analiza la importancia del estudio preventivo mamográfico como método diagnóstico precoz en el cáncer de mama y las patologías mamarias benignas de la mujer
Assuntos
Humanos , Feminino , Neoplasias da Mama , Mamografia , Medicina Preventiva , GinecologiaRESUMO
Se trata de un estudio prospectivo, cross sectorial y observacional realizado en la unidad de Terapia Intensiva del Hospital Eugenio Espejo de Quito. De los pacientes ingresados se tomó aquellos pacientes diagnosticados de Neumonía Nosocomial asociada a la Ventilación Mecánica. Luego de identificados los casos se enviaron muestras de secreción traqueal al laboratorio para identificación del agente bacteriano causal, considerando también sí la neumonía nosocomial estaba asociada a la ventilación mecánica y si esta era de comienzo temprano, esto es luego del segundo día de estar sometido a ventilación mecánica y hasta el quinto día; o sí era de comienzo tardío, esto es luego del quinto día de estar sometido a ventilación mecánica. Además se recabo información relacionada con la morbilidad en cada grupo y otros datos epidemiológicos relevantes...
Assuntos
Hospitais de Ensino , Pneumonia , Respiração Artificial , Equador , PacientesRESUMO
En el presente trabajo se analizan los datos de los informes estadísticos sobre "enfermedades transmisibles" y "defunciones" en el Perú, en el periodo considerado entre 1960 a 1983, estudiándose la incidencia de los enfermedades inmunprevenibles:diftera, poliomielitis, sarampion, tétanos, tos ferina y tuberculosis, objeto del Programa Ampliado de Inmunizaciones (P.A.I.) y de la Organización Mundial de la Salud (OMS) (1974) y el Ministerio de Salud (1979). Este grupo de enfermedades constituye en nuestro país un serio problema, en cuanto a su magnitud epidemiológica expresada en los elevadas tasas de mortalidad, morbilidad y letalidad, los cuales repercuten en la población, especialmente en la infantil. Se ha encontrado que sarampión y tosferina representan la mayor incidencia total de morbilidad, letalidad y mortalidad, en el período considerado. Se establece que las jornadas masivas de vacunación constituyen una de las modalidades más eficaces para el incremento de las coberturas a corto plazo.