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Resumo O internato médico em Medicina Geral e Familiar transformou-se entre 1981 e 2010 de um internato hospitalar de três anos para um internato baseado nos Cuidados de Saúde Primários de quatro anos. Em 2015 e 2019 o programa foi revisto e introduziram-se novos métodos de avaliação. A Coordenação de Internato Médico de Lisboa e Vale do Tejo gere a formação de 850 médicos internos, e, perante o aumento no número de médicos internos e com as alterações no programa, organizou a sua metodologia de trabalho à volta de 4 focos de intervenção: 1) Equipas Regionais; 2) Comunicação e decisão; 3) Colaboração interinstitucional; 4) Organização da equipa central em 5 pilares - a capacidade formativa, a formação de médicos internos, a avaliação contínua, a formação de médicos orientadores e a avaliação final. Entre 2019 e 2023 foi possível capacitar as equipas regionais, melhorar os processos de tomada de decisão, uniformizar o internato médico, e, a nível central, reforçar a quantidade e qualidade de vagas, aumentar a formação para médicos internos e orientadores, criar equipas de avaliação contínua e contribuir significativamente para o processo de avaliação final a nível nacional.

Abstract The General and Family Medicine practice residency program was transformed between 1981 and 2010 from a hospital-based 3-year training to a primary health care-based four-year training. In 2015 and 2019, the curriculum changed, and new evaluation methods were introduced. The Lisbon and Tagus Valley Family Practice Residency Coordination manages 850 residents in training, and due to the increase in the number of residents and changes in the curriculum, focused their team on 4 intervention areas: 1) Regional Teams; 2) Communication and Decision; 3) Collaboration; 4) Organizing the Central team around 5 pillars - training capacity, training residents, continuing assessment, training the supervisors, and final assessment. Between 2019 and 2023, they managed to empower the regional teams, improve decision-making, standardized residency programs, and, at the central level, increased the quality and number of the training slots, increased training opportunities for residents and teachers, created continuous evalutaion teams, and contributed significantly to the national final assessment process.

Resumen El internado médico en medicina general y de familia se transformó, entre 1981 y 2010, de un internado hospitalario de tres años a un internado basado en la atención primaria de cuatro años. En 2015 y 2019, el programa fue revisado y se introdujeron nuevos métodos de evaluación. La Coordinación del Internado Médico de Lisboa y Valle del Tajo gestiona la formación de 850 médicos internos y, ante el aumento en el número de médicos internos y las modificaciones en el programa, organizó su metodología de trabajo en torno a cuatro focos de intervención: 1) equipos regionales; 2) comunicación y toma de decisiones; 3) colaboración interinstitucional; 4) organización del equipo central, en cinco pilares: la capacidad formativa, la formación de médicos internos, la evaluación continua, la formación de médicos tutores y la evaluación final. Entre 2019 y 2023 se logró capacitar a los equipos regionales, mejorar los procesos de toma de decisiones, estandarizar el internado médico y, a nivel central, reforzar la cantidad y calidad de plazas, aumentar la formación para médicos internos y tutores, crear equipos de evaluación continua y contribuir de manera significativa al proceso de evaluación final a nivel nacional.

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The aim of this study was to evaluate whether dentists and dental undergraduate students know the terminology of the International Caries Consensus Collaboration (ICCC), and make their restorative treatment decisions regarding carious tissue removal accordingly. Data collection was performed using an electronic questionnaire, considering: a) profile of the respondent; b) analysis of four clinical cases with respect to possible management strategies; and c) questions on cariology field terminology. Sample size consisted of 175 dentists and 66 last semester dental students. Statistical analyses were performed comparing profile, type of institution and dental specialty of the participants. Results showed students were less conservative and agreed less with the ICCC than dentists, and private schools, less than public institutions. Private institutions were 12% (95%CI = 0.833-0.949; p = 0.000) more likely to be less updated with the ICCC recommendations than public institutions, and dentists were 20% more likely to agree with them than students (95%CI = 1.118-1.302; p = 0.000). Dentists were 66% more likely to be conservative than students (95%CI = 0.203-0.554; p = 0.000); dentists and students who graduated or were graduating from public universities were twice as likely to be conservative as those from private universities (95%CI = 1.336-3.333; p = 0.001). In conclusion, students in the last semester are less conservative than dentists, and respondents who graduated or were graduating from public dental schools were more aligned with the current concepts of the ICCC. Several answers were not aligned with ICCC directives, thus showing that management of deep carious lesions still causes restorative therapeutic insecurity.

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We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7-8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children's satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404-462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients' satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.

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Abstract The aim of this study was to evaluate whether dentists and dental undergraduate students know the terminology of the International Caries Consensus Collaboration (ICCC), and make their restorative treatment decisions regarding carious tissue removal accordingly. Data collection was performed using an electronic questionnaire, considering: a) profile of the respondent; b) analysis of four clinical cases with respect to possible management strategies; and c) questions on cariology field terminology. Sample size consisted of 175 dentists and 66 last semester dental students. Statistical analyses were performed comparing profile, type of institution and dental specialty of the participants. Results showed students were less conservative and agreed less with the ICCC than dentists, and private schools, less than public institutions. Private institutions were 12% (95%CI = 0.833-0.949; p = 0.000) more likely to be less updated with the ICCC recommendations than public institutions, and dentists were 20% more likely to agree with them than students (95%CI = 1.118-1.302; p = 0.000). Dentists were 66% more likely to be conservative than students (95%CI = 0.203-0.554; p = 0.000); dentists and students who graduated or were graduating from public universities were twice as likely to be conservative as those from private universities (95%CI = 1.336-3.333; p = 0.001). In conclusion, students in the last semester are less conservative than dentists, and respondents who graduated or were graduating from public dental schools were more aligned with the current concepts of the ICCC. Several answers were not aligned with ICCC directives, thus showing that management of deep carious lesions still causes restorative therapeutic insecurity.

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PURPOSES: To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS: Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS: Out of 1,500 enrolled patients, 1,039 (69.3%) underwent the test for the first time. The mean age was 58 +/- 16 years and the median age was 60 years. Of these, 628 (60.4%) were women. Nausea occurred in 71 (6.83%) patients, vomiting in 14 (1.35%), urticaria in 11 (1.06%), bronchospasm in 4 (0.38%) and laryngeal edema in 1 (0.01%). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A cumulative incidence of 9.72% adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.

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PURPOSES: To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS:Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS: Out of 1,500 enrolled patients, 1,039 (69.3 percent) underwent the test for the first time. The mean age was 58 ± 16 years and the median age was 60 years. Of these, 628 (60.4 percent) were women. Nausea occurred in 71 (6.83 percent) patients, vomiting in 14 (1.35 percent), urticaria in 11 (1.06 percent), bronchospasm in 4 (0.38 percent) and laryngeal edema in 1 (0.01 percent). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS: A cumulative incidence of 9.72 percent adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.

OBJETIVO: Determinar a incidência de reações adversas em pacientes submetidos à angiofluoresceinografia pela primeira vez e determinar se hipertensão arterial sistêmica, diabetes ou história de alergia aumentam a chance de reações à fluoresceína intravenosa. MÉTODOS: Os dados foram coletados entre janeiro de 2001 e outubro de 2002 em Recife, Brasil. Pacientes com angiofluoresceinografia prévia, gestantes ou pacientes em uso de medicamentos corticosteróides, imunossupressores ou anti-histamínicos foram excluídos. RESULTADOS: Dos 1.500 pacientes iniciais, 1.039 (69,3 por cento) realizavam o exame pela primeira vez. A idade média foi de 58 ± 16 anos e a mediana de 60 anos. Dentre esses, 628 (60,4 por cento) pessoas eram do sexo feminino. Náusea ocorreu em 71 (6,83 por cento) pacientes, vômito em 14 (1,35 por cento), urticária em 11 (1,06 por cento), broncoespasmo em 4 (0,38 por cento) e edema de laringe em 1 (0,01 por cento). Cinco pacientes apresentaram mais de uma reação adversa. Maiores incidências de reações adversas foram observadas em diabéticos [p<0,002, RR=1,80 (IC=1,24-2,60)], hipertensos [p<0,002, RR=1,84 (IC=1,26-2,71)] e pacientes com história de alergia [p<0,001, RR=3,90 (IC=2,70-5,63)]. CONCLUSÕES: Uma incidência cumulativa de 9,72 por cento de reações adversas foi observada em pacientes submetidos à angiofluoresceinografia pela primeira vez. Presença de história de alergia, diabetes ou hipertensão arterial aumentou a incidência de reações adversas ao contraste.

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