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BACKGROUND: The follow-up of health sciences graduates is relevant due to the commitment of universities to train professionals who contribute to solve the country's health problems. The National Autonomous University of Mexico (UNAM) has health sciences graduates who join the workforce every year. OBJECTIVE: To identify the perception of health sciences graduates regarding the curriculum and their incorporation into the labor market from 1994 to 2015, and compare it according to the degree program and campus. MATERIAL AND METHODS: Observational, cross-sectional, comparative, quantitative study. The sample of 26,866 graduates was obtained from information of three decades of the institutional questionnaire for graduates applied by the General Directorate of Planning of the UNAM. RESULTS: Most graduates were females (68.4%), with admission to the degree course at between 19 and 20 years of age (65.4%). At least 47% had a job; incorporation into the labor market depended on not having an income, a higher grade point average, not having presented extraordinary exams, or failed subjects, among others. CONCLUSIONS: Adequate job insertion is associated with starting the degree course at age 18, having financial support, having an average of 8.1 or higher and perceiving low academic and teaching training.
ANTECEDENTES: El seguimiento de egresados en ciencias de la salud es de relevancia debido al compromiso de las universidades de formar profesionales que contribuyan a resolver los problemas de salud del país. La Universidad Nacional Autónoma de Mexico (UNAM) cuenta con egresados en ciencias de la salud que cada año se incorporan al campo laboral. OBJETIVO: Identificar la percepción de los egresados de ciencias de la salud de 1994 a 2015 respecto su formación académica y su incorporación laboral, y compararla según licenciatura y plantel. MATERIAL Y MÉTODOS: Estudio observacional, transversal, comparativo y cuantitativo. La muestra de 26 866 graduados se obtuvo de la información de tres décadas del cuestionario institucional para egresados de la Dirección General de Planeación de la UNAM. RESULTADOS: La mayoría de los egresados fue del sexo femenino (68.4 %), con ingreso a la licenciatura entre los 19 y 20 años (65.4 %). Al menos 47 % trabajaba; la incorporación laboral dependió de no contar con ingresos, mayor promedio, no haber presentado exámenes extraordinarios ni recursado materias, entre otros. CONCLUSIONES: La inserción laboral adecuada se asocia a iniciar la licenciatura a los 18 años, contar con apoyo económico, tener promedio de 8.1 o más y percibir la formación académica y docente baja.
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Currículo , Humanos , Feminino , Estudos Transversais , Masculino , México , Adulto , Adulto Jovem , Inquéritos e QuestionáriosRESUMO
Marker-less hand-eye calibration permits the acquisition of an accurate transformation between an optical sensor and a robot in unstructured environments. Single monocular cameras, despite their low cost and modest computation requirements, present difficulties for this purpose due to their incomplete correspondence of projected coordinates. In this work, we introduce a hand-eye calibration procedure based on the rotation representations inferred by an augmented autoencoder neural network. Learning-based models that attempt to directly regress the spatial transform of objects such as the links of robotic manipulators perform poorly in the orientation domain, but this can be overcome through the analysis of the latent space vectors constructed in the autoencoding process. This technique is computationally inexpensive and can be run in real time in markedly varied lighting and occlusion conditions. To evaluate the procedure, we use a color-depth camera and perform a registration step between the predicted and the captured point clouds to measure translation and orientation errors and compare the results to a baseline based on traditional checkerboard markers.
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OBJETIVO: Comparar el control glucémico entre pacientes con diabetes mellitus tipo 2 prepandemia vs pandemia de Covid-19 que acudieron a unidades de salud de primer nivel de atención de la Ciudad de México. Material y métodos. Se analizaron los registros de 23 912 pacientes con diabetes; 78.7% fueron del grupo prepandemia (2016 a 2020) y 21.3% del grupo pandemia (marzo 2020 a julio 2021). Se calcularon medidas de tendencia central y de dispersión, pruebas t de Student y se ajustó un modelo de regresión logística múltiple. RESULTADOS: La mayoría de los pacientes con diabetes fueron mujeres (66.6 y 62.6%) con edad promedio de 59 y 58 años, respectivamente, y con hemoglobina glucosilada (HbA1) final de 7.7 vs el grupo pandemia (8.0). Las variables asociadas con el descontrol glucémico incluyeron periodo, nivel de HbA1, sobrepeso, obesidad, antecedente de padres con diabetes, número de medicamentos y tipo de insulina. CONCLUSIONES: La mayoría de los pacientes con diabetes en ambos grupos tuvieron descontrol glucémico. Los pacientes del grupo pandemia tuvieron mayor descontrol glucémico de HbA1 comparados con los del grupo prepandemia. Después de recibir atención médica en ambos grupos, los pacientes mejoraron su control glucémico.
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Experimental and computational approaches were used to study the microstructure of IN718 produced via powder bed fusion additive manufacturing (PBF-AM). The presence, chemical composition, and distribution of stable and metastable phases (γ'', δ, MC, and Laves) were also analyzed. The information obtained from the microstructural study was used to construct a tailored time-temperature transformation (TTT) diagram customized for additive manufacturing of IN718. Experimental techniques, including differential scanning calorimetry (DSC), scanning electron microscopy, energy dispersive X-ray spectroscopy, and electron backscatter diffraction (EBSD), were employed to establish the morphological, chemical, and structural characteristics of the microstructure. The Thermo-Calc software and a Scheil-Gulliver model were used to analyze the presence and behavior of phase transformations during heating and cooling processes under non-thermodynamic equilibrium conditions, typical of AM processes. Unlike conventional TTT diagrams of this alloy, the diagram presented here reveals that the precipitation of γ'' and δ phases occurs at lower temperatures and shorter times in AM-manufactured parts. Significantly, the superposition of γ'' and δ phase curves in the proposed diagram underscores the interdependence between these phases. This TTT diagram is a valuable insight that can help in the development of heat treatment processes and quality control for IN718 produced via PBF-AM.
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Introduction: The columella is an important subunit of the nose, essential for nasal architecture and facial aesthetics. The total reconstruction of the nasal columella becomes a great challenge after repairing trauma, carcinomas, and necrosis in this region. There are descriptions in the literature of numerous reconstruction techniques using different flaps, such as a frontal region flap, an infraclavicular region flap, and a unilateral and bilateral nasolabial flap. Case Report: A total reconstruction of the nasal columella after resection of basal cell carcinoma (BCC) using a bilateral nasolabial flap is reported. Conclusion: The technique proved effective for correcting the complex defect after BCC resection, with technical ease for resolution and good aesthetic and functional results.
Introdução: A columela é uma importante subunidade do nariz, sendo essencial para a arquitetura nasal e estética facial. A reconstrução total da columela nasal torna-se, portanto, um grande desafio após reparação de traumas, carcinomas e necroses nesta região. Há na literatura a descrição de inúmeras técnicas de reconstrução com uso de diferentes retalhos, como retalho da região frontal, retalho da região infraclavicular, retalho nasolabial unilateral e bilateral. Relato de Caso: Reporta-se uma reconstrução total da columela nasal pós-ressecção de carcinoma basocelular (CBC) utilizando retalho nasolabial bilateral. Conclusão: A técnica utilizada mostrou-se eficaz para correção do defeito complexo pós-ressecção de CBC, apresentando facilidade técnica para resolução e bom resultado estético-funcional.
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Introduction: Squamous cell carcinoma (SCC) is a malignant epidermal keratinocyte tumor closely related to sun exposure. When diagnosed, through biopsy, its staging, tumor resection with oncological safety margins must be performed, and lymph node dissection and treatment of metastases, if present, may be performed. Case Report: Skin traction is reported as a complement to the parascapular flap, used reconstructively after the excision of a large SCC in the left shoulder. Conclusion: The technique used proved effective for the satisfactory correction of large dehiscence in the postoperative period of the parascapular flap, promoting partial closure of the defect, reduced time to perform, and correction of the residual defect in a single step.
Introdução: O carcinoma espinocelular (CEC) é um tumor maligno dos queratinócitos epidérmicos e está intimamente relacionado à exposição solar. Quando diagnosticado, por meio de biópsia, deve ser realizado seu estadiamento, ressecção tumoral com margens de segurança oncológica, podendo ser feito esvaziamento ganglionar e tratamento de metástases, caso presentes. Relato de Caso: Reporta-se a utilização da tração cutânea como complemento ao retalho paraescapular, utilizado reconstrutivamente pós excisão de CEC de grande dimensão em ombro esquerdo. Conclusão: A técnica utilizada mostrou-se eficaz para correção satisfatória de grandes deiscências em pós-operatório de retalho paraescapular, promovendo fechamento parcial do defeito, tempo reduzido para realização e correção do defeito residual em tempo único.
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Nowadays, mental health has acquired greater relevance and attention as a consequence mainly of the COVID-19 pandemic, to which is attributed a negative impact on the development of life, work and social coexistence of people, along with the magnitude derived from non-communicable diseases. This is why the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) developed the Mental Health Comprehensive Program 2021-2024, whose main purpose was to establish strategies and lines of action for the prevention, early detection and timely management regarding mental health and addictions. Based on this, different actions have been carried out, for example, the identification of the material and human resources available at IMSS to meet the mental health issue; the training of healthcare professionals at the three levels of care; the integration of a census that has reported a prevalence of anxiety and depressive episodes in the users of 39.9 and 3%, respectively, as well as the evaluation of instruments for screening mental disorders. Therefore, this document describes what has been done in the IMSS in relation to the user's mental health in the context of the COVID-19 pandemic.
Hoy en día la salud mental ha adquirido mayor relevancia y atención como consecuencia principalmente de la pandemia por COVID-19, a la cual se le atribuye un impacto negativo en el desarrollo de la vida, el trabajo y la convivencia social de las personas, todo esto aunado a la magnitud derivada de los padecimientos no transmisibles. Es por eso que en el Instituto Mexicano del Seguro Social (IMSS) se elaboró el Programa Integral de Salud Mental 2021-2024, cuyo principal propósito fue establecer estrategias y líneas de acción para la prevención, detección temprana y manejo oportuno respecto a la salud mental y adicciones. A partir de ello se han materializado diferentes acciones, entre las que destaca la identificación de los recursos materiales y humanos con los que cuenta el IMSS para atender esta necesidad; la capacitación del personal de salud de los tres niveles de atención; la integración de un censo que ha reportado una prevalencia de ansiedad y episodio depresivo en la población derechohabiente de 39.9 y 3%, respectivamente, y la evaluación de instrumentos para realizar tamizajes de trastornos mentales. Por lo anterior, en este documento se describe lo que se ha hecho en el IMSS en relación con la salud mental de la población derechohabiente en el contexto de la pandemia por COVID-19.
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The heat treatment of a metal is a set of heating and cooling cycles that a metal undergoes to change its microstructure and, therefore, its properties. Temperature-time-transformation (TTT) diagrams are an essential tool for interpreting the resulting microstructures after heat treatments. The present work describes a novel proposal to predict TTT diagrams of the γ' phase for the Ni-Al alloy using artificial neural networks (ANNs). The proposed methodology is composed of five stages: (1) database creation, (2) experimental design, (3) ANNs training, (4) ANNs validation, and (5) proposed models analysis. Two approaches were addressed, the first to predict only the nose point of the TTT diagrams and the second to predict the complete curve. Finally, the best models for each approach were merged to compose a more accurate hybrid model. The results show that the multilayer perceptron architecture is the most efficient and accurate compared to the simulated TTT diagrams. The prediction of the nose point and the complete curve showed an accuracy of 98.07% and 86.41%, respectively. The proposed final hybrid model achieves an accuracy of 96.59%.
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INTRODUCTION: Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population. OBJECTIVE: To evaluate the relationship between ETCO2 and PCO2 in newborns. METHODS: Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnograph, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement. RESULTS: A total of 277 samples (ETCO2 / PCO2) from 83 newborns were analyzed. The mean values ââof ETCO2 and PCO2 were 41.36mmHg and 42.04mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r=0.5402; P<.001) and in the analysis of each unit (P<.001). The mean difference was 0.68 mmHg (95% CI, -0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2). DISCUSSION: The correlation between ETCO and PCO2 was significant, although the obtained values ââwere not equivalent, with differences ranging from 0.1mmHg and 20mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions.
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Capnografia , Dióxido de Carbono , Capnografia/métodos , Dióxido de Carbono/análise , Estudos Transversais , Humanos , Recém-Nascido , Respiração Artificial/métodosRESUMO
RESUMEN Fundamento: es necesario lograr la motivación y activar el pensamiento creador y la cultura científica de los educandos desde las clases de Historia de Cuba utilizando herramientas educativas. Objetivo: diseñar un sitio web para la enseñanza de Historia de Cuba, en vínculo con la historia local y de las ciencias médicas del municipio Sagua la Grande en la formación de los profesionales de la salud. Métodos: se realizó un estudio cualitativo en la Facultad de Ciencias Médicas de Sagua la Grande durante 2018-2019. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción, histórico-lógico y modelación; empíricos: el análisis documental, observación participante, entrevista grupal a estudiantes, entrevista a docentes y criterio de especialistas. Resultados: son insuficientes los medios de enseñanza para contribuir al perfeccionamiento de Historia de Cuba, por lo que predominó el uso de los tradicionales en las clases; las bibliografías básica y complementaria establecidas por el programa no incluyen contenidos de la historia local, ni de la salud del municipio; alumnos y docentes mostraron interés por utilizar la tecnología para el diseño de un sitio web que facilite los mencionados contenidos en vínculo con la Historia de Cuba. Los estudiantes disponen de habilidades en el uso de la tecnología digital; todo lo cual justificó la elaboración de Histoweb. Conclusiones: el sitio web constituye una herramienta educativa para la enseñanza de la Historia de Cuba en ciencias médicas; su diseño permite consultar documentos únicos sobre historia local y de salud pública del municipio, además compila una amplia bibliografía investigada en diferentes fuentes históricas.
ABSTRACT Background: it is necessary to achieve motivation and activate the creative thinking and scientific culture of the students from the History of Cuba classes using educational tools. Objective: to design a website for the teaching of Cuban History, in connection with the local history and medical sciences of the Sagua la Grande municipality in the training of health professionals. Methods: a qualitative study was carried out at the Faculty of Medical Sciences of Sagua la Grande during 2018-2019. Theoretical methods were used: analysis-synthesis, induction-deduction, historical-logical and modeling; empirical ones: documentary analysis, participant observation, group interview with students, interview with teachers and criteria of specialists. Results: the teaching aids are insufficient to contribute to the improvement of Cuban History, where the use of the traditional ones prevailed in the classes; The basic and complementary bibliographies established by the program do not include contents on local history or the health of the municipality; Students and teachers showed interest in using technology to design a website that facilitates the aforementioned contents in connection with the History of Cuba. Students have skills in the use of electronic technology; reason why the development of Histoweb is justified. Conclusions: the website constitutes an educational tool for teaching the History of Cuba in medical sciences; its design allows consulting unique documents on local history and public health of the municipality, it also compiles a wide bibliography researched in different historical sources.
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Estudantes , Aplicações da Informática Médica , Projetos de Tecnologias de Informação e ComunicaçãoRESUMO
Abstract Introduction: there are several variations of randomized clinical trials. Trials can be classi fied by design as parallel, cross-over, factorial, assignment by group, n-of-1, paired, withdrawal, adaptive and pragmatic; and by purpose as superiority, non-inferiority and equivalence. Given this heterogeneity, the Consolidated Standards of Reporting Trials (CONSORT) were introduced in 1996 to provide a guideline for reporting randomized clinical trials. Objective: to describe the publication tendency of the various types of randomized clinical trials over 40 years, with reference to the publication of CONSORT and its extensions. Methods: the PubMed tool was used to search for randomized clinical trials published between 1979 and 2018, classifying them according to the varieties described. Results: a total of 472,114 published articles were found; 90.2% did not report the type of design and 98.2% did not report the purpose. Among the articles that reported the variety of randomized clinical trial, the predominant design was cross-over (5.9%), followed by parallel groups (2.34%); while the most common purpose was superiority (0.84%). After the launch of CONSORT, there was an increased proportion of articles published with the following designs: parallel groups; difference in proportions 1.89 95% CI (1.1-2.7); paired 1.07 95% CI (0.2-1.9); and pragmatic 4.73 95% CI (4.4-5.1); and for the purpose of non-inferiority 5.97 95% CI (5.6-6.3). Discussion: most articles on randomized clinical trials do not mention their type in the title and abstract. The proportion of articles that did, increased slightly after CONSORT was published. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1884).
Resumen Introducción: existen múltiples variantes del ensayo clínico aleatorizado; según diseño: grupos paralelos, cruzado, factorial, asignación por grupos, N de 1, pareado, retiro, adaptativo y pragmático; y por propósito: superioridad, no inferioridad y equivalencia. Debido a esta heterogeneidad, en 1996 se introdujo el CONSORT (Consolidated Standards of Reporting Trials) para suministrar una guía para el reporte de los ensayos clínicos aleatorizados. Objetivo: describir la tendencia de publicación de los tipos de ensayos clínicos aleatorizados durante 40 años, en relación con la publicación del CONSORT y sus extensiones. Métodos: se utilizó la herramienta PubMed para realizar una búsqueda de ensayos clínicos aleatorizados publicados entre 1979 y 2018, discriminándolos según las variantes descritas. Resultados: se encontraron 472 114 artículos publicados, el 90.2% no reportó tipo de diseño y 98.2% no reportó propósito. Entre los artículos que reportaron la variante de ensayos clínicos aleatorizados, el diseño predominante fue el cruzado (5.9%), seguido por grupos paralelos (2.34%); mientras que el propósito más frecuente fue el de superioridad (0.84%). Hubo un aumento en la proporción de artículos por variante publicados después del lanzamiento del CONSORT para los diseños de: grupos paralelos; diferencia de proporciones 1.89 IC 95% (1.1-2.7); pareado 1.07 IC 95% (0.2-1.9); pragmático 4.73 IC 95% (4.4-5.1); y para el propósito de no inferioridad 5.97 IC 95% (5.6-6.3). Discusión: la mayoría de los artículos sobre ensayos clínicos aleatorizados no mencionan en su título y resumen la variante de estos. La proporción de artículos que sí lo hicieron, aumentó discre tamente después de la publicación del CONSORT. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1884).
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Introducción: El síndrome de Prader-Willi es una enfermedad genética, causada por deleciones de novo en la región 15q11q13 en el cromosoma paterno. Se caracteriza por falta de saciedad que conduce a obesidad mórbida, trastornos del comportamiento, discapacidad intelectual, baja estatura e hipogonadismo. Objetivo: Describir los resultados obtenidos del análisis e intervención multidisciplinar realizados en paciente diagnosticado con el síndrome de Prader-Willi. Presentación del caso: Análisis de caso clínico en menor de 8 años, sexo masculino, diagnosticado con síndrome de Prader-Willi, a través de intervención multidisciplinaria realizado en tres momentos: evaluación, diagnóstico e intervención con enfoque cognitivo conductual. Conclusiones: Las estrategias adoptadas generaron cambios significativos en el contexto familiar y social, entre ellas, apropiación de las recomendaciones suministradas, adopción de factores protectores, identificación de roles y optimización en la adherencia farmacológica. La atención a estas consideraciones proporciona mejoras, que apuntan a la calidad de vida y clínica del paciente(AU)
Introduction: Prader-Willi syndrome is a genetic disease caused by de novo deletions in the 15q11q13 region in the paternal chromosome. It is characterized by lack of satiety leading to morbid obesity, behavioral disorders, intellectual disability, short height and hypogonadism. Objective: To describe the results obtained from the multidisciplinary analysis and intervention performed in a patient diagnosed with Prader-Willi syndrome. Presentation of the clinical case: Clinical case analysis in an 8 years old child, male sex, diagnosed with Prader-Willi syndrome through a multidisciplinary intervention performed in three moments: assessment, diagnosis and intervention with cognitive behavioral approach. Conclusions: The strategies adopted generated significant changes in the social and family context, family´s appropriation of the recommendations provided, adoption of protective factors, roles identification and improving of adherence to treatment. By taking into account this considerations, improvements lead to clinic and life quality of the patient(AU)
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Humanos , Masculino , Criança , Síndrome de Prader-Willi/terapia , Intervenção Educacional Precoce/métodos , Síndrome de Prader-Willi/epidemiologia , Saúde da Família/educaçãoRESUMO
BACKGROUND: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). METHODS: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study. They were randomized to a control group and an intervention group that used DXplain. Both groups solved 30 clinical diagnosis cases (internal medicine, pediatrics, gynecology and emergency medicine) in a multiple-choice question test that had validity evidence. RESULTS: The percent-correct score in the Diagnosis Test in the control group (44 residents) was 74.1±9.4 (mean±standard deviation) whereas the DXplain intervention group (43 residents) had a score of 82.4±8.5 (p<0.001). There were significant differences in the four knowledge content areas of the test. CONCLUSIONS: Family Medicine residents have appropriate diagnostic accuracy that can improve with the use of DXplain. This could help decrease diagnostic errors, improve patient safety and the quality of medical practice. The use of clinical decision support systems could be useful in educational interventions and medical practice.
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Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Diagnóstico , Medicina de Família e Comunidade/educação , Internato e Residência , Adulto , Competência Clínica , Feminino , Humanos , Masculino , MéxicoRESUMO
BACKGROUND: There is no systematic evaluation of teaching performance in the clinical area at UNAM Faculty of Medicine. The study purpose is to assess the teaching competence level in the Undergraduate Medical Internship (UMI). METHODS: The paper describes the process of psychometric validity for the instrument designed to evaluate teaching competence in the UMI. This instrument was constructed from two previously developed instruments. The final version with 54 items in a Likert scale was studied with exploratory factorial analysis. Four dimensions were obtained: Solution of clinical problems, Psychopedagogy, Mentoring, and Evaluation. The instrument had a reliability of 0.994, with an explained variance of 77.75%. RESULTS: To evaluate the teaching competence level, we administered 844 questionnaires to a sample of students with a response rate of 89%. We obtained an overall global score of 89.4 ± 9.6 (mean ± SD). The dimension Solution of clinical problems was the one with a greater value, in contrast with the dimension of Evaluation, which had a lower score. CONCLUSION: The teachers of the UMI are considered educators with high level of teaching competence, according to the perceptions of the undergraduate internal doctors. The evaluation of teaching competence level is very important for institutions that look for the continuous professional development of its faculty.
Introducción: en la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM) no hay una evaluación sistemática del desempeño docente del área clínica. El propósito de este estudio fue evaluar el nivel de competencia docente en el Internado Médico de Pregrado (IMP). Método: se describe el proceso de la validación psicométrica de un instrumento diseñado para evaluar la competencia docente en el IMP. El instrumento se construyó a partir de dos instrumentos previamente desarrollados y con base en el análisis factorial exploratorio de un instrumento con 54 reactivos y una escala tipo Likert, se obtuvieron cuatro dimensiones. El instrumento tuvo una confiabilidad de 0.994, con una varianza explicada de 77.75%. Resultados: para evaluar en nivel de competencia docente, se utilizaron 844 cuestionarios, lo que constituye la muestra de estudiantes, con una tasa de respuesta del 89%. Se obtuvo una media global de 89.4 ± 9.6 de desviación estándar. La Solución de problemas clínicos fue la que obtuvo mayor valoración, en contraste con la dimensión de Evaluación, que observó menor valoración. Conclusiones: los docentes del IMP son considerados educadores con alto nivel de competencia docente, según las percepciones de los médicos internos de pregrado. Se advierte cómo la evaluación de la competencia docente es indispensable en cualquier institución que busque el desarrollo profesional continuo de sus profesores.
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Educação de Graduação em Medicina/normas , Docentes de Medicina/normas , Competência Profissional/normas , Ensino/normas , Humanos , México , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Research on diagnostic and formative assessment competencies during undergraduate medical training is scarce in Latin America. OBJECTIVE: To assess the level of clinical competence of students at the beginning of their medical internship in a new curriculum. METHODS: This was an observational cross-sectional study in UNAM Faculty of Medicine students in Mexico City: a formative assessment of the second class of Curriculum 2010 students as part of the integral evaluation of the program. The assessment had two components: theoretical and practical. RESULTS: We assessed 577 students (65.5%) of the 880 total population that finished the 9th semester of Curriculum 2010. The written exam consisted of 232 items, with a mean of 61.0 ± 19.6, a difficulty index of 0.61, and Cronbach's alpha of 0.89. The mean of the objective structured clinical examination (OSCE) was 62.2 ± 16.8, with a mean Cronbach's alpha of 0.51. Results were analyzed by knowledge area and exam stations. CONCLUSIONS: The overall results provide evidence that students achieve sufficiently the competencies established in the curriculum at the beginning of the internship, that they have the necessary foundation for learning new and more complex information, and integrate it with existing knowledge to achieve significant learning and continue their training.
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Competência Clínica , Educação de Graduação em Medicina , Internato e Residência , Estudos Transversais , DiagnósticoRESUMO
Resumen Este caso clínico muestra los resultados del análisis e intervención interdisciplinar que se realizó en una paciente femenina de 8 años diagnosticada a la edad de 3 años con enfermedad de moyamoya. Remitida para evaluación, se encontró estenosis progresiva de las arterias cerebrales. La evaluación del desarrollo motor mostró poca agilidad motora gruesa y fina, bajo tono, debilidad muscular, dificultad para establecer movimientos alternos y simultáneos, además dificultad al masticar y deglutir, por lo que requirió ajuste de la minuta alimenticia por parte de nutrición. Falta de control esfinteriano. En los aspectos cognitivos se evidenció déficit, falta de comprensión de órdenes, desconocimiento de categorías semánticas, falta de seguimiento de instrucciones, tratado por fonoaudiología y terapia ocupacional. Estado emocional preservado, capacidad de establecer vínculos afectivos y empatía; en lo familiar se presentó disfuncionalidad familiar por miembro enfermo, que es el eje central en la dinámica familiar, negligencia familiar con otros miembros, desajuste de roles. Se estableció intervención psicoterapéutica, con enfoque cognitivo conductual, apoyado en el modelo de Terapia Racional Emotiva, Psicoeducación, Terapia familiar sistémica. Seguimiento médico con fármacos y evaluación de pruebas diagnósticas. En tres años de seguimiento se evidenció: adaptación progresiva en adquisición de habilidades sociales, reacciones afectivas en su núcleo familiar y entorno, lo cual permitió concluir que las estrategias adoptadas generaron un cambio significativo en el contexto familiar, con adopción de factores protectores, identificación de roles, cambios en la adherencia, lo que en conjunto permitió mejoras en la calidad de vida y clínica de la paciente.
Abstract The clinical case presented in this article reflects the results of the analysis and interdisciplinary intervention that was performed on a 8 year old female patient diagnose at 3 years old with the Moyamoya disease, she was referred for evaluation, finding progressive stenosis of the brain arteries, the motor development evaluation exhibit low gross and fine motor agility, low muscle tone, muscular weakness, difficulty to set alternating and simultaneous movements, also trouble to masticate and swallowing, so it required adjustment of the food diet in the behalf of her nutrition. Absence of sphincter control. In the cognitive aspects it was evident the lack of understanding orders, lack of semantic categories, failure to follow instructions, it was treated by speech therapy and occupational therapy. Emotional state preserved, ability to bond and empathy, in the familiar aspect it exhibit family dysfunctionality because of sick family member that is now the focus on the family dynamic, family neglect with other members, mismatch roles. Was established psychotherapeutic intervention with cognitive behavioral approach, supported the model of Rational Emotive Therapy, psychoeducation, systemic family therapy. Medical monitoring with drugs and evaluation of diagnostic tests. It was evident in three years follow-up: Progressive adaptation acquisition of social skills, affective reactions in the household and environment, which it led to the conclusion that the strategies adopted generated a significant change in the family context, with adoption of protective factors, identifying roles, changes in adhesion, which together allowed improvements in quality of life and clinical patient.
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OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN: Observational study and a survey of available healthcare setting resources. SETTING: Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS: Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.
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Estado Terminal/terapia , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/fisiopatologia , Influenza Humana/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Corticosteroides/economia , Corticosteroides/uso terapêutico , Adulto , Idoso , Antivirais/economia , Antivirais/uso terapêutico , Canadá/epidemiologia , Estado Terminal/epidemiologia , Oxigenação por Membrana Extracorpórea/economia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Gastos em Saúde , Humanos , Influenza Humana/economia , Influenza Humana/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Respiração Artificial/economia , Respiração Artificial/métodos , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapiaRESUMO
Resumen El uso de los sitios web denominados redes sociales es cada vez más frecuente en la práctica médica. El objetivo de este artículo es proporcionar a los médicos y estudiantes de medicina algunas recomendaciones éticas para tomar en cuenta antes de publicar contenido en la internet. Para ello, ofrece un panorama histórico de la evolución de las redes sociales y presenta diversos ejemplos de los beneficios de usarlas como medios de actualización, de comunicación entre colegas, con pacientes, como medios de promoción de los servicios profesionales y de difusión de eventos. Al final provee de recomendaciones puntuales a tomar en cuenta para hacer un uso efectivo, profesional y ético de ellas.
Abstract The use of Social Networking sites has become very frequent in medicine. This article aims to provide physicians and medical students with ethical recommendations to consider before publishing Web content. For that purpose, we provide a historical overview of the evolution of social networks, and we present several examples of the benefits acquired by using them for knowledge updating, promoting professional services and events, and as communication tools among colleagues and patients. Finally, specific recommendations for an effective, professional and ethical use of these media are given.
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BACKGROUND: Biomedical Informatics (BMI) education in medical schools is developing a sound curricular base, but there are few published reports of their educational usefulness. The goal of this paper is to assess knowledge change and satisfaction in medical students after a BMI curriculum. METHODS: The National Autonomous University of México Faculty of Medicine (UNAM) recently implemented a curricular reform that includes two BMI sequential courses (BMI-1 and BMI-2). The research design was one-group pretest-posttest. An objective test with evidence of validity was used for knowledge measurement. A satisfaction questionnaire was applied at the end of the courses. Two-tailed paired Student's t-tests were applied, comparing knowledge scores in the pre and post-test for each course. RESULTS: The study included student cohorts during two consecutive academic years. The 2013 BMI-1 course (n = 986 students) knowledge pretest score was 43.0 ± 8.6 (mean percent correct ± SD), and the post-test score was 57.7 ± 10.3 (p < 0.001); the 2014 BMI-1 (n = 907) pretest score was 43.7 ± 8.5, and the post-test was 58.1 ± 10.5 (p < 0.001). The 2012 BMI-2 course (n = 683) pretest score was 26.3 ± 7.9, the post-test score was 44.3 ± 13.3 (p < 0.001); the 2013 BMI-2 (n = 926) pretest score was 27.5 ± 7.5, and the post-test was 42.0 ± 11.0 (p < 0.001). The overall opinion of the students regarding the course was from good to excellent, with a response rate higher than 90%. The satisfaction questionnaires had high reliability (Cronbach's alpha of 0.93). CONCLUSIONS: The study shows a significant increase in BMI knowledge after an educational intervention in four medical student cohorts, and an overall positive evaluation by the students. Long-term follow-up is needed, as well as controlled studies of BMI educational interventions using performance endpoints.
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Currículo , Países em Desenvolvimento , Educação Médica , Avaliação Educacional , Docentes de Medicina , Informática Médica/educação , Atitude do Pessoal de Saúde , Estudos de Coortes , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , México , Modelos Educacionais , Adulto JovemRESUMO
Biomedical informatics (BMI) competencies are recognized as core requirements for the healthcare professional, but the amount of BMI educational interventions in the curricula of medical schools is limited. UNAM Faculty of Medicine in Mexico is a large public medical school, with more than 7000 undergraduate students. The undergraduate program recently underwent a major curricular revision, which includes BMI education. Two one-semester BMI courses (BMI-1 and BMI-2) were designed, with a blended-learning educational model. A department of BMI was created, with budget, offices and personnel. The first class of 1199 students started the course in 2010, with 32 groups of 40 students each. BMI-1 includes core conceptual notions of informatics applied to medicine (medical databases, electronic health record, telemedicine, among other topics), and BMI-2 embodies medical decision making and clinical reasoning. The program had a positive evaluation by students and teachers. BMI can be successfully incorporated in a large-scale medical school program in a developing country, using a blended-learning model and organizational change strategies.