Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study.

OBJECTIVE: Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians' activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. METHODS: In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians' numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians' time since graduation, age, and gender. RESULTS: A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. CONCLUSION: The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program.

Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study / Associação entre participação e cumprimento de um programa de Educação Médica Continuada e produção assistencial dos médicos: estudo transversal

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. Conclusion The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program. .

Objetivo A participação de médicos em programas de Educação Médica Continuada pode ser influenciada por inúmeros fatores. Para avaliar os fatores associados ao cumprimento dos requisitos para Educação Médica Continuada em um hospital privado, investigamos se a atividade médica, medida por volume de internações e procedimentos, esteve relacionada à obtenção de 40 créditos (40 horas-aula) em um ciclo do programa de 12 meses. Métodos Em um programa exclusivo e não obrigatório de Educação Médica Continuada, coletamos o número de admissões e de procedimentos realizados por médico. Analisamos dados como tempo de formado, idade e sexo. Resultados Foram analisados dados de 3.809 médicos credenciados e autônomos. A análise univariada mostrou que os requisitos de Educação Médica Continuada eram mais preenchidos por médicos do sexo masculino (odds ratio de 1,251; p=0,009) e que eles apresentavam números de internações mais significativos (odds ratio de 1,022; p<0,001). A análise multivariada mostrou que idade e número de admissões estiveram associados ao cumprimento das metas estabelecidas. Cada admissão aumentou a chance de atingir a meta em 0,4%. Entre os que realizaram procedimentos cirúrgicos, a análise multivariada mostrou que médicos do sexo masculino eram 1,3 vez mais propensos a atingir a meta estabelecida que seus pares do sexo feminino. Cada procedimento cirúrgico realizado elevou a chance de atingir a meta em 1,4%. Conclusão O número de admissões e de procedimentos cirúrgicos realizados por médicos em nosso hospital foi associado à probabilidade de alcançar a meta de Educação Médica Continuada. Estes achados lançaram uma nova luz sobre o nosso programa de Educação Médica Continuada. .

The cost-effectiveness ratio of a managed protocol for severe sepsis.

PURPOSE: Severe sepsis is a time-dependent disease, and implementation of early treatment has been associated with mortality rate reduction. However, the literature is controversial regarding cost-effectiveness analysis of this intervention. The aim was to assess the cost-effectiveness of a managed protocol for the treatment of severe sepsis. MATERIALS AND METHODS: This is a prospective cohort study involving a historical comparison (before and after the implementation of the protocol) of patients who had been hospitalized with severe sepsis and septic shock. The group of patients who were treated before the assistance routine was implemented was considered to be the control. The case-managed nurse involved with assistance protocol performed the data collection. This nurse received special training to ensure the quality of the data and to measure the intervention throughout the implementation process. RESULTS: A total of 414 patients were analyzed. The mortality rates were 57% in the control group and 38% in the protocol group (P=.002). After the implementation of the protocol, the absolute risk reduction was 18%; and the relative risk reduction was 31.8%. There was a tendency for a reduction in the cost of the full hospitalization, but this trend did not reach statistical significance. Nevertheless, the cost of hospitalization in the intensive care unit was reduced significantly from US $138,237±$202,418 in the control group to US $85,484±$127,471 in the protocol group (P=.003). The managed protocol for sepsis resulted in an average gain of 3.2 life-years after being discharged from the hospital (8.8±13.3 years in the control group and 12.0±14.0 years in the protocol group, P=.01). CONCLUSIONS: Given that the incremental cost was lower than or equal to zero, the effectiveness of the protocol was justified by the significant increase in the life-years saved and the reduced mortality.

Morbidity due trauma in children of the community of Paraisopolis, São Paulo, Brazil.

OBJECTIVE: To identify the factors that determine unintentional injuries in children living in the community of Paraisopolis, in the city of São Paulo, Brazil. METHODS: A cross-sectional and non-controlled study. Data collected during 4 consecutive months through questionnaires filled out for the Einstein Program in Paraisopolis Community included identification of the patient and his/her family, scholarity level, housing conditions, storage of hazardous products, access to the streets and concrete slab ceilings, supervision, and trauma mechanism involved. The observed data were treated as absolute and relative frequencies; χ(2), Fisher's exact test, Student's t test, and Mann-Whitney's tests were implemented, with a significance level of 5% (p<0.05). RESULTS: A total of 1,490 questionnaires were analyzed. There was a predominance of trauma within boys (59.6%) and the medium age was 5.2 years. The predominant educational level of the parents was incomplete junior school education. The main caregiver identified was the mother (69.4%). Among the children that suffered trauma, 56.4% belonged to large families (≥ 6 people), lived in houses up to three rooms, and a family income up to R$ 1,000.00 (76.6%). Easy access to hazardous materials was considerable and free access to concrete slab ceilings was reported in 92.8% of the cases. The main trauma mechanisms were falls and burns. In this study, the child victim of a fall was aged under 5 years. CONCLUSION: Small children that live in a hazardous environment have a significant tendency to suffering trauma.

Morbidity due trauma in children of the community of Paraisopolis, São Paulo, Brazil / Morbidade por trauma em crianças moradoras da comunidade de Paraisópolis, São Paulo, Brasil / Morbidade por trauma em crianças moradoras da comunidade de Paraisópolis, São Paulo, Brasil

Objective : To identify the factors that determine unintentional injuries in children living in the community of Paraisopolis, in the city of São Paulo, Brazil. Methods : A cross-sectional and non-controlled study. Data collected during 4 consecutive months through questionnaires filled out for the Einstein Program in Paraisopolis Community included identification of the patient and his/her family, scholarity level, housing conditions, storage of hazardous products, access to the streets and concrete slab ceilings, supervision, and trauma mechanism involved. The observed data were treated as absolute and relative frequencies; χ2, Fisher’s exact test, Student’s t test, and Mann-Whitney’s tests were implemented, with a significance level of 5% (p<0.05). Results : A total of 1,490 questionnaires were analyzed. There was a predominance of trauma within boys (59.6%) and the medium age was 5.2 years. The predominant educational level of the parents was incomplete junior school education. The main caregiver identified was the mother (69.4%). Among the children that suffered trauma, 56.4% belonged to large families (≥6 people), lived in houses up to three rooms, and a family income up to R$ 1,000.00 (76.6%). Easy access to hazardous materials was considerable and free access to concrete slab ceilings was reported in 92.8% of the cases. The main trauma mechanisms were falls and burns. In this study, the child victim of a fall was aged under 5 years. Conclusion : Small children that live in a hazardous environment have a significant tendency to suffering trauma .

Objetivo : Identificar os fatores determinantes de lesões não intencionais na população pediátrica residente na comunidade de Paraisópolis, em São Paulo. Métodos : Estudo transversal, não controlado. Os dados coletados durante 4 meses consecutivos, por meio de questionários preenchidos para o Programa Einstein na Comunidade de Paraisópolis foram: identificação do paciente e familiares, escolaridade, condições da moradia, armazenamento de produtos perigosos, acesso à rua e à laje, supervisão e mecanismo de trauma envolvido. Os dados observados foram tratados por meio de frequências absolutas e relativas; foram empregados os testes χ2, exato de Fisher, t de Student Mann-Whitney, com nível de significância de 5% (p<0,05). Resultados : Foram analisados 1.490 questionários. Houve predominância de traumatismos entre meninos (59,6%) e a média de idade foi de 5,2 anos. Ensino Fundamental incompleto foi o nível de escolaridade predominante entre os pais. O cuidador principal identificado foi a mãe (69,4%). Das crianças que sofreram trauma, 56,4% pertenciam a famílias numerosas (≥6 pessoas), moravam em casas de até três cômodos com renda familiar de até R$ 1.000,00 (76,6%). O acesso fácil a substâncias perigosas foi considerável, e o livre acesso a lajes foi relatado em 92,8% dos casos. Os principais mecanismos de trauma foram quedas e queimaduras. Neste estudo, a criança vítima de queda tinha menos de 5 anos de idade. Conclusão : Crianças pequenas que vivem em um ambiente de risco apresentam tendência significativa a sofrer eventos traumáticos. .

Programa de Educação Médica Continuada: avaliação de um sistema de créditos / Continuing Medical Education Program: a credit system evaluation

Objetivos: Analisar o programa de Educação Médica Continuada(EMC) desenvolvido no Hospital Israelita Albert Einstein, iniciadoformalmente em 2002, através de seis ciclos sucessivos de 12 meses,com foco de atenção voltado para médicos participantes, quantoà adesão ao programa no decorrer do tempo e quanto à produçãoeducacional medida através de um sistema de créditos. Métodos:Estudo descritivo (populacional) que utilizou um modelo de pontuaçãoatravés de crédito medido por tempo (um crédito = uma hora-aula),baseado em ferramentas educacionais formais e informais, analisandosea adesão do corpo clínico ao programa e o perfil da distribuição decréditos em eventos promovidos pela instituição e fora desta para osparticipantes, para os que cumpriram a meta estabelecida e para umgrupo que participou dos seis ciclos com meta institucional atingida.Para as comparações entre os ciclos, foram utilizadas equações deestimação generalizadas com distribuição Normal (para as médiasde créditos) e Binomial (para as freqüências de médicos com metacumprida). Resultados: Comparando-se os seis ciclos, a adesão docorpo clínico cresceu gradativamente e houve aumento da pontuaçãode créditos no decorrer do tempo (média de créditos crescente). Adistribuição dos créditos segundo o tipo de atividade foi similar aoapresentado na literatura, com maior representação a participação emcongressos, cursos, reuniões científicas e publicações, entre outrasmodalidades educacionais. Conclusões: A análise desse sistema decréditos demonstrou consolidação do programa de EMC no decorrer dotempo com atitude madura e consistente dos participantes.