Lineamientos técnicos para la receta repetitiva en unidades de salud, farmacias especializadas y consulta externa de hospitales nacionales / Technical guidelines for repetitive prescriptions in health units, specialized pharmacies and outpatient consultations in national hospitals

En el presente documento se establece el mecanismo para la ejecución de la estrategia de la receta repetitiva, en el marco de la transformación digital. La receta repetitiva es una estrategia organizada y sistemática que se ha implementado en las unidades de salud del Primer Nivel de Atención y consulta externa de los hospitales incluyendo farmacias especializadas, para garantizar el abastecimiento de medicamentos de uso crónico por usuarios con diagnóstico de enfermedades no transmisibles, que estén en control o seguimiento en el sistema público de salud. En ese sentido se desarrolla la actualización y se reestructura la ejecución adaptándola al uso del expediente clínico electrónico del Sistema Integrado de Salud (SIS), con el propósito de fortalecer la prestación de los servicios; siendo una de las estrategias que contribuye a reducir la concentración en los establecimientos de salud de usuarios clínicamente compensados con patologías que requieran medicamentos de uso crónico y facilitándoles el abastecimiento continuo

This document establishes the mechanism for the implementation of the repetitive recipe strategy, within the framework of digital transformation. The repetitive prescription is an organized and systematic strategy that has been implemented in the health units of the First Level of Care and outpatient consultation of hospitals including specialized pharmacies, to ensure the supply of medicines for chronic use by users diagnosed with non-communicable diseases, which are under control or monitoring in the public health system. In this sense, the update is developed and the execution is restructured adapting it to the use of the electronic clinical record of the Integrated Health System (SIS), in order to strengthen service delivery; being one of the strategies that contributes to reduce the concentration in health establishments of users clinically compensated with pathologies that require drugs of chronic use and facilitating the continuous supply

Evaluating Public Perceptions of Cosmetic Procedures in the Medical Spa and Physician's Office Settings: A Large-scale Survey.

BACKGROUND: Medical spa and cosmetic procedure markets have grown substantially in recent years. The lack of consistent medical oversight at medical spas raises safety concerns. OBJECTIVE: To understand how the public views medical spas compared with physician's offices as places to receive cosmetic procedures with a focus on safety. METHODS: 1,108 people were surveyed on an internet platform about their perceptions of the safety of receiving cosmetic procedures at medical spas and physician's offices. Respondents were grouped by their past experiences. Chi-squared and analysis of variance models were used to determine statistically significant differences between groups at the 0.05 level. RESULTS: Respondents who had only received cosmetic procedures at physician's offices or had never received a cosmetic procedure cared more about being treated by a physician ( p < .001) and rated safety as more important ( p = .03). Total complication rates were numerically higher at medical spas compared with physician's offices ( p = .41). Minimally invasive skin tightening (0.77 vs 0.0, p < .001) and nonsurgical fat reduction (0.80 vs 0.36, p = .04) had higher complication rates at medical spas. CONCLUSION: There were concerns among the public about the safety of cosmetic procedures at medical spas, and some procedures demonstrated higher complication rates in this setting.

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Reflexiones acerca de algunos de los efectos de la pandemia en la clínica con niños y adolescentes / Reflections on some of the effects of the pandemic in the clinic with children and adolescents / Réflexions sur certains effets de la pandémie dans la clinique avec les enfants et les adolescents / Reflexões sobre alguns dos efeitos da pandemia na clínica com crianças e adolescentes

El presente artículo plantea reflexiones respecto de algunas consecuencias en la clínica con niños/as y adolescentes debidos al impacto de la pandemia por Covid19. Se señala la acción de la incertidumbre y lo imprevisible sobre la subjetividad de la población y se propone recordar los acontecimientos ligados a las medidas de protección (Aislamiento Social Preventivo y Obligatorio, de dos años de duración) y resignificarlos para aventurar una incipiente historización sobre algunos de los efectos que la pandemia produjo sobre la labor clínica con niños/as y adolescentes. A tal fin, se toma como eje conceptual rector el desarrollo freudiano sobre la retracción libidinal y sus consecuencias para el Yo, y los cambios en los recursos técnicos que debieron implementarse al incluirse las sesiones on-line. Se puntualizan las consecuencias perturbadoras de la pandemia respecto de los niños pequeños, con patologías graves y en los adolescentes tomando en cuenta la especificidad de sus características subjetivas AU

The following paper presents reflections on certain consequences on the clinic with children and teenagers due to the impact of the Covid-19 pandemic. The action of uncertainty and the unpredictable on the subjectivity of the population is pointedout and it is proposed to recall the events linked to protection measures (Mandatory Preventive Isolation, lasting two years) and resignify them to venture an incipient historicization about some of the effects that the pandemic produced on clinical work with children and adolescents.For this purpose, the Freudian development on libidinal withdrawal and its consequences for the Self, and the changes in the technical resources that had to be implemented when online sessions were installed, are taken as theguiding conceptual axis. The disturbing consequences of the pandemic are pointed out regarding young children, those with serious pathologies and in adolescents, taking into account the specificity of their subjective characteristics AU

Cet article propose des réflexions concernant certaines conséquences en clinique auprès des enfants et des adolescents dû à l'impact de la pandémie de Covid19. Les conséquences de l'incertitude et de l'imprévisible sur la subjectivité de la population sont dénotées et il est proposé de rappeler les événements liés aux mesures de protection (Isolement Préventif Obligatoire, d'une durée de deux ans) et de les resignifier pour s'aventurer à un début d'historisation de certains des effets que la pandémie a eu sur le travail clinique avec les enfants et les adolescents. Pour cela, le développement freudien sur le retrait libidinal et ses conséquences sur le Moi, et les évolutions des moyens techniques qu'il a fallu mettre en œuvre lors de l'implémentation des séances en ligne, sont pris comme axe conceptuel directeur.Les conséquences inquiétantes de la pandémie sont dénotées concernant les jeunes enfants, atteints de pathologies graves, et les adolescents, tout en prenant en compte la spécificité de leurs caractéristiques subjectives AU

Este artigo traz reflexões sobre algumas consequências na clínica com crianças e adolescentes devido ao impacto da pandemia de Covid19. Aponta-se a ação da incerteza e do imprevisível sobre a subjetividade da população e propõe-se relembrar os eventos vinculados às medidas de proteção (Isolamento Preventivo Obrigatório, com duração de dois anos) e ressignifica esses para arriscar uma incipiente historicização sobre alguns dos efeitos que a pandemia produziu no trabalho clínico com crianças e adolescentes. Para tanto, toma-se como eixo conceitual constitutivo o desenvolvimento freudiano sobre a retirada libidinal e suas consequências para o Ego, e as mudanças nos recursos técnicos que tiveram que ser implementados quando da inclusão das sessões online. As consequências perturbadoras da pandemia são apontadas em relação às crianças pequenas, aos portadores de patologias graves e aos adolescentes, tendo em conta a especificidade das suas características subjetivas AU

[Management of human papillomavirus at the doctor's office : what to do for men ?] / Prise en charge du papillomavirus humain au cabinet médical : que faire pour les hommes ?

In primary care medicine, doctors may be facing with human papillomavirus (HPV)-related questions regarding prevention, screening or treatment, more so with women than with men. Through three clinical vignettes, this article aims to offer some clinical management recommendations in a primary care setting when HPV-related questions are raised by the male population.

En médecine de premier recours, le médecin peut être confronté à des questions de prévention, de dépistage ou de traitement en lien avec le papillomavirus (HPV), situations généralement ­rencontrées chez la femme mais parfois aussi chez l'homme. Au travers de trois vignettes cliniques, cet article vise à proposer quelques recommandations de prise en charge au cabinet dans le but de répondre aux questions liées au HPV susceptibles d'être soulevées par la population masculine.

El malestar a través de la voz y la forma subjetiva del saber hacer con el conflicto. Un estudio de caso / Discomfort through the voice and the subjective form of knowing do with the conflicto. A case study

La voz es un elemento particular de los primeros años de vida en el sujeto debido a que es una de las formas de manifestar su necesidad, un deseo, u otro, por lo cual se adopta como una herramienta que se vincula a los procesos anímicos; puede ser una forma de ver síntomas o malestares que el paciente no quiere ni confesarse, ni confesar en una consulta. Objetivo: Comprender la manifestación del malestar a través de la voz del sujeto y la forma subjetiva del saber hacer con el conflicto, que apertura la importancia de la voz en el proceso psicoterapéutico. Materiales y métodos: Se enmarcó en un paradigma fenomenológico, es una investigación de campo con enfoque cualitativo mediante un estudio de caso. Resultados: A partir de este estudio se pudo determinar que el malestar incide en la voz del sujeto cuando no puede ser expresado con anterioridad, por tanto, la voz es una forma de expresión inconsciente que en ocasiones no es percibida por el sujeto que manifiesta un malestar. Conclusiones: El fenómeno de la voz está presente en los sujetos que formaron parte de esta investigación, pero cada uno de ellos lo formula de manera distinta, haciendo del malestar un saber hacer individual; por medio de la voz se manifiestan los silencios, el grito, el llanto y variadas formas orales que indican que hay asuntos pendientes, reflejando el conflicto que tiene el individuo con lo que está refiriendo, así deja huellas fonéticas en todo lo que nos relata(AU)

The voice is a particular element of the first years of life in the subject due to which is one of the ways to express their need, a desire, or another, for which it is adopted as a tool that is linked to psychic processes; it may be a way of seeing symptoms or discomforts that the patient does not want to confess or confess in a consultation. Objective:Understand the manifestation of discomfort through the voice of the subject and the subjective form of knowing how to deal with conflict, which opens up the importance of the voice in the psychotherapeutic process. Materials and methods:It was framed in a phenomenological paradigm, it is an investigation of field with a qualitative approach through a case study. Results:From this study it was possible to determine that discomfort affects the voice of the subject when it cannot be expressed with previously, therefore, the voice is a form of unconscious expression that sometimes is not perceived by the subject who manifests discomfort. Conclusions:The phenomenon of the voice is present in the subjects who were part of this investigation, but each one of them formulates it in a different way, making discomfort an individual know-how; through the voice silences, screaming, crying and various oral forms that indicate thatthere are issues pending, reflecting the conflict that the individual has with what he is referring to, thus leaving traces phonetics in everything he tells us(AU)

Office Insertion of Tympanostomy Tubes and the Role of Automated Insertion Devices.

OBJECTIVE: Insertion of tubes in an office setting and automated tube insertion devices were identified as high-priority quality improvement opportunities during the update process for the 2013 clinical practice guideline on tympanostomy tubes from the American Academy of Otolaryngology-Head and Neck Surgery. The guideline update group, however, decided to avoid any recommendations on these topics, based on limited research evidence, and instead selected a subset of group members to author this state of the art review, with the goal of facilitating informed decisions in clinical practice. DATA SOURCES: PubMed through September 2021, Google search of device manufacturer websites, and SmartTots research website for articles on anesthesia neurotoxicity. REVIEW METHODS: A state of the art review format emphasizing evidence from the past 5 years, with manual cross-checks of reference lists of identified articles for additional relevant studies. CONCLUSIONS: The existing literature is too sparse to make recommendations about procedure setting and optimal technique or assess long-term outcomes. The role of automated devices is uncertain, given the increased equipment cost and limited information on characteristics of the proprietary preloaded tubes, including intubation duration and rates of otorrhea, obstruction, medialization, granulation tissue, and persistent perforation. IMPLICATIONS FOR PRACTICE: Whether to undertake in-office tube insertion in awake children should be based on clinician experience, clinician ability to interact with and reassure caregivers, shared decisions with caregivers, and judgment regarding the level of cooperation (or lack thereof) to be expected from a given child. Clinicians should remain alert to new research and expect increasing queries from patients and families.

Incidence of Accommodations for Patients With Significant Vision Limitations in Physicians' Offices in the US.

IMPORTANCE: Despite documented disparities in health care for patients with significant vision impairments and legal mandates that patients with disability receive equitable care, little is known about the extent to which physicians practicing in the US accommodate these patients in outpatient clinical settings. OBJECTIVE: To empirically explore the extent of basic accommodations physicians practicing in the US provide to patients with significant vision limitations in outpatient care. DESIGN, SETTING, AND PARTICIPANTS: In this physician survey study, randomly selected physicians were surveyed throughout the US on their attitudes toward patients with disability. A total of 1400 randomly selected active board-certified physicians representing 7 specialties (family medicine, general internal medicine, rheumatology, neurology, ophthalmology, orthopedic surgery, and obstetrics-gynecology) were surveyed. Data were collected from October 2019 to June 2020. MAIN OUTCOMES AND MEASURES: Reported use of basic accommodations when caring for patients with significant vision limitations (defined here as blind or significant difficulty seeing even with glasses or other corrective lenses). Physicians' accommodation performance was assessed based on whether they always or usually described the clinic space and always or usually provided printed material in large font. Use of Braille materials was reported too rarely to include in analyses. RESULTS: Of the 462 survey participants, 297 of 457 (65.0%) were male. The weighted response rate was 61.0%. Only 48 physicians (9.1%; 95% CI, 6.6-12.3) provided both accommodations (always or usually describing clinic spaces and providing large-font materials), while 267 (60.2%; 95% CI, 55.3-65.0) provided neither of these accommodations. Although 62.8% (95% CI, 57.5-67.8; n = 245) of nonophthalmologists did not provide either accommodation, 29.3% (95% CI, 20.1-40.7; n = 22) of ophthalmologists also did not do so; only 24.0% (95% CI, 15.6-35.0; n = 18) of ophthalmologists provided both accommodations compared with 8.4% (95% CI, 5.4-12.7) of other physicians. CONCLUSIONS AND RELEVANCE: This survey study suggests that less than one-tenth of physicians practicing in the US who care for patients with significant vision limitations usually or always describe clinic spaces or provide large-font materials, and less than one-third of ophthalmologists do so. Actions to address this seem warranted.

Satisfacción de usuarios de consultorios urbanos del Policlínico Norte, municipio Placetas, Villa Clara / User Satisfaction with Urban Family Medical Offices Belonging to the Norte Policlinic from Placetas Municipality, Villa Clara Province

Introducción: La satisfacción del usuario juega un rol protagónico, pues se convierte en el censor activo para evaluar la calidad del servicio. Objetivo: Determinar el grado de satisfacción de los usuarios de consultorios urbanos. Métodos: Se realizó un estudio descriptivo transversal que pertenece a las investigaciones en organización y eficiencia en los sistemas de salud. La población estuvo conformada por los 8371 pacientes mayores de 19 años del Policlínico Docente Norte del municipio Placetas en el año 2020. La muestra, seleccionada por muestreo estratificado aleatorio, quedó conformada por 124 sujetos previo consentimiento informado. Resultados: En la muestra predominó el grupo etario mayor de 60 años (42,7 por ciento); el sexo femenino (78,2 por ciento); el nivel escolar preuniversitario (52,4 por ciento); la presencia de enfermedad crónica (65,3 por ciento). El coeficiente de contingencia V de Cramer mostró que la satisfacción no guarda relación con la presencia de enfermedad crónica, que está parcialmente correlacionada con las condiciones estructurales y las informaciones para los pacientes. La correlación de Pearson mostró correlación parcial con los aspectos de la atención médica, excepto el tiempo de espera prolongado y el respeto a las creencias religiosas. Conclusiones: Los usuarios de consultorios urbanos de forma general se encuentran satisfechos, dependiendo dicha satisfacción de las condiciones estructurales, las informaciones adecuadas para los pacientes y los aspectos relacionados a la atención médica(AU)

Introduction: User satisfaction plays a leading role, since it becomes the active censor to evaluate the quality of service. Objective: To determine the degree of satisfaction of users with urban family medical offices. Methods: A cross-sectional and descriptive study was carried out as part of the research on organization and efficiency in health systems. The population consisted of the 8371 patients over 19 years of age from Norte Teaching Policlinic of Placetas Municipality in 2020. The sample, selected by stratified random sampling, consisted of 124 subjects with prior informed consent. Results: The sample was dominated by the age group older than sixty years (42.7 percent), the female sex (78.2 percent), the senior high school level (52.4 percent), as well as the presence of chronic disease (65.3 percent). The Cramer's V contingency coefficient showed that satisfaction is not related to the presence of any chronic disease, which is partially correlated with structural conditions and information for patients. Pearson's correlation showed partial correlation with aspects of medical care, except long waiting time and respect for religious beliefs. Conclusions: Users of urban family medical offices are generally satisfied, such satisfaction depending on structural conditions, adequate information for patients, and aspects related to medical care(AU)

Atendimento de saúde à pessoas hipertensas e diabéticas: percepção de enfermeiros / Atención de salud a personas hipertensas y diabéticas: percepción de enfermeros / Health care for hypertensive and diabetic people: nurses' perception

RESUMO Objetivo: conhecer a percepção de enfermeiros em relação à atenção às pessoas com hipertensão e/ou diabetes na Atenção Primária a Saúde (APS). Método: trata-se de pesquisa qualitativa, descritiva e exploratória, desenvolvida com 14 enfermeiros vinculados a municípios de uma regional de saúde do Paraná/BR. A coleta dos dados ocorreu no mês de setembro de 2021 por meio da técnica participativa intitulada Painel Integrado, a partir de quatro questões norteadoras, mediadas por três docentes e quatro discentes. Os dados foram transcritos e submetidos a análise interpretativa. Resultados: foram identificados seis tópicos de interesse: Estratégias de atendimento; Organização das consultas de enfermagem; Desafios para a realização da consulta de enfermagem; Potencialidades para a realização da consulta de enfermagem; Desafios da Rede de Atenção as Condições Crônicas; e Potencialidades da Rede de Atenção as Condições Crônicas. Considerações finais: a percepção dos enfermeiros sobre o atendimento às pessoas hipertensas e diabéticas se dá por ações programadas e espontâneas que visam ao controle glicêmico e pressórico. As consultas de enfermagem usualmente ocorrem previamente à consulta médica e sem sistematização. Desvelou-se também que os enfermeiros reconhecem sua importância nesse contexto, porém a rotina e a alta demanda se constituem como desafios a serem vencidos a sim de melhorar a prática exercida.

RESUMEN Objetivo: conocer la percepción de enfermeros con relación a la atención a las personas con hipertensión y/o diabetes en la Atención Primaria de Salud (APS). Método: se trata de investigación cualitativa, descriptiva y exploratoria, desarrollada con 14 enfermeros vinculados a municipios de una regional de salud de Paraná/Brasil. La recolección de los datos ocurrió en el mes de septiembre de 2021 por medio de la técnica participativa titulada Panel Integrado, a partir de cuatro cuestiones orientadoras, mediadas por tres docentes y cuatro discentes. Los datos fueron transcriptos y sometidos al análisis interpretativo. Resultados: se identificaron seis tópicos de interés: Estrategias de atención; Organización de las consultas de enfermería; Desafíos para la realización de la consulta de enfermería; Potencialidades para la realización de la consulta de enfermería; Desafíos de la Red de Atención a las Condiciones Crónicas; y Potencialidades de la Red de Atención a las Condiciones Crónicas. Consideraciones finales: la percepción de los enfermeros sobre la atención a las personas hipertensas y diabéticas se da por acciones programadas y espontáneas que tienen como objetivo el control glucémico y presórico. Las consultas de enfermería generalmente ocurren previamente a la consulta médica y sin sistematización. Se reveló también que los enfermeros reconocen su importancia en ese contexto, pero la rutina y la alta demanda se constituyen como desafíos a vencer a fin de mejorar la práctica ejercida.

ABSTRACT Objective: to know the nurses' perception in relation to care for people with hypertension and/or diabetes in Primary Health Care (PHC). Method: this is a qualitative, descriptive and exploratory research, developed with 14 nurses linked to municipalities of a regional health of Paraná/ BR. Data collection took place in September 2021 through the participatory technique entitled Integrated Panel, from four guiding questions, mediated by three teachers and four students. The data were transcribed and submitted to interpretative analysis. Results: six topics of interest were identified: Care strategies; Organization of nursing consultations; Challenges for conducting nursing consultation; Potential for conducting nursing consultation; Challenges of the Care Network the Chronic Conditions; and Potentialities of the Care Network the Chronic Conditions. Final thoughts: nurses' perception about the care of hypertensive and diabetic people is given by programmed and spontaneous actions aimed at glycemic and blood pressure control. Nursing consultations usually occur prior to medical consultation and without systematization. Moreover, nurses recognize their importance in this context, but routine and high demand are challenges to be overcome to improve the practice.

Factores de riesgo de la aterosclerosis en población atendida por cuatro consultorios médicos / Risk factors for atherosclerosis in a population attended by four medical offices

Introducción: La aterosclerosis es una enfermedad compleja, tan antigua como el hombre, a quien acompaña desde la concepción hasta su muerte. Objetivo: Describir el comportamiento de los factores de riesgo de la aterosclerosis. Método: Se realizó un estudio descriptivo de corte transversal durante el periodo 2016 a 2019. Resultados: Los factores de riesgo que predominaron fueron la hipertensión arterial, 348 para el 44,9 por ciento y la dislipidemia con más de un año de evolución en 247 para el 89,2 por ciento. La hipertensión arterial tiene el mayor riesgo asociado con el sobrepeso/obesidad, el sedentarismo, la circunferencia de la cintura alterada, el índice cintura talla alterado, los antecedentes familiares de hipertensión arterial, la diabetes mellitus tipo 2, la dislipidemia y con las enfermedades cardiovasculares. La dislipidemia tiene el mayor riesgo asociado con el sobrepeso/obesidad, la circunferencia de la cintura alterada, el índice cintura talla alterado, la hipertensión arterial, la diabetes mellitus tipo 2, los antecedentes familiares de dislipidemia y con la enfermedad arterial periférica y renal crónica. Conclusiones: Predominó el diagnóstico de hipertensión arterial, así como el diagnóstico de dislipidemia de más de un año de evolución. La hipertensión arterial y la dislipidemia presentaron un alto riesgo asociado con la mayoría de los factores de riesgo y enfermedades consecuentes de la aterosclerosis estudiados(AU)

Introduction: Atherosclerosis is a complex disease, as old as man, whom it accompanies from conception to death. Objective: To describe the behavior of risk factors for atherosclerosis. Method: A descriptive cross-sectional study was carried out during the period 2016 to 2019. Results: The predominant risk factors were the diagnosis of hypertension, 348 for 44.9 percent and the diagnosis of dyslipidemia over one year in 247 for 89.2 percent. hypertension has the highest risk associated with overweight / obesity, sedentary lifestyle, altered waist circumference, altered waist-to-height index, family history of hypertension, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease. Dyslipidemia has the highest risk associated with overweight / obesity, altered waist circumference, altered waist-height index, hypertension, type 2 diabetes mellitus, a family history of dyslipidemia and with peripheral arterial and chronic kidney disease. Conclusions: The diagnosis of hypertension and the diagnosis of dyslipidemia of more than one year predominated. Hypertension and dyslipidemia presented a high risk associated with most of the risk factors and diseases resulting from atherosclerosis studied(AU)

Factores de riesgo asociados a diabetes mellitus tipo 2. Policlínico Docente José Jacinto Milanés. Matanzas, 2019 / Risk factors associated with type 2 diabetes mellitus. Teaching Polyclinic José Jacinto Milanés. Matanzas, 2019

RESUMEN Introducción: la diabetes es un trastorno endocrino-metabólico crónico que afecta a diversos órganos y tejidos. Más del 90 % de los que la padecen sufren diabetes tipo 2. Esta se acompaña de complicaciones crónicas, que pueden prevenirse mediante un control adecuado de la hiperglucemia y de los factores de riesgo cardiovascular. Objetivo: caracterizar los factores de riesgo asociados a la diabetes mellitus tipo 2, en pacientes del Consultorio del Médico de la Familia no. 27 del Policlínico Docente José Jacinto Milanés, del municipio Matanzas. Materiales y métodos: se realizó un estudio descriptivo de corte transversal, durante el período de enero a diciembre de 2019. El universo estuvo constituido por 50 pacientes pertenecientes al consultorio no. 27 del Policlínico Docente José Jacinto Milanés, del municipio Matanzas, dispensarizados con diabetes mellitus tipo 2. Resultados: el sexo femenino fue el predominante, y el 24 % de los pacientes se encontraban entre 55 y 59 años. En cuanto al estado nutricional, resultó la obesidad el de mayor frecuencia. En el 52 % existían antecedentes familiares de diabetes tipo 2. Conclusiones: la obesidad, los malos hábitos dietéticos, el sedentarismo y la hipertensión arterial constituyeron los factores de riesgo más frecuentes en estos pacientes (AU).

ABSTRACT Introduction: diabetes is a chronic endocrine-metabolic disorder that affects numerous organs and tissues. More than 90 % of those with it suffer from type 2 diabetes. This is accompanied by chronic complications, which can be prevented by adequate control of hyperglycemia and cardiovascular risk factors. Objective: to characterize the risk factors associated with type 2 diabetes mellitus in patients from the Family Physician's Office no. 27 of the Teaching Polyclinic José Jacinto Milanés, of the municipality of Matanzas. Materials and methods: a cross-sectional, descriptive study was carried out during the period from January to December 2019. The universe were 50 patients belonging to Family Physician's Office no. 27 of the Teaching Polyclinic José Jacinto Milanés, of the municipality of Matanzas, diagnosed with type 2 diabetes mellitus. Results: female sex predominated, and 24 % of patients were aged 55-59 years. According to the nutritional status, obesity was the more frequent. There was a family history of type 2 diabetes mellitus in 52 %. Conclusion: obesity, poor dietary habits, sedentary way of life, and arterial hypertension were the most frequent risk factors found in these patients (AU).

Situación de salud bucal en un consultorio médico de la familia. Área Centro, Sancti Spíritus / Oral health situation in a family medical office. Central Area, Sancti Spíritus

RESUMEN Introducción: la situación de salud bucal de la población es factible de conocerse a partir del análisis de la situación de salud. Objetivo: caracterizar la situación de salud bucal de 30 familias pertenecientes a un consultorio médico. Materiales y métodos: se realizó un estudio observacional descriptivo transversal en el Consultorio Médico de la Familia No. 3 del área Centro del municipio Sancti Spíritus, entre diciembre de 2019 y febrero de 2020. El universo estuvo constituido por toda la población del consultorio (n = 937) y la muestra por 98 pacientes pertenecientes a 30 familias, seleccionados por un muestreo aleatorio simple. Se estudiaron las variables edad, sexo, clasificación epidemiológica, factores de riesgo, enfermedades bucales y nivel de conocimientos. Se emplearon métodos empíricos y estadísticos. Resultados: existió predominio del sexo femenino (56,1 %) y del grupo de 20 a 59 años (48 %). Respecto a la clasificación epidemiológica, el 49 % de los pacientes eran sanos con riesgo y el 46,9 % enfermos. La higiene bucal deficiente se identificó en 52 % de la muestra estudiada. La enfermedad bucal de mayor prevalencia fue la caries dental (41,8 %) y el nivel de conocimientos sobre salud bucodental resultó ser regular (61,7 %) en la mayoría de la población. Conclusiones: el sexo femenino y el grupo etario de 20 a 59 años fueron los más representativos. Predominaron los pacientes sanos con riesgo, siendo la higiene bucal deficiente el factor más prevalente. La caries dental representó la enfermedad con mayor aparición y se evaluó de regular el nivel de conocimientos sobre salud bucodental (AU).

ABSTRACT Introduction: it is feasible to know the oral health situation of the population from the analysis of the health situation. Objective: to characterize the oral health situation of 30 families belonging to a medical office. Materials and methods: a cross-sectional descriptive observational study was carried out in the Family Medical Office No. 3 of the Central area of Sancti Spiritus municipality, from December 2019 to February 2020. The universe was formed by the entire office population (n = 937) and the sample by 98 patients from 30 families, chosen by simple random sampling. The variables that were studied were age, sex, epidemiological classification, risk factors, oral diseases and level of knowledge. Empirical and statistical methods were used. Results: female sex (56.1 %) and 20-59 years age-group (48 %) predominated. Regarding epidemiological classification, 49 % of patients were healthy at risk and 46.9 % were sick. Poor oral hygiene was identified in 52 % of the sample studied. The most prevalent oral disease was dental caries (41.8 %) and the level of knowledge about oral health proved to be regular (61.7 %) in most of the population. Conclusions: female sex and the 20-59 years age-group were the most representative. Healthy patients at risk predominated, being poor oral health the most prevalent factor. Tooth decay represented the most common disease and the level of knowledge about oral health was evaluated as regular (AU).

Price Differences To Insurers For Infused Cancer Drugs In Hospital Outpatient Departments And Physician Offices.

The prices paid in 2019 by Blue Cross Blue Shield health plans in hospital outpatient departments were double those paid in physician offices for biologics, chemotherapies, and other infused cancer drugs (99-104 percent higher) and for infused hormonal therapies (68 percent higher). Had these plans excluded hospital clinics from their networks, channeling all of the infusions to physician offices, they would have saved $1.28 billion per year, or 26 percent of what they actually paid. Had they relied on cost-sharing incentives to channel infusions to physician offices-with either uniform 20 percent coinsurance or reference pricing-they would have realized savings but increased the financial burden on patients who received care at the higher-price hospital clinics. Under 20 percent coinsurance, patients' payment obligations for care at hospital clinics would have exceeded those for care in physician offices by a median of 67 percent for biologics, 72 percent for chemotherapies, 87 percent for hormonal therapies, and 75 percent for other cancer drugs. Large savings are potentially available to commercial insurers from shifting cancer infusion care to nonhospital settings, but cost-sharing burdens could become very high for patients.

Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016.

BACKGROUND/OBJECTIVES: With an aging population suffering from increased prevalence of chronic conditions in the United States (U.S.), a large portion of these patients are on multiple medications. High-risk medications can increase the risk for drug-drug interactions and medication nonadherence. This study aims to describe the prevalence of polypharmacy and high-risk medication prescribing in U.S. physician offices. METHODS: This was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. All patients over 65 years old were included. Polypharmacy was categorized as no polypharmacy (< 2 medications), minor polypharmacy (2-3 medications), moderate polypharmacy (4-5 medications), and major polypharmacy (>5 medications). Medications were further categorized into high-risk medication categories (anticholinergics, cardiovascular agents, central nervous system (CNS) medications, pain medications, and other). Comparisons between the degrees of polypharmacy were performed utilizing chi-square or Wilcoxon rank-sum tests with JMP Pro 14® (SAS Institute, Cary, NC). RESULTS: Over 2 billion patient visits were included. Overall, Polypharmacy was common (65.1%): minor polypharmacy (16.2%), moderate polypharmacy (12.1%), and major polypharmacy (36.8%). Patients with major polypharmacy were older compared to those with moderate or minor polypharmacy (75 vs. 73 years, respectively) and were most frequently prescribed pain medications (477.3 per 1,000 total visits). NSAIDs were the most frequently prescribed, with 232.4 per 1,000 total visits resulting in one high-risk NSAID prescription, while 21.9 per 1,000 total visits resulted in two or more high-risk NSAIDs. CONCLUSION: Most patients over 65 years experienced some degree of polypharmacy, with many experiencing major polypharmacy. This indicates an increased need for expanded pharmacist roles through medication therapy management and safety monitoring in this patient population.

Prevalencia del deterioro cognitivo en personas mayores de 60 años, en un consultorio médico de la región de Altahabana (Cuba), perteneciente al Municipio Boyeros. Año 2020 / Prevalence of cognitive impairment in people over 60 years old at a medical office in the region of Altahabana (Cuba), belonging to the Boyeros Municipality. Year 2020

El deterioro cognitivo es un problema de salud a nivel mundial, el cual se ha convertido en uno de las mayores demandas de atención médica en las personas mayores. Con el objetivo de determinar la prevalencia del deterioro cognitivo en las personas mayores de 60 años, se realizó un estudio descriptivo, con carácter retrospectivo de corte transversal a 323 adultos mayores en el Consultorio Médico de la Familia # 20, ubicado en la región de Altahabana, perteneciente al Policlínico Universitario "Federico Capdevila" del Municipio Boyeros (Cuba). El estudio se realizó entre enero y diciembre de 2020. Se encontró que el 31% de las personas mayores, pertenecen al grupo de edades de 65 a 69 años, con un predominio del género femenino en un 61%. El nivel de escolaridad universitario estuvo presente en un 57,5%. El deterioro cognitivo de las personas mayores prevaleció en un 14%; la hipertensión arterial, en un 64,8% fue la enfermedad crónica no transmisible que más se asoció al deterioro cognitivo.

Cognitive impairment is a global health problem, which has become one of the greatest demands for medical care in older people. In order to determine the prevalence of cognitive impairment in people over 60 years of age, a descriptive, retrospective, cross-sectional study was carried out on 323 older adults in the Family Medical Clinic # 20, located in the Altahabana region, belonging to the "Federico Capdevila" University Polyclinic of the Boyeros Municipality (Cuba). The study was carried out between January and December 2020. It was found that 31% of the elderly belong to the 65 to 69 age group, with a 61% predominance of the female gender. The level of university education was present in 57.5%. Cognitive impairment in the elderly prevailed in 14%; arterial hypertension, in 64.8%, was the chronic non-communicable disease that was most associated with cognitive deterioration.

Sexually transmitted infection laboratory testing and education trends in US outpatient physician offices, 2009-2016.

OBJECTIVE: To describe national rates of sexually transmitted infection (STI) testing and education overall and among patient subgroups in US outpatient physician offices from 2009 to 2016. DESIGN: This was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Data weights were applied to extrapolate to national estimates. SETTING: Data were collected from a systematic random sample of outpatient physician office visits throughout USA. Physician office types include free standing clinics, private or group setting practices, centres offering community and mental health services, family planning clinics and health maintenance organisations/other prepaid clinics. PARTICIPANTS: All sampled patient visits were eligible for inclusion and were assessed for the provision of STI prevention education and STI testing for chlamydia, gonorrhoea, hepatitis, human papillomavirus (HPV) and HIV. RESULTS: Of 7.6 billion total visits, 123 million included an STI test. Hepatitis was the most commonly tested STI (9.12 per 1000), followed by chlamydia (6.67 per 1000), gonorrhoea (6.00 per 1000), HIV (5.40 per 1000) and HPV (5.03 per 1000). Testing rates for the three STIs measured for the entire 8-year period increased over time and peaked in 2015 compared with 2009: chlamydia (R2=0.36), HPV (R2=0.28) and HIV (R2=0.51). Testing was highest among women (21.93 per 1000), 15-24-year olds (46.04 per 1000), non-Hispanic blacks (37.33 per 1000) and those seen by obstetrics/gynaecology specialists (103.75 per 1000). STI prevention education was provided to 4.89 per 1000 patients and remained relatively unchanged from 2013 to 2016. CONCLUSION: STI testing in outpatient physician offices increased over the study period but varied by patient characteristics and site of care. Few patients received STI prevention education, highlighting a potential gap in resource utilisation in these settings.

Crisis Management of Hysteroscopic Surgical Complications in the Office Setting.

IMPORTANCE: As health care providers are increasingly motivated to perform office procedures, there is marginal training and attention related to crisis management (CM). OBJECTIVE: We review the CM in office gynecology and illustrate the value of applying the STOP (stop, think, observe, plan) mental framework to acute management of office hysteroscopy complications. EVIDENCE ACQUISITION: We performed a literature review on crisis management in gynecology. RESULTS: Concepts of team leadership, simulation training, awareness of human error, and panic control are implemented in CM. CONCLUSIONS: Health care providers need to be cognizant of the importance of CM for optimizing patient safety and quality improvement and consider its application on office-based procedures. RELEVANCE: Crisis management has become increasingly relevant in the outpatient setting, seeking to better equip physicians with the skills to manage adverse outcomes while performing office-based procedures.

Home- and Office-Based Vergence and Accommodative Therapies for Treatment of Convergence Insufficiency in Children and Young Adults: A Report by the American Academy of Ophthalmology.

PURPOSE: To review home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency (CI) in children and young adults up to 35 years of age. METHODS: Literature searches were conducted through October 2020 in the PubMed database for English-language studies. The combined searches yielded 359 abstracts, of which 37 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. RESULTS: Of the 12 studies included in this assessment, 8 were graded as level I evidence, 2 were graded as level II evidence, and 2 were graded as level III evidence. Two of the level I studies included older teenagers and young adults; the remainder of the studies exclusively evaluated children. Two randomized controlled trials found that office-based vergence and accommodative therapies were effective in improving motor outcomes in children with symptomatic CI. However, the studies reported conflicting results on the efficacy of office-based therapy for treating symptoms of CI. Data were inconclusive regarding the effectiveness of home-based therapies (including pencil push-ups and home computer therapy) compared with home placebo. In young adults, office-based vergence and accommodative therapies were not superior to placebo in relieving symptoms of CI. CONCLUSIONS: Level I evidence suggests that office-based vergence and accommodative therapies improve motor outcomes in children with symptomatic CI, although data are inconsistent regarding symptomatic relief. Evidence is insufficient to determine whether home-based therapies are effective.