RESUMO
INTRODUCCIÓN: Los centros asistenciales docentes cumplen un rol relevante en los sistemas de salud, aportando experticia a los cuidados clínicos a través de la educación y la investigación (2). En Chile, la relación asistencial docente (RAD) se encuentra regulada por la Norma Técnica General N°254 (1). La RAD es un vínculo estratégico y de largo plazo que une al sector público de salud con centros formadores, que tiene como objetivo formar y disponer de profesionales y técnicos competentes para satisfacer las necesidades de salud de la población, generando un beneficio sobre la calidad de atención que reciben los usuarios del SNSS (1). En este sentido, la formación de profesionales y técnicos del sector salud constituye un eje estratégico en el desarrollo del sistema. Esta norma detalla el alcance de los centros formadores y docentes, y de las actividades de colaboración entre profesionales y estudiantes (1). En este sentido, en la literatura se ha reportado el posible impacto que pudiera tener este tipo de relación en el tiempo de espera, calidad de la atención, satisfacción usuaria y otros temas relacionados en la atención a personas en contextos hospitalarios y ambulatorios, tanto para usuarios, estudiantes e instituciones asistenciales (hospitales, clínicas o centros ambulatorios docentes) que se vinculan con centros formadores (37). En este contexto, y con el objetivo de entregar justificación actualizada y relevante para el proyecto de ley que regula la RAD, la Jefatura del Dpto. de Formación, Capacitación y Educación Continua, junto con la Oficina del Gabinete de la Subsecretaría de Redes Asistenciales, han solicitado una síntesis rápida de la evidencia sobre el efecto de la formación académica en establecimientos asistenciales de estudiantes de pre y postgrado, en la productividad asistencial. METODOLOGIA: Se identificaron inicialmente 634 revisiones sistemáticas (RS). De éstas, se excluyeron 632 por disenso o duplicados, y se utilizaron 2 RS (3,4) publicadas en 2002 y 2015. A los estudios primarios incluidos en las RS utilizadas, se les aplicaron los mismos criterios de inclusión y exclusión que los aplicados en las RS (cuadro de metodología). Con estos criterios, se consideraron finalmente 10 estudios primarios, la totalidad de ellos fueron de tipo observacional (817). Para estimar el efecto de los hallazgos de esta SRE, se utilizaron los 10 estudios referidos en las 2 RS (3,4), en los cuales la comparación se realizó con centros asistenciales no docentes. RESULTADOS: Los hallazgos aquí presentados se han separado de acuerdo a tres desenlaces de interés: 1. Productividad clínica medida como tiempo de atención (8,10,11,13); 2. Productividad clínica medida como la cantidad de tareas realizadas por rango de tiempo (número de usuarios o trámites administrativos)(8,9,1113) y 3. Satisfacción Usuaria (1417). Cada hallazgo contiene además una tabla resumen con los resultados, mostrando la certeza en la evidencia de cada uno de los desenlaces reportados. CONSIDERACIONES DE IMPLEMENTACIÓN: Para el análisis de las consideraciones de implementación, durante la selección de títulos, resúmenes y texto completo de esta síntesis, se realizó una selección de revisiones sistemáticas que pudieran entregar antecedentes para el análisis de la aplicabilidad de la evidencia al contexto local, consideraciones económicas, equidad y de monitoreo y evaluación.
Assuntos
Humanos , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Educação em Saúde/organização & administração , Docentes/organização & administração , Hospitais Universitários/organização & administração , Análise Custo-Benefício/economiaRESUMO
Introdução: Pacientes com câncer em estádios avançados e metástases ósseas frequentemente não apresentam condições clínicas para a realização de esquemas quimioterápicos convencionais subsequentes, restringindo as opções de tratamento. Anteriormente, demonstramos que nanopartículas artificiais lipídicas (LDE), semelhantes à lipoproteína de baixa densidade (LDL) rica em colesterol, são captadas por tecidos malignos, e quando associadas aos quimioterápicos, após injeção pela via endovenosa, reduz drasticamente a toxicidade do tratamento. Os objetivos deste presente estudo foram avaliar a resposta clínica ao tratamento quimioterápico com paclitaxel (PTX) associado à LDE; avaliar as toxicidades clínicas e laboratorial, e a capacidade da associação LDE-PTX em reduzir a dor oncológica relacionada às metástases ósseas em pacientes com carcinoma de mama, próstata e pulmão, previamente tratados e não elegíveis para tratamento quimioterápico convencional subsequente. Métodos: Dezoito pacientes (8 com câncer de mama, 5 de próstata e 5 de pulmão) com metástases ósseas foram incluídos. O tratamento consistiu no esquema LDE-PTX na dose convencional do PTX (175 mg/m2 de superfície corpórea de 3/3 semanas) e os pacientes foram avaliados por resposta clínica, redução da dor óssea, uso de medicamentos opióides, e ocorrência de fraturas ósseas patológicas. Resultados: No total, 104 ciclos de quimioterapia foram realizados, e nenhum paciente apresentou toxicidade clínica, laboratorial, assim como não houve fraturas patológicas. Dos 18 pacientes incluídos, 9 tiveram sobrevida livre de progressão de doença 6 meses. Houve em todos os pacientes redução da dor óssea, permitindo substituição da medicação opióide por analgésico não opióide. Conclusão: A melhora significativa na dor óssea sem que tenha ocorrido toxicidade do tratamento, e o tempo de não progressão de doença 6 meses na metade dos pacientes sugere que esses pacientes tenham se beneficiado consistentemente do tratamento com a LDE-PTX. Portanto, a LDE-PTX pode tornar- se uma opção terapêutica interessante em pacientes com carcinomas de próstata, mama ou pulmão em estágios avançados e sem condições clínicas de se submeterem a outros esquemas quimioterápicos convencionais
Introduction: Patients with advanced cancer and bone metastases usually do not have clinical conditions to perform additional conventional chemotherapy regimens, restricting treatment options. Previously, we showed that lipid core nanoparticles (LDE), similar to cholesterol-rich low-density lipoprotein (LDL), are taken up by malignant tissues, and when associated to chemotherapy, after endovenous injection, it drastically decreases the toxicity of the treatment. The objectives of this study were to evaluate the clinical response to chemotherapy treatment with paclitaxel (PTX) associated with LDE; to evaluate the clinical and laboratorial toxicities, and the ability of the LDE-PTX to reduce cancer pain related to bone metastases in patients with breast, prostate or lung carcinoma, previously treated and not eligible for subsequent conventional chemotherapy treatment. Methods: Eighteen patients (8 with breast cancer, 5 with prostate and 5 with lung) with bone metastases were included. Treatment consisted of the LDE-PTX regimen at a conventional dose of PTX (175 mg/m2 body surface area, 3/3 weeks) and patients were evaluated for clinical response, reduction in bone pain, use of opioid medications, and the occurrence of pathological bone fractures. Results: In total, 104 chemotherapy cycles were performed, and none of the patients showed clinical or laboratorial toxicities, as well as there were no pathological fractures. Of the 18 patients evaluated, 9 had progression-fee survival 6 months. Patients had decrease in bone pain allowing replacement of opioid medication by another non-opioid analgesic. Conclusion: Significant improvement in bone pain without treatment toxicity, and time to disease progression of 6 months in half of the patients suggest that these patients have consistently benefited with LDE-PTX treatment. Therefore, LDE-PTX may become an interesting therapeutic option in patients with advanced stage of prostate, breast or lung carcinomas and without clinical conditions to undergo other conventional chemotherapy regimens
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Pacientes/classificação , Paclitaxel/efeitos adversos , Tratamento Farmacológico/classificação , Uso de Medicamentos/classificação , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Preparações Farmacêuticas/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Metástase Neoplásica/diagnóstico , Neoplasias/patologiaRESUMO
Trata-se de um relato de experiência, que descreve, sob estratégia narrativo-argumentativa, as significâncias político-pedagógicas atreladas ao planejamento estratégico de ações de educação em saúde bucal vivenciadas em um ambiente escolar e experimentadas por acadêmicos estagiários de um curso de Odontologia. Após análise detalhada, algumas inferências se destacaram: o reconhecimento do ambiente escolar como território fértil para o desenvolvimento de ações promotoras de saúde; a efetividade do instrumento "TPC" (Teorizar-Praticar-Criticar) no direcionamento dos acadêmicos estagiários no planejamento estratégico de atividades de educação em saúde bucal; a importância de se disseminar, em espaços científicos, os aprendizados advindos de experimentações práticas de estágios.
This is a report on an experience that describes, under a narrative-argumentative strategy, the political-pedagogical significance linked to the strategic planning of oral health education actions experienced in a school environment and experienced by university trainees from a Dentistry course. After a detailed analysis, some inferences were observed: the recognition of the school environment as a fertile territory for the development of health-promoting actions; the effectiveness of the "TPC" (Theorize-Practice-Criticize) instrument in directing university trainees in the strategic planning of oral health education activities; the importance of disseminating, in scientific spaces, the learning from practical experimentation during internships.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Jogos e Brinquedos , Planejamento Estratégico/normas , Educação em Saúde Bucal/métodos , Higiene Bucal/educação , Estudantes de Odontologia , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Políticas, Planejamento e Administração em Saúde/organização & administração , Saúde Bucal/educação , Atividades Científicas e Tecnológicas , Promoção da Saúde/métodos , AprendizagemRESUMO
The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level (P < .05).
Assuntos
Atitude do Pessoal de Saúde , Competência Cultural/educação , Internato e Residência/métodos , Pediatria/educação , Preconceito/prevenção & controle , Adulto , Estudos Transversais , Educação de Pós-Graduação em Medicina/métodos , Feminino , Humanos , Masculino , Apoio ao Desenvolvimento de Recursos Humanos/métodosAssuntos
Trato Gastrointestinal/cirurgia , Neoplasias de Cabeça e Pescoço/terapia , Medicina Regenerativa/métodos , Sistema Respiratório/cirurgia , Osso Temporal/cirurgia , Bioengenharia/métodos , Transplante de Células/métodos , Dissecação/métodos , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/história , História do Século XX , Humanos , Injeções , Procedimentos Cirúrgicos Nasais/métodos , Publicações Periódicas como Assunto , Compostos Fitoquímicos/administração & dosagem , Medicina Regenerativa/educação , Alicerces Teciduais/efeitos adversos , Apoio ao Desenvolvimento de Recursos Humanos/métodosAssuntos
COVID-19 , Educação a Distância , Educação de Pós-Graduação em Medicina/organização & administração , Geriatria/educação , Avaliação de Programas e Projetos de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Currículo , Educação a Distância/métodos , Educação a Distância/organização & administração , Humanos , Inovação Organizacional , SARS-CoV-2 , Ensino , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Estados UnidosRESUMO
ABSTRACT: Malignant gastric lymphoma (MGL) accounts for a small proportion (upto 5%) of gastric malignancies. However, unlike for advanced gastric cancer (AGC) that requires surgical treatment, the standard treatments for MGL are chemotherapy and radiotherapy. Hence, the initial impression of the endoscopist is critical for the differential diagnosis and for planning future treatment. The purpose of this study was to assess the endoscopic diagnostic accuracy and the possibility of distinguishing between AGC and MGL depending on the endoscopist's experience.A total of 48 patients who had MGL, and 48 age and sex-matched patients who had AGC were assessed by endoscopic review at a tertiary referral hospital between June 2008 and February 2017. Two endoscopic specialists reviewed the endoscopic findings and divided these diagnoses into 5 groups: Borrmann type (1, 2, 3, and 4) and early gastric cancer-like type. After this, 7 experts and 8 trainees were asked to complete a quiz that was comprised of 6 images for each of the 96 cases and to provide an endoscopic diagnosis for each case. The test results were analyzed to assess the diagnostic accuracy according to the pathologic results, endoscopic subgroups, and endoscopists' experience. For inter-observer agreement was calculated with Fleiss kappa values.The overall diagnostic accuracy of endoscopic findings by the experts was 0.604 and that by the trainees was 0.493 (Pâ=â.050). There was no significant difference in the diagnosis according to the final pathology (lymphoma cases, 0.518 vs 0.440, Pâ=â.378; AGC cases, 0.690 vs 0.547, Pâ=â.089, respectively). In the subgroup analysis, the experts showed significantly higher diagnostic accuracy for the endoscopic Borrmann type 4 subgroup, including lymphoma or AGC cases, than the trainees (Pâ=â.001). Inter-observer agreement of final diagnosis (Fleiss kappa, 0.174) and endoscopic classification groups (Fleiss kappa, 0.123-0.271) was slightly and fair agreement.The experts tended to have a higher endoscopic diagnostic accuracy. Distinguishing MGL from AGC based on endoscopic findings is difficult, especially for the beginners. Even if the endoscopic impression is AGC, it is important to consider MGL in the differential diagnosis.
Assuntos
Endoscopia/métodos , Linfoma não Hodgkin/patologia , Neoplasias Gástricas/patologia , Competência Clínica/estatística & dados numéricos , Diagnóstico Diferencial , Tratamento Farmacológico/métodos , Endoscopia/classificação , Endoscopia/estatística & dados numéricos , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/radioterapia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radioterapia/métodos , Reprodutibilidade dos Testes , Especialização/estatística & dados numéricos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/radioterapia , Neoplasias Gástricas/cirurgia , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricosRESUMO
Global health and its predecessors, tropical medicine and international health, have historically been driven by the agendas of institutions in high-income countries (HICs), with power dynamics that have disadvantaged partner institutions in low- and middle-income countries (LMICs). Since the 2000s, however, the academic global health community has been moving toward a focus on health equity and reexamining the dynamics of global health education (GHE) partnerships. Whereas GHE partnerships have largely focused on providing opportunities for learners from HIC institutions, LMIC institutions are now seeking more equitable experiences for their trainees. Additionally, lessons from the COVID-19 pandemic underscore already important lessons about the value of bidirectional educational exchange, as regions gain new insights from one another regarding strategies to impact health outcomes. Interruptions in experiential GHE programs due to COVID-19-related travel restrictions provide an opportunity to reflect on existing GHE systems, to consider the opportunities and dynamics of these partnerships, and to redesign these systems for the equitable benefit of the various partners. In this commentary, the authors offer recommendations for beginning this process of change, with an emphasis on restructuring GHE relationships and addressing supremacist attitudes at both the systemic and individual levels.
Assuntos
Países em Desenvolvimento/economia , Saúde Global/educação , Equidade em Saúde/estatística & dados numéricos , Apoio ao Desenvolvimento de Recursos Humanos/métodos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Países em Desenvolvimento/estatística & dados numéricos , Educação em Saúde/estatística & dados numéricos , Equidade em Saúde/tendências , Humanos , Comunicação Interdisciplinar , Cooperação Internacional , Liderança , SARS-CoV-2/isolamento & purificaçãoRESUMO
PURPOSE: The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula. METHOD: In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded. RESULTS: Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%). CONCLUSIONS: The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.
Assuntos
Currículo/normas , Internato e Residência/métodos , Motivação/fisiologia , Percepção/fisiologia , Bases de Dados Factuais , Atenção à Saúde/tendências , Técnica Delphi , Humanos , Participação dos Interessados , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricosRESUMO
Feedback pedagogies and research tend to focus on immediate corrective actions rather than learning for the longer term. This approach means that feedback may not support trainees who are managing complex, competing, and ambiguous practice situations, often with limited supervision. There is an opportunity to consider how feedback can help medical trainees sustain their own development into the future, including when they have completed formal training. This article explores how feedback pedagogies can facilitate medical trainees' abilities to develop challenging aspects of practice across multiple clinical environments to eventually practice without supervision. From a sociocultural perspective, clinical training takes place within a practice curriculum; each clinical environment offers varying opportunities, which the trainees may choose to engage with. The authors propose feedback as an interpersonal process that helps trainees make sense of both formal training requirements and performance relevant information, including workplace cues such as patient outcomes or colleagues' comments, found within any practice curriculum. A significant pedagogic strategy may be to develop trainees' evaluative judgment or their capability to identify and appraise the qualities of good practice in both themselves and others. In this way, feedback processes may help trainees surmount complex situations and progressively gain independence from supervision.
Assuntos
Competência Clínica/estatística & dados numéricos , Organização e Administração/normas , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Atitude do Pessoal de Saúde , Currículo , Retroalimentação , Humanos , Internato e Residência , Local de Trabalho/psicologiaRESUMO
Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.
Assuntos
Competência Clínica , Infecções por Coronavirus , Educação , Cirurgia Geral/educação , Pandemias , Pneumonia Viral , Treinamento por Simulação , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação/métodos , Educação/organização & administração , Avaliação Educacional , Humanos , Modelos Anatômicos , Modelos Educacionais , Pandemias/prevenção & controle , Satisfação Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Autoimagem , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Reino UnidoRESUMO
This study explores how a three-way collaboration between a University library, writing centre and faculty created avenues of training and support for students within a Doctor of Nursing Practice (DNP) program in an American University. The role of each partner involved in the collaboration is discussed alongside the profile of the DNP students. Lesson planning and classroom techniques for DNP information literacy classes are described and feedback from the partners and the students are discussed. The study confirms that collaboration is effective in improving research and writing skills. D.I.
Assuntos
Comportamento Cooperativo , Bibliotecários/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Apoio ao Desenvolvimento de Recursos Humanos/normas , Currículo/normas , Currículo/tendências , Docentes de Enfermagem/tendências , Humanos , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Redação/normasRESUMO
Hahnemann University Hospital provided care for Philadelphians starting in 1848, but its recent history has been riddled with financial turmoil that culminated in its rapid closure in summer 2019. As the hospital shuttered its doors to patients, it also orphaned 583 medical trainees. This crisis exposed vulnerabilities in graduate medical education (GME). In a firsthand account of the situation that developed in Philadelphia and reached academic institutions across the country, the authors reflect on lessons learned that may help leaders at other institutions mitigate the inevitable difficulties that arise when academic hospitals close. These lessons pertain to handling panic and administrative burdens in the aftermath of closure, the importance of well-defined processes, a clear understanding of GME funding, and strategies for placement of trainees that minimize disruption of their education.
Assuntos
Educação de Pós-Graduação em Medicina/métodos , Medicina Interna/educação , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Humanos , Internato e Residência , Estados UnidosRESUMO
INTRODUCTION: Observational gait analysis is a widely used skill in physical therapy. Meanwhile, the skill has not been investigated using objective assessments. The present study investigated the differences in eye movement between professionals and trainees, while observing gait analysis. METHODS: The participants included in this study were 26 professional physical therapists and 26 physical therapist trainees. The participants, wearing eye tracker systems, were asked to describe gait abnormalities of a patient as much as possible. The eye movement parameters of interest were fixation count, average fixation duration, and total fixation duration. RESULTS: The number of gait abnormalities described was significantly higher in professionals than in trainees, overall and in limbs of the patient. The fixation count was significantly higher in professionals when compared to trainees. Additionally, the average fixation duration and total fixation duration were significantly shorter in professionals. Conversely, in trunks, the number of gait abnormalities and eye movements showed no significant differences between groups. CONCLUSIONS: Professionals require shorter fixation durations on areas of interest than trainees, while describing a higher number of gait abnormalities.