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1.
Rev Gastroenterol Peru ; 35(4): 307-12, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26802883

RESUMO

INTRODUCTION: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). OBJECTIVE: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. MATERIAL AND METHODS: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. RESULTS: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). CONCLUSION: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia.


Assuntos
Doença Hepática Terminal/mortalidade , Cirrose Hepática/mortalidade , Índice de Gravidade de Doença , Adulto , Idoso , Doença Hepática Terminal/diagnóstico , Feminino , Seguimentos , Mortalidade Hospitalar , Hospitais Públicos , Humanos , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Peru , Prognóstico , Estudos Prospectivos , Curva ROC
2.
Rev Gastroenterol Peru ; 33(4): 301-5, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-24419026

RESUMO

UNLABELLED: Liver cirrhosis is a public health problem. In Peru, is the leading cause of death in liver diseases. In addition, patients with chronic liver disease and cirrhosis are at increased risk for readmission. OBJECTIVES: To determine the frequency of mortality and readmission at 3 months, and clinical-epidemiological characteristics of hospitalized cirrhotic patients in a general hospital. MATERIALS AND METHODS: Data were collected prospectively of hospitalized cirrhotic patients in the Hospital Nacional Cayetano Heredia,Lima,Peru, from October 2011 to October 2012; telephone follow-up was at 3 months after hospital discharge. RESULTS: The study included 96 patients. The mean age was 59.2 years. The most common etiology of cirrhosis was alcohol (45.8%) and the main reason for hospitalization was upper gastrointestinal bleeding (29.2%). Global mortality was 39.6% (38 patients), from them, 63.2% (24/38) were inpatients, its main cause was septic shock 31.5% (12/38). Forty-four percent of the deceased had infection as complication. Hospital readmission was 42.8% (33/77) and 36.3% of them died. CONCLUSIONS: Hospitalized cirrhotic patients showed high mortality at 3 months, these patients at discharge revealed a high readmission within 3 months of follow up.


Assuntos
Cirrose Hepática/mortalidade , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
3.
Medwave ; 19(9): e7705, 2019 Oct 18.
Artigo em Espanhol | MEDLINE | ID: mdl-31665130

RESUMO

OBJECTIVE: To determine the perception of patients regarding physicians communication skills at the outpatient clinic of a teaching hospital in Lima-Peru, using the Communication Assessment Tool (CAT). METHODS: The study population was the group of patients treated in the outpatient clinics of the Cayetano Heredia Hospital. The CAT questionnaire contains 15 questions, and a version validated for Spanish was used. The perception of communication skills was defined as the sum of the scores of all the items, over the number of items, defined as: poor (1), fair (2), good (3), very good, (4), and excellent (5). RESULTS: The percentage of patients who rated communication skills as "poor" (average CAT Score) was 6.8%, "fair" 27.2%, "good" 23.9%, "very good" 30.1 and "excellent" 12.1%. Statistically significant differences were found when comparing the age ranges and among the different levels of education. The group of patients between 18 and 29 years old gave higher scores in the instrument (range 2.2 to 4.87, p = 0.001). Furthermore, when the educational level of the respondent was high, the participants tended to rate physicians with higher scores (range 3.67 to 4.73, p = 0.001). CONCLUSION: We found that 66.2% of patients had a positive perception of the physicians communication skills; only 12.1% rated it as "excellent," a value well below what is reported in the literature. Those who gave the best rating were younger patients with the highest level of education.


OBJETIVO: Determinar la percepción de los pacientes sobre la destreza en la comunicación de los médicos que atienden en consultorio externo de un hospital docente de Lima, Perú, según el instrumento Communication Assessment Tool. MÉTODOS: La población de estudio fue el colectivo de pacientes atendidos en los consultorios externos del Hospital Cayetano Heredia. El cuestionario Communication Assessment Tool consta de 15 preguntas, se utilizó una versión validada al castellano. La percepción de la destreza en comunicación se determinó como la sumatoria de los puntajes del total de las premisas, entre la cantidad de las premisas. Se definió como mala (1), justa (2), buena (3), muy buena (4) y excelente (5). RESULTADOS: El porcentaje de pacientes que calificaron la competencia comunicativa como “mala” (puntaje Communication Assessment Tool promedio) fue de 6,8%, “justa” 27,2%, “buena” 23,9%, “muy buena” 30,1% y “excelente” 12,1%. Se hallaron diferencias estadísticamente significativas respecto a los rangos de edad y entre los distintos grados de instrucción. El grupo de pacientes entre 18 y 29 años otorgó puntajes más altos en el Communication Assessment Tool (rango = 2,2 a 4,87; p = 0,001). Además, cuando el nivel educativo del encuestado fue superior tendió a colocar puntajes más altos (rango = 3,67 a 4,73; p = 0,001). CONCLUSIONES: Se determinó que 66,2% de los pacientes tuvo una percepción positiva, sólo 12,11% lo calificó como “excelente”, un valor muy por debajo a lo reportado en la literatura. Los que brindaron mejor calificación fueron los pacientes jóvenes y con mayor grado de instrucción.


Assuntos
Competência Clínica , Comunicação , Relações Médico-Paciente , Médicos/normas , Adolescente , Adulto , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial , Escolaridade , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Inquéritos e Questionários , Adulto Jovem
4.
Eur J Gastroenterol Hepatol ; 31(11): 1322-1327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31389847

RESUMO

BACKGROUND: Previous studies suggest that medical students may have higher rates of irritable bowel syndrome as compared to the general population. We hypothesized lifestyle characteristics may be associated to irritable bowel syndrome. METHODS: A cross-sectional survey was conducted in 2015 among students in their fourth, fifth, sixth and seven years of a medical school in Peru. Volunteer participants responded to questions pertaining to demographics, surveys including the Rome III criteria and the Self-reported Stress questionnaire. Regression models were performed to establish variables independently associated with irritable bowel syndrome. RESULTS: Out of 452 students, 346 responded the survey (response rate: 76.5%; female rate: 47%; median age: 22 years). The irritable bowel syndrome prevalence in respondents was 9.5% (95% confidence interval: 6.7%-13.1%). On univariate analysis, being a senior medical student (odds ratio: 2.8; 95% confidence interval: 1.3-5.9; P < 0.01), mental illness (odds ratio: 3.3; 95% confidence interval: 1.6-6.8; P = 0.002), psychiatric medication use (odds ratio: 2.8; 95% confidence interval: 1.4-5.9; P = 0.005), sedentary lifestyle (odds ratio: 4.4; 95% confidence interval: 1.8-11; P = 0.001) and stress (odds ratio: 4.4; 95% confidence interval: 2.1-9.3; P < 0.001) were associated to irritable bowel syndrome. On a multivariate analysis, a sedentary lifestyle (odds ratio: 3.2; 95% confidence interval: 1.25-8.20; P = 0.01) and stress (odds ratio: 3.0; 95% confidence interval: 1.35-6.67; P < 0.01) were independently associated with irritable bowel syndrome. CONCLUSION: The prevalence of irritable bowel syndrome in medical students from Peru is slightly lower compared to the global prevalence of irritable bowel syndrome. Stress and a sedentary lifestyle were independent risk factors associated with irritable bowel syndrome. Our study suggests that lifestyle modifications and stress coping techniques could have an impact to reduce the rates of irritable bowel syndrome in medical students.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Comportamento Sedentário , Estresse Psicológico/epidemiologia , Estudantes de Medicina/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Peru/epidemiologia , Prevalência , Psicotrópicos/uso terapêutico , Fatores de Risco , Estresse Psicológico/psicologia , Estudantes de Medicina/psicologia , Adulto Jovem
6.
Rev. neuro-psiquiatr. (Impr.) ; 84(1): 3-10, ene-mar 2021. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1251971

RESUMO

RESUMEN Objetivo: Describir conceptos, experiencias y perspectivas que alumnos del último año de medicina en una universidad peruana tienen respecto al Profesionalismo Médico. Material y Métodos : Se aplicó una encuesta a alumnos que cursaban la rotación clínica final de su último (7º) año de estudios en la Facultad de Medicina de la Universidad Peruana Cayetano Heredia, durante el año 2015. Resultados : El porcentaje de respuestas fue 90,5%. Las tres respuestas más comunes fueron ética (51,2%), buena comunicación médico-paciente (43%) y conocimientos (41,9%). El 81,4 % de los estudiantes estuvo "de acuerdo" o "muy de acuerdo" con el hecho de que profesionalismo puede ser aprendido y enseñado. El contacto con modelos positivos del personal docente de la Facultad (4,26/5,00) fue considerado el método más útil para el aprendizaje sobre profesionalismo médico, en tanto que sólo el 25,6% consideró adecuado el número de actividades dedicadas a la enseñanza del tema. Conclusiones: Los Internos de medicina consideran a la ética, una buena relación médico-paciente, conocimiento, respeto y responsabilidad como principales atributos del profesionalismo médico. Percibieron que su concepto de profesionalismo fue más influenciado por modelos positivos que por actividades académicas formales.


SUMMARY Objective : To describe concepts, experiences, and perspectives from senior (7th Year) medical students of a Peruvian university, regarding Medical Professionalism. Material and Methods : A survey was applied to medical students that completed their Internship at the Faculty of Medicine of the Universidad Peruana Cayetano Heredia, during 2015. Results : The percentage of responses reached a 90.5%. The three most common responses were ethics (51.2%), a good doctor-patient relationship (43%), and knowledge (41.9%). Approximately eighty-one percent (81.4%) of the students "agreed" or "strongly agreed" with the fact that professionalism can be learned and taught. The contact with positive models from the faculty (4.26 / 5.00) was considered as the most useful method for learning about professionalism, while only 25.6% considered adequate the number of activities dedicated to the teaching of the topic. Conclusions: Medical interns consider ethics, good patient-physician communication, knowledge, respect and responsibility as the main attributes of medical professionalism. They perceived that their concept of professionalism was more influenced by positive faculty models than by formal academic activities.

7.
Rev Peru Med Exp Salud Publica ; 33(3): 498-506, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-27831613

RESUMO

OBJECTIVES.: To assess the implementation of an intervention based on the sending of text messages and e-mails to internal medicine residents in order to achieve an increase in the prescription of thromboprophylaxis according to Clinical Practice Guidelines (CPG). MATERIALS AND METHODS.: A quasi-experimental study was conducted in the inpatient units of internal medicine at two general hospitals in Lima, Peru: one selected to implement the intervention and the other as control. The unit of analysis was the therapeutic order sheet. It was considered that the intervention should increase the order of thromboprophylaxis according to CPG with respect to the initial assessment and also in relation to the control hospital. RESULTS.: Atotal of 394 therapeutic order sheets, 227 (57.4%) from the intervention hospital and 167 (42.4%) from the control, were evaluated. In the intervention hospital, 64.5% initially had an order of thromboprophylaxis according to CPG, which decreased to 54.4% after the intervention; overuse increased from 13.6 to 26.8%. CONCLUSIONS.: Intervention based on sending text messages and e-mails had no impact, showing a tendency to overuse of thromboprophylaxis post-intervention.


Assuntos
Fibrinolíticos/uso terapêutico , Trombose/prevenção & controle , Hospitalização , Hospitais , Humanos , Internato e Residência , Peru , Médicos , Envio de Mensagens de Texto
9.
Rev Peru Med Exp Salud Publica ; 32(2): 289-93, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26338389

RESUMO

We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% have mobile Internet. Differences were evident in the frequency of use of ICT in 25-34 year old age group as well as a higher level of skills (p<0.05). 86% use PubMed, Facebook and WhatsApp as a means of exchanging images and data related to health, 50% participated in medical blogs, online courses or videoconferences. The use and access of ICT is common among doctors in this hospital and there is positive interest in its use in education.


Assuntos
Comportamento de Busca de Informação , Informática Médica , Médicos , Adulto , Comunicação , Feminino , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Autorrelato
10.
Diabetol Metab Syndr ; 7: 49, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26034512

RESUMO

BACKGROUND: The highly active antiretroviral therapy (HAART) has altered the course of HIV infection, transforming it from a fatal illness to a chronic condition, reducing morbidity and mortality. However, this therapy has led to an increased incidence of metabolic problems such as insulin resistance, dyslipidemia, lipodystrophy and impaired glucose metabolism. The objectives of this study are to determine the prevalence of insulin resistance (IR) in a cohort of human immunodeficiency virus (HIV)-infected patients on highly active antiretroviral therapy (HAART) and to investigate the potentially associated factors. METHODS: We conducted a cross-sectional study including 219 adult patients with HIV on HAART. IR was determined through the homeostasis model assessment (HOMA-IR) mathematical model, using fasting plasma glucose (FPG) and insulin. Bivariate and multivariate analyses were performed to assess the association between demographic information, clinical characteristics and laboratory results, and IR. RESULTS: 75 (34.2 %) [95 % confidence interval (CI) 28.9-40.9] HIV-patients on HAART showed IR. 61 (81 %) of these patients were on HAART for more than one year, which was mainly composed by non-protease inhibitors drugs (88 %). Metabolic syndrome (MS) was found in 59 (26.9 %) subjects. In the multivariate analysis, the factors associated with IR were age ≥ 46 years (Prevalence ratio = 2.767, 95 % CI 1.325 to 5.780) and greater body mass index (BMI) (Prevalence ratio = 1.148, 95 % CI 1.054 to 1.250). CONCLUSIONS: The prevalence of IR was 34.2 %. Factors associated with IR were age and BMI. We did not find any significant association between IR and protease inhibitors (PI), which may be explained by the small number of patients using PI as part of their HAART regimen included in our study.

11.
Rev Peru Med Exp Salud Publica ; 31(2): 292-6, 2014 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-25123869

RESUMO

In order to determine the frequency of publication in a scientific journal of the research projects done for medical specialty certification, a search was conducted in Google Scholar, Pubmed, biomedical databases and Peruvian medical society journals. These publications were research projects carried out by medical residents graduated from the Faculty of Medicine at the Universidad Peruana Cayetano Heredia, to obtain the certification of medical specialist. Of 351 medical residents graduated between the years 2007-2010, 199 (65.5%) completed their research project and 47 (23.6%) published it in a scientific journal. The "medicine" (non-surgical) specialty area had the highest frequency of publications. All publications were in Spanish journals, the majority in indexed journals in regional databases. We conclude that 23.6% of the research projects for certification as medical specialists are published, most often in low visibility journals.


Assuntos
Certificação , Medicina , Editoração/estatística & dados numéricos , Pesquisa , Estudos Transversais , Internato e Residência , Peru , Fatores de Tempo , Universidades
12.
Rev Peru Med Exp Salud Publica ; 31(1): 48-55, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24718526

RESUMO

OBJECTIVES: To determine the frequency and associated factors with the completion of research projects done by medical residents. MATERIALS AND METHODS: A descriptive, retrospective and cross-sectional case series study was performed. The unit of analysis was the graduated medical resident during 2010-2012. The archives of the School of Medicine of the Universidad Peruana Cayetano Heredia (UPCH) were used. Continuous and categorical variables were summarized in central tendency measures and frequencies, respectively. Factors were considered for medical residents with an approved project and that was or was not completed. RESULTS: 217 medical residents were included in the sample. 32.7% (71/217) completed their project in the study period. Factors favoring the completion of the project were university of origin, the rate of publications of the advisor, academic year, and duration of residency. In the multivariate analysis, the only two significantly associated factors were having done a thesis during undergraduate studies (OR: 3.41; IC 95%: 1.18-9.79), and having an advisor with an average of ≥2.0 (OR: 3.21; IC 95%: 1.01-12.56) publications per year. CONCLUSIONS: The completion frequency of the research projects in medical residency of the School of Medicine of the UPCH is associated with whether the medical resident performed a research during his undergraduate studies and has an advisor with a high rate of publications per year.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Internato e Residência , Medicina , Editoração/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Retrospectivos , Faculdades de Medicina , Adulto Jovem
13.
Rev. neuro-psiquiatr. (Impr.) ; 82(2): 131-140, abr. 2019. graf, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1058691

RESUMO

La empatía es definida como la capacidad de comprender los sentimientos y emociones de los demás, basada en el reconocimiento del otro como persona similar o semejante. Aplicada a la relación médico-paciente, puede mejorar los resultados clínicos, por lo que es considerada una habilidad esencial en la capacitación de todo profesional médico. Objetivo: Identificar el nivel de empatía y factores relacionados en médicos residentes de áreas médicas y quirúrgicas realizando entrenamiento especializado en un hospital de Lima, Perú. Material y métodos: Se obtuvieron esenciales datos sociodemográficos y profesionales y se aplicó la Escala de Empatía Médica de Jefferson, conformada por 20 preguntas, con puntuación Likert de 1 a 7, puntaje mínimo de 20 y máximo de 140, y nivel de empatía directamente proporcional al puntaje obtenido. Resultados: Cien médicos residentes, 52% de sexo femenino constituyeron la muestra. La media del puntaje obtenido fue 112,88, con DE 14.51, mediana de 115 y coeficiente alfa de Cronbach de 0,82. Los valores de los cuartiles fueron de 102, 115 y 124. Veintiséis por ciento de los médicos residentes de medicina, 19,2% de cirugía, 10% de Gineco-obstetricia y 35% de pediatría alcanzaron puntajes del cuartil superior. No se hallaron diferencias estadísticamente significativas al comparar el puntaje de los encuestados con cada una de las variables estudiadas. Conclusiones: Los médicos residentes de la especialidad de Pediatría presentaron puntajes más altos que el resto de especialidades, pero no se encontraron variables específicas significativas para explicar las diferencias detectadas en niveles de empatía.


Empathy is defined as the ability to understand the feelings and emotions of others, based on the recognition of the other as similar. Applied to the doctor-patient relationship can improve clinical outcomes, reason for which it is considered an essential ability in the training of every medical professional. Objective: To identify the level of empathy and related factors in resident physicians in medical and surgical specialized training in a hospital in Lima, Peru. Material and methods: Sociodemographic, personal and professional data were obtained and the Jefferson Medical Empathy Scale, consisting of 20 questions and a 1 to 7 Likert scoring type, was applied; with a minimum score of 20 and maximum of 140, the level of empathy is directly related to the obtained score obtained. Results: One hundred resident physicians, 52% of them female, were surveyed. The mean score obtained was 112.88, with DE 14.51, median of 115, and a Cronbach’s alpha coefficient of 0.82. The values of the quartiles were 102, 115 and 124. Twenty-six per cent of medical residents, 19.2% of surgery, 10% of gynecology-obstetrics and 35% of pediatrics reached higher values of the upper quartile. No statistically significant differences were found when comparing the respondents’ scores with each of the identified variables. Conclusions: Residents of the Pediatrics specialty has higher scores than the rest of the specialties, although no specific significant variables were found to explain the differences between the empathy levels.

14.
PLoS One ; 9(5): e95403, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24789071

RESUMO

AIM: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. METHODS: Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. RESULTS: DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07-1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02-1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001). CONCLUSION: DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin.


Assuntos
Assistência Ambulatorial , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/epidemiologia , Hospitais Gerais , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Pé Diabético/diagnóstico , Pé Diabético/etiologia , Feminino , Hemoglobinas Glicadas , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Fatores de Risco
15.
Rev Peru Med Exp Salud Publica ; 30(4): 635-40, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-24448942

RESUMO

In order to determine the frequency and factors associated to rehospitalization among elderly patients in a general hospital in Lima (Peru), a longitudinal study was conducted. An interview was administered to patients or care providers during their hospitalization, and data were collected from their medical records. After they were discharged from the hospital, they were followed up for 30 days through phone calls to become aware of their condition and if they were hospitalized at some health center during this period of time. 276 elderly patients were included, 14% of which were rehospitalized. It was found that rehospitalization was associated to functional dependency (p=0,003), pneumonia diagnosis upon admission (p=0,045) and lack of outpatient control (p<0,001); the latter having had RRa 2.22 (95% CI: 1,23-3,22). In conclusion, the most important associated factor in the rehospitalization of the elderly is the lack of control visits after being discharged.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Peru
16.
Rev. méd. hered ; 28(3): 192-199, jul.-set. 2017. ilus, tab
Artigo em Espanhol | LILACS, LIPECS | ID: biblio-1043160

RESUMO

Los programas de especialización médica consideran a la comunicación y profesionalismo como competencias que debe tener un médico especialista. El objetivo de esta revisión fue evaluar la utilización de la simulación clínica como instrumento de entrenamiento y evaluación de las competencias profesionalismo y comunicación en los programas de especialización médica. La Evaluación Clínica Objetiva y Estructurada (ECOE) evalúa el aprendizaje y es recomendada por sistemas de acreditación internacional como el Royal College of Physicians of Canada que elaboró los estándares Canadian Medical Education Directives for Specialist (CanMEDS) y el Comité de acreditación de los programas de postgrado de los Estados Unidos de América, Accreditation Council for Graduate Medical Education (ACGME). Para la evaluación de competencias de comunicación y profesionalismo, el ECOE aplica escenarios de simulación clínica validados que permiten una evaluación formativa y sumativa en los programas de especialización. El ECOE puede ser implementado como instrumento de evaluación de competencias en los programas de especialización de Perú. (AU)


Communication and professionalism are two competences that training subspecialties programs in medicine do consider essential among trainees. This review has the objective to evaluate the use of clinical simulation as an instrument to train residents of medicine subspecialties in getting competences in communication and professionalism. The OSCE is recommended by international accredited systems such as the Royal College of Physicians of Canada and the Accreditation Council for Graduate Medical Education of the USA. To asses competences in communication and professionalism, the OSCE uses validated scenarios of clinical simulation allowing formative and summative evaluations. OSCE can be implemented as a tool to asses competences in medicine subspecialties training programs. (AU)


Assuntos
Humanos , Masculino , Feminino , Competência Clínica , Educação Médica , Internato e Residência
17.
Acta méd. peru ; 34(1): 6-15, ene. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-989109

RESUMO

Objetivo: Determinar la relación entre el estado nutricional y los grados de ausentismo laboral. Materiales y métodos: El diseño del estudio fue de tipo transversal. Se recolectó la información a través de las historias clínicas tras el examen médico ocupacional y el registro de las ausencias durante todo el año 2013. Se utilizó estadística descriptiva para el cálculo de la frecuencia y regresión logística para la obtención de los factores asociados. Resultados: Ingresaron 545 trabajadores. Al incrementarse la edad se incrementan las frecuencias de sobrepeso y obesidad. Las complicaciones asociadas al incremento de peso: hipertensión arterial (48,8%), diabetes mellitus tipo 2 (57,1%), dislipidemia (54,5%) y los trastornos musculo esqueléticos (61,9%) se presentan con mayor frecuencia en los trabajadores con sobrepeso, el valor de 28 kg/m2 tuvo la mayor significancia estadística para explicar la relación entre el índice de masa corporal (IMC) incrementado y grados de ausentismo (p=0,01). Conclusiones: El sobre peso está relacionado con mayores índices de ausentismo, específicamente al de mediano plazo. Un IMC de 28 kg/m2 se asocia a un incremento significativo del ausentismo, y los trastornos osteomusculares son los modifican de manera sustancial la relación entre ausentismo e incremento de peso


Objective: To determine the relationship between nutritional status and the levels of absenteeism in the workplace. Materials and methods: This was a cross-sectional study. The information was collected from the medical records after the occupational medical check-up and by reviewing all absences in the workplace during 2013. Descriptive statistics were used for calculating the rates and logistic regression for obtaining the associated factors. Results: Five hundred and forty-five workers were included in the study. The rates of being overweight and obese increased with age. Complications associated with weight gain were: high blood pressure (48.8%), type 2 diabetes (57.1%), dyslipidemia (54.5%) and skeletal muscle disorders (61.9%), which occur more often in overweight workers. The value of 28 Kg/ m2 had the highest statistical significance for explaining the relationship between an increased BMI and the rates of absenteeism in the workplace (p= 0.01). Conclusions: Being overweight is linked to higher rates of absenteeism, specifically in the medium term. A 28- Kg/m2 BMI is associated with a significant increase in absenteeism in the workplace, and musculoskeletal disorders substantially modify the relationship between absenteeism and weight gain

18.
Rev Peru Med Exp Salud Publica ; 29(1): 135-8, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22510919

RESUMO

Diffuse tropical primary pyomyositis is an infrequent entity in our country, with few cases associated to community-acquired Methicillin- resistant Staphylococcus aureus. There are no reported cases of Community-Acquired Methicillin- Resistant Staphylococcus aureus (CA- MRSA) in Peru. We present the case of a 70 year old male with a previous diagnosis of type 2 diabetes mellitus, receiving irregular treatment, who was admitted to the hospital with a history of 10 days of low back pain radiating to the left leg, fever and forced flexion of the right hip due to pain during movement. The diagnosis of diffuse pyomyositis of both psoas muscles was performed with MRI and culture of a posterior paravertebral collection, from which Staphylococcus aureus resistant to oxacillin, penicillin and dicloxacillin was isolated.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Doenças Musculares/diagnóstico , Doenças Musculares/microbiologia , Músculos Psoas , Piomiosite/diagnóstico , Piomiosite/microbiologia , Infecções Estafilocócicas/diagnóstico , Idoso , Humanos , Masculino
19.
Rev Peru Med Exp Salud Publica ; 29(3): 386-9, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23085802

RESUMO

There is a case of a 38 year-old male patient coming from an area where hepatic fascioliasis is endemic in Peru. He was hospitalized because he showed 4 weeks of symptoms like fever, intense myalgias, erythematous and painful injuries on limb extensions. The electromyography and nerve conduction velocity showed a global inflammatory myopathy. A skin biopsy showed polyarteritis nodosa-type vasculitis. During the evaluation process prior to the immunosuppressive therapy, hepatic Fasciola eggs were found in the parasitological examination of stools. The fascioliasis diagnosis was confirmed by fas2-ELISA: 0.46 (VN <0.20). Clinical symptoms started to subside after treatment with ticlabendazol. Contact with the patient was maintained for a year and there was no evidence of disease recurrence, and he was asymptomatic.


Assuntos
Fasciolíase , Poliarterite Nodosa/parasitologia , Adulto , Humanos , Masculino
20.
Acta méd. peru ; 33(1): 15-20, ene.-mar.2016. ilus, tab
Artigo em Espanhol | LILACS, LIPECS | ID: lil-790666

RESUMO

Conocer el tiempo de espera para la instauración del tratamiento quirúrgico en pacientes de un hospital de tercer nivel de atención de Lima-Perú, para luego describir los factores médicos y/o administrativos que se encuentren vinculados al tiempo preoperatorio prolongado y describir las complicaciones más frecuentes durante ese tiempo. Materiales y Métodos: Estudio de tipo descriptivo û retrospectivo durante el primer semestre del 2013. Se midió los tiempos preoperatorios, complicaciones, seguro médico, antecedentes patológicos, características de la cirugía en pacientes hospitalizados con fractura de cadera. Resultados: El 71% de pacientes fue de sexo femenino. La mediana de edad fue de 66 años. El 70% de pacientes recibió tratamiento quirúrgico con una mediana del tiempo preoperatorio de 18 días. El 77% tuvo antecedentes patológicos al ingreso, la mayoría por anemia, hipertensión arterial o diabetes mellitus tipo 2. El 62% tuvo complicaciones médicas. Los pacientes con tratamiento quirúrgico tuvieron menos porcentaje de complicaciones (47%) que los que no recibieron tratamiento quirúrgico (94%), así como menos estancia hospitalaria. La mediana de estancia hospitalaria en los pacientes con tratamiento quirúrgico fue de 26 días y la de los que no recibieron tratamiento quirúrgico fue 41 días. Conclusiones: El tiempo preoperatorio fue mayor a las 2 semanas en la mayoría de los casos, especialmente en los pacientes de mayor edad y usuarios del Seguro Integral de Salud...


Know the waiting time for the establishment of surgical treatment in patients of a third level attention hospital in Lima-Peru for the later description of medical and/or administrative factors that are linked to a prolonged preoperative time and description of the most common complications during that time. Materials and Methods: Descriptive-retrospective study during first semester of 2013. Preoperative times, medical complications, medical assurance, pathological background, surgery characteristics in patients hospitalized for hip fracture were assessed. Results: 71% of the patients were women. The median of age was of 66 years old. 70% of the patients received surgical treatment with a preoperative time of 18 days. 76.9% had a pathological background at the admission, mostly anemia, arterial hypertension and type 2 diabetes mellitus. 62% had medical complications. Post-surgery patients had a smaller percentage of complications (47%) than the non-surgery patients (94%), as well as a smaller hospitalization rate. The median of hospitalization on surgery patients was of 26 days and on non-surgery patients was of 41 days. Conclusions: The preoperative time was higher than 2 weeks in most of cases, especially on elderly patients and SIS users...


Assuntos
Humanos , Masculino , Feminino , Idoso , Fraturas do Quadril , Período Pré-Operatório , Epidemiologia Descritiva , Estudos Retrospectivos , Peru
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