Knowledge and practice of covid-19 preventive measures: comparative analysis of medical and non-medical students university of Port Harcourt

The influence of COVID-19 has impacted the education sector just like it has other sectors. This study examined the level of knowledge, attitude, and practice of COVID-19 preventive measures among medical and non-medical students of the University of Port Harcourt, Rivers StateMethod: A comparative cross sectional study design using a self-administered structured questionnaire involving a total of 406 students; medical (200) and non-medical (200), using multi-stage sampling. Frequency, percentages, means, and standard deviation were used to describe data where necessary. Chi-square and Fisher exact was used to compare knowledge, attitude, and practice of COVID-19 preventive measures between medical and non-medical students. Results:The mean age of medical and non-medical students was 25.04 and 22.59 respectively. A total of 70% from medical students arm received COVID-19 vaccines while 15.5% of non-medical students arm. 152(73.8%) non-medical students and 123(61.5%) medical studentshad good knowledge of COVID-19. Positive attitude toward COVID-19 preventive measures was showed by 119(59.5%) medical students and 62(30.1%) non-medical students. Concerning practice of COVID-19 preventive measures, 99(48.1%) medical students and78(39.0%) non-medical students practiced appropriately. A chi-square test for association showed that gender, academic level, religion, accommodation status, vaccination status, geopolitical zone, and faculty of students were significantly associated withknowledge, attitude, and practice of COVID-19 preventive measures. Chi-square test also showed that knowledge of COVID-19 was significantly associated with the practice of COVID-19 preventive measures. Conclusion: Non-Medical students had better knowledge than medical student although difference was not significant. Attitude was good and practice of COVID-19 preventive measures was poor among medical students, while poor attitude and poor practice among non-medical students was observed

Protocolo para la recepción, organización y distribución de los traslados de los pacientes confirmados o sospechosos sintomáticos de COVID-19 / Protocol for the reception, organization and distribution of transfers of confirmed or suspected symptomatic COVID-19 patients

El documento establece procesos y procedimientos que coadyuven a salvaguardar la salud, reforzando la capacidad de respuesta de la atención para el transporte asistido de pacientes, a fin de evitar y reducir la transmisión, el impacto sanitario, social y económico, ante la presencia de la enfermedad por Coronavirus (COVID-19) en el país.

Is Follow-up of Adrenal Incidentalomas Always Mandatory?

Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as “adrenal incidentalomas” and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.

Conceptualising social accountability as an attribute of medical education

Background: Health professionals need to be both person- and community oriented to improve population health. For educators to create socially accountable physicians, they must move learners from understanding social accountability as an expectation to embracing and incorporating it as an aspect of professional identity that informs medical practice. Aim: The aim of this article was to assess the degree to which medical students, preceptors and community mentors understand the concept of social accountability. Setting: The setting is the KwaZulu-Natal Province in Durban, South Africa. Methods: Using an observational design, we surveyed 332 participants, including the first- and sixth-year medical students, physician preceptors and community mentors. Results: Whilst most respondents understood social accountability as requiring an action or set of actions, it was defined by some as simply the awareness one must have about the needs of their patients, community or society at large. Some respondents defined social accountability as multi-dimensional, but these definitions were the exception, not the rule. Finally, most respondents did not identify to whom the accountable party should answer. Conclusion: Whilst the development of professional identity is seen as a process of 'becoming', the ability to define and understand what it means to be socially accountable is not a linear process. Assessment of this progress may start with comprehending how social accountability is understood by students when they begin their education and when they are graduating, as well as in knowing how their educators, both clinical and community, define it

Variabilidad de la práctica médica: a 80 años del efecto Glover / Variability of medical practice: at 80 years since the Glover effect

At this moment, it seems to be clear, that the application of the epidemiological logic to the sanitary administration, by one side, to specify which are the diseases or the needs that have a greater importance in a determined population to identify which individuals are at risk situation or with unnoticed requeriments to focuse resources mainly in them, and on the other side, to planify politics at macro level or logistic to supply resources and at level meso or micro through the analysis of the configuratiion of the employement of services or their polinomic terms: patient, providers and mediating organizations. Rarefieds, however a little the atmosphere of the called variability phenomen in the medical practice, prefigurted by Glover in the decade of the 30 th. It has been however a fundational basis the study of Allison Glover on the amigdalectomies in the British school districts, chronologically the first call for attention on the wide variation over the poblational rates of the interventions (Glover 1938), to such an extent that it was coined the concept "Glover effect" to refer to this fact. These facts showd that there was in England and Wale a rate of tonsillectomies between 50% and 70%, and indication 3 times more frequent in children from more accommodated class, a higher incidence in boys than in girls, an age of higher incidence between 5 to 7 years of age, and the absence of correlatively with the so called impersonal facts as accumulation , powerty, deficient dwelling or clime. In our analysis it was proved that in the practice the Glover effect continues producing fullness. These aspects are anayzed in the study

Niveles de empatía según la escala de Jefferson en estudiantes de Medicina, Enfermería y Odontología de Honduras / Levels of empathy according to Jefferson's scale in students of Honduras Medicine, Nursing and Dentistry

Introducción: La empatía es un componente importante en la relación-medico paciente y es una cualidad recomendada en todos los trabajadores de la salud, existen métodos cuantitativos para medir la empatía a través de encuestas especializadas con el objetivo de detectar niveles medios de empatía y posibles factores correlaciónales en su aumento o disminución, una vez detectados estos factores se puede actuar para reforzarlos o reducirlos. Objetivo: Analizar los niveles de empatía de los estudiantes de medicina, enfermería y odontología cursando áreas básicas, correlacionando con datos socio-académicos para identificar posibles variables que alteren global mente los niveles de empatía. Método: Estudio transversal en estudiantes de pregrado de medicina, enfermería y odontología. Se encuestaron 146 estudiantes que respondieron a la Escala Jefferson de empatía médica del estudiante versión en español. Junto a una encuesta de 10 preguntas cerradas de aspectos socio-académicos. Los datos se introdujeron en el programa estadístico Epi-Info™7 donde se analizaron por medio de valores absolutos, frecuencias y valores porcentuales. Resultados: En la población estudiada no se encontró puntajes de empatía significativamente distintos entre las 3 carreras, los hombres obtuvieron un puntaje superior a las mujeres a diferencia de lo demostrado en otro estudios internacionales, se encontró una relación inversamente proporcional en puntaje de empatía en relación al puntaje académico global; el resto de las preguntas socio-culturales utilizadas en la encuesta no revelaron diferencias significativas en el puntaje de empatía. Conclusiones: No existen una diferencia significativa del nivel de empatía a nivel de áreas básicas entre enfermería, medicina y odontología, en este estudio se podrían considerar a los hombres más empáticos que las mujeres, el puntaje académico podría considerarse como un potencial indicador de nivel de empatía, las variables socio-académicas estudiadas no muestran diferencias significativas en el puntaje de empatía.

Introduction: Empathy is an important component in the patient-physician relationship and is a recommended quality in all health workers; there are quantitative methods to measure empathy through specialized surveys with the aim of detecting average levels of empathy and possible Correlation factors in their increase or decrease, once detected these factors we can act to reinforce or reduce them. Objective: To analyze empathy levels of medical, nursing and dentistry students studying in basic areas, correlating with socio-academic data to identify possible variables that alter the empathy levels globally. Method: Cross-sectional study of undergraduate students in medicine, nursing and dentistry. We surveyed 146 students who responded to the Jefferson Student Empathy Medical Scale version in Spanish. Next to a survey of 10 closed questions of socio-academic aspects. Data were entered into the Epi-Info™7 statistical program where they were analyzed by means of absolute values, frequencies and percentage values. Results: In the study population, no significant empathy scores were found between the 3 careers, the men scored higher than the women, as compared to other international studies, an inversely proportional relationship was found in empathy scores To the overall academic score; The rest of the socio-cultural questions used in the survey did not reveal significant differences in the empathy score Conclusions: There is no significant difference in the level of empathy at the level of basic areas between nursing, medicine and dentistry, men in this study could be considered more empathic than women, the academic score could be considered as a potential indicator of level of empathy, The socio-academic variables studied do not show significant differences in empathy score.

Improving the self-confidence level of medical undergraduates during emergencies using high fidelity simulation

Introduction: Medical practice involves routinely making critical decisions regarding patient care and management. Many factors influence the decision-making process, and self-confidence has been found to be an important factor in effective decision-making. With the proper transfer of knowledge during their undergraduate studies, selfconfidence levels can be improved. The purpose of this study was to evaluate the use of High Fidelity Simulation as a component of medical education to improve the confidence levels of medical undergraduates during emergencies. Methodology: Study participants included a total of 60 final year medical undergraduates during their rotation in Medical Senior Posting. They participated in a simulation exercise using a high fidelity simulator, and their confidence level measured using a self-administered questionnaire. Results: The results found that the confidence levels of ‘Assessment of an Emergency Patient’, ‘Diagnosing Arrhythmias’, ‘Emergency Airway Management’, ‘Performing Cardio-pulmonary Resuscitation’, ‘Using the Defibrillator’ and ‘Using Emergency Drugs’ showed a statistically significant increase in confidence levels after the simulation exercise. The mean confidence levels also rose from 2.85 to 3.83 (p<0.05). Conclusion: We recommend further use of High Fidelity Simulation in medical education to improve the confidence levels of medical undergraduates.

Reflexiones sobre Subjetividad y Contexto en la Práctica de Salud / Reflections on Subjectivity and Context in Health Practice

El autor realiza un trabajo de reflexión sobre las interacciones entre subjetividady contexto, repasando algunos conceptos que permiten pensarla práctica institucional en salud. Se analiza brevemente el caso de lasproblemáticas adictivas como un ejemplo de la articulación entre el sujetoy el contexto.

The author makes a work of reflection on the interaction between subjectivity and context by reviewing some concepts which suggest institutional health practice . The case of addictive problems are briefly discussed as an example of the connection between the subject and the context.

Rational use of blood calcium determinations / Uso racional da dosagem de cálcio no sangue

CONTEXT AND OBJECTIVE: This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING: Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS: The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS: From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS: Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs. .

CONTEXTO E OBJETIVO: Este trabalho foi motivado pelo recente aumento excessivo de solicitações de dosagem de cálcio no sangue, assim como de exames laboratoriais em geral, no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Seu objetivo foi sugerir regras para a determinação de cálcio total e iônico nas nossas unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios e contribuir para a melhoria da qualidade da assistência médica, com utilização mais adequada dos recursos humanos e financeiros. TIPO DO ESTUDO E LOCAL: Análise crítica de dados clínicos, laboratoriais e da literatura médica pertinente, realizada pelo grupo de estudos para o uso racional do laboratório clínico, vinculado à Divisão de Laboratório Central do HCFMUSP. MÉTODOS: O grupo de estudos reviu publicações científicas, estatísticas e dados clínico-laboratoriais relativos às solicitações de cálcio total e iônico nos ambientes das unidades de terapia intensiva, prontos-socorros, enfermarias e ambulatórios. RESULTADOS: A partir dessa análise crítica, foram construídos fluxogramas de decisão clínica que visam orientar a requisição desses testes. CONCLUSÕES: A utilização dos fluxogramas propostos pode ajudar a limitar a solicitação inadequada das dosagens de cálcio total e iônico, com consequente redução do número de exames, de riscos para os pacientes e de custos desnecessários. .

Standardized management of acupuncture-moxibustion clinic in Singapore General Hospital / 中国针灸

The standardized management of acupuncture-moxibustion in Singapore General Hospital is introduced. With gradual improvement of outpatient infrastructure, re-training of medical staff, strict disinfection of manipulation, periodical inspection of medical instruments, unified management of writing, saving and processing in medical records and public education of TCM knowledge, a standardized management system in accordance with modernized hospital is gradually established. As a result, efficiency and quality of clinical treatment is continuously increasing. From April of 1998 to December of 2012, a total of 74 654 times of treatment were performed, and treatment amount per day is gradually increased. The unusual condition of acupuncture is avoided. Periodical strict inspection of joint committee authenticated by domestic and overseas medical health organization is repeatedly passed and accepted. Additionally, three clinical researches funded by Singapore Health-care Company are still in progress in acupuncture-moxibustion department.

Familia y práctica médica / Family and Medical Practice

La familia tiene un papel determinante en el proceso salud-enfermedad. No obstante, esta área del conocimiento no se ha estudiado suficientemente y su consideración en la práctica médica es variable. Se realizó una revisión de la literatura con el propósito de analizar la conceptualización del término familia, las interrelaciones entre familia y proceso salud-enfermedad, la clasificación de la tipología familiar y su caracterizaciónen Colombia y el abordaje del contexto familiar en los pacientes que así lo requieran. Diversas circunstancias clínicas ameritan incluir este enfoque, particularmente las enfermedades crónicas que representan una carga creciente en nuestro medio, por loque se requiere la adquisición de conocimientos y el desarrollo de habilidades para la obtención y uso de información familiar, lo cual puede realizarse con distintos gradosde profundidad. Es recomendable fortalecer los currículos de la carrera de medicina, incluyendo la perspectiva familiar...

The family has an important role within the health-disease process. However, this area of knowledge has not been sufficiently studied and its inclusion in medical practice isvariable. We conducted a literature review in order to analyze the conceptualization of family, the relationship between family and the health-disease process, the familytypology classification and its characterization in Colombia, and the ways for addressing the family context among patients who require it. Some clinical conditions should include the family perspective in health care, particularly chronic diseases whichrepresent an increasing burden in Colombia; thus, enhanced knowledge and skills for getting and using family information is necessary in different levels. Strengthening the curricula of medical career including the familyperspective would be desirable...

La Responsabilidad Civil Médica / Medical Liability

A la hora de gerenciar y administrar determinado establecimiento sanitario o servicio de salud, existen una multiplicidad de variables, entre ellas la jurídica, que deben mantenerse balanceadas y controlas para mantener un equilibrio financiero, contable y económico sustentable y sostenido que permita el mantenimiento del uncionamiento y el crecimiento de la empresa. Sin embargo, la realidad demuestra que muchas empresas han sido víctimas de contingencias legales que han acabado con su ruina. Es por ello que en este trabajo de tesis se buscó identificar y analizar los distintos supuestos de la“Responsabilidad Civil Médica” que pueden surgir y afectar a los profesionales de la salud, entidades sanatoriales, obras sociales, empresas de medicina prepaga y al estado mismo en sus distintos ordenes, nacional, provincial o municipal .En especial se abarcó el estudio de la “Responsabilidad Civil Médica Individual”, la“Responsabilidad Civil Médica Colectiva”, sus diversas especies, la “Responsabilidad Civil del Grupo Médico”, la “Responsabilidad Civil de Equipo Médico” y la “Perdida deChance”. El resultado de dicho trabajo fue el siguiente, se encontraron diversos tipos de responsabilidad con alcances diferentes respecto al profesional involucrado, al resto de los profesionales y demás instituciones y entidades involucradas. En todas ellas los efectos conómicos pueden ser sumamente perjudiciales o hasta devastadores para los agentes involucrados, pero dichas consecuencias pueden prevenirse, evitarse y/o minimizarse con una buena praxis médica y sanatorial.

SUMMARY: When it comes to managing a certain sanitary institution or health service provider, there are multiple variables: among them legal, that need to be balanced to keep a financial equilibrium and economic sustainability allowing proper performance and growth. However, past experience has and continues demonstrating that many companies have been victims of legal contingencies that resulted in bankruptcy. This thesis attempts to identify and analyze different suppositions of “Civil Medical Responsibility” that may surface and affect health professionals; Health Maintenance Organization; prepaid medicine and government. Special attention has been given to “Indivdual Civil Medical Responsibility”, “Collective Civil Medical Responsibility”, “Civil Medical Group responsibility”, “Civil Medical Staff Responsibility” and “Lost chance” . The result of said paper was the following: diverse types of responsibilities with different degrees of involvement were reported. Parties include: health professionals and institutions. In all cases the economic impact can beoverwhelming and devastating for the parties involved, but such damages can be prevented or minimized with good medical praxis.

Identidade e competências profissionais: um estudo com diretores executivos de uma cooperativa de trabalho médico de Minas Gerais / Identity and the professional skills

O objetivo do presente estudo foi analisar a configuração da identidade de cooperados diretores executivos de uma cooperativa de trabalho médico, considerando as competências profissionais mobilizadas para o exercício da função. O cenário do estudo foi uma cooperativa Unimed, situada no interior de Minas Gerais. Como sujeitos participaram 29 profissionais, divididos em dois grupos. O primeiro grupo foi composto por quatro médicos-cooperados que exerciam a função de gestores na cooperativa atuando como diretores executivos. Estes foram aqueles cuja identidade e competências se buscou conhecer e, portanto, sujeitos chamados de primários. O segundo grupo, denominado sujeitos secundários foi composto por: quatro cooperados membros do Conselho de Administração 2009-2012; dois Conselheiros Fiscais; cinco membros do Conselho Técnico e Ético; dois gerentes executivos; um secretário executivo; três assessores da diretoria executiva; seis gerentes e dois supervisores, perfazendo25 profissionais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. Para a coleta de dados, realizada em 2011, adotou-se a entrevista individual com roteiro semi estruturado, aplicada mediante assinatura do Termo de Consentimento Livre e Esclarecido pelo entrevistado. Para a análise dos dados utilizou-se a técnica de análise de conteúdo. Uma perspectiva integrada de análise da identidade e das competências profissionais foi elaborada pela autora para analisar os dados, com base em Dubar (1997, 2005) e Cheetham e Chivers (1996, 1998, 2000) adaptado por Paiva (2007). Em uma abordagem biográfica e relacional foram desvelados: a formação, a experiência anterior e a trajetória dos diretores; o exercício profissional atual na Unimed e fora dela; as expectativas relacionadas ao trabalho que realizam na função; e a identidade relacional na visão deles próprios e de outros significativos com os quais eles compartilham o cotidiano do trabalho...

The health system in Brazil is constituted of three interwoven subsystems: the Unified Health system (SUS), public subsystem; the private, direct subsystem payment; and supplementary medical attention or the private health care insurance plans market. In 2012, more than aquarter of the Brazilian population had some kind of supplementary assistance, whereby 36% of these beneficiaries were assisted by 326 Unimed medical work cooperatives, the largest supplementary medical assistance network in Brazil, present in more than 83% of nationalterritory and numbering 112,000 associate doctors. Each Unimed cooperative is independent, being the property of the doctors associated to it and responsible for its management. Factors related to the transformation of the global environment, as well as specific aspects of the national reality, added to cooperative management specificitites, have created a complex working scenario for doctors who become executive directors of a Unimed cooperative. Therefore, the objective of this study was to analyze the configuration of executive director cooperative member identity in a Unimed medical work cooperative, considering theprofessional skills mobilized for the execution of the function. The study scenario was a Unimed cooperative, located in Minas Gerais. 29 profissionals participated, divided into two groups. The primary group was composed of four cooperative-doctors carrying out the function of managers in the cooperative, acting as executive directors. These were the people whose identity and skills we sought to establish and we therefore called them the primary subjects. The second group, called secondary subjects, was composed of 25 professionals whowork alongside the executive director doctors on a daily basis. The study was approved by the UFMG Research Ethics Committee. Data collection was performed in 2011, and an individual interview with semi-structured script was adopted...