Medical school dean's scientific production of the main universities by continent / Produção científica dos reitores de medicina das principais universidades por continente

Introduction: promoting scientifi c research is one of the main functions of universities. Medical schools should not be an exception; deans should also have appropriate research experience that allows them to have a different perspective on the importance of research in undergraduate medicine. Aim: to determine the medical school dean's scientific production of the main universities by continent. Methods: an observational, analytical, and transversal study. We identify the medical school dean's scientific production of the 20 universities with the best position from South America, Central America, North America, Europe, Asia, Africa, and Oceania, according to the Ranking Webometrics 2022, in the Scopus database. Results: 140 directors or deans of medicine were evaluated, of which 136 (97.1%) had published an article at least once in their life, 128 (91.4%) in the last fi ve years, 103 (73.6%) in the previous year, and 93 (66.4%) in the current year. The total number of published articles was 24.5 (Me=98), receiving a total of 1,251,766 citations (range 0 to 101,868), an Hindex 24 (range 0 to 140), and in collaboration with 154,711 coauthors. Conclusions: the medical school dean's scientific production from the main universities by continent was high, with notable differences between those who came from universities in Asia, North America, and Europe compared to Oceania, Africa, South America, and Central America

Introdução: promover a pesquisa científica é uma das principais funções das universidades. As escolas médicas não devem ser uma exceção. Os reitores também devem ter uma experiência de pesquisa adequada que lhes permita ter uma perspectiva diferente sobre a importância da pesquisa na graduação em medicina. Objetivo: determinar a produção científica dos reitores de medicina das principais universidades por continente. Métodos: estudo observacional, analítico e transversal. Identificamos a produção científica dos pró-reitores de medicina das 20 universidades com melhor posição da América do Sul, América Central, América do Norte, Europa, Ásia, África e Oceania, segundo o Ranking Webometrics 2022, na base Scopus. Resultados: foram avaliados 140 diretores ou reitores de medicina, dos quais 136 (97.1%) publicaram artigo pelo menos uma vez na vida, 128 (91.4%) nos últimos cinco anos, 103 (73.5%) no ano anterior, e 93 (66.4%) no ano corrente. O número total de artigos publicados foi de 24.5 (Me=98), recebendo um total de 1,251,766 citações (intervalo de 0 a 101.868), índice H = 24 (intervalo de 0 a 140) e em colaboração com 154,711 coautores. Conclusões: a produção científica dos reitores de medicina das principais universidades por continente foi alta, com diferenças notáveis entre aqueles que vieram de universidades da Ásia, América do Norte e Europa em comparação com Oceania, África, América do Sul e América Central

Dr. Rodrigo Álvarez Cambras, padre de la Ortopedia en Cuba. Homenaje en su 85 aniversario / Dr. Rodrigo Alvarez Cambras, father of Orthopedics in Cuba. Tribute in his 85th anniversary

El doctor y profesor Rodrigo Álvarez Cambras constituye una de las figuras que despuntó desde los mismos inicios del triunfo de la Revolución Cubana en las ciencias ortopédicas con repercusión en las ciencias pedagógicas. El objetivo fue argumentar porqué se considera al ilustre profesor Rodrigo Álvarez Cambras, el padre de la Ortopedia y la Traumatología en Cuba en el marco de sus 85 de aniversario. Se realizó este trabajo de corte histórico mediante sus datos biográficos y teniendo en cuenta sus principales aportes como médico, pedagogo, científico y directivo, avalados por sus más de cinco décadas dedicadas por entero a las ciencias médicas y pedagógicas. Se estimula al estudio de esta figura con el propósito de valorar su trabajo en beneficio de la sociedad cubana y su contribución al desarrollo de la medicina, específicamente de la Ortopedia y Traumatología universal (AU).

Doctor and professor Rodrigo Álvarez Cambras is one of the figures who exceled in the orthopedic and pedagogical sciences from the first moments after the triumph of the Revolution. The aim of this historic work is to sustain why the illustrious professor Rodrigo Alvarez Cambras is considered the father of Orthopedics and Traumatology in Cuba in the context of his 85th anniversary. The authors review his biographical data and his main contributions as doctor, professor, scientist, and executive, all this activities endorsed by more than five decades entirely devoted to the medical and pedagogic sciences. The study of this personality is promoted with the purpose of assessing his work in benefit of Cuban society and his contribution to the development of Medicine, especially to universal Orthopedics and Traumatology (AU).

Comparison of trauma systems in Asian countries: a cross-sectional study

OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.

Principle and perspective of healthcare-associated infection control

The concept of healthcare-associated infections broadens the scope of the previously developed concept of hospital-acquired infections. The principles of infection control can be summarized as follows: fight against resistance and block the spread of infection. To manage Infection control well, one should be familiar with the relevant mode(s) of transmission, appropriate precautions, hand hygiene, and the concepts of incidence, disinfection, sterilization, and resistance. Medical directors should also run the infection control committee competently and play the role of a liaison between departments. Although infectious disease management originated as a system implemented by each medical institution, it is developing into a networked system due to improvements in efficiency, the emergence of widespread information sharing, and the necessity of coherent guidelines. Therefore, infectious disease management is expected to be integrated into the foundation of public and private partnerships in the future. In addition, developments in molecular and digital technologies are expected to have further effects on infection control in the future. In particular, since science and technology are developing exponentially, with innovations emerging on a daily basis, it is necessary for workers in the infection control management field to actively engage with rapidly changing trends.

The accuracy of the international ovarian tumor analysis (IOTA) simple rules in predicting malignant ovarian tumors with biopsy as the reference standard / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: The IOTA Simple Rules provide a standardized ultrasound description in order to correctly classify ovarian tumors as benign or malignant even among non - expert readers. Its high accuracy rate was noted in foreign studies but was never validated in the local setting. The IOTA inconclusive tumors that were either assumed to be malignant or referred to experts in other studies were separately addressed in this research.GENERAL OBJECTIVE: To determine the accuracy of the IOTA Simple Rules to predict malignant ovarian tumorsMATERIALS AND METHODS: Subjects: Patients with ovarian tumors admitted for surgery with complete ultrasound records done at Women's Health Unit and those with histopathologic report from the Department of Pathology. Setting: Department of Obstetrics and Gynecology in a tertiary hospital from August 2015 to February 2017. Design: Cross-sectional Diagnostic Accuracy Test. Data Collection: After obtaining approval from the IRB and Office of the Medical Director, the ovarian tumors were tallied and categorized according to their IOTA classification and final histopathologic diagnoses. The sensitivity, specificity, positive and negative predictive values, and accuracy were obtained using a 2x2 table. The biopsy reports of the inconclusive tumors were also reviewed and the sonographic characteristics of those which turned out to be malignant were noted.RESULTS: A total of 110 adnexal masses were included, with the IOTA Simple Rules applicable in 84.55% of cases. It produced an accuracy rate of 100%. Among the 17 inconclusive tumors, two proved to be truly malignant with the presence of only one papillarity in a borderline tumor and the complex appearance of a germ cell tumor.CONCLUSION: The IOTA Simple Rules is an accurate preoperative diagnostic tool in predicting ovarian malignancy. Two malignant tumors were classified as inconclusive and their sonographic characteristic of only one papillarity and the complex appearance of these tumors may warrant malignancy.

Clinical Analysis of Direct Medical Oversight in a Korean Metropolitan City

PURPOSE: In Korea, the EMS system is a municipal governmental fire-based system. Since 2012, an EMS medical director has been appointed in all fire stations by legislation. This study examined the direct medical oversight (DMO) clinically in a Korean metropolitan city. METHODS: This is a descriptive analysis of the fire-based centralized DMO in a metropolitan city. The current status of the ambulance crew of a fire station including certification, EMS experience, the number of requested DMO, and the statistics of DMO, and the DMO physicians of a fire department dispatch center, was studied. The ambulance run sheets of a fire station were reviewed to survey the assessment and intervention of ambulance-receiving DMO. RESULTS: Although it is increasing every year, the ratio of ambulance runs receiving DMO was 2.5–11.1% in a fire station. The fire station has 45 ambulance crew, half of which were level 1 emergency medical technicians and registered nurses. In a fire department dispatch center, most (70%) of the DMO physicians were emergency physicians. The ratio of prehospital assessment, including consciousness (100%), full vital sign (78.8–91.2%), oxygen saturation (86.5–100%), blood sugar test (31.3–94.4%), and ECG (16.7–48.5%), was higher than the ratio of prehospital intervention, including advanced airway (1.9–21.15), bag mask ventilation (3.0–63.2%), IV dextrose water (55.6%), nitroglycerin subligual (42.9%), cervical immobilization (57.7%), and wound dressing (53.85) in an ambulance run receiving DMO in a fire station. CONCLUSION: The ratio of patients transported by ambulance receiving DMO is still low in a metropolitan city. The DMO should be strengthened to improve the patient safety and quality of EMS in Korea.

Sistema de trabajo con los cuadros directivos del Estado y Gobierno cubanos / Work system with the directive cadres of the Cuban State and Government

En este artículo se exponen las consideraciones relacionadas con la política de cuadros de dirección, aprobadas en la Primera Conferencia Nacional del Partido Comunista de Cuba. Además se analizan el sistema de trabajo con los cuadros directivos del Estado y del Gobierno cubanos y la vigencia de dicho tema a través del pensamiento de Raúl Castro Ruz. Finalmente se concluye con una frase de este líder de la Revolución, que resume todo el trabajo necesario a realizar con los cuadros para lograr mayores resultados, y que debe ser guía de acción para todos los dirigentes.

In this work the considerations related to the policy of direction cadres, approved in the First National Conference of the Cuban Communist Party are exposed. Besides, the work system with the directive cadres of the Cuban State and Government and the validity of this topic through Raúl Castro Ruz `s thought are analyzed. Finally it is concluded with a sentence of this Revolution leader that summarizes the whole necessary work to be carried out with the cadres to achieve higher results, and that should be action guide to all the leaders.

Conocimientos y práctica clínica de los proveedores de salud para la prevención del embarazo adolescente según marco legal chileno / The legal framework to prevent teenage pregnancies

Background: There are legal regulations about sexual and reproductive rights of adolescents. However, this legal framework (LF) may have contradictory elements: there are laws assuring confidentiality and access to contraception at any age but there are other laws that consider any sexual contact with an adolescent younger than 14 a sexual assault, whose report to the legal authorities in mandatory. Aim: To explore the knowledge and clinical practice of primary health care (PHC) providers regarding prevention of teenage pregnancy. Material and Methods: Qualitative study collecting data using semi-structured interviews made to midwives and directors of PHC centers. Analysis of the data was based on Grounded Theory. Results: There is a differentiated clinical care for pregnancy prevention among adolescents if they are over 14 years old. This is due to the LF, specifically to the sexual crime’s law (19,927) and the law about regulation of the fertility (20,418). The differences affect health care, access and counseling about contraception and confidentiality. Healthcare of teenagers under the age of 14 is perceived as problematic for providers, due to the possible legal implications. Conclusions: The LF causes insecurity on health care providers and derives in a differentiated clinical approach according to the patient´s age. This is a barrier to provide timely and confidential access to counseling and contraception.

Impacto del entrenamiento a equipos de dirección en la provincia de Santiago de Cuba / Impact of training management teams in Santiago de Cuba province

Introducción: el entrenamiento es una figura académica del posgrado, utilizada en el sistema de preparación y superación de los directivos. Objetivo: evaluar el impacto del entrenamiento a equipos de dirección de la provincia de Santiago de Cuba, luego de 2 años de realizado. Métodos: se realizó una investigación en sistemas y servicios de salud, cuya muestra se seleccionó por conveniencia y consistió en 120 cuadros y reservas, quienes cursaron el entrenamiento y se mantenían en el cargo o fueron promovidos a otro durante ese período. A tales efectos se utilizó la metodología establecida por la Escuela Nacional de Salud Pública, y se trazaron criterios, indicadores y estándares a partir de las temáticas de algunas habilidades que fueron impartidas en el entrenamiento. Asimismo se aplicaron encuestas a los entrenados y a sus colaboradores y se efectuó una revisión documental. Resultados: en la serie predominaron los directivos del grupo etario de 41-55 años y del sexo femenino; de igual modo, más de la tercera parte de los directivos presentaban de 1-3 años en el cargo y otra cantidad similar, más de 6 años. Los médicos representaron la profesión más frecuente (46,0 %), cuya mayoría (60,0 %) provenía de la reserva o había sido promovida de otros cargos. Al triangular los datos, el criterio "reunión", con los subcriterios "tiempo de duración", "el no nombramiento de un facilitador" y "la presencia del directivo no era necesaria", fueron los de mayor desviación con el estándar trazado. Conclusiones: la evaluación resultó inadecuada, pues 82,6 % de los criterios y 81,1 % de los subcriterios obtuvieron calificación de inadecuada.

Introduction: training is an academic element of postdegree, used in the preparation and training system for cadres. Objective: to evaluate the impact from the training management teams from Santiago de Cuba province, after 2 years. Methods: an investigation in systems and services of health was carried out whose sample was selected by convenience and it consisted on 120 cadres and substitutes who studied the training and they stayed in their responsabilities or they were promoted to another one during that period. For this purpose, the methodology established by the National School of Public Health was used, and criteria, indicators and standards were traced based on the thematic of some skills that were delivered during training. Also surveys were applied those trained and to their collaborators and a literature review was carried out. Results: in the series, cadres of the group 41-55 years and female sex prevailed; in the same way, more than the third part of the cadres had of 1-3 years in the responsability and other similar quantity, more than 6 years. The doctors represented the most frequent profession (46.0%), whose majority (60.0%) came from the substitutes or had been promoted from other responsability. When triangulating data, the criterium "meeting", with the subcriterium "duration time", "the non designation of a facilitator" and "the cadres presence was not necessary", were those of greater deviation with the standard. Conclusions: the evaluation was inadequate, because 82.6% of the criteria and 81.1% of the subcriteria obtained qualification of inadequate.

Interfaces entre produção de saúde e coordenação do cuidado: perspectiva da psicodinâmica do trabalho na compreensão do trabalhar de médicos inseridos em um hospital universitário - São Paulo, Brasil / Interfaces between health production and coordination of care: perspective of psychodynamics of work in the understanding about the work of doctors inserted at a university hospital - São Paulo, Brazil

INTRODUÇÃO: Com base no referencial teórico da Psicodinâmica do Trabalho, compreende-se que a construção da subjetividade e, consequentemente, da identidade e da saúde mental dos sujeitos adultos têm no trabalho lugar central. OBJETIVO: Evidenciar componentes da organização do trabalho que possam favorecer a produção da saúde, a construção e o fortalecimento da identidade de sujeitos singulares e coletivos profissionais, a partir da compreensão de uma situação especifica de trabalho. METODOLOGIA: Trata-se de estudo de caso de caráter exploratório. Foi desenvolvido com um grupo de médicos inseridos no Hospital Universitário da Universidade de São Paulo, cujo trabalhar é atravessado pela coordenação de equipes e/ ou ações de cuidado. Realizou-se 14 entrevistas semi-estruturadas entre os meses de setembro de 2013 e abril de 2014, organizadas em duas fases. Da primeira, participaram sete médicos que ocupavam cargos de gestão. Puderam auxiliar na compreensão do organograma geral da instituição, do fluxo e da organização do trabalho médico. Da segunda fase, participaram sete médicos que, além de assistentes, atuavam como chefes de plantão. Pela importância das ações desenvolvidas por estes profissionais na dinâmica hospitalar e pela disponibilidade em participar do estudo, constituíram-se como a população alvo do mesmo. Adotou-se a postura fenomenológico hermenêutica para interpretação dos achados. Caracterizou-se o trabalhar e a identidade profissional desses sujeitos a partir de quatro eixos: conteúdo do trabalho; recursos disponíveis para realização das atividades previstas; trajetória para chegada nessa função e; experiências de sofrimento e prazer no trabalho. RESULTADOS: Semanalmente, por 12 horas consecutivas, os médicos chefes de plantão respondem por questões administrativas, representando a diretoria do hospital frente aos trabalhadores e usuários do serviço. Baseados em aspectos técnicos, nas regras institucionais e do trabalho tomam, simultaneamente,...

INTRODUCTION: Based on the theoretical framework of work psychodynamics, it is understood that the construction of subjectivity and, hence, the identity and mental health of adult subjects have in the work its central point. PURPOSE: To highlight components of work organization which may support the health production, the building and strengthening of the identity of specific individuals and collective professionals based on an understanding of a specific work situation. METHODS: It is an exploratory case study. It was conducted with a group of doctors inserted in the University Hospital of University of São Paulo and whose work is crossed by coordination of teams and/or care actions. Fourteen semi-structured interviews taken between September 2013 and April 2014, which were organized into two phases. In the first one, seven manager doctors participated. They helped in the understanding of the general chart organizational of the institution, the flow and organization of medical work. In the second phase participated seven professionals who were doctors assistants and also duty chefs. Due to the importance of the actions developed by these professionals in the hospital and their availability to participate in the study, they were constituted as the target population of it. It was adopted the phenomenological-hermeneutic approach to the interpretation of the findings. The work and the professional identity of these subjects were characterized according to four areas: content of the work; resources available to carry out the planned activities; trajectory for arrival in this role and; experiences of suffering and pleasure at work. RESULTS: Weekly, for 12 consecutive hours, the doctors on duty chiefs are responsible for administrative matters and representing the board of the hospital face workers and service users. Based on the technical aspects, institutional and work rules, they make clinical decisions regarding the possibility of receiving and hosting...

Communication for Medical Advices between Prehospital Providers and Physician Medical Directors

PURPOSE: On-line medical control, in addition to indirect control like protocols, is known to exert a positive effect on the quality of prehospital care. Because the decision-making process of directing physicians depends on the information provided by prehospital providers via telecommunication, brief and organized reporting of significant points is of paramount importance. METHODS: Telecommunications regarding direct medical control provided by emergency physicians in a university hospital were recorded from May 1 to June 30, 2012. All communications were between cellular phones. Analysis of the recorded dialogues was performed by an independent researcher. RESULTS: A total of 115 cases were included for analyses. Affiliated fire offices were reported in 107 (93.0%) cases, while certification of responding officers was reported in only 62 (53.9%) cases. All five vital signs were reported in only 9 cases (7.8%), including blood pressure, heart rate, respiration rate, temperature, and oxygen saturation. Procedures delivered before telephone contact were reported in 30.4% of cases, and reporting rate of patient response to treatment was 16.5%. Estimated times of arrival to the destined hospital were reported in only 8.7%. CONCLUSION: Reporting procedures regarding prehospital direct medical control should be concise and comprehensive, including essential elements like certification of the provider, consciousness and vital signs of the patient, and estimated time of hospital arrival.

Agreement of Medical Directors for Indirect Medical Oversight on Prehospital Care

PURPOSE: The medical director is a core factor in maintaining high quality emergency medical services. This study was conducted to evaluate the agreement of medical oversight for prehospital emergency care between medical directors. METHODS: Two medical directors assessed the same 119 rescue run sheets with 28 cases of cardiac arrest, 12 cases of withhold or interruption of cardiopulmonary resuscitation (CPR), and 22 cases of severe trauma. The assessment for prehospital evaluation of patients, treatment and medical direction was compared between the two medical directors, RESULTS: The use of an automated external defibrillator in cardiac arrest that was assessed as appropriate was 17/28, 22/28, respectively. In assessing for withhold or interruption of CPR, one medical director assessed as all appropriate for checking for pulse, respiration, and mental status regardless of recording on a 119 rescue runsheet, but the other medical director as inappropriate if there are no records on the runsheet. The assessment for airway treatment, aid for circulation, appropriateness of treatment for trauma, and appropriateness of medical direction in severe trauma differed between the two medical directors. CONCLUSION: Some differences were found in assessing the prehospital care between medical directors. A quality program for improving agreement between medical directors is necessary and the protocol for prehospital care should be modified according to the local situation.