Subject(s)
Jurisprudence , Medical Care/standards , Community Health Services , Primary Health Care , SpainABSTRACT
O objetivo deste estudo foi apresentar uma revisão narrativa do atendimento à parada cardiorrespiratória, baseada nas diretrizes mais atuais e, também, uma análise crítica de informações de literatura recente, que vão além das recomendações gerais das diretrizes vigentes. A parada cardiorrespiratória, quando ocorre de forma inesperada, abrupta, em indivíduo que se encontrava estável horas antes do evento, é chamada de morte súbita. Essa condição é a principal causa de óbito extra-hospitalar não traumático e, dentre suas diversas causas, a síndrome coronariana aguda é a mais comum em adultos. Uma vez que a frequência de síndrome coronariana aguda tende a aumentar com o aumento da expectativa de vida e de prevalência de outros fatores de risco na população, a ocorrência de morte súbita também tende a aumentar nesse cenário. No intuito de orientar o atendimento de pacientes em parada cardiorrespiratória, há mais de quatro décadas foram criadas diretrizes internacionais, que evoluíram com o surgimento de novas evidências, especialmente nos últimos 20 anos. Todo médico deve estar preparado para atender uma situação de parada cardiorrespiratória, pois ele pode ser chamado para atender tais casos em diferentes cenários (emergência, unidade de internação ou em ambiente extra-hospitalar). Entretanto, apesar da importância da incorporação de novas evidências nessas diretrizes, mudanças frequentes nas recomendações representam grande desafio para os clínicos se manterem atualizados. Além da dificuldade na atualização permanente, há recomendações feitas pelas diretrizes de sociedades médicas que divergem entre si e são questionadas por especialistas, o que gera dúvida na tomada de decisão do clínico. Conforme pormenorizado neste artigo de atualização, as etapas do algoritmo de Suportes Básico e Avançado de Vida são apresentadas como uma sequência, para facilitar para o socorrista que atua sozinho a oferecer intervenções com impacto na sobrevivência do paciente, devendo priorizar a reanimação cardiopulmonar de qualidade e a desfibrilação precoce, se indicada.
The objective of this study was to present a narrative review of cardiac arrest care based on the most current guidelines, and also a critical analysis of recent literature information that goes beyond the general recommendations of the current guidelines. Cardiac arrest, when occurring unexpectedly, abruptly, in an individual who was stable hours before the event, is called sudden death. This condition is the leading cause of non-traumatic out-of-hospital death and, among its many causes, acute coronary syndrome is the most common in adults. Since the frequency of acute coronary syndrome tends to increase with increasing life expectancy and the prevalence of other risk factors in the population, sudden death also tends to increase in this scenario. In order to guide the care of patients with cardiopulmonary arrest, for over 4 decades, international guidelines have been created and have evolved with the emergence of new evidence, especially in the last 20 years. Every physician should be prepared to deal with a cardiac arrest situation as he or she may be called upon to treat such cases in different scenarios (emergency, inpatient unit or out-of-hospital setting). However, despite the importance of incorporating new evidence into these guidelines, frequent changes to the recommendations pose a major challenge for clinicians to update their knowledge. In addition to the difficulty of constantly updating, there are recommendations made by the guidelines of medical societies that differ from each other and are questioned by specialists, which creates doubt in the process of decision making among clinicians. As detailed in this update article, the stages of the algorithm of Basic and Advanced Life Support are presented in a sequence to help the rescuer who works alone to provide interventions that impact the patient's survival, and prioritize quality cardiopulmonary resuscitation and early defibrillation, if required.
Subject(s)
Humans , Medical Care/standards , General Practitioners/education , Heart Arrest/therapy , Cardiopulmonary Resuscitation/standards , Emergency Responders , First Aid/methods , Heart Arrest/diagnosis , Life Support Care/standardsABSTRACT
La relación entre el médico paciente se ha modificado y se requiere realizar una reflexión crítica en torno a los procesos de salud y enfermedad en los diversos escenarios en que éstos se producen para desarrollar una nueva cultura sanitaria. En este contexto, la Bioética y sus principios favorece una manera diferente de entender la relación entre el médico y el paciente, en donde se privilegia el derecho que tiene el paciente como persona con autonomía en la toma de decisiones sobre su salud y se reconoce una responsabilidad compartida que considera el impacto de factores biológicos, sociales, culturales, económicos, psicológicos y éticos sobre la atención médica y el cuidado de la salud. Se hace necesario el aporte de la Filosofía, la Bioética y Ética Médica para investigar y estudiar la relación médico paciente en sus diferentes dimensiones: ética, médica, social y moral; fortalecer las bases éticas y legales de los médicos, lograr que sean capaces de analizar y hacer propuestas que lleven a la solución de los conflictos y dilemas que se generan con el desarrollo, la innovación del conocimiento y la aplicación de la tecnología en los seres humanos, y en todos los seres vivos (AU).
The doctor-patient relationship has changed and it is necessary to carry out a critical reflection on the health-disease processes in the different sets where they take place to develop a new sanitary culture. In this context, Bioethics and its principles favor a different way of understanding the doctor-patient relationship, where the right the patient has as a person with autonomy in taking decisions about his health is privileged, and it is recognized the a shared responsibility that takes into consideration the strike of ethic, psychological, economic, cultural, social and biological factors on medical and health care. The contribution of Philosophy, Bioethics, and Medical Ethics is necessary to investigate and study the doctor-patient relationship in its different dimensions: ethic, medical, social and moral; strengthening the physicians' ethic and legal bases, achieving them to be able of analyzing making propositions leading to the solution of conflicts and dilemmas generated with the development, knowledge innovation and the application of technology in human people and all the rest of living beings (AU).
Subject(s)
Humans , Male , Female , Physician-Patient Relations/ethics , Culturally Competent Care/ethics , Bioethics/education , Patient Satisfaction , Medical Care/methods , Medical Care/standards , Medical Care/ethics , Ethics, Medical/education , Ethics, Professional/education , Culturally Competent Care/methods , Culturally Competent Care/standards , Culturally Competent Care/trendsABSTRACT
La relación entre el médico paciente se ha modificado y se requiere realizar una reflexión crítica en torno a los procesos de salud y enfermedad en los diversos escenarios en que éstos se producen para desarrollar una nueva cultura sanitaria. En este contexto, la Bioética y sus principios favorece una manera diferente de entender la relación entre el médico y el paciente, en donde se privilegia el derecho que tiene el paciente como persona con autonomía en la toma de decisiones sobre su salud y se reconoce una responsabilidad compartida que considera el impacto de factores biológicos, sociales, culturales, económicos, psicológicos y éticos sobre la atención médica y el cuidado de la salud. Se hace necesario el aporte de la Filosofía, la Bioética y Ética Médica para investigar y estudiar la relación médico paciente en sus diferentes dimensiones: ética, médica, social y moral; fortalecer las bases éticas y legales de los médicos, lograr que sean capaces de analizar y hacer propuestas que lleven a la solución de los conflictos y dilemas que se generan con el desarrollo, la innovación del conocimiento y la aplicación de la tecnología en los seres humanos, y en todos los seres vivos (AU).
The doctor-patient relationship has changed and it is necessary to carry out a critical reflection on the health-disease processes in the different sets where they take place to develop a new sanitary culture. In this context, Bioethics and its principles favor a different way of understanding the doctor-patient relationship, where the right the patient has as a person with autonomy in taking decisions about his health is privileged, and it is recognized the a shared responsibility that takes into consideration the strike of ethic, psychological, economic, cultural, social and biological factors on medical and health care. The contribution of Philosophy, Bioethics, and Medical Ethics is necessary to investigate and study the doctor-patient relationship in its different dimensions: ethic, medical, social and moral; strengthening the physicians' ethic and legal bases, achieving them to be able of analyzing making propositions leading to the solution of conflicts and dilemmas generated with the development, knowledge innovation and the application of technology in human people and all the rest of living beings (AU).
Subject(s)
Humans , Male , Female , Physician-Patient Relations/ethics , Culturally Competent Care/ethics , Bioethics/education , Patient Satisfaction , Medical Care/methods , Medical Care/standards , Medical Care/ethics , Ethics, Medical/education , Ethics, Professional/education , Culturally Competent Care/methods , Culturally Competent Care/standards , Culturally Competent Care/trendsABSTRACT
El programa de la asignatura no propia de la actividad del egresado Psicología I refleja carencia en los niveles de complejidad para contribuir a la formación laboral del Médico General en los servicios básicos del sistema de Salud Pública. Por consiguiente, en el proceso docente educativo ejecutado a través de la misma, incide la inadecuada comprensión de la concepción de las tareas docentes que favorecen la apropiación de conocimientos, habilidades, valores y motivaciones, desde la lógica de atención integral que corresponde al modelo del profesional a egresar en la Educación Superior cubana. Por tal motivo, en el presente artículo de revisión se propone argumentar, con sustento teórico-metodológico en el modelo cubano de formación universitaria desde el trabajo, el enfoque de la formación laboral en atención médica integral desde las tareas docentes de la asignatura Psicología I(AU)
Psychology I program shows a complexity level deficiency to contribute to the success of general doctor's professional formation on public health system´s basic services. Consequently, the inadequate understanding of the educational tasks that allows assimilating knowledge, abilities, values and motivations from an integral attention approach that follows the professional´s formation pattern in Cuban superior education, impacts negatively during this subject´s teaching process. For such a reason this article aims to argue the educational tasks´ approach for integral medical care professional formation through the subject ¿Psychology I¿, following theoretical-methodological considerations based on Cuban pattern of university student formation from working(AU)
Subject(s)
Medical Care/standards , Health Education , Basic Health ServicesABSTRACT
El programa de la asignatura no propia de la actividad del egresado Psicología I refleja carencia en los niveles de complejidad para contribuir a la formación laboral del Médico General en los servicios básicos del sistema de Salud Pública. Por consiguiente, en el proceso docente educativo ejecutado a través de la misma, incide la inadecuada comprensión de la concepción de las tareas docentes que favorecen la apropiación de conocimientos, habilidades, valores y motivaciones, desde la lógica de atención integral que corresponde al modelo del profesional a egresar en la Educación Superior cubana. Por tal motivo, en el presente artículo de revisión se propone argumentar, con sustento teórico-metodológico en el modelo cubano de formación universitaria desde el trabajo, el enfoque de la formación laboral en atención médica integral desde las tareas docentes de la asignatura Psicología I.
Psychology I program shows a complexity level deficiency to contribute to the success of general doctor's professional formation on public health system´s basic services. Consequently, the inadequate understanding of the educational tasks that allows assimilating knowledge, abilities, values and motivations from an integral attention approach that follows the professional´s formation pattern in Cuban superior education, impacts negatively during this subject´s teaching process. For such a reason this article aims to argue the educational tasks´ approach for integral medical care professional formation through the subject ¨Psychology I¨, following theoretical-methodological considerations based on Cuban pattern of university student formation from working.
Subject(s)
Humans , Psychology/education , Health Education , Staff Development/methods , Comprehensive Health Care , Basic Health Services , Medical Care/standards , Professional Training , Family Practice/educationABSTRACT
El artículo analiza iniciativas para organizar la lucha contra el cáncer en la Argentina entre comienzos de la década de 1920 y mediados de la década de 1940. En particular, hace eje en las acciones del Instituto de Medicina Experimental, un hospital-instituto de investigación dependiente de la Facultad de Ciencias Médicas de la Universidad de Buenos Aires que tuvo un papel central en este proceso. Se presta atención a la organización de la atención médica en el establecimiento, a las campañas de difusión de conocimiento a la población, a los intentos por incorporar esta cuestión a la formación profesional, a la articulación de las actividades con organismos estatales para dar mayor alcance territorial a la lucha contra el cáncer y a las investigaciones científicas que apuntaron a vincular el desarrollo del cáncer con estilos de vida (AU)
This article analyses initiatives to organize the fight against cancer in Argentina between the early 1920s to mid 1940s. Specifically, it focuses on the initiatives of the Instituto de Medicina Experimental, a hospital-research institute dependent on the Facultad de Ciencias Médicas of the Universidad de Buenos Aires that played a key role in this process. This paper considers the organization of the medical attention within the establishment, knowledge awareness campaigns, and the intents to incorporate cancer as a topic in the professional curricula and scientific research linking cancer and life styles (AU)
Subject(s)
History, 19th Century , Health Promotion/history , Health Promotion/methods , Health Promotion/organization & administration , Neoplasms/prevention & control , Life Style/history , Medical Care/history , Medical Care/methods , Medical Care/standards , Argentina/epidemiology , Health Behavior , Health Services/history , Health Services/standards , Health Planning/history , Health Planning/organization & administration , National Health Programs/history , National Health Programs/organization & administrationABSTRACT
Introducción. El hospital de día es una alternativa a la hospitalización, que mejora la accesibilidad y el confort del paciente, evitando ingresos. No obstante, la eficacia del hospital de día médico polivalente en la evitación de estancias hospitalarias no ha sido evaluada. Objetivo. Analizar las estancias evitadas por el hospital de día médico polivalente de un hospital universitario del Servicio Andaluz de Salud. Métodos. Estudio observacional prospectivo de los pacientes estudiados y/o tratados en el hospital de día médico polivalente del Hospital Universitario Puerto Real durante un año. Resultados. Se han atendido 3.640 pacientes, realizándose 1.413 procedimientos y 4.921 tratamientos i.v. La consulta de atención preferente del hospital de día médico polivalente realizó 2.182 visitas. Los motivos de consulta más frecuentes fueron los síntomas constitucionales (15,9%) y la anemia (14,5%). Tras la primera visita, el 21,5% de los casos fueron dados de alta y menos de un 3% eran ingresados. En el 16,8% de los casos se evitó la hospitalización convencional, con una disminución del 6,0% en la necesidad de camas (5% en la unidad de Medicina Interna). Los ingresos inadecuados y los reingresos en 30 días disminuyeron un 93,3% y un 4,2% respectivamente. La afección diagnosticada con mayor frecuencia es la neoplásica (26,0%), más de la cuarta parte de las camas liberadas se generan por pacientes con neoplasias (26,7%). Conclusión. Con este tipo de hospital de día médico polivalente se observa una mejora de la eficiencia asistencial, liberándose camas hospitalarias mediante la reducción de los ingresos, ingresos no adecuados y de los reingresos precoces en las unidades implicadas(AU)
Introduction. The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. Objective. To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. Methods. An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. Results. A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). Conclusion. With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved(AU)
Subject(s)
Humans , Male , Female , Day Care, Medical , Practice Management, Medical/organization & administration , Patient Care Management/standards , Patient Care Management , Case Management/standards , Hospitals, University/organization & administration , Internal Medicine/organization & administration , Patient Satisfaction , Medical Care/standards , Medical Care , Case Management/organization & administration , Internal Medicine/methods , Medical Care/trends , Case Management , Hospitals, University , Case Management/trends , Practice Management, Medical , Prospective Studies , Hospitals, University/standardsSubject(s)
Neurology , Medical Care/standards , Data Collection , Simple Random Sampling , House Calls , ColombiaSubject(s)
National Health Programs/standards , Medical Care/standards , Blood Pressure , Hypertension/prevention & control , Hypertension/classification , Hypertension/pathology , Hypertension/etiology , Hypertension/diagnosis , Hypertension/therapy , Hypertension/pharmacology , Hypertension/epidemiology , Age Factors , ArgentinaABSTRACT
Alimentación, Cardiología, Cirugía, Crecimiento y desarrollo, Dermatología, Desnutrición, Diarrea aguda, Endocrinilogía, Gastroenterología, Genética, Ginecología, Hematología, Infectología, Inmunizaciones, Laboratorio, Legal, Medio interno, Meningitis, Nefrología,Neonatología, Neumotisiología, Neurocirugía, Neurología, Odontopediatría, Oftalmología, Ortopedia, Otorrinolaringología, Procedimientos, Psicopatología, Quemaduras, Radiología, Shock
Subject(s)
Humans , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Pediatrics/education , Malpractice , Medication Errors , Diagnostic Errors , Diet , Cardiology , General Surgery , Growth , Growth Disorders , Dermatology , Child Nutrition Disorders , Infant Nutrition Disorders , Diarrhea, Infantile , Endocrinology , Gastroenterology , Genetics, Medical , Gynecology , Hematology , Communicable Diseases , Immunization , gamma-Globulins , Liability, Legal , Meningitis , Clinical Laboratory Techniques , Patient Discharge/legislation & jurisprudence , Nephrology , Pulmonary Medicine , Neonatology , Neurosurgery , Neurology , Pediatric Dentistry , Ophthalmology , Orthopedics , Otolaryngology , Psychopathology , Burns , Radiology , Shock , Infusions, Parenteral/standards , Fluid Therapy/standards , Spinal Puncture/standards , Punctures , Blood Specimen Collection/standards , Practice Patterns, Physicians'/standards , Professional Practice/standards , Evaluation of Results of Therapeutic Interventions/methods , /standards , Medical Care/standards , Medical Audit/methods , Quality of Health Care/standards , Quality Assurance, Health Care/standards , Pediatrics/standards , Patient Discharge/standards , Medical Audit/standardsABSTRACT
Alimentación, Cardiología, Cirugía, Crecimiento y desarrollo, Dermatología, Desnutrición, Diarrea aguda, Endocrinilogía, Gastroenterología, Genética, Ginecología, Hematología, Infectología, Inmunizaciones, Laboratorio, Legal, Medio interno, Meningitis, Nefrología,Neonatología, Neumotisiología, Neurocirugía, Neurología, Odontopediatría, Oftalmología, Ortopedia, Otorrinolaringología, Procedimientos, Psicopatología, Quemaduras, Radiología, Shock
Subject(s)
Humans , Pregnancy , Infant, Newborn , Infant , Child , Patient Discharge/legislation & jurisprudence , Medical Audit/methods , Evaluation of Results of Therapeutic Interventions/methods , Cardiology , Shock , General Surgery , Blood Specimen Collection/standards , Growth , Medical Care/standards , Dermatology , Diarrhea, Infantile , Diet , Communicable Diseases , Endocrinology , Diagnostic Errors , Medication Errors , Quality Assurance, Health Care/standards , Gastroenterology , Genetics, Medical , Gynecology , Hematology , Fluid Therapy/standards , Malpractice , Immunization , Infusions, Parenteral/standards , Meningitis , Nephrology , Neonatology , Neurosurgery , Neurology , Pediatric Dentistry , Ophthalmology , Orthopedics , Otolaryngology , Practice Patterns, Physicians'/standards , Pediatrics/education , Pulmonary Medicine , Professional Practice/standards , Psychopathology , Spinal Puncture/standards , Punctures , Quality of Health Care/standards , Burns , Radiology , Liability, Legal , Child Nutrition Disorders , Infant Nutrition Disorders , Growth Disorders , Clinical Laboratory Techniques , gamma-Globulins , Patient Discharge/standards , Medical Audit/standards , Pediatrics/standardsABSTRACT
Since 1977, the status of the autopsy has been the subject of much debate. The following questions have been posed: (i) Has the autopsy outlived its usefulness? (ii) Is the autopsy worth the expended effort and cost? (iii) How can the contributions of this physician service achieve their maximum usefulness and receive appropriate recognition? The College of American Pathologists' Foundation Conference has made an appeal to revitalize the autopsy. There was concern about the falling rate of autopsies in teaching hospitals. The Queen Elizabeth Hospital has been one of the hospitals involved in the Eastern Caribbean Medical Scheme since 1965. There is undergraduate and postgraduate teaching. Medical students have been doing their Pathology and Microbiology clerkships at this hospital since 1981. The morbid anatomy sub-department of Pathology also services the whole island. Is the autopsy rate at this institution, a teaching hospital, acceptable? Is maximum benefit being gained from the autopsies performed? In order to answer the above questions, the autopsy reports from the Pathology Department were reviewed for the four-year period (1979-1982). The autopsy rates were 17 percent, 14 percent, 13 percent and 16 percent respectively. The concordance score of 303 of the 400 autopsies performed during this period was calculated. Ninety-seven cases had to be excluded because of insufficient data. In 149 cases, the primary disease as diagnosed at autopsy had been recognized clinically, but in 154 cases it had not. The predominant diseases missed included sepsis, pulmonary thrombo-embolism, pulmonary oedema and gastrointestinal haemorrhage. Though the autopsy rate is low, there is a high discordant rate. The autopsy in Barbados is therefore potentially capable of improving medical care, not only through the teaching of medical students, but through the interest and involvement of the clinicians in autopsies requested (AU)