RESUMO
Una buena gestión y calidad de la Formación Sanitaria Especializada (FSE) exige el compromiso explícito de los responsables de las CCAA y de los centros sanitarios. Esto implica la acreditación y reconocimiento de tutores, desarrollar el marco normativo que establece el RD 183/2008 (a los nueve años de su publicación sólo Cataluña, Canarias, Castilla y León, Extremadura, La Rioja y el País Vasco, lo han hecho), una mención explícita de la FSE en los planes estratégicos de las organizaciones sanitarias y en los contratos-programa con las unidades docentes y una participación activa de los jefes de estudio en los consejos de dirección de los centros. Por parte del Ministerio de Sanidad, es preciso agilizar la acreditación de las nuevas unidades docentes y abordar, junto con las CCAA, los problemas de financiación del proyecto de troncalidad y la organización de las unidades docentes troncales. Respecto al sentido de la formación, esta se ha de centrar en la seguridad del paciente, aquí la simulación es una metodología formativa idónea, y en la humanización, con una práctica de la medicina bajo un modelo deliberativo, siendo los formadores ejemplo para los que aprenden
The commitment of the heads of the Autonomous Communities and the health centers is key to a good management and the quality of the Specialized Healthcare Training (SHT). This implies the accreditation and recognition of tutors, developing the regulatory framework established by Royal Decree 183/2008 (nine years after its publication, only Catalonia, the Canary Islands, Castilla y León, Extremadura, La Rioja and the Basque Country have done so), an explicit mention of the SHT in the strategic plans of the health organizations and an active participation of the heads of SHT in the boards of directors. On the part of the Ministry of Health, it is necessary to speed up the accreditation process of new teaching units and, together with the Autonomous Communities, and address the financing problems of the core curriculum project and the organization of the core teaching units. Regarding the sense of training, this has to focus on safety patient, here the simulation is a suitable training methodology, and in the humanization, with a practice of medicine under a deliberative model, being the trainers an example for those who learn
Assuntos
Humanos , Fóruns de Discussão , Mentores/legislação & jurisprudência , Educação Médica/legislação & jurisprudência , Acreditação/normas , Educação Médica/normas , Grupos Focais/normasRESUMO
AIM: To assess the clinical features, length of stay, incidence rate, mortality, and hospital admissions of patients with episodes of diabetic ketoacidosis (DKA). PATIENTS: It was conducted retrospective, cross-sectional study of 164 consecutive admissions of adult patients (2008-August 2012), with type 1 or type 2 diabetes already known or new onset. RESULTS: Mortality rate was 1.2%. The DKA episodes were mild (18.9%), moderate (31.7%), or severe (49.4%). The cumulative incidence was 2.66 cases/1000 patients with diabetes (DM) in 4.5 years. The most common causes triggering DKA were infection (33.2%) and dietary transgression and/or insulin dose omission (30.7%). A total of 12.8% of patients had new onset DM, 56.7% type 1, and 26.8% type 2 DM. Patients with type 2 DM were older and had at admission higher creatinine, BUN, osmolality, sodium, and anion gap levels. Patients with new-onset of DM had higher levels of glucose and sodium, but lower potassium levels. No differences were found in pH or bicarbonate. Admission to the intensive care unit (ICU) was required in >50% of cases (p<0.001), and 86.6% of patients were finally admitted to a medical ward (p=0.005). The length of stay at the ICU (p<0.001) and hospital (p=0.013) was significantly different depending on DKA severity. CONCLUSIONS: Most DKA episodes require hospital admission, but mortality is <2%, and length of stay at the ER and medical ward depends on type of DM and initial severity of the episode.
