Línea de base sobre los mecanismos e instrumentos de los países andinos para homologación o reconocimiento de los títulos de medicina, enfermería, odontología, matronería y/o partería / Baseline on the mechanisms and instruments of Andean countries for homologation or recognition of medical, nursing, midwifery and/or patería

El propósito general de este manuscrito es generar la línea base sobre los mecanismos e instrumentos que se encuentran normados en los países andinos para homologación, o reconocimiento de los títulos de Medicina, Enfermería, Odontología, Matronería y/o partería, que determinan o influyen en los desplazamientos migratorios de los profesionales de salud de estos países, en especial a las áreas de medicina y enfermería.

Decision-making under pressure: medical errors in uncertain and dynamic environments.

Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations. Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review. Results Six themes emerged in the present narrative review using thematic analysis: organisational systems, workload, time pressure, teamwork, individual human factors and case complexity. This analysis highlights that clinical outcomes in emergency situations are the result of a variety of interconnecting factors. These factors may affect the ability of clinical staff in emergency situations to provide quality, safe care in a timely manner. Conclusions The challenge for researchers is to build the body of knowledge concerning the safe management of patients, particularly where clinicians are working under pressure. This understanding is important for developing pathways that optimise clinical decision making in uncertain and dynamic environments. What is known about the topic? Emergency departments (EDs) are characterised by high complexity, high throughput and greater uncertainty compared with routine hospital wards or out-patient situations, and the ED is therefore prone to unpredictable workflows and non-replicable conditions when presented with unique and complex cases. What does this paper add? Clinical decision making can be affected by pressures with complex origins, including organisational systems, workload, time constraints, teamwork, human factors and case complexity. Interactions between these factors at different levels of the decision-making process can increase the complexity of problems and the resulting decisions to be made. What are the implications for practitioners? The findings of the present study provide further evidence that consideration of medical errors should be seen primarily from a 'whole-of-system' perspective rather than as being primarily the responsibility of individuals. Although there are strategies in place in healthcare organisations to eliminate errors, they still occur. In order to achieve a better understanding of medical errors in clinical practice in times of uncertainty, it is necessary to identify how diverse pressures can affect clinical decisions, and how these interact to influence clinical outcomes.

Mechanical intestinal obstruction secondary to congenital diaphragmatic hernia in an adult. Report of a case.

We present a case of congenital diaphragmatic hernia diagnosed in an adult. It is a kind of exceptional pathology outside the pediatric age with few cases reported in the literature. Its presentation is unusual, especially in the form of mechanical intestinal obstruction, requiring surgical treatment.

Oclusión intestinal mecánica secundaria a hernia diafragmática congénita en un adulto. Presentación de un caso / Mechanical intestinal obstruction secondary to congenital diaphragmatic hernia in an adult. Report of a case

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Traumatismo cráneo encefálico pediátrico: manejo primario / Traumatismo pediatrico encephalic skull: primary handling

Expone que el presente trabajo es una revisión bibliográfica sobre trauma cráneo encefálico pediátrico en donde se enfoca la importancia epidemiológica y etiológica del mismo, se abordan los aspectos relacionados con el manejo primario urgente de esta patología, diagnóstico y pronóstico dependiendo de su tipo y de las complicaciones que se deriven del mismo, tratando de establecer un algoritmo que se asegure una atención pronta y eficaz acompañada de un uso racional de los recursos. La presente revisión considera los problemas propuestos con la mayor subjetividad y claridad posible, sobre la base de recomendaciones actualizadas.

Micosis pulmonares

Las micosis pulmonares son procesos crónicos que no se definen clinicamente como una entidad establecida, mas aún, sus síntomas y signos radiológicos mimetizan a la tuberculosis, cáncer pulmonar o abscesos pulmonares crónicos o se las puede encontrar asociadas a la tuberculosis. Dentro de las micosis pulmonares más conocidas podemos citar a la histoplasmosis, coccidioidomicosis, blastomicosis, paracoccidioidomicosis, criptococosis, aspergilosis, mucormicosis y candidiasis. Las micosis pulmonares se hace evidentes para los pacientes cuando la sintomatología clínica es muy florida, sin embargo, no se puede determinar qué tipo de micosis es a menos que se realice un cultivo de esputo. el tratamiento para cualquiera de ellas suele basarse en la administración de anfotericina B en altas dosis, que son tan honerosas como peligrosas por sus efectos indeseables. La candidiasis pulmonar ha tomado especial importancia en los pacientes inmunodeprimidos, a excepción de las otras micosis, resonde bien al tratamiento con nicostatina.