RESUMO
Objetivo: Analizar el impacto durante 10 años de nuestro programa de enseñanza semipresencial en ecocardiografía. Métodos y resultados: Se envió una encuesta retrospectiva a todos los médicos especialistas que se graduaron en el programa, desarrollado en la Universidad de Chile, con un equipo docente de Chile y España. Un total de 140 de entre 210 estudiantes, graduados en nuestro programa de 2011 a 2020, respondieron voluntariamente a la encuesta. Entre quienes respondieron, el 53,57% fueron anestesiólogos y el 26,42% intensivistas. Más del 85% de los respondedores indicó que el periodo de enseñanza online cumplió sus expectativas, y el 70,2% indicó que la experiencia práctica cumplió sus objetivos. En un análisis retrospectivo utilizando datos autorreportados, se observaron incrementos significativos en cuanto a frecuencia del uso de ecocardiografía transtorácica y transesofágica del 24,29% al 40,71% y del 13,57% al 27,86%, respectivamente, tras el programa, en comparación con el periodo anterior al mismo. Se usó la ecocardiografía principalmente en el periodo perioperatorio (56,7%) y en cuidados intensivos (32,3%), mientras que solo el 11% de los respondedores la utilizó en unidades de urgencia. Además, el 92,4% de los respondedores reveló que la información aprendida durante el programa había sido muy útil para su práctica posterior. Conclusiones: A lo largo de una década de uso, el programa de aprendizaje semipresencial de ecocardiografía fue evaluado satisfactoriamente por los especialistas que se graduaron en el programa, siendo asociado a un incremento significativo del uso de ecocardiografía en el periodo perioperatorio y en cuidados intensivos. El principal desafío es establecer un periodo más prolongado de práctica, y lograr un mayor alcance en la medicina de urgencias.(AU)
Objective:To analyse the impact of 10 years of blended echocardiography teaching. Methods and results: A questionnaire was emailed to all medical doctors who graduated from the blended learning diploma in echocardiography developed by the University of Chile and taught by a team from Chile and Spain. One hundred and forty of the 210 students who graduated from the program between 2011 and 2020 completed the questionnaire: 53.57% were anaesthesiologists, and 26.42% were intensivists. More than 85% of respondents indicated that the online teaching met their expectations, and 70.2% indicated that the hands-on practice fulfilled the stated objectives. In a retrospective analysis using self-reported data, graduates reported that their use of transthoracic and transoesophageal echocardiography has increased from 24.29% to 40.71% and from 13.57% to 27.86%, repectively, after the programme compared to before the programme. They used echocardiography mainly in the perioperative period (56.7%) and during intensive care (32.3%), while only 11% of respondents used it in emergency care units. Nearly all (92.4%) respondents reported that the skills learned was very useful in their professional practice. Conclusions: Ten years after its launch, the blended learning diploma in echocardiography was well rated by graduate specialists, and is associated with a significant increase in the use of echocardiography in the perioperative period and during intensive care. The main challenges are to establish a longer period of practice and achieve greater implantation in emergency medicine.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Estudantes de Medicina , Ecocardiografia/métodos , Educação Médica , Anestesiologistas/educação , Ultrassonografia/classificação , Ensino , Chile , Estudos Retrospectivos , Inquéritos e Questionários , Espanha , Especialização , Período PerioperatórioRESUMO
El desarrollo de la Neonatología en Chile ha logrado mejorar las tasas de mortalidad infantil y neonatal, y ha traído un nuevo escenario epidemiológico con presencia de patología crónica en muchos de los sobrevivientes. Situaciones clínicas como la prematuridad y sus limites de viabilidad, malformaciones congénitas graves, enfermedades degenerativas o secuelas de asfixia perinatal con graves alteraciones neurológicas nos enfrentan a decisiones difíciles por la futura calidad de vida del niño. El equipo médico y los padres deben confrontar valores que pueden ser diferentes en unos y otros. Es importante analizar las decisiones que se toman, el criterio que las fundamenta y las personas que participan de la decisión. Se consideran los fines de la medicina, la buena practica médica, el concepto de calidad de vida, la proporcionalidad de las medidas terapéuticas y la necesidad de apoyar a los padres para una participación más activa en las decisiones que afectan a sus hijos.
The development of Neonatology in Chile has achieved to improve the infant and neonatal mortality rate, and had brought a new epidemiology scenery, presence of chronic pathology in many of the survivors. Clinic situations like prematurity and the viability limits serious congenital malformations, degenerative diseases, or perinatal asphyxia results, like serious neurological disturbance; they confront us to difficult decisions looking to the future life quality of the child. Medical team and the parents have to bring face to face the values that could be different between them. It is important to analyze very carefully the decisions that will be taken, the criterion in what are based on and the persons that participate in them. To analyze the decisions are considered, the medicine purposes, the good medical practice, the quality of life concept, the therapeutic measures proportionality, and the need of parents support, so that they have a more active participation in the decisions the will affect their child life.
Assuntos
Humanos , Feminino , Gravidez , Neonatologia/ética , Conflito de Interesses , Tomada de Decisões/éticaRESUMO
BACKGROUND: The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent. AIM: To evaluate decision making of patients in health care and to identify the notion of capacity for decision making, according to lawyers and physicians. MATERIAL AND METHODS: A semi-structured interview about procedures to assess decision making capacity was applied to 27 selected physicians and lawyers, considering their experience in this area. A qualitative analysis of answers was performed. RESULTS: Several differences were observed between physicians and lawyers, probably originated in their respective disciplines as well as the context of their professional practice. For physicians the notion of capacity is associated to comprehension of the information, it is not absolute, and it must consider the intellectual maturity of the teenager and the autonomy of the elderly. This evaluation is frequently performed in the clinical interview and standardized protocols do not exist. For lawyers, capacity is established by age and is associated to rights and obligations, as determined by law. When it is assessed by experts, including physicians, it becomes evidence. These professionals assume that experts will use standardized assessment instruments. Capacity has significance in the legal system. CONCLUSIONS: Since there are substantial consequences when a person is deemed incompetent, it is necessary to distinguish between health capacity and legal capacity, and to inverted exclamation markink the informed consent with the fundamental rights of citizens, such as taking decisions about our own health.
Assuntos
Tomada de Decisões , Consentimento Livre e Esclarecido , Advogados , Competência Mental , Médicos , Prática Profissional , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Chile , Compreensão , Direitos Humanos , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Responsabilidade SocialRESUMO
Background: The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent. Aim: To evaluate decision making of patients in health care and to identify the notion of capacity for decision making, according to lawyers and physicians. Material and methods: A semi-structured interview about procedures to assess decision making capacity was applied to 27 selected physicians and lawyers, considering their experience in this area. A qualitative analysis of answers was performed. Results: Several differences were observed between physicians and lawyers, probably originated in their respective disciplines as well as the context of their professional practice. For physicians the notion of capacity is associated to comprehension of the information, it is not absolute, and it must consider the intellectual maturity of the teenager and the autonomy of the elderly. This evaluation is frequently performed in the clinical interview and standardized protocols do not exist. For lawyers, capacity is established by age and is associated to rights and obligations, as determined by law. When it is assessed by experts, including physicians, it becomes evidence. These professionals assume that experts will use standardized assessment instruments. Capacity has significance in the legal system. Conclusions: Since there are substantial consequences when a person is deemed incompetent, it is necessary to distinguish between health capacity and legal capacity, and to ¡ink the informed consent with the fundamental rights of citizens, such as taking decisions about our own health.
Assuntos
Adolescente , Adulto , Idoso , Criança , Humanos , Pessoa de Meia-Idade , Tomada de Decisões , Consentimento Livre e Esclarecido , Advogados , Competência Mental , Médicos , Prática Profissional , Fatores Etários , Chile , Compreensão , Direitos Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Responsabilidade SocialRESUMO
The decision making capacity of patients will acquire special relevance with the introduction of informed consent in clinical practice and the new normative that will appear in the future when the bills about health services are approved in the Congress. This paper reviews the concept of decision making capacity in the context of health care and its legal background in Chile. The main problems that arise from the comprehension, use and assessment of decision making capacity, are analyzed. The assessment of this capacity is, in most cases, subjective since there are no criteria, protocols or standards to be used. In courts of justice, the exercise capacity assessment is requested to experts. These specilized physicians will evaluate the mental health of the subject and its implications in the capacity to make decisions. In practice, it is difficult to integrate the concept of capacity from the law or health care perspective. It is concluded that the elaboration of criteria, standards and procedures to evaluate the decision capacity of patients, is mandatory.
Assuntos
Humanos , Atenção à Saúde , Competência Mental , Consentimento Livre e Esclarecido , Participação do Paciente , Tomada de Decisões , Chile , Competência Mental/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Prova Pericial , Ética MédicaRESUMO
La limitación del esfuerzo terapéutico es una de las decisiones más complejas que se ha de tomar en la atención de los enfermos. Caso clínico: Laura, es una niña prematura de 25 semanas que durante su hospitalización en cuidado intensivo neonatal recibe todo el apoyo diagnóstico y terapéutico al alcance, sin embargo muere a los 17 días. Se reflexiona desde el punto de vista bioético respecto de la necesidad de hacer un análisis de proporcionalidad de tratamiento a tiempo el que deriva, en este caso, en la decisión de limitación del esfuerzo terapéutico. Se reconoce la complejidad de las decisiones que se debe tomar. Se enfatiza el rol de los padres en las decisiones de sustitución. Conclusión: Ante la duda razonable la conducta éticamente correcta es actuar en favor de la vida, pero la duración de los tratamientos de prueba deben ser por un tiempo razonable para no caer, como en el caso de Laura en el Encarnizamiento Terapéutico.
Assuntos
Humanos , Recém-Nascido , Ética Médica , Recém-Nascido Prematuro , Terapia Intensiva Neonatal , Papel do Médico , Tomada de Decisões/ética , Temas Bioéticos , Relações Profissional-Família/ética , Suspensão de TratamentoRESUMO
Background: Personnel working in neonatal intensive care units frequently face difficult ethical problems related to the initation, maintenance or withdrawal of life support therapies. Aim: To assess the importance of ethical issues in the clinical decision making of health care providers in neonatal intensive care units. Material and methods: A questionnaire based on five clinical vignettes that assessed judgments about quality of life, impact of parent's opinions and decision making in emergency situations and with different degrees, of certainty, was designed. Eleven neonatologists and 20 nurses and midwives specialized in neonatology anonymously answered this questionnaire. Results: There was a great inter individual variability in therapeutic approaches in cases with a bad vital and neurological prognosis. In cases of medical emergencies with uncentain diagnoses, bad vital prognosis but neurological indemnity, most professionals coincided in delivering all possible therapeutic options. Parent's opinions had a great impact in medical decisions, except when there was neurological indemnity. Conclusions: The specific responsibilities of the different agents in medical decision making must be delimited. Parents do not have absolute rights over their offspring and physicians must reject useless therapies
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Tomada de Decisões , Doenças do Recém-Nascido/terapia , Ética Médica , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Atitude do Pessoal de Saúde , Terapia Intensiva Neonatal , Consentimento Livre e Esclarecido/legislação & jurisprudência , Anencefalia/terapia , Doenças e Anormalidades Congênitas, Hereditárias e Neonatais/terapia , Doenças do Sistema Nervoso/terapia , Pesquisas sobre Atenção à Saúde , PrognósticoRESUMO
Se analizan 317 fichas clínicas de consultantes del Servicio de Oftalmología del Hospital San Juan de Dios, Servicio Metropolitana Occidente, en el mes de agosto (34 por ciento) y otros meses de 1983. Los consultantes del sexo femenino predominaron con un 62,5 por ciento. Un 25,5 por ciento de la consulta total corresponde a personas de 60 años y más. El estudio estadístico por sexo y grupo de edad no fue significativo (p > 0,01). Se encuentra un 75,5 por ciento de visión normal en individuos menores de 59 años. El grupo de 60 años y más presenta el mayor porcentaje de ceguera en los grados 3-4 y 5 con 27,6 por ciento, 24.1 por ciento y 48,3 por ciento respectivamente para el ojo derecho y de 20,0 por ciento, 36,0 por ciento y 44,0 por ciento respectivamente para el ojo izquierdo. Los grados de ceguera 3,4 y 5 son mayores para el sexo masculino. El tratamiento más indicado fue entrega y uso de lentes (41 por ciento) con una mejoría de la agudeza visual de 70,6 por ciento. La catarata fue la mayor causa de tratamiento quirúrgico (35,3 por ciento), seguida por el glaucoma (12,2 por ciento), la enucleación (8,5 por ciento) y la retinopatía (7,4 por ciento). Las consultas con mayor frecuencia fueron: vicios de refracción y glaucoma, seguido por patología de polo posterior y pterigion, tanto en sector urbano como rural. La ceguera y su causa específica en 88 consultantes fue por: glaucoma (18,2 por ciento), catarata (17 por ciento) y miopía (10,2 por ciento). La hipertensión ocular alcanzó un 11 por ciento.
