Validation of collection and anaerobic fermentation techniques for measuring prebiotic impact on gut microbiota.

BACKGROUND: Defining the ability of prebiotic dietary carbohydrates to influence the composition and metabolism of the gut microbiota is central to defining their health impact in diverse individuals. Many clinical trials are using indirect methods. This study aimed to validate collection and fermentation methods enabling their use in the context of clinical studies. METHODS AND RESULTS: Parameters tested included stool sample acquisition, storage, and growth conditions. Stool from 3 infants and 3 adults was collected and stored under varying conditions. Samples were cultured anaerobically for two days in the presence of prebiotics, whereupon optical density and pH were measured across time. Whole genome shotgun sequencing and NMR metabolomics were performed. Neither the type of collection vial (standard vial and two different BD anaerobic collection vials) nor cryopreservation (-80 °C or 4 °C) significantly influenced either microbial composition at 16 h of anaerobic culture or the principal components of the metabolome at 8 or 16 h. Metagenomic differences were driven primarily by subject, while metabolomic differences were driven by fermentation sugar (2'-fucosyllactose or dextrose). CONCLUSIONS: These data identified a feasible and valid approach for prebiotic fermentation analysis of individual samples in large clinical studies: collection of stool microbiota using standard vials; cryopreservation prior to testing; and collecting fermentation read-out at 8 and 16 hr. Thus, fermentation analysis can be a valid technique for testing the effects of prebiotics on human fecal microbiota.

A Simple Disk Stacking Plus Micro-Elution Method for Rapid Detection of the Synergistic Effect of Aztreonam and Ceftazidime/Avibactam Against Metallo-ß-Lactamase Producing Enterobacterales.

Purpose: To establish and evaluate a simple disk stacking plus micro-elution (DSE) method that can be routinely performed to rapidly detect the synergistic effect between aztreonam (ATM) and ceftazidime/avibactam (CZA) against metallo-ß-lactamase (MBL)-producing carbapenem-resistant Enterobacterales (CRE). Methods: The DSE method was established, and a total of 32 MBL-producing CRE isolates collected from multiple centers were tested for ATM-CZA synergy. The results obtained after 8 h of incubation were compared with those obtained by a reference checkerboard assay (CBA) after 18~24 h. Reproducibility experiments were completed on three separate days. Results: The reproducibility study showed that the results of the DSE method were precise. Compared with CBA, the DSE method exhibited excellent performance, with 92.8% sensitivity, 100.0% specificity 93.8% categorical agreement, 0.0% very major error, 0.0% major error, and 6.2% minor error over three days of testing. Conclusion: The DSE method is a simple, rapid and practical method for ATM-CZA combination testing. Further evaluation should be completed to improve its clinical application.

Intervención didáctica para la enseñanza-aprendizaje de los fundamentos teóricos del método clínico 20 años de experiencia

Introducción: Dada la incuestionable importancia del método clínico en la labor asistencial, continua como tema medular en la docencia médica. Objetivo: Perfeccionar la enseñanza y el aprendizaje del método clínico en la educación médica superior. Métodos: Se transitó por un momento inicial de diagnóstico del estado de aprendizaje del método clínico en el contexto local, seguido de los momentos de concepción, diseño y aplicación de una intervención didáctica. Resultados: La intervención didáctica implementada está constituida por un sistema de conferencias orientadoras dirigidas a estudiantes de tercer año de la carrera de medicina, impartidas en las asignaturas propedéutica clínica y medicina interna, las cuales abordan áreas complejas de la enseñanza-aprendizaje del método clínico: el interrogatorio, el razonamiento diagnóstico y la toma de decisiones terapéuticas; todas las conferencias se acompañan de sus correspondientes materiales de apoyo a la docencia. Forman parte de la intervención, como diseñadas acciones complementarias dirigidas a estimular la participación de los profesores en la ejecución de la intervención, como cursos de capacitación, la elaboración de un modelo del pase de visita docente asistencial. Conclusiones: La intervención didáctica expuesta contribuyó a perfeccionar la "base orientadora de la acción" para la enseñanza y el aprendizaje del método clínico en sí, y de la mayoría de sus habilidades esenciales constituyentes, por lo que tributa al perfeccionamiento curricular en la carrera de medicina. La intervención didáctica diseñada puede ser aplicada, o servir de referente, en cualquiera de los centros de enseñanza médica superior del país.

Introduction: Given the unquestionable importance of the clinical method in health care work, it continues as a core theme in medical teaching. Objective: To improve the teaching and learning of the clinical method in higher medical education. Methods: There was an initial moment to diagnose the learning state of the clinical method in the local context, followed by the stages for conception, design and implementation of a didactic intervention. Results: The implemented didactic intervention is made up of a system of guiding lectures aimed at third-year students of the medical studies, taught in the clinical propaedeutic and internal medicine subjects, which address complex areas of the clinical method teaching-learning: questioning, diagnostic reasoning, and therapeutic decision-making. All the lectures are accompanied by their corresponding teaching support materials. They are part of the intervention, as designed complementary actions aimed at stimulating the participation of professors in the intervention operation, such as training courses, development of a model of medical rounds supporting teaching. Conclusions: The described didactic intervention contributed to perfecting the guiding basis of action for teaching and learning the clinical method itself, and most of its constituent essential skills, which is why it contributes to curricular improvement in the studies of medicine. The designed didactic intervention can be applied, or serve as a reference, in any of the higher medical education schools in the country.

Habilidades procedimentales invariantes para el diagnóstico y el tratamiento de la peritonitis posoperatoria

Introducción: Las habilidades procedimentales invariantes en las peritonitis posoperatorias, les permite a los cirujanos el diagnóstico temprano y la reoperación abdominal urgente. Objetivo: Diseñar las habilidades procedimentales invariantes de atención diagnóstica y terapéutica a la peritonitis posoperatoria dirigida a los cirujanos. Método: Se realizó una investigación cualitativa en el Hospital Clínico Quirúrgico "Ambrosio Grillo" de Santiago de Cuba en el trimestre mayo-julio de 2022. La población de estudio estuvo constituida por 33 profesionales tratantes de la peritonitis posoperatoria: 22 médicos (12 cirujanos y 10 intensivistas) y 11 licenciadas en Enfermería. Se utilizó la sistematización como método teórico y como método empírico la revisión documental con la revisión de las historias clínicas y la observación con la práctica atencional-docente de la autora principal. Resultados: Se diseñaron las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria dirigida a los cirujanos con especial importancia en el método clínico. La autopreparación del tema en cuestión posibilita la complementación de conocimientos y habilidades aprendidas, así como la actualización de saberes que garantiza la atención clínica quirúrgica a este complejo enfermo. Conclusiones: El diseño de las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria en la necesaria superación permanente y continuada de los cirujanos representa una herramienta asistencial-docente que contribuye al mejoramiento del desempeño profesional ante este tipo de enfermo.

Introduction: Invariant procedural skills in postoperative peritonitis allow surgeons an early diagnosis and the performance of urgent abdominal resurgery. Objective: To design invariant procedural skills to be implemented for surgeons on the diagnostic and therapeutic care of postoperative peritonitis. Method: A qualitative research was conducted at the Hospital Clínico Quirúrgico "Ambrosio Grillo" of Santiago de Cuba in the quarter period of May-July 2022. The study population consisted of 33 specialists on postoperative peritonitis: 22 physicians (12 surgeons and 10 intensivists) and 11 graduated bachelor in nursing. Systematization was used as the theoretical method and the empirical methods used were the document analysis supported with the review of clinical histories and the observation with the main author's attentional-teaching practice. Results: It was designed an invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis with special emphasis on the clinical method. The self-preparation on the subject makes possible the complementation of both knowledge and skills learned, as well as an update of knowledge that guarantees the surgical clinical care of these complex patients. Conclusions: The design of invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis in the necessary permanent and continuous knowledge improvement of surgeons represents a care-teaching tool that contributes to improve the professional performance at the time to attend to this type of patient.

Introdução: As habilidades processuais invariantes na peritonite pós-operatória permitem aos cirurgiões o diagnóstico precoce e a reoperação abdominal urgente. Objetivo: Projetar as habilidades processuais invariantes de atenção diagnóstica e terapêutica para peritonite pós-operatória destinadas a cirurgiões. Método: Uma pesquisa qualitativa foi realizada no Hospital Clínico Cirúrgico "Ambrosio Grillo" em Santiago de Cuba no trimestre maio-julho de 2022. A população do estudo consistiu em 33 profissionais que tratam de peritonite pós-operatória: 22 médicos (12 cirurgiões e 10 intensivistas) e 11 graduados em enfermagem. Utilizou-se como método teórico a sistematização e como métodos empíricos a revição documental com revisão de histórias clínicas e a observação com a prática docente-atencional da autora principal. Resultados: Desenharam-se competências processuais invariantes para o diagnóstico precoce e terapêutica da peritonite pós-operatória dirigidas a cirurgiões com especial importância no método clínico. O autopreparo do sujeito em questão possibilita a complementação dos conhecimentos e habilidades aprendidas, bem como a atualização de conhecimentos que garantem o cuidado clínico cirúrgico desta complexa doença. Conclusões: O desenho de habilidades processuais invariantes para o diagnóstico precoce e tratamento da peritonite pós-operatória no necessário aperfeiçoamento permanente e contínuo dos cirurgiões representa uma ferramenta cuidado-ensino que contribui para o aperfeiçoamento da atuação profissional frente a este tipo de paciente.

El error en la práctica médica / Error in Medical Practice

Introducción: El error está presente en cualquier actividad humana y la práctica de la medicina no es una excepción. Debido al aumento de los conocimientos sobre la salud y las enfermedades, la posibilidad de error, relacionada con la atención de estas últimas, disminuye, pero no se ha eliminado en su totalidad. Objetivo: Exponer las experiencias de los autores acerca del error en la práctica médica. Métodos: Revisión bibliográfica entre los años 2000 y 2020. Se localizaron y consultaron fuentes bibliográficas validadas en: Medline, PubMed y SciELO, a las que se accedió a través de la biblioteca virtual de salud. Se utilizaron para la búsqueda las palabras clave error médico, iatrogenia, responsabilidad penal del médico, método clínico. Se revisaron también tres bibliografías anteriores que se consideraron de utilidad para el artículo y tres capítulos de libros con temas afines, además de las resoluciones del Ministerio de Salud Pública de Cuba que tratan acerca del error médico. Al final se seleccionaron 21 bibliografías en idiomas español e inglés. Conclusiones: Existen grandes posibilidades de errores en el proceso del diagnóstico y tratamiento de los enfermos. El desarrollo de la tecnología y la mejoría en la construcción de guías y protocolos disminuyen las probabilidades de equivocaciones, pero no las eliminan. El perfeccionamiento en la formación de recursos humanos, unido al uso correcto del método clínico es una estrategia eficaz para disminuir los errores en la práctica médica(AU)

(AU)ntroduction: Error is present in any human activity; the medical practice is not an exception. Due to an increase in knowledge about health and diseases, error possibility related to disease management is decreasing, but has not been totally eliminated. Objective: To expose the authors' experiences regarding error in medical practice. Methods: A bibliographic review was carried out, covering the years between 2000 and 2020. Validated bibliographic sources were located and consulted in Medline, PubMed and SciELO, accessed through the Virtual Health Library. The following keywords were used for the search: error médico [medical error], iatrogenia [iatrogenic error], responsabilidad penal del médico [physician criminal liability] and método clínico [clinical method]. Three previous bibliographies considered useful for the article and three book chapters with related topics were also reviewed, in addition to the resolutions of the Ministry of Public Health of Cuba dealing with the topic of medical error. Finally, 21 bibliographies in Spanish and English were selected. Conclusions: There are great possibilities of errors in the process of patient diagnosis and management. The development of technology, as well as the improvement in the construction of guides and protocols, decreases the probabilities of errors, but do not eliminate them. The improvement in the training of human resources, together with the correct use of the clinical method, is an effective strategy to reduce errors in medical practice(AU)

Alfredo Darío Espinosa Brito: insigne de las ciencias médicas

Introducción: Cuando se habla del símbolo de las generaciones de especialistas que se dedican a la Medicina Interna es necesario referirse al Doctor Alfredo Darío Espinosa Brito, destacado internista cienfueguero que cuenta con una fecunda trayectoria merecedora del reconocimiento de la comunidad médica. Objetivo: Describir los acontecimientos significativos de su vida y obra. Métodos: Se realizó una investigación de tipo descriptiva, que utiliza la historia de vida para lograr su propósito. Fue empleado el método teórico histórico-lógico; para la recolección de datos, se realizó una revisión documental y el testimonio directo de la voz del profesor como fuente primaria de obtención de la información. Desarrollo: los progenitores le inculcaron nobles principios de honradez que definieron su personalidad. Tuvo una trayectoria estudiantil sobresaliente marcada por ideas progresistas. Cuenta con una brillante carrera profesional merecedora de múltiples condecoraciones, pues su influencia ha sido esencial en la enseñanza del método clínico. Conclusiones: El doctor Espinosa ha contribuido sobremanera al desarrollo de la Medicina Interna, la Terapia Intensiva y la Geriatría en el territorio, además de realizar importantes aportes docentes, investigativos, teóricos y prácticos al avance de la enseñanza y de la Salud Pública en Cuba.

Introduction: When talking about the symbol of the generations of specialists dedicated to Internal Medicine, it is necessary to refer to Dr. Alfredo Darío Espinosa Brito, an outstanding internist from Cienfuegos who has a fruitful career deserving the recognition of the medical community. Objective: To describe the significant events of his life and work. Methods: A descriptive research was carried out, using life history to achieve its purpose. The historical-logical theoretical method was used; for data collection, a document review and the direct testimony of the professor's voice were used as the primary source of information. Development: His parents instilled in him noble principles of honesty that defined his personality. He had an outstanding student career marked by progressive ideas. He has a brilliant professional career deserving of multiple decorations, as his influence has been essential in the teaching of the clinical method. Conclusions: Dr. Espinosa has contributed greatly to the development of Internal Medicine, Intensive Care and Geriatrics in the territory, in addition to making important teaching, research, theoretical and practical contributions to the advancement of teaching and Public Health in Cuba.

The biopsychosocial model in paediatric clinical practice-An interdisciplinary approach to somatic symptom disorders.

AIM: The paper aims to show how the biopsychosocial (BPS) model can be applied as a clinical method and guide the assessment and treatment of children and adolescents with somatic symptom disorders (SSD). METHODS: Based on relevant literature and our clinical work with children and adolescents with SSD, we have developed a method to ensure a structured, interdisciplinary examination of biological, psychological and social factors, operationalising the BPS model into a clinical method. RESULTS: The BPS model renders assessment and treatment of complex conditions as a basis for evaluating phenomena not confined by diagnostic tools, but still includes all information from these tools. It requires an interdisciplinary approach, giving individual patient and caregivers a central position. A thorough medical examination is required as a starting point for assessments. Good results rest upon a shared understanding between patient, caregivers and professionals. CONCLUSIONS: 'Biopsychosocial' is often claimed as a basis for clinical work with complex cases, medical, functional and psychiatric, but scarcely with a corresponding BPS method or practice. The BPS method should guide further development of holistic, interdisciplinary health care on all levels, to assess and help children and adolescents with SSD.

Nutrición clínica o clínica de la nutrición / Clinical Nutrition or Nutrition Clinic

Introducción: El diagnóstico de la desnutrición ha tenido un complejo proceso histórico y su concepto ha transitado por numerosas tentativas para definirla. La palabra desnutrición y especialmente el término malnutrición crean bastante confusión entre los estudiosos del tema. En la última década han surgido consensos variados para clasificar la desnutrición asociada a las enfermedades unida a la carga que representan el sobrepeso y obesidad en la presencia de enfermedades crónicas y agudas. Objetivo: Conocer cómo las nuevas tecnologías mejoran el conocimiento de los trastornos nutricionales mediante la descripción e integración de sus compartimentos corporales, pero no están al alcance de los equipos de salud ni de los pacientes en los diversos escenarios de trabajo. Desarrollo: La nutrición constituye una ciencia integrada por un conjunto de disciplinas científicas que transitan desde las ciencias exactas, hasta las ciencias políticas. La aplicación del método clínico como una modalidad del método científico obliga a considerar a la nutrición también con esta visión y no como la última opción del médico en una intervención diagnóstica o terapéutica, contaminada por mitos, tabúes y prejuicios culturales. La medicina clínica proporciona competencias duras adquiridas en forma de conocimientos y habilidades a lo largo de la formación preprofesional y de postgrado, que unidas a la competencias blandas garantizarán una labor exitosa incluidos los entornos culturales hostiles, tóxicos y /o caóticos. Conclusiones: Existen tendencias a seguir patrones y guías de sociedades de países con grandes recursos financieros y tecnológicos para la investigación, que no siempre en están en consonancia con nuestras realidades. La aparición de la pandemia COVID-19, ha planteado nuevos desafíos y serias amenazas tanto para las personas, como a los sistemas de salud de forma global que afectó de manera importante a los pacientes ancianos, con cáncer y enfermedades crónicas junto al choque de la pandemia de la obesidad con la del Coronavirus(AU)

Introduction: The diagnosis of malnutrition has had a difficult historical process and its concept has gone through numerous attempts to define it. The word undernourishment and especially the term malnutrition creates a lot of confusion among scholars of the subject. In the last decade, various consensuses have emerged to classify malnutrition associated with diseases together with the burden represented by overweight and obesity in the presence of chronic and acute diseases. Objective: To identify how new technologies improve knowledge of nutritional disorders through the description and integration of their body compartments, but they are not available to health teams or patients in various work settings. Findings: Nutrition is a science made up of a set of scientific disciplines that range from exact sciences to political sciences. The application of the clinical method as a modality of the scientific method makes it necessary to consider nutrition also with this vision and not as the last option of the doctor in a diagnostic or therapeutic intervention, contaminated by myths, taboos and cultural prejudices. Clinical medicine provides hard skills acquired in the form of knowledge and skills throughout pre-professional and postgraduate training, which together with soft skills will guarantee successful work, including hostile, toxic and/or chaotic cultural environments. Conclusions: There are tendencies to follow patterns and guides of societies in countries with great financial and technological resources for research, which are not always in line with our realities. The appearance of the COVID-19 pandemic has posed new challenges and serious threats to both people and health systems globally, significantly affecting elderly patients, those with cancer and chronic diseases, along with the shock of the COVID-19 pandemic, obesity with that of the Coronavirus(AU)

Aproximación a la formación por competencias profesionales desde las asignaturas Propedéutica Clínica y Medicina Interna / An approach to professional competence-based formation from the subjects of Clinical Propaedeutic and Internal Medicine

Introducción: La formación del capital humano en salud y, por tanto, la del médico no están estructuradas sobre la base de competencias profesionales, a pesar de su importancia en la educación del hombre y estar contempladas en el propósito básico de la carrera de Medicina. Objetivo: Exponer mediante análisis crítico las potencialidades del diseño curricular basado en competencias profesionales desde las asignaturas de Propedéutica Clínica y Medicina Interna en la carrera de Medicina. Desarrollo: Se aborda cómo el proceso de formación del pregrado requiere redimensionamiento y perfeccionamiento curricular, con mayor aproximación al objeto de la profesión, a través de la formación por competencias. Además, cómo aprovechar la educación en el trabajo en Propedéutica Clínica y Medicina Interna, esenciales y rectoras, mediante el pase de visita y la discusión diagnóstica, que constituyen ambientes inapreciables para desarrollar la formación por competencias, donde el método clínico tiene su cimiento más sólido. De manera que la formación por competencias se convierta en instrumento esencial para el perfeccionamiento en el campo educacional y represente una propuesta útil avalada por prestigiosos organismos internacionales, que urge generalizar en pos del mejoramiento continuo de la educación. Conclusiones: La estructuración de un plan de estudio basado en competencias profesionales puede respaldar resultados formativos superiores, para lograr un egresado universitario más preparado, trascendente y comprometido con la sociedad, que sea capaz de cumplir mejor el encargo social del sistema de salud cubano(AU)

Introduction: The formation of human resources in health and, subsequently, that of the physician are not structured on the basis of professional competences, despite their importance in the education of human beings and the fact that they are included in the basic purpose of the medical major. Objective: To expose, through critical analysis, the potentialities of the curricular design based on professional competences with respect to the subjects of Clinical Propaedeutic and Internal Medicine in the medical major. Development: This work addresses how the undergraduate training process requires redimensioning and improvement of its curricular design, with greater approximation to the object of the profession, through competence-based training. In addition, it addresses how to take advantage of education at work in the subjects of Clinical Propaedeutic and Internal Medicine, as far as they are both essential and guiding, by means of patients' visits and diagnostic discussions as invaluable settings for developing competence-based training, where the clinical method has its most solid foundation. Thus, competence-based training becomes an essential instrument for improvement in the educational field and represents a useful proposal endorsed by prestigious international organizations, which urgently needs to be generalized for the continuous improvement of education. Conclusions: The structuring of a study plan based on professional competences can support superior training outcomes, in view of achieving a more prepared university graduate, with a transcendent performance and committed to society, who is able to fulfill better the social task of the Cuban health system(AU)

El método clínico en la atención a niños con neumonías recurrentes: contradicciones teórico-prácticas

RESUMEN Introducción: Las manifestaciones pulmonares recurrentes en los niños se definen con la frase neumonías recurrentes. La aplicación del método clínico en la atención a pacientes con esas afecciones debe estar encaminada a cumplir su objetivo rector, definido por la identificación y control de la causa subyacente que motiva la recurrencia de las manifestaciones pulmonares. Sin embargo, ese objetivo no siempre se cumple adecuadamente. Objetivo: Describir un grupo de contradicciones en el cuerpo del conocimiento de las neumonías recurrentes en los niños y su influencia en la ejecución del método clínico durante el proceso de atención médica a esos pacientes. Método: A partir de la revisión de la literatura, en una primera etapa se realizó un análisis etimológico y terminológico de la frase "neumonías recurrentes", así como de sus definiciones conceptual y operacional. En una segunda etapa, a partir de las insuficiencias detectadas, se efectuó una valoración crítica de cómo éstas pueden influir en la forma en que los profesionales aplican el método clínico en la atención médica a los niños con esas afecciones. Análisis e integración de la información: Se identificaron contradicciones teórico-prácticas en las definiciones conceptual y operacional de las neumonías recurrentes en niños, las cuales pueden constituir el fundamento de los errores que se producen de manera sistemática durante la recogida de la información y la formulación de hipótesis en el proceso de atención médica en esos pacientes. Consideraciones finales: La aplicación del método clínico en la atención a niños con neumonías recurrentes puede presentar insuficiencias condicionadas por contradicciones teórico-prácticas.

ABSTRACT Introduction: Recurrent pulmonary manifestations in children are defined by the phrase recurrent pneumonias. The application of the clinical method in the care of patients with these conditions must be aimed at fulfilling its guiding objective, defined by the identification and control of the underlying cause that motivates the recurrence of pulmonary manifestations. However, that goal is not always adequately met. Objective: Describe a group of contradictions in the body of knowledge of recurrent pneumonias in children and their influence on the execution of the clinical method during the process of medical care for these patients. Method: Based on the literature review, in a first stage an etymological and terminological analysis of the phrase "recurrent pneumonias" was carried out, as well as its conceptual and operational definitions. In a second stage, based on the insufficiencies detected, a critical assessment was made of how these can influence the way in which professionals apply the clinical method in medical care to children with these conditions. Analysis and integration of information: Theoretical-practical contradictions were identified in the conceptual and operational definitions of recurrent pneumonias in children, which may constitute the basis of the errors that occur systematically during the collection of information and the formulation of hypotheses in the process of medical care in these patients. Final considerations: The use of the clinical method in the care of children with recurrent pneumonia may present insufficiencies conditioned by theoretical-practical contradictions.

R. B. Braithwaite's influence on Bion's epistemological contributions.

This paper presents evidence that Bion's epistemological contributions drew on the work of R. B. Braithwaite, a British philosopher of science, more than has generally been acknowledged. Braithwaite introduced the "scientific deductive system", a term Bion adopted. It proposed that empirical scientific methods could be applied to immaterial subjects of study, including "unconscious mental processes" (Braithwaite 1953, ix). Bion's private work journal, collected in Cogitations, documents Braithwaite's direct influence throughout its entries, particularly in one dated 10 January 1959, entitled "Scientific method" (Bion 1959b). This paper reviews relevant elements of Braithwaite's work, and examines Bion's "Scientific method" and samples from his epistemological work to argue that one of Bion's goals was to bring an empirically based scientific model to psychoanalytic theory and clinical practice. More than a matter of academic interest, Braithwaite's work lends pragmatically useful context to understand Bion's theoretical and clinical intentions in greater depth. It also suggests the main reasons why his project did not come fully to fruition, which led Bion to turn from the scientific deductive system towards his later developments.

El método clínico y el carácter científico de la medicina clínica / The clinical method and the scientific character of clinical medicine

Introducción: El cuestionamiento del carácter científico de la medicina clínica se incluye entre los problemas epistemológicos de las ciencias. Objetivo: Revisar la contribución de la medicina clínica como ciencia aplicada, con énfasis en la metódica que le distingue: el método clínico. Métodos: Se revisó la bibliografía especializada, complementada con el empleo de procedimientos de investigación cualitativa que incluyeron: entrevistas a profesionales de reconocida experiencia, trabajo con grupos focales y sesiones en profundidad. Desarrollo: El desarrollo histórico del pensamiento científico tuvo impacto en la medicina clínica, la cientificidad del método clínico explicada desde diferentes enfoques, la respuesta a las críticas del positivismo y la manera en que la medicina clínica cumple con los requerimientos para su aceptación como ciencia aplicada. Conclusiones: Se fundamentó la cientificidad de la medicina clínica desde un enfoque dialéctico distinguida por su carácter interdisciplinar, su condición de ciencia aplicada y por una metódica científica que posibilita el desempeño profesional del médico con el enfermo, el individuo en riesgo de enfermar y el hombre aparentemente sano: el método clínico(AU)

Introduction: The questioning the scientific character of clinical medicine is included among the epistemological problems of science. Objective: To review the contribution of clinical medicine as an applied science, with emphasis on the method that distinguishes it: the clinical method. Methods: The specialized bibliography was reviewed, complemented with the use of qualitative research procedures that included interviews with professionals with proven experience, working with focus groups and in-depth sessions. Findings: The historical development of scientific thought had an impact on clinical medicine, the scientificity of the clinical method explained from different approaches, the response to the criticisms of positivism and the way in which clinical medicine meets the requirements for its acceptance as applied science. Conclusions: The scientificity of clinical medicine was founded from a dialectical approach distinguished by its interdisciplinary nature, its condition of applied science and by a scientific method that enables the professional performance of the physician with the patient, the individual at risk of becoming ill and apparently healthy man: the clinical method(AU)

La percepción de auxiliares de la enseñanza y estudiantes del ciclo clínico de la carrera de medicina de la FCM-UNA, sobre el proceso de enseñanza y aprendizaje del método clínico / The perception of educational assistants and medicine students of the clinical cycle of the FCM-UNA medicine career, on the teaching and learning process of the clinical method

El método clínico (MC) es reconocido como la vía fundamental para la formación y desarrollo de las habilidades profesionales, entre ellas la racionalidad médica. Como método de enseñanza en el ciclo clínico de las escuelas de medicina contribuiría a sistematizar todas las habilidades que la integran. Esta investigación cualitativa con enfoque hermenéutico tiene como propósito comprender e interpretar las percepciones de auxiliares docentes y estudiantes del ciclo clínico de la carrera de medicina de la FCM.UNA., sobre el proceso de enseñanza y aprendizaje (E-A) del mismo. En el año 2012, se analizaron como dimensiones categoriales: estrategia didáctica, planificación, aprendizaje, estilo docente y evaluación. De la percepción de los actores, se aprecia el gran valor que otorgan al MC como estrategia de enseñanza orientada al desarrollo de las habilidades clínicas y de la lógica de la profesión, y a las actividades prácticas con casos reales. Se percibe cierta fricción entre una enseñanza planificada según contenidos y una más flexible con pacientes reales que posibilite enfrentar lo emergente. Se aprecian diferentes estilos y rutinas docentes y una tensión entre estilos tradicionales y progresistas. Se evidencia mayor valoración de clases prácticas respecto a teóricas y preocupación ante la ausencia de estándares de evaluación. Se jerarquiza la evaluación práctica con pacientes para el aprendizaje de las habilidades clínicas y reorientar el proceso formativo. Asumiendo la validez del MC como estrategia para la formación médica integral, surge la necesidad de estimularlo como método de enseñanza en nuestra institución.

The clinical method (CM) is recognized as the fundamental way for the training and development of professional skills, including medical rationality. As a teaching method in the clinical cycle of medical schools, it would contribute to systematize all the skills that comprise it. This qualitative research with a hermeneutical approach aims to understand and interpret the perceptions of teaching assistants and students of the clinical cycle of the FCM.UNA medical career, about the teaching and learning process (E-A) of the same. In the year 2012, they were analyzed as categorical dimensions: didactic strategy, planning, learning, teaching style and evaluation. From the perception of the actors, the great value they give to the CM as a teaching strategy oriented to the development of clinical skills and the logic of the profession, and to practical activities with real cases can be appreciated. There is a friction between a planned teaching according to content or a more flexible one with real patients that makes it possible to face the emergent. Different styles and teaching routines and a certain tension between traditional and progressive styles are appreciated. There is a greater appreciation of practical classes regarding theoretical and concern in the absence of evaluation standards. The practical evaluation with patients is prioritized for learning clinical skills and redirecting the training process. Assuming the validity of the CM as a strategy for comprehensive medical training, the need arises to stimulate it as a teaching method in our institution.

Comparative study of clinical methods versus ultrasound methods for accurate gestational age determination in different trimesters of pregnancy, Ndop District Hospital, North West region, Cameroon.

INTRODUCTION: gestational age is the estimated age of gestation from a fetus during its development and this is very important for the mother who wants to know when to expect the birth of her baby and for the health care provider so they can chose the time at which to perform various assessment. However, from the information outlined in this research, it can be seen that last menstrual period (LMP) and follicle-stimulating hormone (FSH) are used to assess gestational age. While GSD, CRL, BPD, HC, AC and FL are biometric parameters that can be measured on a fetus in order to estimate gestational age. Many clinicians and ultrasonologists feel that if they are unable to obtain an accurate measurement at the time, they have sometimes failed to do an adequate job. METHODS: the study was a comparative study on clinical method versus ultrasound method for accurate gestational age determination and also to determine the significance of fetal biometric parameter in GA determination. The study was an observational, cross sectional and participatory study for a period of 5 weeks from the 22nd of January to the 22nd of February 2018. A total of 72(74.2%) ANC cases were sampled during ultrasonography. Gestational ages from their clinic card were recorded. Twenty five questionnaires were given out to 25(26.8%) health care personnel to assess clinical method. Data was analyzed using SPSS version 16 plus and Microsoft Excel 2010. RESULTS: results showed the best clinical method used was LMP with 9(36%) but when compared to ultrasound, ultrasound presented with greater accuracy of 15(60%) and clinical method 10(40%). CONCLUSION: based on the findings, it could be concluded that compared to the physical examination and clinical methods, ultrasound examination of the fetus provided the physician and health care professionals with greater accuracy for gestational age.

Evaluación del método clínico en el diagnóstico de la cefalea oftalmológica en niños / Evaluation of the clinical method in the diagnosis of ophthalmic headache in children / Avaliação do método clínico no diagnóstico de cefaléia oftálmica em crianças

RESUMEN Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos.

ABSTRACT Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders.

RESUMO Introdução: a dor de cabeça é um dos motivos mais comuns de consulta para as quais as pessoas vão aos serviços médicos; é uma importante causa de incapacidade, o que traz conseqüências em nível pessoal. Objetivo: avaliar o uso do método clínico no diagnóstico de cefaleia de causa oftalmológica em idade pediátrica. Método: estudo observacional, descritivo, transversal, com 192 pacientes atendidos no Serviço de Emergência em Oftalmologia do Hospital Pediátrico Hermanos Cordové, no período de janeiro a dezembro de 2019. As variáveis ​​estudadas foram: idade e sexo, educação escolar, história patológica pessoal, características da dor de cabeça e diagnóstico presuntivo. Resultados: houve predomínio de pacientes do sexo feminino entre 6 e 7 anos de idade, frequentadoras do ensino fundamental, sem histórico patológico pessoal, com cefaléia de início subagudo, episódica, que afeta as atividades diárias, que aparecem a qualquer hora do dia, acompanhadas principalmente de distúrbios visuais e náuseas e vômitos, prevalecendo como diagnóstico presuntivo de enxaqueca. Conclusões: Foi demonstrado que o maior percentual de pacientes que compareceu ao pronto-socorro oftalmológico por cefaleia não estava relacionado a distúrbios oftalmológicos.

[Self-Awareness of Performing Patient-Centered Medicine in General Practice / Family Medicine: Development of a Measurement Scale]. / Auto Perceção do Desempenho da Medicina Centrada na Pessoa em Medicina Geral e Familiar: Criação de Um Instrumento de Medição.

INTRODUCTION: Patient Centred Medicine is a method and a model of practicing allowing gains for both the doctor and the patient. Its practice must be evaluated for purposes of continuous professional development and continuous medical education. The aim of this study was to create an instrument focused in measuring the practice based on person centered medicine in general and family medicine, as well as in determining its reliability and validity. MATERIAL AND METHODS: A first version of a questionnaire according to the four dimensions of the patient- centred clinical method was revised in a focus group providing the content validity. The final questionnaire includes 22 items, using a Likert scale with four response options. Factorial analysis made it possible to confirm the dimensions defined by Moira Stewart, and internal consistency, test-retest reproducibility and item-total correlations were determined. The online implementation of the questionnaire to a sample of 905 family doctors guaranteed the construct and criterion validities. RESULTS: The measurement instrument includes four dimensions: (i) exploring health, disease and the illness experience; (ii) investing in the doctor-patient relationship; (iii) seeking understanding; and (iv) understanding the whole person. The internal consistency was demonstrated with a global Cronbach's alpha of 0.892, varying between 0.783 and 0.844 for all dimensions. The test-retest reproducibility obtained an intraclass correlation value between 0.678 and 1.000. The item-total correlations varied between 0.457 and 0.870. Women doctors are more aware than their colleagues about seeking understanding with the person, and young doctors are more susceptible to approach the disease through history and to seek understanding with the patient. Specialist physicians have shown to be more careful with the history and with viewing the patient as a whole and the professionals who work in a Family Health Unit are those who seek a better understanding with the person. Finally, specific training about person centered medicine and about consultation in person centered medicine demonstrated a positive impact in all dimensions of the person-centred medicine and this is acknowledged by professionals. DISCUSSION: The assessment of self-perception of person-centred medicine is now possible. CONCLUSION: The questionnaire presents good reliability and validity, thus allowing doctors to assess their main weaknesses, as well as enabling the development of specific training.

Introdução: A Medicina Centrada na Pessoa é um método e modelo de prática permitindo ganhos para o médico e o paciente, devendo a sua prática ser avaliada para fins de desenvolvimento profissional contínuo e educação médica continuada. O objectivo deste estudo foi construir, determinar a fiabilidade e a validade de um instrumento capaz de aferir a auto perceção genérica da prática médica segundo a medicina centrada na pessoa no ambiente de medicina geral e familiar.Material e Métodos: Uma primeira versão de um questionário segundo as quatro dimensões do método clínico centrado na pessoa foi revista por um grupo focal garantindo a validade de conteúdo. O questionário final engloba 22 itens, utilizando para resposta uma escala de Likert com quatro opções. A análise fatorial permitiu confirmar as dimensões definidas por Moira Stewart, tendo também sido determinada a consistência interna, a reprodutibilidade por teste-reteste e a correlação item-total. A aplicação online a uma amostra de 905 médicos de medicina geral e familiar permitiu testar as validades de constructo e de critério.Resultados: O instrumento de medição inclui quatro dimensões: (i) explorar a saúde, a doença e a experiência de doença, (ii) investir na relação médico-doente; (iii) procurar entendimento; e (iv) compreender a pessoa como um todo. A consistência interna foi demonstrada com um alfa de Cronbach global de 0,892, variando entre 0,783 a 0,844 para todas as dimensões. A reprodutibilidade teste-reteste obteve um valor de correlação intraclasse entre 0,678 e 1,000. As correlações item-total variaram entre 0,457 e 0,870. As mulheres médicas estão mais sensibilizadas do que os seus colegas no que respeita à procura de entendimento com o doente e os médicos mais novos são os mais sensíveis à abordagem da doença através da anamnese e à procura de entendimento com o doente. Os especialistas demonstraram ter mais cuidado com a anamnese e com o facto de encarar o doente como um todo, e os profissionais que trabalham numa unidade de Saúde Familiar são os que procuram um melhor entendimento com a pessoa. Por fim, a formação específica sobre medicina centrada na pessoa e sobre consulta em medicina centrada na pessoa demonstraram ter um impacto positivoem todas as dimensões da medicina centrada na pessoa e isso é reconhecido pelos próprios profissionais.Discussão: A avaliação da auto perceção de desempenhar medicina centrada na pessoa é agora possível.Conclusão: O presente questionário apresenta boa fiabilidade e validade permitindo ao médico verificar quais as principais insuficiências bem como desenvolver formação específica.

Exchanges and interactions between Padua and Vienna medical schools in the XIX century.

It is well known that Padua Medical School, Italy, played a fundamental role in shaping modern medicine. Its golden age lasted from the late XV to the late XVIII century, thanks in particular to its extraordinary anatomical school. One of the last fundamental achievements of the Padua Medical School was the founding of the anatomo-clinical method and organ pathology by Giovanni Battista Morgagni, Professor of Theoretical Medicine in Padua from 1711 and 1715 and of Anatomy from 1715 to his death. This method, which dramatically changed the course of medical diagnosis and therapy, was immediately developed by the so-called Anatomo-Clinical School of Paris. Figures such as Jean-Nicolas Corvisart and René Laennec improved this new approach in the clinical setting with the method of auscultation and the introduction of the stethoscope. However, organ pathology probably found its most important modern expression in the so-called Viennese School of Medicine, thanks to figures such as Karl von Rokitansky, Joseph Skoda and Theodor Billroth. In that period, this school was described by the anatomist Rudolf Virchow as "the Mecca of medicine." As is well known, Padua and Venice fell under the rule of the Austro-Hungarian Empire between the end of the XVIII and the beginning of the second half of the XIX century. The most important influences and changes at the University of Padua were introduced by the Viennese School during the so-called Third Austrian Domination (1813-1866), with improvements of medical curriculum, the founding of new specialist medical institutes and a general advancement of medical science, inspired by the technical-practical approach typical of this school. In particular, the new chair and Institute of Pathological Anatomy was founded by Lodovico Brunetti, pupil of Rokitansky, who influenced his appointment at Padua. In this way, we can advance that, at the end, the Morgagni method came back to Padua through the leading role of the Vienna Medical School, which deeply influenced the University of Padua during the different phases of Austrian domination in north Italy.

Non-invasive in vivo measurement of ocular rigidity: Clinical validation, repeatability and method improvement.

Ocular rigidity (OR) is thought to play a role in the pathogenesis of glaucoma, but the lack of reliable non-invasive measurements has been a major technical challenge. We recently developed a clinical method using optical coherence tomography time-lapse imaging and automated choroidal segmentation to measure the pulsatile choroidal volume change (ΔV) and calculate OR using Friedenwald's equation. Here we assess the validity and repeatability of this non-invasive technique. We also propose an improved mathematical model of choroidal thickness to extrapolate ΔV from the pulsatile submacular choroidal thickness change more accurately. The new mathematical model uses anatomical data accounting for the choroid thickness near the equator. The validity of the technique was tested by comparing OR coefficients obtained using our non-invasive method (OROCT) and those obtained with an invasive procedure involving intravitreal injections of Bevacizumab (ORIVI) in 12 eyes. Intrasession and intersession repeatability was assessed for 72 and 8 eyes respectively with two consecutive measurements of OR. Using the new mathematical model, we obtained OR values which are closer to those obtained using the invasive procedure and previously reported techniques. A regression line was calculated to predict the ORIVI based on OROCT, such that ORIVI = 0.655 × OROCT. A strong correlation between OROCT and ORIVI was found, with a Spearman coefficient of 0.853 (p < 0.001). The intraclass correlation coefficient for intrasession and intersession repeatability was 0.925, 95% CI [0.881, 0.953] and 0.950, 95% CI [0.763, 0.990] respectively. This confirms the validity and good repeatability of OR measurements using our non-invasive clinical method.

Implications of a Novel Method for Analyzing Communication in Routine Veterinary Patient Visits for Veterinary Research and Training.

The patient-centered clinical method (PCCM), a model developed to characterize communication during patient-physician visits in the 1980s, identifies elements of patient-orientated, physician-orientated, and shared dialogue during the encounter. The model also includes elements that reflect the emotional aspects of these interactions, recognizing expressions of feelings and exchanges related to both personal and medical interests. Fifty-five routine veterinary patient visits in the United Kingdom and United States were analyzed using the novel application of a PCCM adapted for veterinary patient visits. The patient visits were video recorded, transcribed, coded, and analyzed for frequency and proportion of PCCM elements observed. Elements representing the greatest proportion of patient visits were related to gathering information and shared decision making. Those representing the smallest proportion were related to signs of the presenting condition and effects of the condition on the clients' lives. Dialogue during the patient visits flowed iteratively and back and forth between the veterinarian and the client perspective. The findings suggest that patient visits are focused more on gathering information and planning rather than exploring effects of the health problem on the client's life, and that patient visits flow very iteratively and randomly between veterinarian and client perspectives. Both of these topics should be studied further and given emphasis in the way that communication models are developed and taught in order to enhance client-centeredness in veterinary patient visits.