Competencias profesionales gerenciales para el desempeño de los intensivistas cubanos / Professional Managerial Proficiencies for Cuban Intensivists Performance

Introducción: Los intensivistas son gerentes asistenciales que toman decisiones en situaciones de estrés, por lo que su desempeño no solo depende del conocimiento técnico, sino también de las competencias gerenciales que alcancen. Objetivo: Identificar las competencias profesionales gerenciales para el desempeño de los intensivistas cubanos en la actualidad. Métodos: Se realizó una investigación de desarrollo con enfoque mixto, desde junio hasta octubre del 2021. Se emplean métodos teóricos y empíricos, entre los que se encuentran sujetos clave y un cuestionario en el que se pone a consideración de expertos, por método Delphi, las dieciséis competencias gerenciales del modelo por competencias profesionales del especialista en MIE, se utilizó Alfa de Cronbach y análisis de desligamiento multidimensional. Resultados: El Alfa de Cronbach global y por ítems del cuestionario resultó ser alto. En el análisis de desligamiento multidimensional resultó que, de las 16 competencias analizadas, diez se correlacionan entre sí y seis se disgregan del resto. Conclusión: Fueron identificadas tres competencias profesionales gerenciales con diez elementos de competencias imprescindibles para el desempeño de los especialistas en MIE y se evidencia que el desarrollo de la esfera gerencial es esencial en el desempeño de los intensivistas en la actualidad(AU)

Introduction: Intensivists are care managers who make decisions in stressful situations, so their performance not only depends on technical knowledge, but also on the managerial skills they accomplish. Objective: To identify the managerial professional proficiencies for the performance of Cuban intensivists nowadays. Methods: A development research was carried out with a mixed approach, from June to October 2021. Theoretical and empirical methods are used, among which are key individuals are considered beside a questionnaire assessed by experts, by Delphi method, sixteen managerial capabilities of the model by professional capabilities of a MIE specialist. Cronbach's Alpha and multidimensional disengagement analysis were used. Results: The global Cronbach's Alpha and by items of the questionnaire turned out to be high. In the multidimensional decoupling analysis, it turned out that, out of the 16 competencies analyzed, 10 are correlated with each other and six are disaggregated from the rest. Conclusion: Three managerial professional proficiencies were identified with 10 elements of essential proficiencies for the performance of MIE specialists and it is evident that the development of the managerial sphere is essential in the performance of intensivists these days(AU)

Confidence and knowledge in emergency management among medical students across Colombia: A role for the WHO basic emergency care course.

INTRODUCTION: Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia. METHODS: A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses. RESULTS: Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8-62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1-61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (p<0.0001). CONCLUSION: Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.

A Novel Multimodal Approach to Point-of-Care Ultrasound Education in Low-Resource Settings.

Point-of-care ultrasound (POCUS) enables physicians to make critical diagnosis and treatment decisions at the bedside. However, access to and expertise with this technology remain limited in Peru. Establishing longitudinal POCUS educational curriculums in remote, low-resource settings can be challenging due to geographical distances, encumbering the ability to provide ongoing hands-on support. Previously described educational interventions have focused on training individual users on clinical applications of POCUS, rather than training physicians how to teach POCUS, thereby limiting scalability and sustainable impact. We therefore describe our experiences establishing the first ultrasound fellowship curriculum in Peru, which incorporates tele-ultrasonography to circumvent traditional geographical barriers.

Epidemiología del trauma maxilofacial, tratado quirúrgicamente en el Hospital de Urgencia Asistencia Pública: 3 años de revisión / Epidemiology of maxillofacial trauma, surgically treated in the Emergency Hospital Public Assistance: 3 years of revision

Resumen Introducción: El trauma maxilofacial (TMF) constituye un problema de relevancia en los centros hospitalarios de alta complejidad. Objetivo: Evidenciar y actualizar la epidemiología del trauma maxilofacial de resolución quirúrgica bajo anestesia general, en pabellón central tratado en el Hospital de Urgencia Asistencia Pública durante el período comprendido entre diciembre de 2014 a diciembre de 2017 y compararla con la realidad epidemiológica de otros centros hospitalarios de alta complejidad en Chile y en el extranjero. Materiales y Método: Se realizó un estudio retrospectivo en el que se analizaron los protocolos operatorios de los pacientes intervenidos quirúrgicamente por trauma maxilofacial, en pabellón central, bajo anestesia general, en un período de 37 meses. Las variables analizadas fueron diagnóstico, edad, género, tercio facial y zona anatómica afectada. Resultados: Se realizaron 127 procedimientos quirúrgicos, para resolver 259 fracturas. La edad promedio de los pacientes intervenidos fue de 33 años, con predominio del género masculino (85,8%); el tercio inferior fue el más afectado (77,2%), específicamente en la zona parasinfisiaria mandibular (22,4%). Discusión: Los resultados expuestos concuerdan con estudios realizados internacionalmente, pero tiene discordancia en relación a la zona anatómica más afectada al comparalo con los otros centros que analizaron su epidemiología. Conclusión: Resulta necesario continuar la investigación epidemiológica de estas patologías y unificar criterios de diagnóstico y tratamiento para poder establecer políticas de prevención y tratamiento eficientes en relación a cada servicio y en conjunto a nivel de salud pública.

Introduction: Maxillofacial trauma (MFT) is a relevant problem in highly complex hospital centers. Aim: To show and update the epidemiology of the maxillofacial trauma of surgical resolution under general anesthesia, in a major operating room, treated in the Emergency Hospital Public Assistance during the period from December 2014 to December 2017 and to compare it with the epidemiological reality of other high complexity hospital centers in Chile and abroad. Materials and Method: A retrospective study was carried out and the surgical protocols of the patients operated for maxillofacial trauma, in a major operating room, under general anesthesia, in a period of 37 months, were analyzed. The variables considered were diagnosis, age, gender, facial third and affected anatomic area. Results: 127 surgical procedures were performed, for the resolution of 259 fractures. The average age of the operated patients was 33 years, with predominance of the male gender (85.8%), the lower third was the most affected (77.2%), specifically in the parasymphysis area (22.4%). Discussion: The exposed results agree with studies carried out internationally, but it has discordance in relation to the most affected anatomical area at national level comparing it with the other hospitals that analyzed its epidemiology. Conclusion: It is necessary to continue the epidemiological investigation of these pathologies and to unify diagnostic and treatment criteria in order to establish efficient prevention and treatment policies in relation to each service and jointly at the level of public health.

Cuidados de enfermagem em crise hipertensiva: uma revisão integrativa / Nursing care hypertensive crisis: an integrative review

As formas agudas de hipertensão arterial constituem-se nas crises hipertensivas (CH), as quais representam uma causa frequente de emergência e consultas de atenção primária. O presente estudo teve como objetivo analisar as evidências científicas sobre os cuidados de enfermagem em CH publicadas na literatura nos últimos 10 anos. Trata-se de uma revisão integrativa desenvolvida a partir das etapas propostas pela literatura. Foram utilizadas as bases de dados Public Medline ou Publisher Medline (PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SCIELO) e selecionados os artigos publicados entre 2008 e 2018. Foram encontrados 10 artigos, sendo 40% deles nacionais, 50% dos Estados Unidos e 10% do México. Os achados apontam que os cuidados de enfermagem com o paciente em crise hipertensiva se referem à abordagem inicial do paciente em sala de emergência, avaliação inicial, intervenções da enfermagem relacionadas aos cuidados emergenciais, educação em saúde e medida de pressão arterial. É necessária a realização de estudos que abordem a atuação do enfermeiro frente aos cuidados prestados em CH, a fim de construir evidências para garantir a melhor forma de avaliar o cliente, identificar os diagnósticos de enfermagem para, então, propor intervenções eficazes

Acute forms of hypertension constitute hypertensive crises (HC), which represent a frequent cause of emergency and primary care consultations. This study aims to analyze scientific evidence relating to nursing care in HC published in the literature in the last ten years. This is an integrative review developed based on the stages proposed in the literature. The databases used were Public Medline or Publisher Medline (PubMed), Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SCIELO), selecting articles published between 2008 and 2018. Ten articles were found; 40% from Brazil, 50% from the United States and 10% from Mexico. The findings indicate that the nursing care of patients in hypertensive crisis relate to the initial approach to the patient in the emergency room, initial evaluation, nursing interventions related to emergency care, health education and blood pressure measurement. Studies are needed that address nurses' actions in relation to HC care, in order to construct evidence to ensure the best form of evaluating the client, identify the nursing diagnoses, and then propose effective interventions

Reclassification of risk in an emergency referral center: the need for a specific tool for the classification of onco-hematological patients. A cross-sectional study.

In emergency rooms, patients are usually classified using scales for predicting risk, resource usage, and the maximum time for receiving medical care. Emergency Severity Index (ESI) is a frequently used scale in this context. However, every patient with cancer is automatically classified as ESI level 3. In this study, patients with cancer seen at an emergency setting were reclassified using the ESI without the "cancer" parameter to verify whether there would be any change in the classification. Cross-sectional study. A convenience sample of all cancer patients who sought immediate care at a private center in Brazil during a 6-month period was included in the study. After receiving care according to the institution's standards, they were reclassified using the ESI scale without the "cancer" parameter. Times to receiving care and to reaching a diagnosis were recorded. In the study period, 360 patients were reclassified. They sought treatment for infection, pain, and gastrointestinal problems related to chemotherapy. The reclassification led to significant changes in the ESI risk level: 8.8% of the patients initially classified as level 4 had their level changed, as did 10.6% of those at level 3. The number of patients reclassified as level 1 was 3.2% higher than that of the initial classification (p < 0.001). There is a need to create a new scale for the classification of risk that takes the characteristics of patients receiving cancer treatment into account. Specific populations require specific classification scales for better evaluation of risk.