Clínica médica especializada: norma técnica No. 18-2020-DRACES / Specialized medical clinic: technical standard No. 18-2020-DRACES

DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto: "la regulación, autorización y control de las clínicas médicas especializadas, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo 376-2007." Es de carácter obligatorio, por lo que se aplica en todo el territorio nacional. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico.

Closing a Loophole: Medicine Works to Clarify MOC Law.

It was an important law that gave physicians new life, greatly restricting the discrimination they can face based on their maintenance of certification status. And yet, opponents may have found a way to circumvent the 2017 legislature's Senate Bill 1148.

[Specialism, specificity and identity - the controversiessurrounding autism in the Brazilian Unified Health System (SUS)]. / Especialismo, especificidade e identidade - as controvérsias em torno do autismo no SUS.

The passing of federal law 12,764/2012 marked a victory for the political activism of parents of autistic individuals in Brazil, but it also drew attention to the serious antagonism between parents of autistic individuals and the mental health network. This article examines the perspectives of social actors involved in the controversy that took place after the enactment of this law and seeks to show why this controversy precedes the passing of the law and is not resolved by it. The argument is that the troubled relationship between the political movement of parents of autistic individuals and the mental health network can be better understood when the construction and consolidation of a network of expertise around autism spectrum disorders as being inseparable from the construction of a social and political identity for autistic people in Brazil is taken into consideration. The article draws inspiration from the Studies of Expertise and Experience, which discuss the new regime of relations between scientific research and civil society. Nevertheless, it is also seen that the consolidation of this expertise network has arisen despite the absence of a broad specialized treatment network and of a profound reconfiguration in the regime of scientific research and production of knowledge about autism in Brazil.

A aprovação da Lei no 12.764/2012 representou uma vitória do ativismo político de familiares de autistas no Brasil, mas também deu visibilidade a um enorme antagonismo entre uma parcela significativa de pais de autistas e a rede de saúde mental. Este artigo analisa o posicionamento dos diferentes atores envolvidos na controvérsia que se sucedeu à aprovação e regulamentação da lei, e procura demonstrar as razões pelas quais essa polêmica antecede à lei e não se resolve com ela. Argumenta-se que a conturbada relação entre o movimento político de pais de autistas e a rede de saúde mental pode ser mais bem entendida se tomarmos a construção e a legitimação de uma rede de "expertise" a respeito dos transtornos do espectro autista como indissociável da construção de uma identidade social e política para os autistas no Brasil. O artigo utiliza como referência teórica os Estudos sobre Expertise e Experiência, que têm como principal pano de fundo uma discussão acerca do novo regime de relações entre a pesquisa científica e a sociedade civil. Entretanto, demonstramos também que a consolidação dessa rede de expertise vem ocorrendo apesar da ausência de uma ampla rede de tratamentos especializados e de uma reconfiguração profunda no regime de pesquisa e de produção de conhecimento sobre autismo no Brasil.

Especialismo, especificidade e identidade - as controvérsias em torno do autismo no SUS / Specialism, specificity and identity - the controversiessurrounding autism in the Brazilian Unified Health System (SUS)

Resumo A aprovação da Lei no 12.764/2012 representou uma vitória do ativismo político de familiares de autistas no Brasil, mas também deu visibilidade a um enorme antagonismo entre uma parcela significativa de pais de autistas e a rede de saúde mental. Este artigo analisa o posicionamento dos diferentes atores envolvidos na controvérsia que se sucedeu à aprovação e regulamentação da lei, e procura demonstrar as razões pelas quais essa polêmica antecede à lei e não se resolve com ela. Argumenta-se que a conturbada relação entre o movimento político de pais de autistas e a rede de saúde mental pode ser mais bem entendida se tomarmos a construção e a legitimação de uma rede de "expertise" a respeito dos transtornos do espectro autista como indissociável da construção de uma identidade social e política para os autistas no Brasil. O artigo utiliza como referência teórica os Estudos sobre Expertise e Experiência, que têm como principal pano de fundo uma discussão acerca do novo regime de relações entre a pesquisa científica e a sociedade civil. Entretanto, demonstramos também que a consolidação dessa rede de expertise vem ocorrendo apesar da ausência de uma ampla rede de tratamentos especializados e de uma reconfiguração profunda no regime de pesquisa e de produção de conhecimento sobre autismo no Brasil.

Abstract The passing of federal law 12,764/2012 marked a victory for the political activism of parents of autistic individuals in Brazil, but it also drew attention to the serious antagonism between parents of autistic individuals and the mental health network. This article examines the perspectives of social actors involved in the controversy that took place after the enactment of this law and seeks to show why this controversy precedes the passing of the law and is not resolved by it. The argument is that the troubled relationship between the political movement of parents of autistic individuals and the mental health network can be better understood when the construction and consolidation of a network of expertise around autism spectrum disorders as being inseparable from the construction of a social and political identity for autistic people in Brazil is taken into consideration. The article draws inspiration from the Studies of Expertise and Experience, which discuss the new regime of relations between scientific research and civil society. Nevertheless, it is also seen that the consolidation of this expertise network has arisen despite the absence of a broad specialized treatment network and of a profound reconfiguration in the regime of scientific research and production of knowledge about autism in Brazil.

Tesis doctorales de Medicina defendidas por mujeres pioneras en España (1882-1954) / Doctoral theses in Medicine by pioneer women in Spain (1882-1954)

FUNDAMENTO Y OBJETIVO: La presencia de mujeres pioneras en estudios superiores de Medicina en España cuenta con notables realizaciones. Este estudio indaga tesis doctorales en Medicina defendidas por mujeres en España desde 1882 a 1954 (el 1% de la producción total para ese periodo) e indexadas en las bases Cisne de la Universidad Complutense de Madrid. MATERIAL Y MÉTODO: Se recuperan y revisan 50 tesis doctorales. Se realiza un estudio longitudinal retrospectivo de análisis documental de tesis doctorales identificadas por año de defensa, título de cada tesis, nombre de la doctora, especialidad médica adscribible y palabras clave. RESULTADOS: El número de tesis de mujeres autoras se incrementa linealmente a lo largo del tiempo. Las especialidades médicas más comunes de tales tesis son: Ginecología y Obstetricia, Farmacología, Hematología, Pediatría y Endocrinología. También se realiza un conteo de frecuencias de los descriptores, en el cual destacan los términos: farmacología/terapia, educación, patogenia, enfermedad y niños. DISCUSIÓN Y CONCLUSIONES: La Medicina española dispone de 50 tesis doctorales pioneras defendidas por mujeres entre 1882 y 1954, aunque estas representan solo el 1% de la producción total de tesis doctorales en Medicina para ese periodo. Tan exiguo porcentaje alerta de un sesgo por techo de cristal que podría estar gravitando aún sobre las mujeres médicas. Una recomendación final se emite alentando a mejorar la situación de la mujer investigadora en Medicina

BACKGROUND AND OBJECTIVE: The presence of pioneer women in Spanish Medical Education has a notable impact. The objective of this study is to investigate doctoral theses in Medicine written by women in Spain between 1882 and 1954 and indexed in the Cisne library catalogue of Madrid Complutense University. These theses account for 1% of the total output for the period. MATERIAL AND METHOD: This retrospective longitudinal document analysis study examines doctoral theses identified by year of submission, title, author's name, ascribable medical speciality, and keywords. A total of 50 doctoral theses were identified and reviewed. RESULTS: The number of theses by female authors increased linearly over time. The most common medical specialities studied by female candidates were gynaecology and obstetrics, pharmacology, haematology, paediatrics, and endocrinology. The frequency of study descriptors was also calculated, and the following key terms detected: pharmacology/therapy, education, pathogenesis, disease, and children. DISCUSSION AND CONCLUSIONS: A total of 50 doctoral theses in medicine were written by pioneer female candidates in Spain between 1882 and 1954, accounting for just 1% of total output during this period. This tiny percentage indicates potential bias due to a glass ceiling that may continue to be a barrier to female doctors today. More still needs to be done to improve conditions for female medical researchers

Malpractice litigation in the endovascular era.

OBJECTIVE: The standard of care in the treatment of vascular disease continues to evolve as endovascular therapies develop. Currently, it is unclear how medical malpractice litigation has adapted to the "endovascular era." This retrospective case review is the most comprehensive analysis to date of malpractice actions involving endovascular procedures performed by vascular surgeons (VSs), interventional radiologists (IRs), interventional cardiologists (ICs), and cardiothoracic surgeons (CTSs). METHODS: The legal databases LexisNexis and Westlaw were searched for all published legal cases in the United States involving endovascular procedures. The search was limited to state and federal cases up to and including the year 2016. Keywords included "malpractice," "vascular," "endovascular," "catheter," "catheterization," "stent," "angiogram," "angiography," and "surgery." Cases involving tax revenue, insurance disputes, Social Security Disability, and hospital employment contract disputes were excluded. Data were analyzed using χ2 test. RESULTS: There were 2115 initial search results identified, and 369 cases were included in final analysis. The rate of endovascular procedure-related lawsuits (per 1000 active physicians in the specialty) was highest for ICs (105.56), whereas rates for VSs and IRs were comparable (18.47 and 16.85, respectively); 93% of the IC cases were related to coronary interventions. Overall, 55% (148/271 classifiable cases) of actions were related to elective procedures. For VSs specifically, 46% (25/54) of cases arose from diagnostic angiography and inferior vena cava filter placement, two relatively minor procedure types. Overall, 83% (176/211 finalized cases) of verdicts favored defendants, with no significant differences across the specialties; 43% (157/368) of total cases involved death of the patient. Among the four specialties, there was a significant (P = .0004) difference in the primary allegation (informed consent, preprocedure negligence, intraprocedure complications, or postprocedure complications) underlying the litigation. For CTSs and VSs, there was a predominance of informed consent and preprocedure negligence allegations (70% [7/10] and 52% [28/54], respectively). Intraprocedure negligence was the most common allegation for IRs (59% [23/39]), whereas allegations were more evenly distributed among ICs. CONCLUSIONS: Key issues were identified regarding malpractice litigation involving the specialties that commonly perform endovascular procedures. Despite the increasing number of ICs doing peripheral interventions, a large majority of IC cases were related to coronary treatments. A surprisingly large percentage of VS cases were related to seemingly minor cases. There were significant interspecialty differences in the primary underlying allegations. As the scope of endovascular procedures broadens and deepens, it is important for clinicians to be aware of legal considerations relevant to their practice.

Cambiar para avanzar. Un análisis del debate sobre el itinerario formativo de la psicología clínica en España / No disponible

El itinerario de formación en Psicología Clínica está siendo objeto de un gran debate en el mundo académico y profesional de la Psicología española. En este artículo se analizan críticamente los argumentos expuestos tanto por los partidarios como los detractores de que el Máster de Psicología General Sanitaria sea una condición necesaria para el acceso a la formación especializada. Se defiende claramente una secuenciación de la formación en Psicología Clínica, Grado - Máster - bEspecialidad, por razones lógicas, legales, profesionales, de convergencia con el modelo Europsy, y de oportunidad para establecer fuertes vínculos universidad - profesión. Se concluye que la adopción del itinerario fortalecerá no sólo a la especialidad y a la Psicología General Sanitaria, sino que puede ser una de las bases sobre las que se apoye el desarrollo científico y profesional de la Psicología Clínica en España

The training route in clinical psychology is the subject of much debate in the academic and professional world of Spanish psychology. This article critically analyzes the arguments of both the supporters and the opponents of the Master’s in General Health Psychology as a necessary condition for access to specialized training. A bachelor’s degree - master’s - specialty route for training in clinical psychology is clearly defended, for logical, legal, and professional reasons, and for convergence with the Europsy model, and the opportunity to establish strong ties between the universities and the profession. It is concluded that the adoption of the route will not only strengthen the specialty and general health psychology, but it may also be one of the foundations on which the scientific and professional development of clinical psychology in Spain rests

Impacto del Real Decreto de la Troncalidad en la formación en medicina preventiva y salud pública y en otras especialidades del tronco común médico / Impact of the Core Training Law on preventive medicine and public health training and other common medical specialties

Objetivo: El Real Decreto de Troncalidad (RDT) plantea modificar la formación sanitaria especializada, estableciendo 24 meses de formación troncal común. El objetivo de este estudio es valorar su potencial impacto en la formación especializada de medicina preventiva y salud pública (MPSP) y en otras especialidades del tronco común médico (TCM). Métodos: Se analizaron los programas de las 21 especialidades del TCM, recogiendo los periodos de rotación recomendados por cada especialidad y consensuando la información entre tres observadores. El impacto formativo se calculó como el porcentaje de meses que cada especialidad debería modificar para adaptarse al periodo común. Resultados: MPSP (100%, 24 meses) es la especialidad en la cual el RDT tendrá más impacto. Medicina intensiva (0%, 0 meses) y oncología médica (17%, 4 meses) son las especialidades menos afectadas. Conclusiones: El RDT va a afectar de manera diferente a las especialidades del TCM. El RDT supondrá un replanteamiento completo de sus actividades y de las competencias de los profesionales de MPSP (AU)

Objective: The purpose of the Core Training Law (CTL) is to amend specialised medical training to include 24 months of common training. The aim of this study is to assess its potential impact on the Preventive Medicine and Public Health (PM&PH) training programme and other medical specialties. Method: The programmes of the 21 common medical specialties were analysed and the recommended training periods for each specialty collected, before the information was agreed upon by three observers. The training impact was calculated as the percentage of months that should be amended per specialty to adapt to the common training schedule. Results: The Preventive Medicine and Public Health training programme is the specialty most affected by the Core Training Law (100%, 24 months). Intensive medicine (0%, 0 months) and medical oncology (17%, 4 months) is the least affected. Conclusions: The CTL affects the common medical specialties in different ways and requires a complete reorganisation of the activities and competencies of PM&PH professionals (AU)

Knowledge of the law about withholding or withdrawing life-sustaining treatment by intensivists and other specialists.

OBJECTIVE: Decisions about withholding or withdrawing life-sustaining treatment (WWLST) from adults who lack capacity are an integral part of intensive care (IC) practice. We compare the knowledge, attitudes and practice of intensivists in relation to the law about WWLST with six other specialties most often involved in end-of-life care. DESIGN, SETTING AND PARTICIPANTS: We used a cross-sectional postal survey of medical specialists in the three most populous Australian states, and analysed responses from 867 medical specialists from the seven specialties most likely to be involved in WWLST decisions in the acute-care setting (emergency, geriatric, palliative, renal and respiratory medicine, medical oncology and IC). MAIN OUTCOME MEASURES: Attitudes to, and knowledge and practice of, the law relating to end-of-life care. RESULTS: Of 2702 surveys sent to eligible practitioners, 867 completed questionnaires were returned. There was an overall response rate of 32% and an IC response rate also of 32% (125/388). Intensivists performed better than average in legal knowledge but important knowledge gaps remain. Intensivists had a more negative attitude to the role of law in this area than other specialty groups but reported being seen as a leading source of information about legal issues by other medical specialists and nurses. Intensivists also reported being the specialists most frequently making decisions about end-of-life treatment. CONCLUSIONS: Improved legal knowledge and open engagement with the law can help manage the risk of harm to patients and protect intensivists from liability. IC guidelines and continuing professional development are important strategies to address these issues.

Papel de la troncalidad en la formación especializada / Role of the core curriculum system (troncalidad) in the specialized training

La implantación en 1978 del sistema de formación sanitaria especializada (FSE) mediante residencia supuso un gran avance en el terreno de la educación médica en nuestro país. Años después, se inició su reforma con la Ley 44/2003, de Ordenación de las Profesiones Sanitarias, y, finalmente, después de casi una década de debates y enfrentamientos en diferentes foros, se ha publicado el Real Decreto 639/2014, que regula la troncalidad, la reespecialización y otros aspectos de la formación especializada y representa el cambio más importante desde que comenzó el sistema de residencia. El nuevo sistema distingue dos periodos en la formación especializada: uno en el que los residentes desarrollan las competencias que son comunes a varias especialidades, es decir, aquellas que conforman el bloque de base (o tronco), y otro en el que se adquieren las competencias específicas de la propia especialidad. En este nuevo modelo de troncalidad hay tres tipos bien definidos de competencias que debe lograr el futuro especialista: transversales (comunes a todos los profesionales de la salud), nucleares o troncales (comunes a un conjunto de especialidades de un bloque o tronco) y específicas de cada especialidad. Sin embargo, toda esta extensa regulación contrasta con la falta de adaptación a la realidad y la ausencia de una estructura educativa mínimamente profesionalizada en el sistema de salud en que se basa

The implementation in 1978 of the system of Specialized Healthcare Training (SHT) through residency in Spain has been a breakthrough in the field of medical education. Many years later, reform of the system of SHT came with the Law 44/2003, of planning of the health care professions, and, after a decade of debates and clashes in different forums, has been finally enacted Royal Decree 639/2014, which regulates the common core curricula of the specialties, the respecialisation and other aspects of specialized training, and represents the most significant change since the system of residency began. The new system distinguishes two periods in specialised training: one in which residents develop those competencies that are common across several specialties, that is to say, those that make up the core block (or trunk), and other one in which the competencies of the specialty itself are acquired. In this new model of core subjects there are three clearly defined types of competencies that the future health care specialist must accomplish: transversal (common to health care professionals), core (common to a set of specialties of a core block) and specific to each specialty. However, all this extensive regulation contrasts with the lack of adaptation to the reality and the lack of a minimally professionalized educational structure in the health care system on which it's based

Definign and implementing a model for pharmacy resident research projects / Definición e implantación de un modelo de proyectos de investigación para residentes en farmacia

Objective: To describe a standard approach to provide a support structure for pharmacy resident research that emphasizes self-identification of a residency research project. Methods: A subcommittee of the residency advisory committee was formed at our institution. The committee was initially comprised of 2 clinical pharmacy specialists, 1 drug information pharmacist, and 2 pharmacy administrators. The committee developed research guidelines that are distributed to residents prior to the residency start that detail the research process, important deadlines, and available resources. Instructions for institutional review board (IRB) training and deadlines for various assignments and presentations throughout the residency year are clearly defined. Residents conceive their own research project and emphasis is placed on completing assignments early in the residency year. Results: In the 4 years this research process has been in place, 15 of 16 (94%) residents successfully identified their own research question. All 15 residents submitted a complete research protocol to the IRB by the August deadline. Four residents have presented the results of their research at multi-disciplinary national professional meetings and 1 has published a manuscript. Feedback from outgoing residents has been positive overall and their perceptions of their research projects and the process are positive. Conclusion: Pharmacy residents selecting their own research projects for their residency year is a feasible alternative to assigning or providing lists of research projects from which to select a project (AU)

Objetivo: Describir un abordaje estándar para proporcionar una estructura de apoyo a los residentes de investigación en farmacia que enfatice la autoidentificación de un proyecto de investigación en la residencia. Métodos: En nuestra institución se creó un subcomité del comité asesor de la residencia. Inicialmente el comité se componía de 2 especialistas en farmacia clínica, un farmacéutico de información sobre medicamentos, y dos administradores de farmacia. El comité desarrolló guías que detallaban el proceso de investigación, fechas límite importantes, y recursos disponibles, y que se distribuyeron entre los residentes antes de comenzase la residencia. Se definieron claramente instrucciones para la junta de investigación de la institución (IRB) con entrenamiento y fechas límite para varias tareas y presentaciones a lo largo del año de residencia. Los residentes concebían su propio proyecto de investigación y se colocaba énfasis en completar las tareas de la parte inicial del año de residencia. Resultados: En los 4 años que este procedimiento de investigación lleva en vigor, 15 de los 16 (94%) residentes identificaron con éxito sus propias preguntas de investigación. Todos los 15 residentes enviaron un protocolo de investigación completo al IRB en la fecha límite de agosto. Cuatro residentes presentaron resultados de su investigación en reuniones profesionales nacionales multidisciplinarias y uno publicó un artículo. El retorno de los residentes salientes ha sido en general positivo y sus percepciones sobre sus proyectos de investigación y el proceso son positivas. Conclusión: Residentes de farmacia seleccionando su propio proyecto de investigación es una alternativa factible a asignar oa proporcionar listas de proyectos para que elijan uno (AU)