DNA damage and antioxidant status in medical residents occupationally exposed to waste anesthetic gases

PURPOSE:To investigate the effects of occupational exposure to waste anesthetic gases on genetic material and antioxidant status in professionals during their medical residency. METHODS:The study group consisted of 15 medical residents from Anesthesiology and Surgery areas, of both genders, mainly exposed to isoflurane and to a lesser degree to sevoflurane and nitrous oxide; the control group consisted of 15 young adults not exposed to anesthetics. Blood samples were drawn from professionals during medical residency (eight, 16 and 22 months of exposure to waste anesthetic gases). DNA damage was evaluated by comet assay, and antioxidant defense was assessed by total thiols and the enzymes glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT). RESULTS:When comparing the two groups, DNA damage was significantly increased at all time points evaluated in the exposed group; plasma thiols increased at 22 months of exposure and GPX was higher at 16 and 22 months of exposure. CONCLUSION:Young professionals exposed to waste anesthetic gases in operating rooms without adequate scavenging system have increased DNA damage and changes in redox status during medical residency. There is a need to minimize exposure to inhalation anesthetics and to provide better work conditions.

Advancing nursing practice: The role of the nurse practitioner in an acute stroke program

The Foothills Medical Centre in Calgary, AB, Canada, is a tertiarycare referral center for southern Alberta and southeastern British Columbia. The Calgary Stroke Program, which serves a population of 1.5 million people and a geographic territory of more than 114,233 square kilometers (44,622 square miles), annually offers acute and follow-up care to more than 1,000 people with stroke. Leading the team of healthcare professionals dedicated to providing excellence in stroke patient care is a stroke nurse practitioner (SNP). The nurse practitioner role in Canada, as in many healthcare settings, was initially developed in response to cutbacks in medical residency programs and increasing acuity levels of hospitalized patients (Irvine et al., 2000). This article describes the development of the SNP role and its impact on system and process changes and patient care and outcomes in an acute stroke program in the Calgary Health Region.

A assistência às pessoas vivendo com HIV/AIDS: aprendendo a cuidar do vírus ou da pessoa?

O presente estudo descreve e analisa o aprendizado dos médicos residentes para a prática da assistência às pessoas que vivem com HIV/Aids desenvolvida em um serviço de Doenças Infecciosas e Parasitárias de um Hospital Universitário no Estado do Rio de Janeiro. É uma pesquisa de cunho etnográfico, com a observação do processo de treinamento em consulta em ato da atenção, realizada por médico residente, sob supervisão de staffs do serviço. Os aspectos multicausais da Aids suscitam demandas tanto nos pacientes quanto nos profissionais de saúde envolvidos na assistência a essas pessoas. O processo de ensino/aprendizado na medicina prioriza a doença, relegando a segundo plano, o doente com suas questões subjetivas, sociais, culturais e econômicas. Entretanto, ao lidarem com estas pessoas, os médicos entram em contato com aspectos objetivos e subjetivos do processo de adoecimento individual. É neste momento, que fica evidente as lacunas deixadas neste processo de aprendizado. Paulatinamente, os médicos vão aprendendo a cuidar do vírus e seus efeitos. Eventualmente aprendem a cuidar também da pessoa. Para o alcance de uma atenção integral e humanizada ainda é necessário ampliar e aprofundar as reformulações no processo de ensino/aprendizagem dos médicos. Mudanças essas que permitam o aprendizado de cuidar bem tanto da carga viral, do CD4 e dos anti-retrovirais quanto da pessoa que porta o vírus.

A Residência Médica: articulações entre a prática e o ensino

O objetivo desta tese de doutorado é o estudo da residência médica e de suas articulações com o campo educacional e o da saúde. Propõe-se uma análise histórico - dialética, tomando como ponto de partida a articulação da medicina e da educação na estrutura social. Parte-se da concepção segundo a qual a prática e o saber no campo educacional e na saúde estão ligados à transformação histórica do processo de produção econômica. Essa compreensão remete à chamada determinação em última instância: a estrutura econômica determina o lugar e a forma de articulação da medicina e da educação na estrutura social. Para compreender a peculiaridades do ensino e da residência médica no Brasil faz-se uma caracterização da assistência médica, sobretudo do papel assumido pelo Estado na configuração do campo: primeiro, a adoção de um sistema em que compete ao Estado a responsabilidade pela universalização da atenção básica, através de serviços próprios ou em parceria com organizações não governamentais; segundo, a atenção especializada, com maior incorporação tecnológica, seria prestada pelo setor privado, mediante incentivos concedidos pelo Estado. Dessa divisão, resulta, no desenho atual, ao invés de um único sistema, a conformação de dois ou mais sistemas de saúde, em que a segmentação da assistência implica em práticas diferenciadas. O efeito desta divisão no mercado de trabalho repercute na escola e na residência médicas. A residência, em particular, por suas características de treinamento em serviço, responde diretamente aos condicionantes do mundo do trabalho, reproduzindo o modelo de prática hegemônica.

A educação física adaptada no contexto da formação profissional: implicações curriculares para os cursos de educação física

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Time needed to schedule dermatological consultations in Brazil

BACKGROUND: It is not clear what the population's demand for dermatologists is, nor how many professionals are needed in order to provide adequate care in this area of expertise. Knowledge of the flow of patients at dermatological clinics throughout the country allows for the formation of expansion and distribution policies regarding professionals, and provides backing for the decision to increase medical residency places. OBJECTIVES: To evaluate the time it takes to schedule a private dermatological consultation in Brazil, and other factors concerning consultations. METHODS: Survey with a random sample of 14% of Brazilian dermatologists, simulating the scheduling of emergency clinical and cosmetic consultations, and botulinum toxin procedures. Also, details relating to cost and professionals, were studied. Data were adjusted for each region of the country. RESULTS: A total of 873 dermatologists were evaluated. Full SBD members represented 85%, and 66% were women. The median time to schedule a consultation ranged from 6 (out-of-pocket payment) to 7 (medical insurance) consecutive working days. Times varied depending on the region. A multivariate analysis showed that out-of-pocket consultations and procedures were scheduled sooner than with medical insurance, regardless of whether they were clinical or cosmetic. CONCLUSION: The characteristics of dermatologists are varied throughout regions of the country. Private consultations and procedures are scheduled sooner than with insurance companies.

Utilização do questionário ERG na avaliação do grau de satisfação dos pacientes submetidos à otoplastia em um serviço de residência médica de otorrinolaringologia

A importância da intervenção cirúrgica em diminuir o sofrimento psicológico e melhorar a autoestima em pacientes com deformidades auriculares já está bem documentada. As pesquisas têm focado nos resultados das terapias com ênfase no paciente, observando principalmente satisfação, resultado funcional e impacto na qualidade de vida. Quantificar alterações na qualidade de vida tem sido um desafio. O uso de inquéritos válidos, a exemplo da Escala de Resultados de Glasgow (ERG), auxiliam na obtenção dos dados. OBJETIVO: Avaliar o impacto na qualidade de vida dos pacientes submetidos à otoplastia realizada em serviço de residência médica, utilizando como base a ERG, bem como sua funcionalidade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo incluindo pacientes submetidos à otoplastia entre julho de 2009 e julho de 2010. Os dados foram coletados por meio de questionário oferecido ao paciente no retorno pós-operatório. RESULTADOS: Trinta e seis pacientes responderam ao questionário. Houve aumento na qualidade de vida, demonstrado pelas medianas positivas obtidas pelo questionário. Não houve diferença significativa quanto aos valores obtidos entre os sexos e entre diferentes faixas etárias. CONCLUSÃO: Os pacientes mostraram-se satisfeitos com o resultado pós-operatório. Houve aumento de qualidade de vida, conforme demonstrado pelos resultados positivos. A ERG pareceu-nos fácil e elucidativa.

Características dos programas de residência médica em cardiologia do estado do Rio Grande do Norte

The present study had as goal to evaluate Rio Grande do Norte state’s medical residency programs (MRP) in Cardiology. It’s a descriptive study, including a documental analysis of the program’s accreditation processes (PAP) of cardiology’s medical residency in Rio Grande do Norte state in 2014 and the analysis of the resident’s perception about his professional education as a specialist in Cardiology. Beside the documental analysis of the PAPs, it was applied a semi-structured questionnaire with closed questions Likert style and open questions to all the current and former residents of the MRPs analyzed. Two MRPs in Cardiology were identified in Rio Grande do Norte state, one hosted in a public institution and the other in a private institution. The documental analysis showed a greater amount of preceptors with a good level of ownership on the public institution in comparison with the private one, as well as a bigger number of publications, participation in congresses and in book’s publications. The private institution presents a better Urgency’s infrastructure, with emergency room and cardiologic ICU. It IS clear that the residents are aware of how a good residency must work, as well as the strengths and fragilities of their own residences. Most of Onofre Lopes Universitary Hospital’s residents point out as a strength the organization, participation and quality of the preceptors, practice activities and scientific debates, great amount of patients and the visits and debates with the preceptors on the sickrooms. As the greatest fragilities, they emphasize the lack of a urgency service of their own and a specialized ICU. In Coração Hospital of Natal (HCor), it is listed as weak points the theoretic scheduling and the few ambulatory practices. As positive aspects, they report the preceptors, the agility on the execution of exams, a good number of serious patients and procedures. In both residences, it is seen a certain difficulty in accepting the important and mandatory items imposed by the rules of the Medical Residences’ National Committee, such as: biostatistics, bioethics, medical ethic, epidemiology and research methodology. Besides that, the residents recognize that both hospitals have a good infrastructure and technological support, especially in imaging methods. The evaluation of PRMCs identifies the strengths of each program and the aspects to be improved in both programs. It also allowed the observation of difficulties in accepting some regulations contained in the CNRM resolution by the resident, such as participation in activities such as biostatistics, epidemiology and research methodology as well as the improvement needs of specific technical training, such as in emergency care. Thus, our results make possible to develop strategies for continued improvement of PRMC in RN state. In addition, it enabled the preparation of the resident’s manual in cardiology, containing even a breakdown of resident evaluation system, which could serve as a model for other residency programs.

Estratégia de capacitação pedagógica do residente: uma perspectiva para melhoria do ensino na Universidade Federal do Rio Grande do Norte

Studies have shown that resident informally plays the role of teacher. It is estimated that up to 25% of the residents of the time is devoted to teaching, mainly contributing as a facilitator, however, almost the entire medical residency programs in Brazil did not offer teacher training during residency education. This paper aims to introduce educational content initiation to teaching as part of the training of resident physician inserted in residency program of the University Hospital Onofre Lopes (HUOL). It is an exploratory, descriptive and prospective study in HUOL the Federal University of Rio Grande do Norte. Three steps were developed: preparation and planning of a pedagogic course, associated with a motivating technical content (basic and advanced life support); second stage, testing of pedagogical model for medical students; and finally, replication to residents. The interventions were made two practice stations life support with performance evaluation in practical activity through OSPE (Objective Structured Practical Examination). The techniques presented teachings were one-minute preceptor and feedback. Data collection was conducted through a structured evaluation form during the life support stations and at the end of the course, and analyzed using descriptive statistics. The results showed that the feedback and one minute preceptor were considered important for teaching and learning for more than 85% of participants. The feedback from evaluators practices stations added information about the performance and were held appreciatively way, according to 100% of the participants. Positive aspects highlighted by the participants were related to educational content, especially the participants of the first intervention. The time of the lectures of motivating technical content was the most repeated negative. Based on the good acceptance of pedagogical contents, this pioneer teacher training strategy was included in the formal residency program in Cardiology of our institution. It is considered therefore that the educational training model with motivating technical content was feasible and had a good evaluation and acceptance by most participants in both interventions. Thus, we believe that the educational content can be inserted in the formal curriculum of medical residency of other programs at HUOL through the training model developed in this study.

Estratégia de capacitação pedagógica do residente: uma perspectiva para melhoria do ensino na Universidade Federal do Rio Grande do Norte

Studies have shown that resident informally plays the role of teacher. It is estimated that up to 25% of the residents of the time is devoted to teaching, mainly contributing as a facilitator, however, almost the entire medical residency programs in Brazil did not offer teacher training during residency education. This paper aims to introduce educational content initiation to teaching as part of the training of resident physician inserted in residency program of the University Hospital Onofre Lopes (HUOL). It is an exploratory, descriptive and prospective study in HUOL the Federal University of Rio Grande do Norte. Three steps were developed: preparation and planning of a pedagogic course, associated with a motivating technical content (basic and advanced life support); second stage, testing of pedagogical model for medical students; and finally, replication to residents. The interventions were made two practice stations life support with performance evaluation in practical activity through OSPE (Objective Structured Practical Examination). The techniques presented teachings were one-minute preceptor and feedback. Data collection was conducted through a structured evaluation form during the life support stations and at the end of the course, and analyzed using descriptive statistics. The results showed that the feedback and one minute preceptor were considered important for teaching and learning for more than 85% of participants. The feedback from evaluators practices stations added information about the performance and were held appreciatively way, according to 100% of the participants. Positive aspects highlighted by the participants were related to educational content, especially the participants of the first intervention. The time of the lectures of motivating technical content was the most repeated negative. Based on the good acceptance of pedagogical contents, this pioneer teacher training strategy was included in the formal residency program in Cardiology of our institution. It is considered therefore that the educational training model with motivating technical content was feasible and had a good evaluation and acceptance by most participants in both interventions. Thus, we believe that the educational content can be inserted in the formal curriculum of medical residency of other programs at HUOL through the training model developed in this study.

Médicos residentes

Relatório apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do título de pós-doutorada em Qualidade de Vida

Could Staying Human in Medical Training Help Make Medicine Humane? Review of Allan D. Peterkin, Staying Human During Residency Training

Compte-rendu / Review

Virtual Patients in continuing medical education and residency training: a pilot project for acceptance analysis in the framework of a residency revision course in pediatrics.

AIM Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as "blended learning". So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. METHODS Around 200 participants of a pediatric nephology lecture ('nephrotic and nephritic syndrome in children') were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general. RESULTS N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. CONCLUSION VPs may reasonably complement existing learning activities in residency training.

Medical student scholarship program, Illinois Department of Public Health, Pursuant to The Family Practice Residency Act (110 ILCS 935.1 et seq) : annual report FY... /

Description based on FY1993 ; title from caption.

Prevalence of depressive symptoms as elicited by Patient Health Questionnaire (PHQ-9) among medical trainees in Oman

Background Despite the increasing recognition that medical training tends to coincide with markedly high levels of stress and distress, there is a dearth of validated measures that are capable of gauging the prevalence of depressive symptoms among medical residents in the Arab/Islamic part of the world. Objective The aim of the present study is two-fold. First is to examine the diagnostic validity of the Patient Health Questionnaire (PHQ-9) using an Omani medical resident population in order to establish a cut-off point. Second is to compare gender, age, and residency level among Omani Medical residents who report current depressive symptomatology versus those who report as non-depressed according to PHQ-9 cut-off threshold. Results A total of 132 residents (42 males and 90 females) consented to participate in this study. The cut-off score of 12 on the PHQ-9 revealed a sensitivity of 80.6% and a specificity of 94.0%. The rate of depression, as elicited by PHQ-9, was 11.4%. The role of gender, age, and residency level was not significant in endorsing depression. Conclusion This study indicated that PHQ-9 is a reliable measure among this cross-cultural population. More studies employing robust methodology are needed to confirm this finding.