Termination of pregnancy among teenagers - why more surgical terminations?

Introduction: In 2012, a study by K. Chatziioannidou and S-C. Renteria showed that teenagers chose to undergo a surgical termination of pregnancy (TOP) more often than a medical TOP (mifepristone followed by misoprostol) when they decided to terminate a pregnancy. It also showed that the teenagers' choice for a medical versus surgical method is inversely proportional to the adults' choice although the efficiency of the medical method showed even better results for teenagers than for adults. According to the hypothesis made, the reasons for this choice might be influenced by the following facts: (i) the belated call to make an appointment, the medical procedure not being available after 9 weeks of gestation; (ii) the imperative request for confidentiality; (iii) the beliefs and subjective appreciation of the medical staff. Objectives: The aim of this retrospective and qualitative study is to analyse the reasons why, in case of a TOP, teenagers chose the surgical method more often than their adult counterparts. Material: (i) All teenagers who were admitted for an abortive procedure during 2011 in the in- or outpatient ward. (ii) The professional team (midwives and sexual and reproductive counsellors) in charge in the case of a TOP request. Methods: The information about the patient's history and the biopsycho- social data was retrieved from the patient files filled out by midwives and sexual and reproductive health counsellors during the first appointment for a TOP request or during its process. The professionals' appreciation was evaluated by means of a semi-structured questionnaire. Results: Concerning the choice of the method for a pregnancy termination, the results of our research show that: (i) Out of 47 teenagers, 27 chose the surgical method and 17 the medical method. (ii) Three had a second trimester abortion (which includes use of the medical method). (iii) Fifteen teenagers out of the 27 who chose a surgical method consulted between the 9th and 14th weeks of amenorrhoea and therefore did not have any other choice. The reasons for their 'late arrival' will be explained in detail. The 12 teenagers who arrived before the 8th week of amenorrhoea and chose to undertake abortion by suction & curettage under general anaesthesia did it for the following reasons: (i) Four were afraid of bleeding and pain. (ii) Five thought that the organisation of the surgical procedure was easier. (iii) Two did not trust the abortion pill. (iv) One was taken to her mother's gynaecologist where she had a D&C. Confidentiality was requested nine times out of 27 when choosing the surgical method, and six times out of 17 when choosing the medical method. Therefore, although confidentiality concerns a third of the teenagers' pregnancy termination requests, it does not seem to be a significant element for the choice of the method. As for the subjective appreciation of the professionals, the first results of the discussions seem to show that teenagers were reluctant or resistant towards the medical method. Conclusion: This study shows that the reasons why teenagers still prefer the use of the surgical over the medical method compared to adults, seem to include the late request for an appointment, fear of pain and bleeding and organisational issues. Confidentiality does not seem to greatly influence the teenagers' choice. Nonetheless, medical professionals seem to favour the suction curettage procedure performed under anesthesia because they associate young age with vulnerability and psychological frailty and consequently diminished ability to cope with pain and emotional distress during the medical procedures.

Establishment of a Representative Practice-based Research Network (PBRN) for the Monitoring of Primary Care in Switzerland.

Data are urgently needed to better understand processes of care in Swiss primary care (PC). A total of 2027 PC physicians, stratified by canton, were invited to participate in the Swiss Primary care Active Monitoring network, of whom 200 accepted to join. There were no significant differences between participants and a random sample drawn from the same physician databases based on sex, year of obtaining medical school diploma, or location. The Swiss Primary care Active Monitoring network represents the first large-scale, nationally representative practice-based research network in Switzerland and will provide a unique opportunity to better understand the functioning of Swiss PC.

The Changing Face of Psychiatric Nursing –Care or Control?

This report has been written as part of the project “Toward improved quality – developing nurse’s continuing vocational training in hospitals and inpatient units”. Its overall goal is to ensure high quality, ethically appropriate and therapeutically effective interventions to enable nurses to manage distressed and disturbed patients in European psychiatric hospitals and inpatient units. In this large-scale, multinational projects there are all together six European countries involved: Finland, Ireland, England, Portugal, Italy and Lithuania. The project work plan were during autumn 2006 and spring 2007. The content of this publication was produced in the first stage of the project aiming to collect the preliminary source material for the project. The literature review was carried out in the project stage, providing the groundwork for the next steps for the project. This project aims to develop an interactive multinational portal with training material. Therefore, it is important to share an understanding of basic information, psychiatric nurse’s continuing vocational education, laws and ethical codes and patient restriction used in mental health care. In this publication, the purpose of the material produced here is to understand nurses’ educational need related to vocational continuing education and to be used in further project stages as an empirical data collection. The data were collected as a preliminary source material for latter phases where nurse’s perceptions of the current practice, nurse’s attitudes to mental illness, prevalence of use of seclusion room and existing and desired vocational training provision will be collected in six different European countries. The following organisations are involved in this project: University of Turku, Dublin City University, St. Vincent Hospital, National Council for the Professional Development of Nursing and Midwifery, University of Padova, Klaipeda College - Health Faculty, Klaipeda Psychiatric Hospital, Escola Superior de Enfermagem de Lisboa, Centro Hospitalar Psiquiátrico de Lisboa, Omnia Vocational Institution the Espoo Region, Kellokoski psychiatric hospital, Hyvinkää hospital area, Pirkanmaa Hospital District, Kingston University & St. George’s Medical School and South West London & St. George’s Mental Health NHS Trust. A wide variety of different countries, organisations and individuals in this project give us a strong confidence that theoretical, practical, ethical and political issues around the topic of interest will be taken account during this project lifetime. We are aware the content of this book will be partially outdated almost as soon as it has been published. We still hope that this publication will encourage nurses and different professions working in mental health care field to have a basic understanding of similarities and differences between different European countries related in mental health care. We also hope that this publication will inspirate and motivate nurses in maintaining and developing the quality of psychiatric care in Europe.

An alternative experimental model for training in microsurgery

OBJECTIVE: to describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduate students of the Discipline of Operative Technique of the UFPR Medical School. METHODS: after the completion of splenectomy we performed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After complete dissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made the anastomosis of the vessels with 9.0 nylon. RESULT: the microsurgical training with a well-defined routine, qualified supervision and using low cost experimental materials proved to be effective in the practice of initial microvascular surgery. CONCLUSION: the use of pig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having the consistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the initial learning phase of this technique.

Petri Net approach for modelling system integration in intelligent buildings

In this paper, a Petri Net approach is introduced for modelling and simulation of control strategies in Intelligent Building. In this context, it is claimed that integration with other building systems can be achieved in a more systematic way considering a mechatronic approach (i.e. multidisciplinary concepts applied to the development of systems). The case study is the Ambulatory Building of Medical School Hospital of University of São Paulo. Particularly, the developed methodology is applied to the elevator system and to the HVAC (Heating, Ventilation and Air Conditioning) system. It is shown that using this approach, the control systems could be integrated, improving performance.

A simple HPLC-fluorescence method for the measurement of R,S-sotalol in the plasma of patients with life-threatening cardiac arrhythmias

R,S-sotalol, a ß-blocker drug with class III antiarrhythmic properties, is prescribed to patients with ventricular, atrial and supraventricular arrhythmias. A simple and sensitive method based on HPLC-fluorescence is described for the quantification of R,S-sotalol racemate in 500 µl of plasma. R,S-sotalol and its internal standard (atenolol) were eluted after 5.9 and 8.5 min, respectively, from a 4-micron C18 reverse-phase column using a mobile phase consisting of 80 mM KH2PO4, pH 4.6, and acetonitrile (95:5, v/v) at a flow rate of 0.5 ml/min with detection at lex = 235 nm and lem = 310 nm, respectively. This method, validated on the basis of R,S-sotalol measurements in spiked blank plasma, presented 20 ng/ml sensitivity, 20-10,000 ng/ml linearity, and 2.9 and 4.8% intra- and interassay precision, respectively. Plasma sotalol concentrations were determined by applying this method to investigate five high-risk patients with atrial fibrillation admitted to the Emergency Service of the Medical School Hospital, who received sotalol, 160 mg po, as loading dose. Blood samples were collected from a peripheral vein at zero, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, 8.0, 12.0 and 24.0 h after drug administration. A two-compartment open model was applied. Data obtained, expressed as mean, were: CMAX = 1230 ng/ml, TMAX = 1.8 h, AUCT = 10645 ng h-1 ml-1, Kab = 1.23 h-1, a = 0.95 h-1, ß = 0.09 h-1, t(1/2)ß = 7.8 h, ClT/F = 3.94 ml min-1 kg-1, and Vd/F = 2.53 l/kg. A good systemic availability and a fast absorption were obtained. Drug distribution was reduced to the same extent in terms of total body clearance when patients and healthy volunteers were compared, and consequently elimination half-life remained unchanged. Thus, the method described in the present study is useful for therapeutic drug monitoring purposes, pharmacokinetic investigation and pharmacokinetic-pharmacodynamic sotalol studies in patients with tachyarrhythmias.

Effect of air pollution on pediatric respiratory emergency room visits and hospital admissions

In order to assess the effect of air pollution on pediatric respiratory morbidity, we carried out a time series study using daily levels of PM10, SO2, NO2, ozone, and CO and daily numbers of pediatric respiratory emergency room visits and hospital admissions at the Children's Institute of the University of São Paulo Medical School, from August 1996 to August 1997. In this period there were 43,635 hospital emergency room visits, 4534 of which were due to lower respiratory tract disease. The total number of hospital admissions was 6785, 1021 of which were due to lower respiratory tract infectious and/or obstructive diseases. The three health end-points under investigation were the daily number of emergency room visits due to lower respiratory tract diseases, hospital admissions due to pneumonia, and hospital admissions due to asthma or bronchiolitis. Generalized additive Poisson regression models were fitted, controlling for smooth functions of time, temperature and humidity, and an indicator of weekdays. NO2 was positively associated with all outcomes. Interquartile range increases (65.04 µg/m³) in NO2 moving averages were associated with an 18.4% increase (95% confidence interval, 95% CI = 12.5-24.3) in emergency room visits due to lower respiratory tract diseases (4-day moving average), a 17.6% increase (95% CI = 3.3-32.7) in hospital admissions due to pneumonia or bronchopneumonia (3-day moving average), and a 31.4% increase (95% CI = 7.2-55.7) in hospital admissions due to asthma or bronchiolitis (2-day moving average). The study showed that air pollution considerably affects children's respiratory morbidity, deserving attention from the health authorities.

The effect of sun exposure on 25-hydroxyvitamin D concentrations in young healthy subjects living in the city of São Paulo, Brazil

The range of 25-hydroxyvitamin D (25OHD) concentration was determined in a young healthy population based on bone metabolism parameters and environmental and behavioral aspects. We studied 121 healthy young volunteers (49 men, 72 women) living in São Paulo (23º 34' south latitude) belonging to three occupational categories: indoor workers (N = 28), medical school students (N = 44), and resident physicians (N = 49). Fasting morning blood samples were collected once from each volunteer from August 2002 to February 2004, and 25OHD, total calcium, albumin, alkaline phosphatase, phosphorus, creatinine, intact parathyroid hormone, osteocalcin, and type I collagen carboxyterminal telopeptide were measured. Data are reported as means ± SD. Mean subject age was 24.7 ± 2.68 years and mean 25OHD level for the entire group was 78.7 ± 33.1 nM. 25OHD levels were lower (P < 0.05) among resident physicians (67.1 ± 27.0 nM) than among students (81.5 ± 35.8 nM) and workers (94.0 ± 32.6 nM), with the last two categories displaying no difference. Parathyroid hormone was higher (P < 0.05) and osteocalcin was lower (P < 0.05) among resident physicians compared to non-physicians. Solar exposure and frequency of beach outings showed a positive association with 25OHD (P < 0.001), and summer samples presented higher results than winter ones (97.8 ± 33.5 and 62.9 ± 23.5 nM, respectively). To define normal levels, parameters such as occupational activity, seasonality and habits related to solar exposure should be taken into account. Based on these data, we considered concentrations above 74.5 nM to be desired optimal 25OHD levels, which were obtained during the summer for 75% of the non-physicians.

Prevalence of child malnutrition at a university hospital using the World Health Organization criteria and bioelectrical impedance data

Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients’ prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients’ weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients’ weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.

Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patients

INTRODUCTION: The decision of when to start dialysis in Acute Kidney Injury (AKI) patients with overt uremia is strongly established, however, when blood urea nitrogen (BUN) levels is < 100 mg/dL the timing of initiation of dialysis remains uncertain. Purpose: The aim of this study was to assess mortality and renal function recovery AKI patients started on dialysis at different BUN levels. METHODS: This was a retrospective study performed at Medical School Hospital, São Paulo, Brazil, enrolling 86 patients underwent to dialysis. RESULTS: Dialysis was started when BUN < 75 mg/dl in 23 patients (Group I) and BUN > 75 mg/dl in 63 patients (Group II). Hypervolemia and mortality were higher in Group I than in Group II (65.2% vs. 14.3% - p < 0.05, 39.1% vs. 68.9%- p < 0.05, respectively). Among survivors, the rate of renal function recovery was higher in Group I (71.4% and 36.8%, respectively - p < 0.05). Multivariate analysis showed that sepsis, age > 60 years, peritoneal dialysis and BUN > 75 mg/dl at dialysis initiation were independently related with mortality. CONCLUSIONS: Lower mortality and higher renal function recovery rates were associated with early dialysis initiated at lower BUN leves in AKI patients.

Una respuesta de la Facultad de Medicina ante la problemática infantil

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Some Topics in Relation to José Celestino Mutis and Medicine

José Celestino Mutis showed different interest areas of study and worked in multiple knowledge fields: mathematics, mineralogy, astronomy, zoology and botanic, the one in which is best known. However, he was a medical doctor, whit profound an up to date knowledge. He studied at Sevilla University, and in the Royal College of Cadiz. He arrived to the “Nuevo Reino de Granada” as personal medical doctor of the the viceroy Pedro Messía de la Cerda and during 47 years, period of time he lived there, he always exercised his profession. We showed a special interest in the study of cinchona and the only work he published was El Arcano de la quina. He advised in public health many viceroys and he contributed in different fields but particularly in the prevention of smallpox by inoculation. He played a decisive role in the reopening of the medical school of the Colegio Mayor de Nuestra Señora del Rosario. Some of his achievements justifies the appellative “Father of the Medicine in Colombia”.

Rol del residente de Medicina Interna de la Universidad del Rosario como docente

Antecedentes: Cada vez es mayor la relevancia que se da al papel del residente como docente, no solo por su importancia en la formación de estudiantes, internos y otros miembros del equipo de salud, sino por su deber en la instrucción del paciente y su familia. A pesar de ello, el rol del residente como docente no se encuentra plenamente definido en nuestro medio. Objetivo: Caracterizar el rol de los residentes de Medicina Interna de la Universidad el Rosario en la Fundación Cardioinfantil como docentes. Métodos: Estudio cualitativo a partir de observaciones en escenarios de enseñanza y entrevistas semiestructuradas a 44 participantes distribuidos en grupos focales Resultados: Los residentes asumen un rol docente en diversos escenarios educativos con estudiantes, internos, residentes y docentes. Reconocen que no tienen la preparación necesaria para asumir esta responsabilidad ni funciones establecidas para tal fin. A pesar de esto, utilizan diferentes estrategias para enseñar y se sienten motivados para hacerlo. Conclusiones: El rol del residente como docente en el servicio de Medicina Interna en la Fundación Cardioinfantil es fundamental para la formación de los futuros médicos y especialistas según la percepción que tienen los grupos focales. Los encuentros pedagógicos están enmarcados por la disponibilidad de tiempo y dependen de características personales del residente, conocimiento disciplinar y formación para enseñar. Se considera que se debe apoyar más el entrenamiento en docencia de los residentes, avanzar en la formalización de las funciones docentes de los mismos y generar sistemas de evaluación de este proceso de enseñanza y aprendizaje.

Análisis ecocardiográfico de la función sistólica del ventrículo izquierdo por médicos no cardiólogos con un dispositivo de bolsillo

Se realizó un estudio transversal, se incluyeron 3 residentes no cardiólogos y se les dio formación básica en ecocardiografía (horas teóricas 22, horas prácticas 65), con recomendaciones de la Sociedad Americana de Ecocardiografia y aportes del aprendizaje basado en problemas, con el desarrollo de competencia técnicas y diagnósticas necesarias, se realizó el análisis de concordancia entre residentes y ecocardiografistas expertos, se recolectaron 122 pacientes hospitalizados que cumplieran con los criterios de inclusión y exclusión, se les realizo un ecocardiograma convencional por el experto y una valoración ecocardiográfica por el residente, se evaluó la ventana acústica, contractilidad, función del ventrículo izquierdo y derrame pericárdico. La hipótesis planteada fue obtener una concordancia moderada. Resultados: Se analizó la concordancia entre observadores para la contractilidad miocárdica (Kappa: 0,57 p=0,000), función sistólica del ventrículo izquierdo (Kappa 0,54 p=0.000) siendo esta moderada por estar entre 0,40 – 0,60 y con una alta significancia estadística, para la calidad de la ventana acústica (Kappa: 0,22 p= 0.000) y presencia de derrame pericárdico (Kappa: 0,26 p= 0.000) se encontró una escasa concordancia ubicándose entre 0,20 – 0,40. Se estableció una sensibilidad de 90%, especificidad de 67%, un valor predictivo positivo de 80% y un valor predictivo negativo de 85% para el diagnóstico de disfunción sistólica del ventrículo izquierdo realizado por los residentes.

El vídeo educativo como ayuda audiovisual en el laboratorio de histología

En el proceso Educativo debe existir un firme compromiso por parte del Educador y es precisamente, el servir de guía orientadora a sus alumnos conduciéndolos de la mejor forma posible, en la búsqueda del conocimiento.