Impacto del Policlínico Universitario en los servicios de salud en el municipio Consolación del Sur The impact of the University Out-patient Clinic on health services. Consolación del Sur municipality

La realización de este trabajo se lleva a cabo en los estudiantes pertenecientes a la carrera de Medicina del Proyecto Policlínico Universitario del Municipio de Consolación del Sur , en el período comprendido entre los años 2004 - 2006 , con el objetivo de valorar el impacto que ha tenido durante todo este tiempo la implementación de este proyecto en los servicios de salud del municipio, demostrándose el valor ineludible de las novedosas FOE en la vinculación Teórico Práctica de los contenidos, y su extrapolarización en los Servicios Médicos que se brindan en los diferentes escenarios del Policlínico, evidenciándose el papel de Tutores y Facilitadores, como rectores y guías del PDE. Palabras clave: Servicios de Salud ABSTRACT This research paper was conducted with medical students enrolled on the University Outpatient Clinic Project in Consolación del Sur municipality during 2004-2006, with the aim to assess the impact and implementation of this projecto on heatlth services showing the values of linking theory and practice with the contents and the extrapolarity in medical assistance, with the different scenes of the out-patient clinic. The role of tutors and providers has a great importance on the formation of medical students. Key words: Health Services

Impacto del Policlínico Universitario en los servicios de salud en el municipio Consolación del Sur The impact of the University Out-patient Clinic on health services. Consolación del Sur municipality

La realización de este trabajo se lleva a cabo en los estudiantes pertenecientes a la carrera de Medicina del Proyecto Policlínico Universitario del Municipio de Consolación del Sur , en el período comprendido entre los años 2004 - 2006 , con el objetivo de valorar el impacto que ha tenido durante todo este tiempo la implementación de este proyecto en los servicios de salud del municipio, demostrándose el valor ineludible de las novedosas FOE en la vinculación Teórico Práctica de los contenidos, y su extrapolarización en los Servicios Médicos que se brindan en los diferentes escenarios del Policlínico, evidenciándose el papel de Tutores y Facilitadores, como rectores y guías del PDE. Palabras clave: Servicios de Salud ABSTRACT This research paper was conducted with medical students enrolled on the University Outpatient Clinic Project in Consolación del Sur municipality during 2004-2006, with the aim to assess the impact and implementation of this projecto on heatlth services showing the values of linking theory and practice with the contents and the extrapolarity in medical assistance, with the different scenes of the out-patient clinic. The role of tutors and providers has a great importance on the formation of medical students. Key words: Health Services

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

OBJECTIVE: To develop and scale algorithm-enabled patient prioritization to improve population-level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. RESEARCH DESIGN AND METHODS: We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. RESULTS: The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 ± 0.20 to 1.3 ± 0.24 min per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n = 58) have associated 8.8 percentage points (pp) (95% CI = 0.6–16.9 pp) greater time-in-range (70–180 mg/dl) glucoses compared to 25 control patients who did not qualify at 12 months after T1D onset. CONCLUSIONS: An algorithm-enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time-in-range

Doctor and patient’s relationship at the present time and value of the clinical method

The history of mankind is not only made of the relationships and conflicts among men: the struggle to survive is also part of it and the hardest and most persistent of all has been men’s fight against diseases. The emergence of medical activity is inextricably linked to the development of human relationships. In fact, it is precisely the capacity of establishing relationships with others what identifies and distinguishes man from other biological beings. The recognition of the values of the doctor-patient relationship and its psychological moment is gnoseologically attached to the recognition of the values of the integral vision of man. That is why the Hippocratic school, constantly insisting that man is not only the physical aspect, but an inseparable whole with the psychic aspect and emphasizing on the importance of the environment and the doctor-patient relationship constitutes a milestone in the development of medicine. Over the centuries much has been learned and even more has been written about this unique kind of human relationship that causes everyday a renewed interest not only for medicine but also for many adjacent disciplines, as a sign of its decisive importance and the socio-historical conditions that determine it

Características clínico-epidemiológicas de la enfermedad de Chagas en comunidades del Chapare, Departamento Cochabamba, Bolivia

Fundamento. La enfermedad de Chagas o tripanosomiasis americana existe en el continente americano desde antes de la colonización. Es una zoonosis propia del continente. Constituye un importante problema de salud y afecta a más de 20 millones de personas. Objetivo: Describir las características clínico-epidemiológicas de la enfermedad de Chagas en las comunidades del Chapare, Departamento Cochabamba, República de Bolivia. Métodos: Se realizó un estudio descriptivo, prospectivo, observacional, de serie de casos, en las regiones del Chapare, departamento de Cochabamba, Bolivia, en el periodo comprendido entre el 1ro de enero de 2008 al 30 de junio del propio año. Se estudiaron todos los pacientes (510) que acudieron a consulta y que tenían el diagnóstico previo de la enfermedad. Se estudiaron variables como, la edad, sexo, escolaridad, ocupación, síntomas y signos de la enfermedad, entre otras, procesadas con el paquete estadístico SPSS versión 15.0 para Windows. Resultados: El sexo predominante resultó ser el femenino; el grupo etario más frecuente fue el comprendido entre los 46 a 55 años. Como factores de riesgos para la infección se identificaron el vivir en casa de adobe y paja, la presencia de vectores, animales domésticos y el almacenar alimentos dentro del hogar. El 79,2 % se mantienen asintomáticos y un escaso número de pacientes cumplen con las medidas de prevención. Conclusiones: Esta es una enfermedad común en el Departamento, asociada principalmente a la insalubridad y pobreza, constituyendo la transmisión vectorial la principal vía para adquirir la infección

Applying an Instrument for the Stratification of Patients with Community-acquired Pneumonia in the Emergency Department.

Background: the stratification of patients is a very useful procedure in medical practice. Objective: To assess the implementation of an instrument for the stratification of patients with community-acquired pneumonia in the Emergency Department. Methods: A descriptive study was conducted at the General University Hospital of Cienfuegos. The instrument was applied to 394 (hospitalized or already discharged from the institution) with a diagnosis of community-acquired pneumonia between June 2009 and December 2010. As part of the assessment, indicators for process and results were used. Results: The instrument that has been developed is based on comprehensive clinical information and supported by complementary radiological information. It allows the classification of patients into six different stratifying layers. Of the 394 patients admitted because of pneumonia, more than 85% was stratified. The stratification was correct in 82% of them. There was a high rate of adherence to the suggested location on the instrument (99%). Adherence to antimicrobial therapy was of 73%. Patients with moderate pneumonia and a high probability of poor outcome (60%) predominated. The highest mortality was found in cases with severe pneumonia and little chance of recovery (74%). The overall mortality was 31%. Conclusions: Although susceptible of improvement, this tool is considered to be very useful for the decision making process when dealing with patients suffering from community-acquired pneumonia attended in the Emergency Department. It reduces hospitalization criteria variability and influences in-hospital patients’ location and antimicrobial therapy