Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of nonmelanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection

Formação profissional ética: um compromisso a partir das diretrizes curriculares? Ethical professional education: a commitment based on the curricular guidelines?

Esta reflexão problematiza o discurso e a prática que se estabelecem em torno do tema da formação ética dos profissionais da saúde e, mais particularmente, do cirurgião-dentista, situando o atual momento de implantação das Diretrizes Curriculares Nacionais no ensino superior brasileiro. Procura-se, desta forma, indicar alguns limites e possibilidades para uma formação ética condizente com o novo perfil profissional almejado.<br>This reflection questions the discourse and practice surrounding the ethical education of health professionals and, more particularly, of dentists, situating the current state of deployment of the National Curriculum Guidelines in Brazilian Higher Education. The goal is to point to a few limits and possibilities for an ethical education in line with the new professional profile that is sought

Docente-clínico: o complexo papel do preceptor na residência médica Clinical teacher: the complex role of the preceptor in medical residency

Este estudo analisa o papel do preceptor na residência médica, partindo das percepções dos preceptores dos programas de residência em especialidades clínicas de um hospital de ensino. Através de uma pesquisa descritiva, utiliza-se a técnica de entrevista não-diretiva, com o intuito de estudar o fenômeno a partir da fala de 16 desses preceptores. Utiliza-se a análise de conteúdo, tecendo uma relação com as referências da literatura. Percebe-se que o preceptor assume vários papéis. Encontram-se referências a orientador, tutor, supervisor e mentor. Ele planeja, controla, guia; estimula o raciocínio e a postura ativa; analisa o desempenho; aconselha e cuida do crescimento profissional e pessoal; observa e avalia o residente executando suas atividades; atua na formação moral. É grande a importância do preceptor como educador, oferecendo, ao aprendiz, ambientes que lhe permitam construir e reconstruir conhecimentos. O preceptor ensina realizando procedimentos técnicos e moderando a discussão de casos. Assume papel do docente-clínico, um profissional que domina a prática clínica e os aspectos educacionais relacionados a ela, transformando-a em ambiente e momento educacionais propícios. Identificando as oportunidades de aprendizagem e os cenários de exposição, o preceptor da residência médica funciona como uma vitrine de atributos técnicos e relacionais, proporcionando verdadeiras condições de desenvolvimento técnico e ético nos cenários reais de prática profissional.<br>This study examines the role of preceptor in the medical residency program, based on the perceptions of preceptors in clinical specialties of a university hospital. Through a descriptive research, it uses the technique of non-directive interview, to study the phenomenon from the speech of 16 preceptors. It uses the content analysis, weaving a relationship with the literature. It is perceived that the tutor takes on several roles. There are references to the tutor, supervisor and mentor. He plans, manages, guides; stimulates thinking and active attitude; observes the performance; advises and looks after the professional and personal growth; observes and evaluates the resident running its activities; acts in the moral formation. The importance of the preceptor as an educator is great, offering the learner environments, enabling it to construct and reconstruct knowledge. The preceptor teaches performing technical procedures and moderating the discussion of cases. Heassumes role of teacher-clinician, a professional who dominates the clinical practice and educational aspects related to it, making it a suitable educational environment and time. Identifying learning opportunities and exposure scenarios, the medical residency preceptor serves as a showcase of technical and relational attributes, providing real opportunities for developing actual technical and ethical scenarios for professional practice

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status