Mais Médicos Program for Brazil: an analysis of academic supervision experiences

From the 1990s, there was a movement to expand the Brazilian population's access to health care, mainly through basic care, and the Family Health Strategy is a proposal adopted by the Brazilian government as a way of reorganizing the health system. Unfortunately, most of the Brazilian municipalities encountered many difficulties during their implementation, ranging from infrastructure to lack of professionals, mainly physicians. In this scenario, the Mais Médicos Program in Brazil was launched in 2013 as a proposal to advance the solution of Primary Health Care (PHC) problems in the SUS, with measures that intervene in the training, structure and provision of physicians in health services. APS. To follow up these new doctors, we have the tutor and the academic supervisor, medical professionals indicated by the Supervisory Institutions linked to the Ministry of Education. Academic supervision is one of the educational axes of the Project, and should develop permanent education processes, guided by the perspective of the teaching-service integration, in the assistance component of the training of the doctors participating in the project. For a better understanding of the supervision process, this analytical and qualitative approach was developed, with semi-structured interviews for Project supervisors. The focus is the understanding and repercussions of the supervision process as a whole, identifying difficulties, potentialities and contributions in the qualification of the medical professional. Among the results, we highlight the importance of the understanding of all involved in the supervision process (supervisors, doctors, their respective teams and managers) about the fact that academic supervision is not a mere supervision, but an instrument of continuous training. The supervisor, as an interlocutor of this process, has the opportunity to provide space for dialogue, exchange of experiences, assistance in creating care protocols and training. The proposal is a review of the academic oversight model of the Mais Médicos Project for Brazil, which may be used in other professional qualification and continuing education projects.Não recebi financiamentoA partir da década de 1990, houve um movimento de ampliação do acesso da população brasileira aos cuidados em saúde, principalmente por meio da atenção básica, sendo a Estratégia de Saúde da Família uma proposta adotada pelo governo brasileiro como forma de reorganização do sistema de saúde. Infelizmente, a maioria dos municípios brasileiros encontrou ao longo desse tempo muitas dificuldades na sua implementação, que vão desde a infraestrutura à falta de profissionais, principalmente médicos. Nesse cenário é lançado em 2013 o Programa Mais Médicos no Brasil, como uma proposta para avançar na solução dos problemas da Atenção Primária em Saúde (APS) no SUS, com medidas que intervêm na formação, na estrutura e no provimento de médicos nos serviços de APS. Para acompanhamento desses novos médicos, temos o tutor e o supervisor acadêmico, profissionais médicos indicados pelas Instituições Supervisoras vinculadas ao Ministério da Educação. A supervisão acadêmica é um dos eixos educacionais do Projeto, e deve desenvolver processos de educação permanente, orientados pela perspectiva da integração ensino-serviço, no componente assistencial da formação dos médicos participantes do projeto. Para uma melhor compreensão do processo de supervisão, foi elaborado esse estudo de natureza analítica e abordagem qualitativa, com entrevistas semiestruturadas para supervisores do Projeto. O foco é o entendimento e repercussões do processo de supervisão como um todo, identificando dificuldades, potencialidades e contribuições na qualificação do profissional médico. Dentre os resultados encontrados destacam-se a importância da compreensão de todos os envolvidos no processo de supervisão (próprios supervisores, médicos, suas respectivas equipes e gestores) sobre o fato da supervisão acadêmica não ser uma mera fiscalização, e sim um instrumento de capacitação contínua. O supervisor, como um interlocutor desse processo, tem a oportunidade de proporcionar espaço de diálogo, troca de experiências, auxílio na criação de protocolos assistenciais e capacitações. A proposta é uma revisão do modelo de supervisão acadêmica do Projeto Mais Médicos para o Brasil, e que poderá ser utilizada em outros projetos de qualificação profissional e educação permanente

Give me a kiss! An integrative rehabilitative training program with motor imagery and mirror therapy for recovery of facial palsy

BACKGROUND: Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no evidence that any rehabilitation approach is more efficacious than another. AIM: The purpose of this research was to determine the effects of neurocognitive-rehabilitative approach through mirror-therapy (MT) and motor-imagery (MI), integrated into the traditional rehabilitation with mime-therapy and myofascial-approach. DESIGN: This study was designed as a double-blind, randomized, controlled-trial. SETTING: This study took place from January 2016 to June 2018 at the Unit of Physical Medicine and Rehabilitation, Umberto I Hospital, Rome, Italy. POPULATION: Twenty-two patients were randomized into two groups: mirror-therapy (N=11, MT and MI) and traditional-rehabilitative group (N=11, mime-therapy and a myofascial-approach). METHODS: Outcome assessments were performed before treatment (T0), after one month (T1=10 session, twice/week), after the second and third months (T2=10 twice/week + 5 of MT+MI one/week and T3=10 twice/week + 5 of MT+MI 1/week), and at the 4-week follow-up (T4=2 months follow-up). RESULTS: The analysis of the functional evaluations show that both groups experienced progressive improvement T0 to T3, with stabilization of the results at the follow-up. There was a significant difference in House-Brackmann-Scale scores between T0 and follow-up in favor of the experimental group. In terms of quality of life (FaCE scale), total scores and social function items improved in both groups from T0 to T3. The experimental group obtained better results with regard to quality of life and emotional depression. CONCLUSIONS: The integrated use of MT and MI is efficacious in the rehabilitation of FNP, improving facial physical function. Further studies are needed to determine the predictive factors of the recovery of facial mimic. CLINICAL REHABILITATION IMPACT: The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions and perceive the judgments of others remains underexplored. The likelihood of recovering near-normal facial-function after grade VI facial paralysis is low. Procedures, such as the immediate repair of the facial nerve with an interposed donor graft, might improve facial function in patients with partially injured facial nerves

Parietal intrahemispheric source connectivity of resting-state electroencephalographic alpha rhythms is abnormal in Naïve HIV patients

Previous evidence showed abnormal parietal sources of resting-state electroencephalographic (EEG) delta (< 4 Hz) and alpha (8-12 Hz) rhythms in treatment-Naive HIV (Naive HIV) subjects, as cortical neural synchronization markers in quiet wakefulness. Here, we tested the hypothesis that these local abnormalities may be related to functional cortical dysconnectivity as an oscillatory brain network disorder.The present EEG database regarded 128 Naive HIV and 60 Healthy subjects. The eLORETA freeware estimated lagged linear EEG source connectivity (LLC). The area under receiver operating characteristic (AUROC) curve indexed the accuracy in the classification between Healthy and HIV individuals.Parietal intrahemispheric LLC solutions in alpha sources were abnormally lower in the Naive HIV than in the control group. Furthermore, those abnormalities were greater in the Naive HIV subgroup with executive and visuospatial deficits than the Naive HIV subgroup with normal cognition. AUROC curves of those LLC solutions exhibited moderate/good accuracies (0.75-0.88) in the discrimination between the Naive HIV individuals with executive and visuospatial deficits vs. Naive HIV individuals with normal cognition and control individuals.In quiet wakefulness, Naive HIV subjects showed clinically relevant abnormalities in parietal alpha source connectivity. HIV may alter a parietal "hub" oscillating at the alpha frequency in quiet wakefulness as a brain network disorder