Consideraciones críticas al programa de Medicina Interna vigente desde 2010 en la carrera de Medicina

Para que la universidad médica cumpla su encargo social, deberán considerarse las condiciones cambiantes de la sociedad, de la educación médica y de la práctica médica, así como la revisión periódica de sus planes de formación. Este artículo se propone analizar el programa vigente (2010) para la asignatura Medicina Interna en la carrera de Medicina y fundamentar las transformaciones que se proponen. En el contexto de la universidad médica de Cienfuegos, fueron analizados los ocho aspectos que conforman el programa, mediante la revisión documental y entrevista a informantes clave. Se realizan propuestas de modificaciones en los objetivos, plan temático, y contenidos para cada tema; se plantean orientaciones metodológicas, sistema de evaluación y literatura. Se propone un módulo central para los tiempos electivos y una nueva tarjeta de evaluación para las actividades prácticas. Las transformaciones propuestas obedecen a cambios en la práctica clínica, el desarrollo del proceso docente educativo y las necesidades sociales no solo de Cuba. La actividad académica será desarrollada adecuadamente si los cambios tributan a la calidad del proceso docente educativo y las previsiones consideran los cambios presentes y futuros del proceso salud-enfermedad

Espondilitis anquilopoyética: una reflexión y una interrogante

Ankylosing spondylitis is a chronic inflammatory disease that affects the synovial membrane, joint entheses and para-articular structures of the spine, including the sacroiliac joints and limbs. We present a case of ankylosing spondylitis that had evolved for 12 years despite the relatively early diagnosis and treatment, showing flexion deformity and limitation of spinal movements. On radiological examination an early evolution to ankylosis was observed, which motivated us to make a reflection and a question

Retention of knowledge about basic cardiac-pulmonary resuscitation in medical students. Cienfuegos (2017-2018)

Introduction: knowledge retention at medium and long term in cardiac-pulmonary resuscitation is a problem in education systems worldwide. Objective: to determine the level of knowledge retention about basic cardiac-pulmonary resuscitation in medical students. Method: prospective longitudinal research; developed at the University of Medical Sciences Cienfuegos. An exam was applied to 377 first year medical students about cardiac-pulmonary resuscitation after a 20 hour theoretical-practical course in December 2017. A year later, to a sample of 185 ( simple random, level of confidence 95% and error margin of 5%) the same exam is repeated. Global and particular results are compared according to the initial marking. Results: In the first exam(2017) the general number of students who passed was 80.4%, from it with a degree of quality (good and excellent) 50.66%. A year later, these figures decreased to 46.5 and 14.1 % respectively. The percentages of ratings was also qualitatively lower in 2018 for each group than those obtained in 2017. The worsts ( fair and poor) in 2018 are not related to the rating obtained in 2017. The evaluation of the teaching process to the students and teachers was good. Conclusion: the level of knowledge retention about Basic cardiac-pulmonary resuscitation at a year time is low, independently to the ratings obtained in 2017. The quality of the teaching process was adequate and seems not to influence these results

Actualización en el diagnóstico y manejo del paciente en choque

El síndrome de choque es un problema frecuente en las unidades de urgencias y emergencias con una elevada prevalencia y mortalidad debido a sus múltiples causas. Con el objetivo de caracterizar el diagnóstico y manejo de los pacientes con choque se desarrolló una revisión bibliográfica, citándose 20 artículos recuperados desde SciELO, Scopus, ClinicalKey y otras bases de datos. Los marcadores del shock grave constituyen una herramienta para la estratificación del riesgo, así como objetivos o metas para el restablecimiento precoz de una perfusión tisular adecuada. La monitorización clínica de la oxigenación tisular y de la función orgánica supone habitualmente la medición de criterios de valoración tradicionales, como la frecuencia cardíaca, constituyendo un pilar en el diagnóstico del choque. En general, la clave del tratamiento del shock es mantener la presión arterial media y asegurar una adecuada perfusión y transporte de oxígeno y otros nutrientes a los órganos vitales

Protocol for Detection, Prevention and Action in Alleged Cases of Gender-based Violence and Discrimination

A protocol is presented to prevent, avoid and act in situations of gender-based violence at the University of Medical Sciences of Cienfuegos. This protocol establishes the necessary measures to identify situations of violence that occur in the university environment, whether towards students or teachers, with the aim of investigating them, proposing solutions and mitigating their consequences. The methodological and scientific rigor of the design presented allows us to offer the university community a very useful protocol that is in accordance with the Comprehensive Strategy for Prevention and Attention to Gender Violence and Violence in the Family Setting and the Advancement Plan to Women that is implemented in Cuba

Training and Research in life support and disasters. Recommendations of experts´ workshop. Cienfuegos,2018

Foundation: the National Project ¨Training and Research in life support and disasters¨ has among its objectives to reduce lethality due to emergencies and to contribute to the quality of medical care, but it requires an academic and organizational structure.Objective: to define teaching and research   methodological elements for the project and for its six courses.Methods: qualitative cross research developed in Cienfuegos (July 10/11, 2018) as part of a national workshop called with this purpose with 83 professionals (74, 69% experts) from six provinces. Techniques as brain storming and focal group were used. For the general and specific recommendations about the courses, the group was divided in six sub-groups finally, these were written together to be exposed.Results: the general proposals are related with an updated, uniform, inter-sectorial, face-to-face academic program which is extended to community till post-graduate courses in health institutions and involves computer technologies. Proposals for the integration to the context in the medical practice include the design  and adherence to behaving protocols and the integration to the re-organization of the emergency system.Conclusion: contents of teaching activities and academic and research strategies, so as their integration  to the context of emergency management, may develop the training and training in life support in the project framework. For the impact in health indicators, it is necessary, in addition, inter-sectorial community work and the organizational improvement of the emergency system.</p

Morbilidad y mortalidad en el hospital provincial de Cienfuegos (2018-2022)

Fundamento: la morbilidad y mortalidad son indicadores de salud muy sensibles; expresan la realidad de las poblaciones, incluyendo las esferas económica, cultural, social, al visualizar la dimensión de la muerte en la población y su calidad de vida.Objetivo: determinar las principales causas de morbilidad y mortalidad en el hospital provincial de Cienfuegos.Métodos: estudio descriptivo y transversal, que incluyó a 151670 pacientes atendidos en el Hospital Provincial Dr. Gustavo Aldereguía Lima, de Cienfuegos, en las especialidades clínicas, quirúrgicas, de urgencias y materno-infantil, en el período 2018-2022. Se estudiaron variables como especialidad, año natural, estadía hospitalaria y causas de morbilidad y mortalidad. Se creó una base de datos para el procesamiento estadístico de la información, obtenida a través de los informes estadísticos de la institución.Resultados: el 48,7 % de los ingresos correspondieron a especialidades clínicas. Las principales causas de morbilidad fueron la fiebre de origen desconocido y el parto único espontáneo, ambos con el 7,5 %. El 37,2 % de los fallecidos tuvo como causa de muerte la neumonía. En 2021 fallecieron 2879 pacientes; para una tasa de mortalidad de 8 por cada 1000 habitantes.Conclusiones: la mayoría de los pacientes que acuden a los servicios hospitalarios son ingresados por especialidades clínicas con estadía. La fiebre de origen desconocido y la cercanía al término del embarazo constituyen los principales motivos de consulta; mientras que los procesos inflamatorios neumónicos y el ictus son causas de mortalidad frecuente, con una tasa superior en las unidades de cuidados intensivos.</p

Cuban publications about cardio-pulmonary-cerebral resuscitation: a bibliometric approach from 1998 to 2018

Introduction: multiple researches have been developed along the years about cardio-pulmonary (CPR); new evidences appear and scientific articles are published regularly which show its development. Objective: to characterize scientific publications about CPR in Cuba. Methods: descriptive bibliometric, retrospective study done from January 1998 to November 2018. All Cuban publications indexed to Scientific Electronic Library Online (Scielo) were reviewed. Editorials and letters to the editor were not included. It was designed a registration folder in Microsoft Office Excel 2010, in which the information about the articles was organized for their identification, counting and analysis of the bibliometric indicators. Results: from the 83 articles indexed in Scielo, only 24 had the requirements to be included, there was predominance of original articles with 58, 3%, followed by reviews. Regarding the number of authors per article the category 3 to 6 authors was the most frequent, with 5 articles. Conclusion: scientific production related to cardio-pulmonary-cerebral resuscitation has been unstable and poor. The periods of greater scientific production were 2003 and 2017. There is a predominance of original articles followed by reviews

The clinical method and the evidence-based medicine: some considerations

The correct application of the clinical method has diminished all over the world and particularly in Cuba in the last years as a result different issues, including the loss of the doctor-patient relationship, the rejection of the values of physical interrogation and examination and the increasingly irrational and excessive use of medical technology applied to the diagnosis process. The evidence-based medicine is a technical tool to quantify and qualify which data or study is the most accurate, and therefore valid in each case. It helps us clarifying the best way to use and apply "evidence" but it does not replace the clinical method. This article discusses the proper relationship that must be established between the clinical method and the evidence-based medicine in order to provide the appropriate medical care to our patients

Clinical Practice Guidelines for Cardiogenic Shock.

Clinical Practice Guidelines for Cardiogenic Shock. It has been defined as the persistence of tissue hypoperfusion, usually associated to blood hypotension as the result of heart pumping failure. This document includes a review of the main aspects as concepts, aetiology, diagnosis and treatment. It includes the concept, risk factors, clinical presentations, diagnosis, and therapy based on the possibilities of our environment. It includes assessment guidelines focused on the most important aspects to be accomplished