Revista medica de Chile最新文献

{"title":"[Bioethics Tools in Decision-Making in the Intensive Care Unit].","authors":"Claudio Castillo, Manuel Ramírez, Cristian Grenett, Víctor Rossel","doi":"10.4067/s0034-98872024001101154","DOIUrl":"https://doi.org/10.4067/s0034-98872024001101154","url":null,"abstract":"<p><p>Working in Critical Care Units (CCU) is of a multidisciplinary, high-complexity nature; thus, collegiate decisions are necessary. Bioethics as a discipline in the context of pluralistic, democratic societies provides us with valuable tools for complex clinical cases. In this article, we propose the Principlism tool (Beauchamp & Childress) combined with the Deliberative Method as a major supporting tool for the resolution of these problems at CCU. Additionally, we complement that view with two other tools that consider psychosocial scope: Jonsen, Siegel Winslade, and Diego Gracia Tools. With the help of these tools, it is possible to solve most clinical cases, avoiding extreme courses of action.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1154-1161"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Another Lesson from the Pandemic: Supervisor Social Support for Mental Health Protection in Healthcare Workers, Chile].","authors":"Andrés González-Santa Cruz, Elisa Ansoleaga, Macarena Vargas-Plaza de Los Reyes","doi":"10.4067/s0034-98872024000800875","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800875","url":null,"abstract":"<p><p>The mental health of healthcare workers is strongly affected, and more evidence is needed to determine the dimensions of risk and protection related to the presence of anxious and depressive symptomatology.</p><p><strong>Aim: </strong>To determine whether working conditions, social support and socio-occupational characteristics are associated with anxious and depressive symptoms reported by healthcare workers during the pandemic in Chile.</p><p><strong>Methods: </strong>Observational, correlational and cross-sectional study. A survey was applied to 875 healthcare workers (76% women) through SurveyMonkey between 2020-2021. It included mental health (depressive and anxious symptomatology), related to the pandemic working conditions (i.e., insufficient masks, contact with patients with COVID-19, reassignment of work/place/area, confidence in governmental management to protect personnel), social support (from peers, superiors, and outside work) and socio-occupational variables (sex, occupational status). Bivariate analyses and logistic regressions were conducted to examine the association of pandemic working and socio-occupational conditions on the odds of anxious and depressive symptomatology, and sensitivity analyses to underrepresentation (via post-stratification), missing data and measurement errors (using Rogan-Gladen correction) with 95% confidence intervals(95%CI).</p><p><strong>Results: </strong>Forty-four point five percent (95% CI 35.6-53.8) [crude percentage: 46%] and 41,4% (95% CI 34.5-48.6) [36%] of the respondents reported scores indicative of anxious and depressive symptoms, respectively. Greater superior support was associated with lower odds of anxious (aOR [adjusted Odds ratio]= 0.87 95%CI 0.79-0.96) and depressive (aOR= 0.86 95%CI 0.78-0.94) symptoms. Also, women had twice the odds of anxious symptomatology versus men (aOR= 2.00 95%CI 1.28-3.19), and those who mistrust the government had twice the odds of depressive symptomatology vs. those who did not (aOR= 1.98 95%CI 1.34-2.94).</p><p><strong>Conclusions: </strong>Superior support emerges as a critical factor in the mental health of personnel in health crises. Prioritizing the protective role of organizational and social support over individual or psychological support in similar contexts is suggested. Urgent measures are needed to prevent anxiety symptoms in female workers, who report them more.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"875-888"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Direct Observation of Procedural Skills as an Assessment Tool for Acquiring Procedural Competence in Nursing: A Scoping Review].","authors":"Bernardita Osorio, Rodrigo A Sepúlveda, María Elisa Espinoza, Alejandro Delfino","doi":"10.4067/s0034-98872024001101162","DOIUrl":"https://doi.org/10.4067/s0034-98872024001101162","url":null,"abstract":"<p><p>The DOPS (Direct Observation of Procedural Skills) guidelines are designed for the assessment of procedural skills in the workplace and could be a useful tool for evaluating these competencies in nursing education.</p><p><strong>Aim: </strong>To identify the use, facilitating factors, and barriers influencing the implementation of DOPS guidelines as a formative assessment method in nursing education for acquiring procedural skills.</p><p><strong>Methods: </strong>A Scoping Review was conducted following the PRISMA ScR protocol recommendations. Evidence sources were searched in PubMed, ProQuest, ScienceDirect, and Scopus from 2012 to 2023. Eligibility criteria were applied, and the methodological quality of the sources was analyzed (MERSQI/AMSTAR). Results were analyzed by three thematic groups, which were consensually agreed upon by the researchers according to the objectives (nursing procedures assessed by DOPS, satisfaction with this educational tool, and acquisition of procedural competence).</p><p><strong>Results: </strong>A total of 701 articles were identified, of which 13 were selected. The average quality of prospective studies was 10 points (range 5-18). The nursing procedures reviewed included: venipuncture, arterial sampling, therapeutic abdominal paracentesis, bandaging, dressing changes, and endotracheal suctioning. Satisfaction depends on Knowledge about this tool and the resources available at clinical centers. There is a favorable trend towards the acquisition of procedural competencies through formative assessment using DOPS guidelines.</p><p><strong>Conclusions: </strong>DOPS guidelines are effective for acquiring procedural skills in nursing. The challenges for successful incorporation of the guidelines are directly related to adequate design, planning, and implementation. There is a notable research gap at the national level regarding the use of these guidelines in nursing.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1162-1175"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect of Pharmacokinetics of GLP-1 on Muscle Mass Loss in Patients with Obesity: Should We Be Concerned?]","authors":"Carlos Celis-Morales, Marion Guerrero-Wyss, Fernanda Carrasco","doi":"10.4067/s0034-98872024000800932","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800932","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"932-934"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Training Present and Future Doctors for Chile: How Many and For What? The Urgent Need to Review the Physician Quota Generation Model].","authors":"Miguel O'Ryan G, Pablo Roncagliolo B","doi":"10.4067/s0034-98872024000800909","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800909","url":null,"abstract":"<p><p>Before 1990, Chile showed fewer medical schools, six in total, increasing to 13 by 2000. From then on, there was an explosive increase, reaching 29 faculties or schools by 2024. Medical students increased from 1,816 in 2010 to 3,000 by 2024. The number of doctors in the country in 2010 was 24,455, rising to 65,737 by 2023, of which 25% are foreign professionals. In 2010, there was a ratio of 1.43 doctors per 1000 inhabitants, increasing to 3.13 by 2024, with a reasonable projection for 2034 close to 6, in other words, one doctor for every 170 inhabitants, reaching the OECD curve, surpassing WHO recommendations, and continuing to rise non-linearly. By 2024, one in two doctors practicing in Chile has one or more medical specialties. The Public Health System reported that in 2023, approximately one-third of the total available registered professionals working hours hired represented medical specialists (61%). Specialist doctor rates by region, as of September 2023, are relatively homogeneous, with higher rates tending to be in the southern part of the country. There is underrepresentation in non-metropolitan regions of specialties such as infectious diseases, emergency medicine, adult intensive care, neonatology, hematology, and pediatric neurology. However, for most specialties, this asymmetry is not observed. Compared to other countries, Chile, with a rate of 28.4 between 2012-2020, ranks 57 out of 200 countries with available data, presenting a rate of 1.64 specialist doctors per 1000 inhabitants, while the OECD average was 2.35. This strongly suggests that Chile will likely end up with an excessive number of doctors overall but with room to grow in specialist doctors. It is possible to envision interactions and coordination that could benefit the country without exceeding a regulated system; however, professional training should be avoided to continue unregulated and subject only to free will based on marketing strategies and demand rules. National and international studies assessing healthcare challenges for the coming decades and the professional capacities required to address them at the level of general medicine, primary specialties, and derived specialties are urgently needed. Regarding clinical fields, conducting a relevant study to determine the total public and private sector training capacity that may be part of the training system for the necessary clinical competencies is essential. Forming a working group with relevant stakeholders with knowledge, concern, and involvement would be significant, e.g., the Academy of Medicine, ASOFAMECH, medical schools, Ministry of Health, Ministry of Education, and community representatives. From our higher education perspective, with a nationwide vision, universities should start a joint reflection on our role in this critical topic with a future-oriented view.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"909-926"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Transforming the Management of People with Chronic Kidney Disease: The Necessary Inclusion of Kinesiologists in the Interdisciplinary Teams that Care for Them].","authors":"Hans Müller-Ortiz, Cristian Pedreros-Rosales, Andrea Araneda Gutiérrez, Patricia Sánchez Krause","doi":"10.4067/s0034-98872024000800935","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800935","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"935-936"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Idiopathic Intracranial Hypertension: Clinical-Epidemiological Profile and Factors Associated with Visual Outcome].","authors":"Natalia Urquiola Cortés, Verónica Fernández Salgado, Christian Luco Franzoy, Cecilia Trigo Daroni, Nathaly Amaya Romero, Jorge Klagges Troncoso","doi":"10.4067/s0034-98872024001101120","DOIUrl":"https://doi.org/10.4067/s0034-98872024001101120","url":null,"abstract":"<p><p>The prevalence of idiopathic intracranial hypertension (IIH) has been increasing along with the incidence of obesity in the population. There is little national statistical data on this pathology.</p><p><strong>Aim: </strong>To characterize cases of IIH clinically and epidemiologically and analyze factors associated with visual outcomes.</p><p><strong>Methods: </strong>Retrospective study. Review of clinical records of patients with IIH treated in a Chilean public hospital between 2010-2021. Statistical analysis of clinical, treatment, and visual outcome variables.</p><p><strong>Results: </strong>140 patients were included and 90.7% were women. The average age was 32 years and 92% were overweight/obese. The main presenting symptom was headache, followed by transient visual obscurations and diplopia. Visual acuity was normal in two-thirds, and 10.4% had severe visual impairment. Papilledema was present in 96.5%. In the visual field, the most frequent defect was an 85% increase in the blind spot. Treatment with acetazolamide was effective in 76.8% of cases, requiring high doses and prolonged use. Surgery was necessary in 24% of patients, with the installation of a lumboperitoneal shunt being the most common. In factors associated with visual outcome, greater papilledema and lack of response to medical treatment showed a statistically significant association with visual deterioration.</p><p><strong>Conclusions: </strong>Our study provides national data and confirms the classic profile of patients with IIH. Factors associated with visual impairment are the presence of severe papilledema and lack of response to medical treatment. Studies are required to determine the response to surgical treatment.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1120-1129"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Coronary Angiography in Clinical Practice: Update on Indications, Complications, and Contraindications].","authors":"Pabla Cataldo, Christian Dauvergne, Manuel Duarte, Patricio Julio, Manuel Méndez, Fernando Pineda, Polentzi Uriarte, Jorge Sandoval","doi":"10.4067/s0034-98872024000800889","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800889","url":null,"abstract":"<p><p>Coronary angiography (CA) is the gold standard for identifying the presence and extent of atherosclerotic coronary artery disease or dynamic stenosis of the arteries.</p><p><strong>Aim: </strong>Review of the literature and international clinical guidelines on the evidence of its indications in different clinical scenarios.</p><p><strong>Method: </strong>Qualitative study through a narrative review of the current indications of the technique, limitations, possible complications and contraindications.</p><p><strong>Results: </strong>Information on the different scenarios in which CA is requested is extensive, ranging from expert recommendations to evidence-based clinical guidelines that support its performance. Undoubtedly, technological advances have led to the understanding of coronary pathology with the contribution of complementary techniques that contribute not only to the diagnosis but also to its treatment. It is important to understand its potential complications in order not only to plan a procedure and avoid them, and not to subject patients to tests that will not contribute in their clinical context.</p><p><strong>Conclusions: </strong>Since the first CA, performed by Mason Sones in 1958, there has been an exponential growth in interventional cardiology, where CA has improved its technique generating more evidence in its indications.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"889-900"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Psychotropic Drug and Chronic Medications in a Primary Care Center: Relation with COVID-19 Pandemic].","authors":"Arturo Roizblatt Scherzer, Eduardo Flores Casco, Nicole Grossman Kuperman","doi":"10.4067/s0034-98872024001101138","DOIUrl":"https://doi.org/10.4067/s0034-98872024001101138","url":null,"abstract":"<p><p>The COVID-19 pandemic caused an overall global health crisis, generating an increase in mental health symptoms as well as a shift in health care for chronic conditions.</p><p><strong>Aim: </strong>To assess the modification of psychotropic and chronic prescriptions in a Primary Care Center (CESFAM) in the Metropolitan Region of Santiago, Chile, during the pre-pandemic, pandemic, and post-pandemic periods of COVID-19.</p><p><strong>Methodology: </strong>A cross-sectional observational study was conducted. All prescriptions were reviewed, and the percentage of prescriptions during May of each year and period was studied, considering the pre-pandemic, pandemic, and post-pandemic periods caused by the SARS-CoV-2 virus. The confidence interval for the mean percentage of drug prescriptions in the pre-pandemic years was constructed, and values from 2020 onwards were compared with that period. The distribution of drug prescriptions was analyzed, and the association between each period and type of drug was assessed using the chi-square test.</p><p><strong>Results: </strong>The SARS-CoV-2 pandemic in the Primary Care Center led to a statistically significant increase in the percentage of psychotropic drug prescriptions, with the following percentages per period: pre-pandemic (3.12%), pandemic (3.37%), and post-pandemic (3.89%). For chronic medications, compared to the pre-pandemic period (51.72%), there was an increase during the pandemic (60.29%) and then a decrease post-pandemic (55.17%).</p><p><strong>Conclusions: </strong>The monitoring of drug prescriptions concerning the pandemic in this study revealed modifications that may be of interest as a reliable indicator that could demonstrate an increase in psychiatric and chronic diseases. This could facilitate the development of public health strategies to take action and prevent similar future situations.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1138-1147"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic Insomnia: A Public Health Problem].","authors":"Erika Quintanilla Dominguez, José Manríquez Urbina","doi":"10.4067/s0034-98872024000800937","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800937","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"937-938"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}