Andréia Patrícia Gomes

Transformação da educação médica: é possível formar um novo médico a partir de mudanças no método de ensino-aprendizagem?

The changes in medical training have long been discussed in medical schools. These attempted changes have primarily been of a methodological or pedagogical nature, with curriculum restructuring based on the introduction of problem based learning (PBL) as an underlying axis. The traditional curricular format is still predominant, with PBL emerging as the most common alternative. The aim of this article is to present this method and assessments of its results, in order to create a snapshot of how effective it is in preparing critically-minded, thoughtful and socially responsible doctors. A literature review was conducted based on searches of the SciELO (Scientific Eletronic Library Online), Pubmed (www.nlm.nih.gov) and BVS (Virtual Library in Health) databases, with the selection of articles about the subject published in the last 20 years. The results reveal isolated pedagogical change to be insufficient as a solution to provide medical training capable of combining technical and ethical and humanistic skills.

Sepse: atualidades e perspectivas

This paper aims to provide an update on the main aspects of sepsis, a very relevant health care issue. A number of hypotheses have been proposed to explain its origin, involving interactions between microorganisms and the innate immune system, inflammation/immune mediation and the coagulation system. The clinical features of sepsis are variable and depend on the primary site of infection. The identification of early signs and symptoms is crucial for starting therapeutic measures fundamentally based on volume resuscitation, antibiotic therapy, use of steroids, anticoagulant therapy, biologic viability maintenance interventions and nutritional support.

Malária grave por Plasmodium falciparum

A malaria e uma das principais doencas parasitarias do mundo, acometendo importante contingente de pessoas. Por seu alcance epidemiologico e pela possibilidade de desenvolvimento de quadros graves - quase sempre devidos ao Plasmodium fqalciparum -, se faz necessario o conhecimento adequado de suas manifestacoes clinicas e da terapeutica, para otimizacao da conduta. Na malaria grave a internacao em unidade de terapia intensiva e mandatoria para reducao das complicacoes decorrentes da infeccao. O inicio do tratamento deve ser o mais precoce possivel, o qual tem impacto na sobrevida do paciente, e e baseado na combinacao de drogas antimalaricas e medidas de suporte. Neste âmbito, o presente artigo destina-se a discussao da forma grave da malaria por P. falciparum, com enfase no quadro clinico e no tratamento

Educação e competências para o SUS: é possível pensar alternativas à(s) lógica(s) do capitalismo tardio?

As transformacoes vividas no mundo do trabalho na sociedade contemporânea levam a necessidade de se repensar alternativas para a formacao dos profissionais de saude, permitindo, assim, a abordagem dos problemas de saude dos sujeitos e das coletividades. Com base nessas consideracoes, o presente trabalho pretende discutir a formacao em saude - em torno do conceito de competencia -, tendo como foco a educacao para o SUS, tomando como marco teorico a tentativa de analisar e propor uma alternativa aquelas entrincheiradas na logica do capitalismo tardio. Trata-se, pois, de uma reflexao sobre o assunto, correlacionando a teoria e a praxis, num movimento constante e incessante de construcao, desconstrucao e (re)construcao de proposicoes.

A influência da rede social da nutriz no aleitamento materno: o papel estratégico dos familiares e dos profissionais de saúde

The objective was to raise and classify scientific works on the influence of the social net of lactating mothers in the context of the breastfeeding. A bibliographical review was done in the main databases (MEDLINE, LILACS, SciELO), using as keywords: breastfeeding, weaning and family (and their versions in English and Spanish). Books, thesis, dissertations, and publications in international and national institutions were consulted (WHO, UNICEF, Ministry of Health). It could be observed that the actors that compose the social net of the lactating mothers can interfere in the decision of breastfeeding, through different extents, such as the encouragement/support to the initiative; reviewing the knowledge and cultural values; family tradition; and the cultivation of the indifference/discourage and the pressure exercised on the lactating mothers in relation to the form of feeding the child. In this way, it can infer on the need of the implementation of new health practices regarding to the care of this group. It is worth to highlight, the importance of the professionals to be qualified for the sensitive listening on the meaning of the nursing under the glance of the lactating mothers . Finally, it stands out the importance role of the social net of the lactating mothers, especially the family, for a successful breastfeeding.

Atenção primária à saúde e formação médica: entre episteme e práxis

A tradicional formacao medica no Brasil tem reconhecido no hospital o lugar por excelencia para a aprendizagem pratica do estudante - enfatizando as tecnologias duras e os procedimentos - em detrimento da Atencao Primaria a Saude, ainda que esta seja, reconhecidamente, capaz de resolver cerca de 80% dos problemas de saude. Embora este cenario venha se alterando paulatinamente no seculo XXI, em especial apos a publicacao das Diretrizes Curriculares Nacionais para o Curso de Graduacao em Medicina, ainda permanecem duvidas sobre os melhores modos para viabilizar a insercao de forma exitosa. Com base nestas premissas, o presente artigo tem por escopo contextualizar este debate e apresentar propostas para consecucao de processos ensino-aprendizagem na Atencao Basica.

Problemas bioéticos na Estratégia Saúde da Família: reflexões necessárias

Trata-se de revisao de literatura abordando os principais problemas eticos no âmbito da Estrategia Saude da Familia. Foram utilizados 15 artigos publicados no periodo de 1994 a 2012 e textos qualificados como complementares. Puderam ser destacadas, nos resultados, tres grandes categorias de problemas bioeticos: 1) relacoes entre profissionais/trabalhadores e usuarios do sistema de saude; 2) relacoes entre profissionais/trabalhadores no dominio da equipe; e 3) relacoes etico-politicas, afins a intersetorialidade, na esfera do Sistema de Saude - e uma quarta categoria, ligada a esfera ambiental, que ainda necessita melhor delimitacao empirica e conceitual. As consideracoes finais assinalam os principais complicadores para a adequada abordagem dos problemas bioeticos na Estrategia Saude da Familia e as possibilidades de seu equacionamento a partir do emprego de estrategias de educacao permanente; e analise embasada nos referenciais teoricos da bioetica da protecao e da bioetica de intervencao.

Formação Médica na Estratégia de Saúde da Família: Percepções Discentes

Given current social demands, it has become essential for medical education to break from the traditional model of biological reductionist and training based only at hospitals and redefine itself towards a holistic care (integrality). The construction of new training practices in health with the use of new outdoor scenarios, in partnership with (Unified National Health System — SUS), assumed a key role. In 2005 the Centro Universitario Serra dos Orgaos (Unifeso) incorporated into its curriculum the Problem-Based Learning and the insertion of medical undergraduates into Basic Health Units Family. This paper describes the perception of medical students in this scenario. We conducted a qualitative research working from the application of interviews and the utilization of thematic analysis of responses with the creation of categories. The results show the combination of positive impressions — integration between theory and practice — and negative — problems in the organization of activities, as well as the necessity to identify a local preceptor. A plan is proposed, guided by the new Directives, for teaching in the primary health care in the context of the condition of integrality.

Avaliação no Ensino Médico: o papel do portfólio nos currículos baseados em metodologias ativas

Current changes in medical education related to transformations in contemporary democratic societies have increasingly posed issues pertaining to the evaluation of teaching-learning processes. New methods and strategies are thus needed to supplant the prevailing summative grading approach. The current article thus discusses elements to construct such a new approach to evaluation, highlighting the portfolio as an evaluation tool.

Modelos de tomada de decisão em bioética clínica: apontamentos para a abordagem computacional

Bioethics has become over the recent decades a central question to clinical practice, due to the fact that it provides theoretical tools for decision making in health care. The issue that arises concerns how to know whether the decision made is the most appropriate, considering that a clinic decision – whether working in primary, secondary, or tertiary care – must be accurate from both the technical and the ethical point of views. As a result, different models for decision making in clinical bioethics have been presented in the literature. Based on these considerations, the objective of this article is to point important issues about (i) decision making in the field of clinical bioethics and (ii) the possibilities of computational approaches to assist such decisions.Models of decision making in clinical bioethics: notes for a computational approach Bioethics has become over the recent decades a central question to clinical practice, due to the fact that it provides theoretical tools for decision making in health care. The issue that arises concerns how to know whether the decision made is the most appropriate, considering that a clinic decision – whether working in primary, secondary, or tertiary care – must be accurate from both the technical and the ethical point of views. As a result, different models for decision making in clinical bioethics have been presented in the literature. Based on these considerations, the objective of this article is to point important issues about (i) decision making in the field of clinical bioethics and (ii) the possibilities of computational approaches to assist such decisions.