OBJETIVO: Propor um modelo de programa para residência médica em radiologia e diagnóstico por imagem, com programa básico de treinamento teórico e de treinamento em serviço. MATERIAIS E MÉTODOS: O programa foi idealizado a partir de uma análise e revisão da literatura, com base nas recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem e da Comissão Nacional de Residência Médica, e tendo como modelo o programa do Conselho Americano de Regulamentação de Educação Médica para Graduados. RESULTADOS: A proposta foi desenvolvida para um programa de duração de três anos, dividido em módulos de subespecialidades ou métodos diagnósticos. Foram descritos os objetivos e especificadas as competências a serem alcançadas pelos médicos residentes. CONCLUSÃO: Mudanças no modelo de ensino-aprendizado se tornaram necessárias face ao crescente acúmulo de informações e o desenvolvimento tecnológico. A organização da aquisição de conhecimentos de forma hierarquizada, com um conteúdo programático básico, permite uma formação adequada do futuro especialista. Espera-se que esta proposta possa contribuir como subsídio para o aprimoramento dos programas de residência médica, permitindo a implementação de um modelo em âmbito nacional.
SummaryBackground:The prevalence of atrial fibrillation, expenses with the healthcare system and the associated high morbidity and mortality have justified the search for new therapeutic approaches.
Background: Tuberculosis (TB) remains as an important public health problem worldwide. The most common type is pulmonary TB, and the most prevalent form of extra-pulmonary disease among HIV-negative patients is pleural disease. Objective: The objective of the present study was to determine the effect of continuous positive airway pressure (CPAP) on fluid absorption among patients with pleural effusion due to TB. Methods: Twenty patients were randomized into two groups. The interventional group (n=10) received CPAP three times a week during the initial four weeks of anti-TB treatment, and the control group (n=10) received anti-TB drugs only. The primary endpoint was the volume of pleural fluid after four weeks of treatment. Both groups were submitted to thoracic computed tomography using threedimensional image reconstruction. The Mann-Whitney test for independent samples and the Wilcoxon paired samples test were used for statistical analysis. The normal distribution samples were analyzed using the unpaired t test. Results: The reduction of pleural effusion volume was significantly greater in the intervention group (83.5%±SD 3.6) than in the control group (36.9%±SD 2.9; p<0.001), and the final dyspnea index was lower in the Intervention group than in the control group (p=0.002). Conclusion: Our findings indicate that CPAP during the first month of TB treatment accelerates the absorption of pleural effusion, however, additional studies are needed to confirm these findings and evaluate the impact of CPAP on pleural sequelae after the end of anti-TB treatment.Article registered in the Clinical Trials under the number NCT00560521.Key words: physical therapy; pleural effusion; continuous positive airway pressure; pleural tuberculosis. ResumoContextualização: A tuberculose (TB) permanece como um importante problema de saúde pública no mundo. A forma mais comum de apresentação é a pulmonar e, em pacientes soronegativos, a forma de doença extrapulmonar mais prevalente é a pleural. Objetivo: Palavras-chave: fisioterapia; derrame pleural; pressão positiva contínua em vias aéreas; tuberculose pleural.
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