Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Objectives: This study is a description of the development of a medical audit strategy based on quality provision assurance using tools of participatory supervision in an attempt to generate cooperation between the auditor and the auditee in health services of the first level of  Primary Attention to Health Care of the Ministry of Public Health of Ecuador. Methods: A methodology was developed, implemented and field tested, based on a description of the results (cross-section study). Results: At the beginning of the process, the clinical relevant scores, in general, did not exceed 45% and in relation to legal risks they did not exceed 65%. Progressively, an increase in the score was observed. Additionally, results obtained from the auditees’ perception of this process were obtained, with less resistance in less than 5% of the cases, perhaps due to the participatory nature of the process. Conclusion: The medical audit process is essential for the identification of problems, but it is also necessary to be an active process with their intervention and resolution. The Medical Audit identifies hidden problems for decision-makers and decreases the resistance to the inclusion of strategies for quality improvement.

Objective: This paper discusses medical residency training. The experience of implementing a national medical residency program is introduced and considerations about the issues that came across during this process are commented. Methods: Concepts about training internalization, decentralization and deconcentration, debating the meaning of these terms from the experience reported. Results: Some of the challenges perceived indicate the need to reorganize similar processes to overcome the low occupancy of places in medical residency and to enable skills for the follow up of preceptors-to-be. Conclusion: This innovation is a contribution for qualification and provision of physicians for the Brazilian Unified Health System.

In the last edition of the Cartographic Journal as its publisher, I celebrate a fruitful and positive 2013-2017 journey. In this period, I had the opportunity to coordinate major advances, which will certainly rise the quality standard of the journal, making it even more recognized by readers in the Americas and in the world. The journal is now published in digital format in the new web page <http://comisiones.ipgh.org/CARTOGRAFIA/revista-cartografica.html>, though the printed editions are still published on demand. We obtained the Latindex in 2015, an important indexing system of publications in the Americas. In 2016, the periodicity changed to two editions per year, with an average of 12 articles per edition. As a future goal, we aim at obtaining other prestigious indexing systems. The number of reviewers of the Editorial Board changed from eight to 70 highly-skilled professionals from different countries, reviewing articles in the four official languages of the PAIGH (Spanish, English, Portuguese and French). The review criteria and procedures have also been improved, by using the double blind system and standard sheets to include the reviewers´ comments. The Cartography Commission created the “Prize for the Outstanding Postgraduate’s Thesis”, which fosters part of the articles published in the journal, in addition to awarding relevant Master´s and Doctorate´s works. ...

Introduction: The creation of health care networks (HCN) in national health care systems has proved to be an effective form of organization of health care systems to address some of these epidemiological and structural challenges. Brazil has been moving towards the regionalization and conformation of HCN. In order to assess the development of HCNs, this research offers to define initial items that in the future will compose an evaluation tool capable of measuring two attributes of health care networks: individual care coordination and planning of HCNs by the Primary Health Care. Methods: We used the Delphi method, which involves the following steps: initial setting of items to be evaluated and composition of the experts group, conducting four rounds of Delphi and evaluation of results. Results: The final product was a list of 69 items, of these, 59 items reached stability between experts and can be divided into: a group of 44 items that achieved a high degree of consensus among the experts to include the item in the final list; a group of 12 items that reached an intermediate degree of consensus, and a group of 3 items that reached a low degree of consensus. The construction of this initial proposal of items for evaluation of HCN has the main goal of collaborating with researches related to the more systemic evaluations of health services.

This work is on an experience developed in the Sao Miguel II health unit, in Miguel Alves, state of Piaui, addressing the prevention and control of cervical and breast cancer. Actions were developed in four processes: organization and management, monitoring and assessment, public engagement and practical clinic qualification. After 12 weeks of intervention, coverage indicators of attention on cervical and breast cancer increased to 56.6% and 88.1%, respectively. With respect to the quality indicators, 73.3% of satisfactory samples of pap smears were obtained, 73.3% of pap smears and 23% of mammographies were adequately registered in specific records, 97.7% of women aged between 25 and 64 were assessed on warning signs of cervical cancer and 98% of women aged between 50 and 69 were assessed on breast cancer risk.

Lower body ulcers are a public health problem due to the significant incidence, high cost and frequent recurrence. Often, the Family Strategy Unit team provides first contact care with the ulcer carrier, so is a requirement for the team to be updated about treatment options. A topical product used for treatment of cutaneous ulcers is 10% papain gel, due to its antibacterial and debridant characteristics of necrotic tissues and the promotion of tissue renovation. This report describes the experience of Family Strategy Unit team using 10% papain gel in the treatment of cutaneous ulcers, which regressed after thirty days of this use, with emphasis on the support by the specialist for the resolution of the case.

This is an experience report on the supervisory work of the More Doctors in a city in the Greater São Paulo throughout 2014. More Doctors program was established by the federal government in 2013 and with the participation of physicians from several countries, mostly from Cuba. This experience report seeks to list and analyze briefly some risks and benefits that the program provides for the actors involved.

Primary Care has the ability to enable the end of life care to be systemic, humanized and autonomy promoting. However, working at palliative care requires that the team develop a complex and multidimensional point of view, especially due to the proximity with reflections about death and existential, social, religious and personal perspectives. In this way, questions about how to deal with the subjective dimension of patients, families and professionals emerge as a challenge in clinical practice. Reporting the family physicians’ perspectives, we present the case of a patient in palliative care accompanied by a Family Health Strategy team, an unusual scenario for palliative care in Brazil. Thinking about the personal and existential dimensions of the professionals, we discuss factors that favor or hinder the comprehensive care towards the end of a life. We noticed that, despite the challenge of care in terms of resource and time, the dialogue among the team and the biopsychosocial-spiritual approach enabled the redefinition of the process of care, disease and death.