Biomedical subjects

A Goic

Publications and source records attributed to A Goic.

At least 19 recordsLinked to original sources

PubMed1999

[Trends in current medicine].

Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity. Physicians are uncomfortable with the weak knowledge that they have about some diseases such as cancer, connective tissue diseases, degenerative diseases, mental and psychosocial conditions. They are also worried about the aggressive and mutilating surgical procedures that are required nowadays. One can foresee that molecular medicine and applied technology will advance at a great speed and will modify the therapy of several diseases and the social organization of health care. Scientific progress will also change our values and will pose new political and economical challenges. I believe that medical ethics and bioethics will become a growing concern for medical education and professional organizations. The so called biotechnology century will also be the bioethics century. The revision and elucidation of the fundamentals of medicine will differentiate, in the future, a medicine devoted to mankind with a solid ethical background from an impersonal health care that considers man as an object or maybe a merchandise. The second option will cast medical care through the abyss of decadence, to its end.

Forecasting↗

PubMed1999

[Availability of physicians in Chile and its medium-term projection. 5 years later].

According to a prospective study performed in 1993, Chile had 14,400 active physicians (excluding those over 70 years of age) and a physician/inhabitant ratio of 1:960. The estimated projection for 1998 was of 16,244 physicians and a ratio of 1:921. However, during the present decade, the number of medical schools in Chile has duplicated, increasing by 38.4% the number of available posts in Medical schools. Also, 1,297 physicians graduated abroad, have been incorporated. Therefore, previous projections must be revisited. The present study shows that in 1998, Chile has 17,441 physicians (1:850), will have 20,610 (1:765) in 2003 and 24,449 in 2008. This last figure means a physician/inhabitant ratio of 1:679, similar to that of countries with a consolidated market economy. The foreseen medical population increase rate of 3.5% doubles the general population increase rate. To assure the quality of medical training, a Medical School accreditation process is being held. This study highlights the need to review bilateral agreements subscribed with five countries, that recognize the physician degree without assessing the medical skills of foreign graduates.

Chile↗

PubMed1999

[Claudio Costa Casaretto M.D. (1914-1999) in Revista Medica de Chile].

The work of Dr. Claudio Costa Casaretto covers a broad field in the history of Medicine in Chile. He contributed with the historical aspects in the Centennial issue of Revista Médica de Chile in July, 1972. He published 85 papers in this journal in a lapse of 20 years. In his works, he investigated about medical personalities with the highest relevance for Chilean medicine such as Dr. William Blest, graduated in Edinburgh and director of the first Medicine Course in Chile in 1833, the French obstetrician Dr. Lorenzo Sazie, first Dean of the Faculty of Medicine of the University of Chile in 1843 and Dr. Eloisa Díaz, first physician graduated in Chile and South America in 1887. He published the translation from Latin of Juan Ignacio Molina's verses "Elegies to smallpox", Chilean writer and erudite of the XVIII century. He also undertook the origins of Universidad de San Felipe (1737), Universidad de Chile (1842) and Pontificia Universidad Católica de Chile (1889) and the main educational events occurred in the Faculty of Medicine of the University of Chile, during the past century. He also published about the public health situation and sanitary care during the XIX century, about the conflict between private and public teaching and other political events of the past century. The work of Dr. Costa as a whole, is a real history textbook of Chilean Medicine. Dr. Costa and Dr. Enrique Laval are the most important Chilean medical historians of the XX century.

Chile↗

PubMed1998

[The Hippocratic Oath].

The impact of Hippocratic Oath on medical practice is universally recognized. However, some physicians raise questions about its validity and few medical schools use it in graduation ceremonies. It is postulated that this oath does not harmonize with present bioethical concepts and that the principles of beneficence, lack of harm, autonomy and justice, elaborated by Anglo-Saxon philosophers, would do so. The Hippocratic Oath contains these principles and many others, such as gratitude, compassion, justice, honesty, humbleness, sanctity, integrity, confidentiality, fidelity to the bond, and respect for human life and dignity. These are ethical values that apply to modern dilemmas in medicine. As a whole, the oath expresses an ideal of medical behavior and a life project. It must be interpreted in the context of ancient Greek culture and history. Some uncertainties about its relevance are due to a lack of understanding of its exceptional content of values. Modified versions of the oath or original texts presumptuously pretend to replace a document that has lasted 2500 years and that meant a revolution, not only to medicine, but for all mankind. Students should have the opportunity to analyze its content and the way its values are related to concrete situations of present medical practice. Medical schools should shelter it without objections, as the expression of a reflexive compromise acquired by physicians during their studies and to be applied in medical practice.

Education, Medical↗

PubMed1997

[Revista Médica de Chile: a long and beautiful educational task].

Revista Médica de Chile is one of the oldest medical journals in the world. Since its foundation in 1972, it had an educational character. Its successive editors and members of editorial committees have been distinguished clinicians, investigators and teachers. The diffusion of this journal among physicians and students for more than a century, renders it as a pioneer form of continuous distance education and could be considered as a "silent and peaceful campus". Through the years, this journal has coped with the progress in medical and biological knowledge,the perfecting of graphic arts and editorial processes and the development of computing. It has improved its management and professionalized the editorial process. In the near future, this last aspect will need further improvements due to its increasing complexity. The journal adheres to international publication norms for scientific manuscripts and is connected to international associations of medical journal editors. The editors have assumed the professional and ethical responsibility of controlling that publications provide valid information in a language intelligible for most readers. This compromise implies an independent work and the rejection of any form of undue pressure. We can state that Revista Médica de Chile, as a whole, is a historical document and that its pages reflect the capacity and intelligence of several generations of Chilean physicians.

Chile↗

PubMed1997

[Bioethics in contemporary medicine].

Bioethics arose in a delicate social and political moment in the United States of America. With time, it has become a social and perhaps political movement. Its scope is wider and different than that of medical ethics. Bioethics appeared in the second half of the twentieth century, in the middle of a spectacular advance in biological knowledge and technology. Meanwhile, medical ethics was formulated in the fifth century B.C. in relation to medical care. This defines the main focus of their respective interests. Anglo-Saxon philosophers, deriving from moral philosophy, applied the principles of beneficence, no maleficence, justice and autonomy to medicine. The Hippocratic oath refers specifically to the first three and to a number of other ethical principles. Nothing in its contents, contradicts the principle of autonomy. The emphasis in the principle of autonomy that some specialists in bioethics pose, even over the principle of beneficence, is determined, according to our judgment, by inherent factors of the North American culture. We believe that medical ethics should be distinguished even though not separated from bioethics. Physicians should go back to the Hippocratic oath as the fundamental guide for their professional activity.

Bioethics↗

PubMed1997

[The care of the terminally ill patient].

Drs. Alejandro Goic (internist), Ramón Florenzano (psychiatrist), Bernardino Piñera (physician and Catholic Bishop), Sergio Valdés (internist) and Rodolfo Armas (internist) participated in a round table about the care of the terminally ill, during a Postgraduate Course organized by the Chilean Society of Gastroenterology. After a general introduction, participants discussed the psychological aspects of terminally ill patients, about the sense of death from a Christian anthropological perspective, the terminally ill in intensive care units and finally about the education of medical students in this frequently neglected aspect of medical practice.

Attitude to Death↗

PubMed1996

[Training of internists].

The role of internists has been extensively debated in the last decades. Chile has a 40 years experience in specialist training, based on USA hospital residency programs. The universities have tuition of programs and financing comes from the Ministry of Health. The Chilean Association of Medical Faculties accredits training centers. The present paper proposes a profile for internists (referred as an adult general physician) in the areas of attitudes and behaviors, knowledge and skills. The features, training areas and educational experiences that the internist should have, based on the described profile are also pointed out. Current training programs should be modified, since they have become the vestibule for super-specialization rather than conducting to the practice of general internal medicine. The internist's amplitude and integration of knowledge, fine clinical skills based on medical interview, physical examination and therapeutic mastery, differentiates him from sub-specialists.

Chile↗

PubMed1995

[Development of traditional careers at new universities. The case of medicine].

In 1981, the educational system in Chile was diversified characterizing Universities, Professional Institutes and Technical Training Centers. The provincial seats of traditional Universities were transformed in independent universities, which strongly increased its number. A number of private universities also emerged. This strategy was quantitatively successful, duplicating the number of youngsters between 19 and 24 years old that were following superior studies (from 88 to 199 per 1,000) and duplicating the registers at higher education institutions (from 118,000 to 244,000). The quality of the education is a matter of concern at the present time. In the case of Medicine, the Medical Schools Association has proposed to the Higher Education Council an accreditation system for programs that pursue the M.D. degree, based on explicit standards for all medical schools. Considering that teaching, research, laboratory and library resources in Chile are limited, accreditation is even more important. The splitting relationship between Medical Schools and the Ministry of Health, whose establishments are used as training centers, is also worrisome. Finally the physician:inhabitant relationship in Chile is adequate for its development level (1:960). Its geographical distribution, however, is highly unsatisfactory (1:657 in Santiago and 1:2,200 in some Regions). The implementation of professional and economical incentives could reverse this situation.

Accreditation↗

PubMed1995

[Geographical distribution of physicians in Chile].

In 1994, Chile had 15,451 active physicians (less than 70 years old) for a population of 14,027,344 with a ratio of 1 physician per 908 inhabitants, a satisfactory figure compared to other countries of similar socio-economical development. Ratios of 1:880 and 1:843 are projected for 1999 and 2004 respectively. The annual rate of physician's population growth (2.2%), that is superior to the general population's growth rate (1.6%), will increase to about 2.5% per annum in 2001 as a consequence of the creation of three new medical schools. However, the distribution of physicians along the country is unsatisfactory. While the capital (Metropolitan Region) has a ratio of 1 physician per 629 inhabitants, the figure for the Region of Maule is 1:2,113. Only two of ten regions, excepting the capital, have a ratio lower than 1:1,000. Sixty percent of physicians live in Santiago while only 40% of the general population does so, illustrating their high concentration. Median ratio in Chile, that better reflects the reality than the mean, is 1:1,280. The heterogeneous distribution of physicians in Chile is a sign of social inequity that must be corrected. In a free society a better physician distribution is achieved with economical and professional incentives given by health institutions.

Chile↗

PubMed1995

[Who finances medical research in Chile?].

To identify those institutions granting medical research in Chile, every issue of Revista Médica de Chile published between 1987 and 1994 was reviewed, under the assumption that a vast majority (over 70%) of papers released by Chilean authors in topics of internal medicine and related subspecialties would have been submitted for publication in this journal. This assumption was based in the solid prestige of Revista Médica de Chile among Chilean physicians and investigators: it is one of the oldest medical journals in the world (founded in 1872) and its inclusion in the most important international indexes (e.g. Index Medicus, Current Contents) qualifies it in the "mainstream literature". Papers classified as "Original Articles", "Clinical Experiences", "Review Articles", "Public Health", "Case Reports", "Clinical Laboratory", "Special Articles" and "Medical Education" were screened for acknowledgment of financial support beyond the resources needed for routine clinical work. Among 1,528 manuscripts published, 344 were "Original Articles" and 61.3% of them acknowledged special financial support. Five hundred and one manuscripts were "Clinical Experiences" and 21.5% of them received special financial support; similar proportions were detected in "Review Articles" and "Public Health" topics. The institution ranked as providing support most often was the "Fondo Nacional de Ciencias y Tecnología" (FONDECYT), a governmental fund that assigns resources to research in all areas of science and technology through a peer-reviewed nationwide annual contest. FONDECYT was identified as provider of financial support to 45.2% of the "Original Articles" and "Clinical Experiences"; Chilean universities were mentioned by 33.6% and other entities (including pharmaceutical companies, other national and foreign organizations) by 23.1%. The University of Chile was the main Chilean university mentioned in the acknowledgments. The proportion of papers receiving special financial support was lower in Revista Médica de Chile than in three leading journals from developed countries (70% of Articles published in Annals of Internal Medicine, 74% in Lancet and 78% in The New England Journal of Medicine) but this proportion has been steadily increasing since 1987. The increase has been due only to FONDECYT and it would be unreasonable to expect that this institution will maintain such an expansion indefinitely. Therefore, Chilean investigators should attract more resources from the universities, the pharmaceutical companies and other non-governmental institutions.

Chile↗

PubMed1994

[160th anniversary of the Chilean school of midwifery: in the path of Sifra and Pua].

Midwifery is one of the oldest professions. However, the first attempts to train midwives appeared only in the seventeenth century and the first maternities, that become training centers, arose in the eighteenth century. Legal Norms for training and practice of midwifery began to be dictated during nineteenth century in Holland, Scandinavia, Germany and France. It is thus noteworthy that a young country as Chile is celebrating the 160th anniversary of the School of Midwifery, one of the oldest in the world. After the Independence, Chile gave great impetus to education, numerous european professors were hired and the school of midwifery was founded in 1834 by Dr Lorenzo Sazie, a french surgeon and obstetrician. Due to its nature, midwife education must emphasize the ethical aspects of the profession. Since ancient times, midwives are committed with human life. Hebrew midwives Sifrá and Puá, disobeyed the Egyptian King's order to kill all male newborns, and were rewarded by god, as mentioned in the Old Testament. On the other hand, during the Obstetrics course opening in 1835, Dr Sazie underscored the ethical demands of the profession, exhorting students to be "mankind ministers".

Anniversaries and Special Events↗

PubMed1994

[Establishing new medical schools in Chile].

In Chile there are six established medical schools at public (Chile. Valparaiso and Temuco) or private (Catholic. Concepción and Austral) universities created between 1833 and 1971. Since 1990, three new medical schools (two private) were created and a fourth is projected, concerning the chilean medical corps. We present three position articles on the subject written by Dean Pedro Rosso, from the Catholic University, Dr Pedro Castillo, Chief of Human Resources of the Ministry of Health and Dean Alejandro Goic from the University of Chile. Dean Rosso emphasizes the need to have assessment procedures that guarantee quality standards in the new medical schools. Dr Castillo attracts attention on preserving the compromise with the society, inherent to chilean medicine. Dean Goic analyzes systematically the reasons to prevent the proliferation of medical schools in the country, maintaining an equilibrium between freedom of teaching and public faith protection.

Chile↗

PubMed1993

[Role and responsibility of the professions in the medical act and health actions].

The medical act is a part of health actions, but not every health action is a medical act. The primarily and most generalized medical act is the care of a sick individual. The requirements to execute a medical act are to possess the specific knowledges and skills, have a recognition of the possession of these qualities and to be qualified by the state to practice the profession. The governing condition of medical task is the disease and the essential part is diagnosis and treatment. The diagnosis and treatment prescription are exclusively medical acts. The execution of treatment may be shared with other health care professionals. The actions of health promotion, prevention, repair and rehabilitation must necessarily be performed by a multi professional team in which the physician (or the odontologist) has predominantly the task of repairing the lost health. The diversification of health professions has created interprofessional tensions, with an underlying social power problem. Nevertheless, each profession has its own dignity and specific action boundaries. Although there are always unavoidable superpositions in their respective frontier limits role.

Health Occupations↗

PubMed1993

[Message from editors to authors: review articles. How can the scientific and educational results be improved?].

Most biomedical journals include review articles that pretend to provide the readers with an updated, synthetic and critical appraisal of some important topic. These articles are usually written by experts in the topics reviewed. There are no conventional or universally accepted requisites for the formal organization of contents in a review article. This is in contrast with other kinds of original articles. Therefore, to guide the authors on how to improve the review articles to be submitted to Revista Medica de Chile, some recommendations are proposed. These recommendations were based in the editors' experience and in other pertinent publications: 1) The scope and purpose of the review article should be established in the introductory paragraphs; 2) The methodology used in the selection of the literature reviewed and the time span covered by the search, should also be specified; 3) The author of the review article should systematically appraise the validity of the methods employed in the papers reviewed. A similar attitude should be observed with regards to the results, discussions and conclusions. The limitations and inconsistencies found should be pointed out; 4) The author of the review article should state his (her) own conclusions, identifying the solid as well as the weakly established facts; 5) Whenever feasible, a proposal of future lines of research envisioned after reviewing the literature, is commendable; 6) The literary style of the article should be kept as interesting as possible, to motivate the prospective readers; 7) The scope of the specific journal where the author intends to submit the review article, should always be kept in mind.

Publishing↗

PubMed1993

[General practice: a theme in search of clarity].

Specialization is a consequence of the progress in knowledge and technology, and is essential to increase medical knowledge. Culturally, the population increasingly aspires to be attended by a specialist. On the other hand, generalism is necessary to protect the unitary focus on the sick patient, to mitigate the increasing cost of medicine and to avoid the increasing dehumanization of medical practice. The condition of generalist is not synonym of general practitioner and may be applied to internists or pediatricians with ample knowledge and diagnostic skills based more in medical interview and physical examination than in the sophisticated laboratory. Specialties have clearly defined fields of knowledge and action, have well established training programs and are culturally accepted, not so general medicine. In Chile, a significant number of trained general practitioners has not been attained, in spite of the existence of training programs since more than 20 years. Outpatient care (primary care in the language of health planners) may be undertaken by general practitioners but also, and perhaps with better efficiency, by general internists and pediatricians. The use of ones or others will depend on the geographic location (urban, suburban or rural), on the available physicians and the communication facilities with better developed medical centers. Within this line of thinking, the Faculty of Medicine of the University of Chile is studying a reform of medical curriculum, rotating internship and residency programs.

Education, Medical↗

PubMed1993

[The hippocratic oath: a blind veneration?].

It has been suggested that the Hippocratic oath is no longer relevant in the context of modern morals and current medical practice and that it continues to be administered simply out of blind adherence to tradition. Such judgments may be the result of too superficial an analysis of the oath. The substance of the oath is its ethical content, while the style is shaped by its cultural and historical roots and its literary form. This article carefully examines the Hippocratic oath in order to elucidate the ethical values it contains and consider whether or not these continue to have relevance for contemporary physicians.

Ethics, Medical↗

PubMed1992

["Revista Médica de Chile":120 years of continuous publication].

Revista Médica de Chile has been published monthly since its foundation in 1872. With the present issue, volume 120 is completed. It is the oldest medical journal in South America and the second in antiquity published in Spanish, after the Gaceta de México. It is ranked among the 28 older journals in the world, that were founded in the last century. The multiple aspects of Chilean medicine development are present in its pages. Revista Médica de Chile has been able to adapt to changes in medicine, improving its printing and design, adopting international regulations for periodic medical publications and, above all, making a strict selection of submitted papers using expert peer reviewers. The continuity in management and editorial policies has favored its progress and enhanced its educational role.

Chile↗