Browsing by Author "Carvajal, Sergio"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
Item Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile(Sociedad Chilena de Infectología, 2016) Hernández-Rocha, Cristián; Pidal, Paola; Ajenjo, Cristina; Quera, Rodrigo; Quintanilla, Marcela; Lubascher, Jaime; Jemenao, Irene; Ibáñez, Patricio; Álvarez-Lobos, Manuel; Diomedi, Alexis; Marcotti, Alejandra; Acuña, Mirta; Arab, Juan; Riquelme, Arnoldo; Candia, Roberto; Carvajal, SergioBackground: Clostridium dijfficile-associated diarrhea (CDAD) has become very important due to the increase in its incidence, severity, recurrence and the associated economic burden. Having a national consensus guideline is essential to improve its management. Objective: To build a multidisciplinary and evidence-based consensus in prevention, diagnosis and treatment of CDAD. Methods: We convened a panel of experts in the field of infectious diseases, gastroenterology, evidence-based medicine and consensus methodology. The panel conducted a structured review of published literature in CDAD evaluating evidence levels and recommendation degree according to the methodology proposed by the GRADE working-group. A modified three-round Delphi technique was used to reach a consensus among the experts. Results: A group of 16 experts was established, 12 of them answered 18 clinically relevant questions. The levels of agreement achieved by the panel of 16 experts were 79% in the first round and 100% in the second and third round. The main consensus recommendations in prevention are: restricting the use of proton-pump inhibitors, primary prophylaxis with probiotics in antibiotics users, education of health personnel, isolation for patients hospitalized with CDAD, and cleaning the rooms exposed to C. difficile with products based in chlorine or hydrogen peroxide. In the diagnosis: use of biology molecular-based techniques is preferred and if not available, glutamate dehydrogenase-based algorithms may be recommended. With regard to treatment: the use of oral metronidazole in mild-moderate CDAD and oral vancomycin in severe CDAD are recommended. Treat the first recurrence with the same antibiotics according to severity. In the case of second and subsequent recurrences consider prolonged therapy with vancomycin, rifaximin or fecal microbiota transplant. Conclusion: The first Chilean consensus on prevention, diagnosis and treatment of CDAD is presented, which is a major step in improving national standards in the management of this disease.Item Diagnóstico de situación de los comités de ética asistencial en Chile.(Universidad del Desarrollo. Facultad de Medicina, 2024) Sanhueza Cruzat, Gabriel Hernán; Carvajal, SergioIntroducción: En el marco normativo legal chileno, así como a nivel internacional se ha hecho la distinción entre los Comités de Ética Asistencial (CEA) y los de Investigación o llamados también Científicos (CEC), para relevar funciones y ámbitos de acción que son diferenciadores de su quehacer. En Chile se privilegió el desarrollo de un marco regulatorio especial para los CEC con estándares de acreditación específicos, pautas técnicas, sistemas de seguimiento y monitoreo ad-hoc a sus funciones. Para los Comité de Ética Asistencial el marco se ha dado por la Ley n° 20.584, sobre Derechos y Deberes de las Personas en el contexto de la atención sanitaria, explicitando la necesidad de regular la creación de los mencionados Comités, para lo cual se dispuso del Decreto n°62 del Ministerio de Salud del año 2012 que aprueba un Reglamento para la constitución y funcionamiento de los CEA. El presente estudio nació inicialmente con el propósito de poder entregar herramientas concretas que apoyasen el desarrollo y aseguramiento de la Calidad de los CEA, y al poco andar se visualiza de mayor utilidad y con criterio de realidad, el poder brindar una línea base de lo que ocurre hoy en día con los CEA y que permita sentar los elementos de una sistematización de su trabajo, con miras a consolidar un primer escalón en el camino del fortalecimiento de su quehacerItem Eutanasia: aclarando conceptos(2021) Carvajal, Sergio; Portales, María Bernardita; Beca, Juan PabloEuthanasia is a subject of permanent discussion everywhere, mainly about its ethical appropriateness and about its legalization in different countries. This debate includes many ethical, legal, social, political, spiritual, religious, and public health issues. A relevant problem is the frequent misunderstanding that many have about the meaning of the terms and concepts used in different ethical and clinical end of life settings. Many views and even texts are affected by such mistakes, rendering a constructive discussion almost impossible. The goal of this article is to contribute to an improvement of the social and legislative discussion about euthanasia through an elucidation of the main terms and notions linked to this topic. We present definitions and explanations for euthanasia, assisted suicide, withdrawal or foregoing of therapy, treatment rejection, palliative sedation, dignified death and others.Item The role of physicochemical and biochemical processes on carbonate precipitation within the Laguna Timone maar in the Pali Aike Volcanic Field, southernmost extra-Andean Patagonia(2022) Henríquez, Carolina; Calderón, Mauricio; Fadel Cury, Leonardo; Athayde, Gustavo; Carvajal, Sergio; Oyarzún, Poldie; Bahniuk, Anelizein the regional environmental register. The Laguna Timone is situated within a maar of the Pali Aike Volcanic Field, a Quaternary volcano-tectonic complex in southernmost South America and represents one of hundreds of “pools” of brines developed after explosive volcanic eruptions in a periglacial environment. The lake constitutes an endorheic hydrological system where processes leading to carbonate precipitation took place under extreme physicochemical conditions and biological influences that can be explored. Laguna Timone is recharged by groundwater and sporadic episodes of precipitation (ca. 200 mm/year) and high evaporation rates are controlled by regimes of strong wind (westerlies) and seasonal solar radiation. Carbonate precipitation was studied in microbialite fragments of tufa deposits and carbonate crust located in the edge of the lake, and the mineralogy of all samples is calcite. The clay fraction of the sediment underlying the carbonates was characterized and HRTEM analysis shows that authigenic smectites have influence on calcite crystal precipitation. The positive δ18O values (2.28 ‰) in thin crust layers are associated with evaporation processes. In contrast, the negative δ18O values (−6.52 ‰) in the microbialites show meteoric and/or groundwater influences. The δ13C (−0.43 ‰ to 2.50 ‰) values indicate physico-chemical and biochemical processes controlling the precipitation. The carbonate precipitation involves the interrelations of hydrogeological properties, climate and biological influences. Laguna Timone provides a natural laboratory for understanding mineral precipitation processes that register continuous climatic and environmental archives.Item Virtudes del médico: ¿Qué importancia le atribuyen los pacientes?(2020) Carvajal, SergioBackground: Theoretically, the exercise of good medicine requires physicians who possess and practice virtues. There are good reasons to believe that virtue ethics would be highly appreciated by patients. Aim: To determine the importance that patients attribute to the possession virtues among physicians. Material and Methods: Patients hospitalized in a private and a public hospital were invited to answer a three-question survey. The questions were: first, what do you expect of a good physician? Second, please evaluate, in a scale from 1 to 5, the importance of physician virtues to consider him a good doctor (fidelity to trust given by the patient, benevolence, postponement of self-interests, compassion, intellectual honesty, justice and prudence). Third, among the seven former virtues, select the three more important, and then the most important of all. Results: Most patients responded that they valued that a good physician should have good communication skills, a cordial relationship, commitment to the patient and knowledge. All virtues studied were considered important or very important by almost all patients. The virtues considered the most important were intellectual honesty and fidelity to trust given by the patient. Conclusions: These results support the theoretical argument that, for patients, the practice of virtue ethics is essential for a good medical practice.Item Virtudes del médico: ¿qué importancia le atribuyen los pacientes?(2021) Carvajal, SergioBackground: Theoretically, the exercise of good medicine requires physicians who possess and practice virtues. There are good reasons to believe that virtue ethics would be highly appreciated by patients. Aim: To determine the importance that patients attribute to the possession virtues among physicians. Material and Methods: Patients hospitalized in a private and a public hospital were invited to answer a three-question survey. The questions were: first, what do you expect of a good physician? Second, please evaluate, in a scale from 1 to 5, the importance of physician virtues to consider him a good doctor (fidelity to trust given by the patient, benevolence, postponement of self-interests, compassion, intellectual honesty, justice and prudence). Third, among the seven former virtues, select the three more important, and then the most important of all. Results: Most patients responded that they valued that a good physician should have good communication skills, a cordial relationship, commitment to the patient and knowledge. All virtues studied were considered important or very important by almost all patients. The virtues considered the most important were intellectual honesty and fidelity to trust given by the patient. Conclusions: These results support the theoretical argument that, for patients, the practice of virtue ethics is essential for a good medical practice.