Even though advantages of ultrasound line placement seem obvious, many countries do not have easy access to such technology. This study aims to compare the degree of difficulty in central venous line placement with or without ultrasound and the incidence of complications, and to establish the effect of the operator’s degree of training. The study included 257 patients that required central venous catheterization during the study period. Patients were divided into groups according to the operator’s experience: expert group (over 70 central accesses performed before the study) (n=152) and in-training or non-expert group. Procedures were randomized to “without ultrasound” (n=80 expert and 54 non-expert) and “with ultrasound" (n=72 expert and 51 non-expert). Catheter placements were more successful in the “expert” and in the “with ultrasound” than in the “non-expert” (88% vs 79%; p=0.04) or in the “without ultrasound” groups (91% vs 78%; p=0.005). Incidence of complications was 11.7%, with no significant difference among “with ultrasound” (8.1%) and “without ultrasound” (14.9%) groups. However, the “non-expert” group had fewer complications with the use of ultrasound (7.8% vs 24%). Ultrasound reduces the incidence of complications when placement is performed by inexperienced operators. Centers with residents should emphasize the necessity of ultrasound for central line catheterization. Training in ultrasound might be of paramount importance in the effectiveness of the technique.

Suicide is a major global public health concern and one of the leading causes of death worldwide. Previous suicide attempts are one of the strongest predictors of future suicide risk, underscoring the need for effective prevention strategies. Central to these strategies is the establishment of robust surveillance systems that deliver accurate and timely data at both national and local levels. This article describes the development, implementation, and progress of Uruguay’s national real-time surveillance system for suicide attempts, which comprehensively covers all emergency departments across the country. The Ministry of Public Health conducts continuous monitoring of suicide attempt cases using a real-time surveillance system. This article also explores the implications of this system for suicide prevention at various levels and discusses future challenges and opportunities for optimizing its use to enhance public health interventions.

El trabajo en equipo multidisciplinario aumenta la seguridad del paciente y minimiza los errores médicos además de mejorar la satisfacción y el rendimiento del personal de salud y reducir los gastos generados por mala praxis y complicaciones. Sin embargo la implementación del trabajo médico en equipos es compleja y parecería ser una utopía principalmente en países con escasos recursos. A pesar de los esfuerzos por cambiar el paradigma de la asistencia médica, éste aún se basa en la adquisición de conocimientos individuales más que en la interacción colectiva. El desarrollo de las habilidades necesarias para trabajar en equipo no forma parte del programa curricular en medicina en nuestro país. Se explican los pilares y las ventajas del trabajo en equipo para generar conciencia en iniciar el difícil camino hacia esa forma de trabajo. Recibido: Noviembre 2016 Aceptado: Abril 2017 Correspondencia: 8 de Octubre 3020. C.P. 11600, Montevideo, Uruguay. Tel.: (+598)24876666 int. 8183. E-mail: Karina.rando@gmail.com Multidisciplinary teamwork increases patient safety and minimizes medical errors, as well as improving the satisfaction and performance of healthcare personnel and reducing the costs generated by malpractice and complications. However, the implementation of medical teamwork is complex and seems to be a utopia, especially in countries with scarce resources. Despite efforts to change the paradigm of medical care, it is still based on the acquisition of individual knowledge rather than collective interaction. The development of teamwork skills is not part of the medical curriculum in our country. The pillars and advantages of teamwork are explained in order to generate awareness in initiating the difficult path towards this way of working. O trabalho em equipe multidisciplinar aumenta a segurança do paciente e minimiza erros médicos, além de melhorar a satisfação e o desempenho dos profissionais de saúde e reduzir os custos de negligência e complicações. Entretanto, a implementação do trabalho de equipe médica é complexa e parece ser utópica, especialmente em países com poucos recursos. Apesar dos esforços para mudar o paradigma da assistência médica, ela ainda se baseia mais na aquisição de conhecimentos individuais do que na interação coletiva. aquisição de conhecimento individual em vez de interação coletiva. O O desenvolvimento das habilidades de trabalho em equipe não faz parte dos currículos em trabalho em equipe não faz parte do programa curricular em medicina em nosso país. Os pilares e as vantagens do trabalho em equipe as vantagens do trabalho em equipe são explicadas a fim de aumentar a conscientização para iniciar o difícil caminho em direção a esta forma de trabalho.