ABSTRACT New “clinical pearls” about medical practice are presented (phrases that, in relatively few words, in a brief, concise and coherent manner, include knowledge or useful advice about the profession), transmitted from “experts” to students and young colleagues “in a “master-apprentice”. These “clinical pearls”, generally, are the result of careful observation and the well-used experience of colleagues, which synthesize knowledge that is passed from generation to generation empirically, just as popular knowledge is transmitted through saying, aphorisms, proverbs, etc. The “original” clinical pearls are transmitted “orally”, from person to person regarding various situations that arise during the exercise of the profession in different scenarios, especially healthcare. Although some clinical pearls could serve as starting points for future full-fledged researches, it must be remembered that in medicine not everything is knowledge, it is also art and ethics. After reflecting again on the role in medical education of these “drops of knowledge”, so in line with the fast times that we live in and with the possibility of having rescued a few more clinical pearls, in this work more than 40 “new” ones are presented, classified as clinical, therapeutic and public health and medical ethics, which are expected to be of practical use in our professionals practice and for the benefit of our citizens.

RESUMEN Se presentan nuevas “lápidas” sobre la práctica médica (frases que, en relativamente pocas palabras, de manera breve, concisa y coherente, incluyen conocimientos o consejos útiles sobre la profesión), transmitidas de “expertos” a estudiantes y colegas jóvenes “en modo de maestro-aprendiz”. Estas “lápidas”, generalmente, son fruto de la observación acuciosa y de la experiencia bien aprovechada de colegas, que sintetizan un conocimiento que se va pasando de generación a generación de manera empírica, al igual que se transmite el saber popular por medio de refranes, aforismos, proverbios, etc. Las lápidas “originales” se transmiten por “vía oral”, de persona a persona a propósito de diversas situaciones que surgen durante el ejercicio de la profesión en diferentes escenarios, sobre todo asistenciales. Aunque algunas lápidas pudieran servir de puntos de partida para futuras investigaciones con todas las de la ley, se debe recordar que en la medicina no todo es conocimiento, también es arte y ética. Después de reflexionar nuevamente sobre el papel en la educación médica de estas “gotas de saber”, tan acordes a los tiempos rápidos que corren y con la posibilidad de haber rescatado unas cuantas lápidas más, en este trabajo se presentan más de 40 “nuevas”, clasificadas como clínicas, terapéuticas y de salud pública y ética médica, que se esperan sean de utilidad práctica en el ejercicio de nuestros profesionales y en beneficio de nuestros ciudadanos.

ABSTRACT Introduction: The control of blood pressure is a global challenge and one of the main public health problems nowadays. Objectives: To describe the factors related to the evolution, detection and control of hypertension in Cienfuegos from 2001 to 2011 in a scenario of universal access to health services. Methods: Population study developed during 2011, with a representative, probabilistic sample of 1276 adults in the ages from 25 to 74 years old whom lived in the city of Cienfuegos, Cuba. Results: From the hypertensive patients, 32,8 % were unaware of their condition, 90% of those who knew their condition had treatment, and 29,8 % were controlled. Uncontrolled hypertension’s risk was significantly higher in people with age ≥ 65 years, the ones of black race or mixed race, in the ones not attending to the doctor’s consultation or not controlling the blood pressure for more than one year. In relation to 2001, the percentage of hypertensive patients who did not know their condition increased by 11,3 %; the number of treated patients was reduced by 3,4 % and the level of control by 10%. Conclusions: There are a group of factors as age, race, and the lack of follow up to these patients in the health care services in order to detect and control hypertension that affect its behavior. The results, although better than those observed in other countries in the region, show a gap in terms of detection and control of hypertension, the follow up of the patients and management of the system in the year 2011 in comparison with the previous decade.

RESUMEN Introducción: El control de la presión arterial es un desafío global y uno de los principales problemas de salud pública en la actualidad. Objetivos: Describir los factores relacionados con la evolución, detección y control de la hipertensión arterial en Cienfuegos en el periodo de 2001 a 2011, en un contexto de acceso universal a los servicios de salud. Métodos: Estudio poblacional desarrollado en el año 2011, con una muestra representativa probabilística de 1276 adultos entre 25-74 años, residentes en la ciudad de Cienfuegos, Cuba. Resultados: De los hipertensos, el 32,8 % desconocía su condición, el 90 % de los que conocían su condición llevaban tratamiento y el 29,8 % estaban controlados. El riesgo de no control fue significativamente superior en las personas con más de 65 años, en las de raza negra o mestiza y en las que tenían más de un año sin ir a su médico o controlarse la presión arterial. Con relación al 2001, el porcentaje de hipertensos que desconocían su condición se incrementó en 11,3 %; se redujo el número de tratados en un 3,4 % y el nivel de control en un 10 %. Conclusiones: Existe un grupo de factores como la edad, la raza, y la falta de seguimiento de las personas en los servicios de salud para la detección y control de la HTA que afectan su comportamiento. Los resultados, aunque superan los reportados por otros países de la región, sugieren brechas en la detección, el seguimiento de los casos y la gestión del sistema en el 2011, si se compara con la década precedente.

ABSTRACT Introduction: The control of blood pressure is a global challenge and one of the main public health problems nowadays. Objectives: To describe the factors related to the evolution, detection and control of hypertension in Cienfuegos from 2001 to 2011 in a scenario of universal access to health services. Methods: Population study developed during 2011, with a representative, probabilistic sample of 1276 adults in the ages from 25 to 74 years old whom lived in the city of Cienfuegos, Cuba. Results: From the hypertensive patients, 32,8 % were unaware of their condition, 90% of those who knew their condition had treatment, and 29,8 % were controlled. Uncontrolled hypertension’s risk was significantly higher in people with age ≥ 65 years, the ones of black race or mixed race, in the ones not attending to the doctor’s consultation or not controlling the blood pressure for more than one year. In relation to 2001, the percentage of hypertensive patients who did not know their condition increased by 11,3 %; the number of treated patients was reduced by 3,4 % and the level of control by 10%. Conclusions: There are a group of factors as age, race, and the lack of follow up to these patients in the health care services in order to detect and control hypertension that affect its behavior. The results, although better than those observed in other countries in the region, show a gap in terms of detection and control of hypertension, the follow up of the patients and management of the system in the year 2011 in comparison with the previous decade.

RESUMEN Introducción: El control de la presión arterial es un desafío global y uno de los principales problemas de salud pública en la actualidad. Objetivos: Describir los factores relacionados con la evolución, detección y control de la hipertensión arterial en Cienfuegos en el periodo de 2001 a 2011, en un contexto de acceso universal a los servicios de salud. Métodos: Estudio poblacional desarrollado en el año 2011, con una muestra representativa probabilística de 1276 adultos entre 25-74 años, residentes en la ciudad de Cienfuegos, Cuba. Resultados: De los hipertensos, el 32,8 % desconocía su condición, el 90 % de los que conocían su condición llevaban tratamiento y el 29,8 % estaban controlados. El riesgo de no control fue significativamente superior en las personas con más de 65 años, en las de raza negra o mestiza y en las que tenían más de un año sin ir a su médico o controlarse la presión arterial. Con relación al 2001, el porcentaje de hipertensos que desconocían su condición se incrementó en 11,3 %; se redujo el número de tratados en un 3,4 % y el nivel de control en un 10 %. Conclusiones: Existe un grupo de factores como la edad, la raza, y la falta de seguimiento de las personas en los servicios de salud para la detección y control de la HTA que afectan su comportamiento. Los resultados, aunque superan los reportados por otros países de la región, sugieren brechas en la detección, el seguimiento de los casos y la gestión del sistema en el 2011, si se compara con la década precedente.

ABSTRACT There has been a notable decrease in the global practice of clinical autopsy; the rate has fallen to below 10%, even in high-income countries. This is attributed to several causes, including increased costs, overreliance on modern diagnostic techniques, cultural and religious factors, the emergence of new infectious diseases and negative attitudes on the part of doctors, even pathologists. Alternative methods to autopsy in postmortem studies have been developed based on imaging, endoscopy and biopsy (all quite expensive). These methods have been used in developed countries but never as effectively as the classic autopsy for identifying cause of death and potential medical errors. Although Cuba has also seen a decrease in its autopsy rates, they remain comparatively high. Between 1996 and 2015, there were 687,689 hospital deaths in Cuba and 381,193 autopsies, 55.4% of the total. These autopsies have positively affected medical care, training, research, innovation, management and society as a whole. Autopsies are an important tool in the National Health System’s quest for safe, quality patient care based on the lessons learned from studying the deceased.

ABSTRACT INTRODUCTION Cuba’s science policy is grounded in a scientific and technological innovation system applicable to all institutions. In hospitals, the system should influence medical care and administrative and teaching processes, as well as promotion of scientific activity as such. OBJECTIVE Describe results of the Scientific and Technological Innovation System at the Dr Gustavo Aldereguia Lima University Hospital, the main provincial hospital in Cienfuegos, Cuba. METHOD This was a key informant survey and document review concerning the hospital’s scientific activity during 2000–2014. A questionnaire was administered to 22 key informants to select key indicators and area. Data on the hospital’s scientific activity related to these indicators were retrieved from hospital, provincial public health and scientific publishing databases. A second group of 35 key informants confirmed linkages between scientific outputs and the innovation system’s main activities. RESULTS The following were reported over the study period: sustained development of scientific human resources (40% grade II specialists, 30% master’s degree holders and 11.4% accredited academic researchers among the hospital’s professional staff), high scientific output (annual average of 445 studies completed, 118 publications and 203 projects under way) and high visibility (national and international recognition) of the hospital’s achievements in science and innovation. Key informants considered that results related to development of scientific potential were influenced by the following activities of the Scientific and Technological Innovation System: promotion of grade II specialty training, researcher accreditation and awarding of master’s degrees and PhDs in the sciences, development of an extensive continuing education program (for researchers and their mentors), public recognition of professionals with good scientific results, promotion of research and other scientific activities, and the requirement that professional and technical staff participate in national events sponsored by scientific societies. CONCLUSIONS Implementation of a Scientific and Technological Innovation System can contribute to a hospital’s scientific capacity and productivity.