Estrategia para fomentar el principio de beneficencia en la comunicación entre el logofonoaudiólogo, el paciente afásico y su familia

Introducción: La comunicación por parte del logofonoaudiólogo con el paciente afásico y su familia garantiza el bienestar biopsicosocial de estos y favorece una adecuada relación médico-paciente. Objetivo: Evaluar una propuesta de estrategia para el fomento del principio de beneficencia entre el logofonoaudiólogo, el paciente afásico y su familia en el Policlínico Universitario Dr. René Vallejo Ortiz, ciudad de Manzanillo, Granma, Cuba. Método: Fue aplicada la técnica de Iadov o criterio de usuario que permitió evaluar la propuesta. Para ello se encuestaron 15 logofonoaudiólogos de la provincia de Granma, Cuba, se escogieron de manera intencional 10, cuyas cualidades cumplían los requisitos exigidos para ser considerados usuarios. Se utilizaron diferentes métodos, técnicas y procedimientos para procesar y analizar los datos recogidos. La escala valorativa Likert facilitó la interpretación cualitativa de los datos recogidos. Resultados: Desde el criterio individual el 60 % de los usuarios consideró la propuesta bastante adecuada; la valoración más baja fue de adecuada (20 %). El cálculo de la valoración grupal, el índice obtenido (0,5 %) le confirió confiabilidad a la propuesta para ser implementada. Conclusiones: Los usuarios consideran que la propuesta de estrategia cumple con los requisitos para la aplicación. No obstante, existen algunos elementos que pudieran dificultar la ejecución de la misma: la incorrecta preparación científico-metodológica de los facilitadores, el uso inadecuado de los métodos y técnicas educativas, así como la negativa de aquellos logofonoaudiólogos que no concienticen la necesidad de alcanzar modos de actuación acorde a los principios y valores profesionales.

Introduction: Communication by the speech-language pathologist with the aphasic patient and his family guarantees their biopsychosocial well-being and promotes an adequate doctor-patient relationship. Objective: To evaluate a proposed strategy to promote the principle of beneficence between the speech-language pathologist, the aphasic patient and their family at the Policlínico Universitario Dr. René Vallejo Ortiz, Manzanillo city, Granma province, Cuba. Method: The Iadov technique or user criteria was applied that allowed the proposal to be evaluated. For this, 15 speech-language pathologists from the province of Granma, were surveyed; 10 were intentionally chosen, whose qualities met the requirements to be considered users. Different methods, techniques and procedures were used to process and analyze the data collected. The Likert rating scale facilitated the qualitative interpretation of the data collected. Results: From individual criteria, 60% of users considered the proposal quite appropriate; the lowest rating was adequate (20%). The calculation of the group assessment, the index obtained (0.5%) conferred reliability to the proposal to be implemented. Conclusions: Users consider that the strategy proposal meets the requirements for the application. However, there are some elements that could make its execution difficult: the incorrect scientific-methodological preparation of the facilitators, the inappropriate use of educational methods and techniques, as well as the refusal of those speech-language pathologists who do not raise awareness of the need to achieve methods. of action in accordance with professional principles and values.

Introdução: A comunicação do fonoaudiólogo com o paciente afásico e sua família garante o seu bem-estar biopsicossocial e promove uma adequada relação médico-paciente. Objetivo: Avaliar uma proposta de estratégia para promover o princípio da beneficência entre o fonoaudiólogo, o paciente afásico e sua familia na Policlínico Universitario Dr. René Vallejo Ortiz, cidade de Manzanillo, Granma, Cuba. Método: Foi aplicada a técnica de Iadov ou critérios de usuário que permitiram avaliar a proposta. Para isso, foram entrevistados 15 fonoaudiólogos da província de Granma, foram escolhidos 10 intencionalmente, cujas qualidades atendiam aos requisitos para serem considerados usuários. Diferentes métodos, técnicas e procedimentos foram utilizados para processar e analisar os dados coletados. A escala de classificação Likert facilitou a interpretação qualitativa dos dados coletados. Resultados: A partir de critérios individuais, 60% dos usuários consideraram a proposta bastante adequada; a classificação mais baixa foi adequada (20%). No cálculo da avaliação do grupo, o índice obtido (0,5%) conferiu confiabilidade à proposta a ser implementada. Conclusões: Os usuários consideram que a proposta de estratégia atende aos requisitos para aplicação. Porém, existem alguns elementos que podem dificultar sua execução: o incorreto preparo científico-metodológico dos facilitadores, o uso inadequado de métodos e técnicas educativas, bem como a recusa dos fonoaudiólogos que não conscientizam sobre o necessidade de alcançar métodos de ação de acordo com princípios e valores profissionais.

Os impactos da comunicação inadequada na relação médico-paciente / The impacts of inadequate communication on the physician-patient relation

Resumo: Introdução: Como um componente substancial na relação médico-paciente, a comunicação pode ser determinante na construção da hipótese diagnóstica e na adesão ao tratamento por parte do paciente, e, por isso, há a necessidade de compreender os fatores que influenciam no processo comunicativo e descrever a efetividade dele. Objetivo: Este estudo teve como objetivo avaliar os impactos da comunicação inadequada na relação médico-paciente. Método: Vinte e três pacientes voluntários com a maioridade atingida preencheram questionários de informações socioeconômicas, uso da linguagem e impressões da consulta médica. O médico preencheu um questionário sobre a experiência da consulta. Resultado: Os resultados indicaram que os pacientes apresentaram alguma dificuldade em comunicar ao médico o que sentiam, e, de modo complementar, os médicos, em 20% dos casos, tiveram algum grau de dificuldade de chegar à hipótese diagnóstica a partir do relato do paciente, o que se relaciona com a linguagem pouco descritiva utilizada pela maior parte dos pacientes. Conclusão: Dada a necessidade da qualidade da comunicação entre o médico e o paciente, conhecer os fatores que impactam o processo comunicativo é o primeiro passo para a garantia de um atendimento eficaz com autonomia do paciente e maior adesão ao plano terapêutico.

Abstract: Introduction: As a substantial component of the doctor-patient relationship, communication can be crucial in the construction of a diagnostic hypothesis and patient adherence to treatment. It is therefore necessary to understand the factors that influence the communicative process and describe the effectiveness of the communication. Objective: The aim of this study is to evaluate the impacts of inadequate communication in the doctor-patient relationship. Method: Twenty-three voluntary patients of legal age completed questionnaires on socioeconomic information, language use, and impressions of the medical consultation. The doctor filled out a questionnaire regarding their experience of the consultation. Result: The results indicated that patients experienced some difficulty in communicating their feelings to the doctor, and furthermore, in 20% of cases, doctors encountered some degree of difficulty in reaching a diagnostic hypothesis based on the patient's report, which is related to the predominantly non-descriptive language used by most patients. Conclusion: Given the need for high quality communication between the doctor and the patient, understanding the factors that impact the communicative process is the first step towards ensuring effective care with patient autonomy and improved adherence to the treatment plan.

Utilización de imágenes de pacientes para marketing médico

El uso de estrategias de imagen en las redes sociales médicas está cada vez más extendido, cumpliendo el límite ético establecido por el CEM. Sabiendo esto, el presente estudio buscó comprender el problema de la exposición de los pacientes en las redes sociales médicas. Para ello, se realizó una revisión bibliográfica a partir de las bases Scientific Electronic Library Online (Scielo), PubMED, UpToDate, LILACS, incluyendo artículos en inglés, español y portugués publicados a partir de 2018. Así, se percibió en algunas ciudades la tendencia a crear leyes para regular esta exposición, dado que el uso de imágenes se ha vuelto rutinario en la publicidad médica, como una forma de demostrar resultados. Sin embargo, esta práctica está muy acompañada de faltas éticas como recomienda el CFM.

The use of imagem strategies in medical socieal networks is increasingly widespread, meeting the ethical limit established by the CEM. Knowing this, the present study sought to understand the problem of patient exposure in medical social networks. For this, a literature review was carried out from the Scientific Electronic Library Online (Scielo), Pubmed, UpToDate, LILACS databases, articles in English, Spanish and Portuguese published from 2018 onwards were included. Thus, a tendency was noticed in some cities to create laws to regulate this exposure, given that the use of images has become routine in medical advertising, as a way to demonstrate results. However, this practice is greatly accompanied by ethical failures as recommended by the CFM.

A utilização das estratégias de imagem nas redes sociais médicas está cada vez mais disseminada, encontrando-se no limite ético estabelecido pelo CEM. Sabendo disso, o presente estudo buscou entender a problemática da exposição do paciente nas redes sociais médicas. Para isso, foi feita uma revisão da literatura a partir das bases Scientific Eletronic Library Online (Scielo), PubMED, UpToDate, LILACS, foram incluídos artigos em inglês, espanhol e português publicados a partir de 2018. Assim, percebeu-se em algumas cidades a tendência de criar leis para regular essa exposição, haja vista que a utilização de imagens tornou-se rotineira na propaganda médica, como forma demonstrar resultados. Todavia, tal prática vem acompanhada grandemente de falhas éticas segundo o preconizado pelo CFM.

What it means to be a patient: An introspection into doctor–patient communication

In this essay, we talk about the importance of the relationship between doctors and patients, and the need for patient-centric communication rather than that with a paternalistic approach. Training of a medical student should include communication skills besides technical training in healthcare. As patient care evolves, communication becomes more crucial; therefore, it is important to understand the repercussions of poor communication skills and how improvement in this vital area can be beneficial.

Are doctors allowed to cry at work?

This article recounts a poignant interaction between the author and a mother of a child with cerebral palsy. The mother's remarkable strength and optimism in the face of adversity deeply moved the author, leading to a tearful moment which prompted a comforting response from the mother. The ongoing debate regarding whether doctors are allowed to display emotions in their professional lives centers around the challenge of balancing professionalism with the emotional impact of providing healthcare to patients. While doctors are expected to uphold professionalism and make sound decisions in their work environment, simultaneous expression of emotions, empathy, and vulnerabilities becomes inevitable.

La medicina y el metaverso: aplicaciones actuales y futuro / Medicine and the metaverse: current applications and future

Resumen Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.

Abstract Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.

Cuestiones bioéticas involucradas en los Cuidados Paliativos: desde la perspectiva de los profesionales de la salud / Bioethical issues involved in Palliative Care: from the perspective of health professionals

Las cuestiones inherentes al final de la vida constituyen un inmenso desafío para los médicos, debido a la falta de educación formal en lo inherente a cuidados paliativos, y a que se entrelazan conceptos médicos, religiosos, legales y bioéticos en su abordaje. El objetivo de este estudio es identificar, desde la perspectiva de los profesionales de la salud, las cuestiones éticas involucradas en el proceso de atención de pacientes incluidos en cuidados paliativos. Para ello se llevó a cabo de una revisión de 10 artículos, en los cuales se observa la carencia de formación bioética y la aplicación inadecuada (o falta) en lo inherente a manejo adecuado de la información y la dificultad en su comunicación, toma de decisiones compartidas, respeto de la autonomía del paciente, verdad médica, limitación de esfuerzos terapéuticos (AU)

End-of-life issues constitute an immense challenge for physicians, due to the lack of formal education regarding palliative care, and the intertwining of medical, religious, legal, and bioethical concepts in their approach. The objective of this study is to identify, from the perspective of health professionals, the ethical issues involved in the care process for patients included in palliative care. For this, a review of 10 articles was carried out, in which the lack of bioethical training and the inadequate application (or lack) is observed in terms of the proper management of information and the difficulty in its communication, decision making shared, respect for patient autonomy, medical truth, limitation of therapeutic efforts (AU)

Ética médica y atención a pacientes en estadio terminal en el nivel primario de atención / Medical Ethics and End-stage Patient Care at the Primary Care Level

Introducción: El artículo reflexiona sobre la naturaleza multidimensional y compleja de la ética y su relación con las ciencias médicas. Objetivo: Reflexionar sobre la atención a pacientes en estadio terminal desde el punto de vista de la ética médica para una atención médica integral en el primer nivel de atención. Métodos: estudio cualitativo; se emplearon análisis documental, sistematización, análisis y síntesis de publicaciones sobre la temática estudiada como métodos teóricos, para ello se valoran los criterios de autores y resultados que se expresan en artículos publicados. Se realizaron búsquedas, tanto en bases de datos estudiadas como en las plataformas de productos del Nacional Council for Biotechnology Information de la Nacional Library of Medicine of United States of America; y de Elsevier, esta última productora de Embase y Scopus, a través del motor de búsqueda Google Académico, en español e inglés, y sin límite de tiempo. Se emplearon los términos: ética médica, deontología médica, relación médico-paciente, paciente terminal y cuidados paliativos. Se excluyeron aquellos artículos que no habían sido revisados por pares o no mostraban el texto completo. Se revisó la información suministrada por cada fuente y se sintetizó. Conclusiones: En Cuba, la bioética avanza en la medida que lo permite la estrategia de Atención Primaria de Salud, con un Programa del Médico y Enfermera de la Familia resiliente y de valores humanos demostrados nacional e internacionalmente. Como reto se plantea estimular el debate entre saberes para generar cambios a favor de los pacientes, las familias, las comunidades y la sociedad(AU)

Introduction: The article reflects on the multidimensional and complex nature of ethics and its relationship to the medical sciences. Objective: To reflect on the care of terminally ill patients from the point of view of medical ethics for comprehensive medical care at the primary level of care. Methods: A qualitative study was carried out using documentary analysis, systematization, analysis and synthesis of publications on the subject studied as theoretical methods. For this purpose, the criteria of authors and results expressed in published articles were evaluated. Searches were carried out in Spanish and English through Google Scholar, and without time limit, both in the databases studied and in the product platforms of the National Council for Biotechnology Information of the National Library of Medicine of the United States of America and Elsevier. The terms: medical ethics, medical deontolog, physician-patient relationship, terminal patient and palliative care were used. Articles that were not peer-reviewed and those that did not show the full text were excluded. The information provided by each source was reviewed and synthesized. Conclusions: In Cuba, bioethics advances to the extent allowed by the Primary Health Care strategy, with a resilient Family Physician and Nurse Practitioner Program and human values demonstrated nationally and internationally. The challenge is to stimulate the debate between knowledge to generate changes in favor of patients, families, communities and society(AU)

Asociación entre niveles de empatía en médicos y satisfacción del paciente / Association between empathy levels in physicians and patient satisfaction

Resumen Introducción: Una buena relación médico-paciente es crucial para la práctica médica. Un elemento fundamen tal de la misma es la empatía del médico tratante, y esta puede ser cuantificada mediante una escala validada llamada Escala de Empatía de Jefferson. Métodos: En este estudio buscamos correlacionar los valores de empatía de los médicos del servicio con los resultados de las encuestas de satisfacción del pa ciente ambulatorio, medido mediante una herramienta llamada HCAPS. Resultados: Encontramos que los pacientes percibían un mayor trato respetuoso y que se les explicaba mejor sus opciones de tratamiento por parte de los médicos con mayores niveles de empatía. No hubo diferencias en los niveles de empatía de los médicos según su edad, sexo, o tiempo desde la obtención del título de especialista. Discusión: Los resultados validan a la empatía como una habilidad clave dentro de la relación médico-paciente.

Abstract Introduction: A good doctor-patient relationship is crucial to medical practice. A fundamental element of it is the empathy of the treating physician, and it can be quantified by means of a validated scale called the Jefferson Empathy Scale. Methods: In this study we sought to correlate the empathy values of our physicians with the results of outpatient satisfaction surveys, measured using a tool called HCAPS. Results: We found that patients perceived greater respectful treatment and had their treatment options better explained to them by physicians with higher lev els of empathy. There were no differences in physicians' empathy levels according to their age, gender, or time since qualifying as a specialist. Discussion: These results validate empathy as a key skill in the doctor-patient relationship.

Percepciones y prácticas de clínicos sobre la autonomía del paciente quirúrgico durante el proceso de toma del consentimiento informado. Santo Domingo de los Tsáchilas, Ecuador / Perceptions and practices of clinicians on the autonomy of the surgical patient during the process of taking informed consent. Santo Domingo de los Tsáchilas, Ecuador / Percepções e práticas dos clínicos sobre a autonomia do paciente cirúrgico durante o processo de consentimento informado. Santo Domingo de los Tsáchilas, Equador

La forma como el clínico percibe al paciente y sus conocimientos sobre el consentimiento informado (CI) se reflejan en prácticas de respeto hacia el paciente, con relación a su autonomía y privacidad, desde un marco ético, deontológico y legal. El objetivo fue analizar las percepciones y prácticas de cirujanos en relación con el respeto de la autonomía del paciente durante el proceso de toma del CI en un hospital de la ciudad de Santo Domingo de los Tsáchilas, Ecuador. Metodología Cualitativa. La muestra fue por saturación, aplicando una entrevista semiestructurada. Los datos se analizaron por medio del programa Atlas Ti 8.0®, utilizando rastreo de categorías estructuradas. La mayoría de los médicos asume el consentimiento como un documento legal y obligatorio, por el miedo a procesos sancionatorios. Además, suele delegar su responsabilidad a otros profesionales, desconociendo componentes estructurales y éticos de la toma del consentimiento informado. Concluimos que la falta de conocimiento sobre CI lleva a percepciones y, por ende, a prácticas que vulneran la autonomía y la confidencialidad, además del respeto de recibir la información por parte del clínico que realiza la intervención.

The way in which the clinician perceives the patient and his knowledge about informed consent (IC) are reflected in practices of respect for the patient, in relation to their autonomy and privacy from an ethical, deontological and legal framework. Objective. Analyze the perceptions and practices by surgeons in relation to the respect of the autonomy of the patient during the process of taking the IC in a hospital in the city of de Santo Domingo de los Tsáchilas / Ecuador. Methodology. Cualitattivo. The sample was by saturation applying a semi-structured interview. The data were analyzed using the Atlas Ti 8.0 ® program using structured category tracking. Result. Most doctors take consent as a legal and mandatory document, for fear of sanctioning processes. In addition, they usually delegate their responsibility to other professionals ignoring structural and ethical components of taking informed consent. Conclusion. It is evident that the lack of knowledge about IQ leads to perceptions, and therefore, to practices that violate autonomy and confidentiality, in addition to the respect of receiving information from the clinician who performed the intervention.

A forma como o médico percebe o paciente e seus conhecimentos sobre o consentimento informado (IC) se refletem nas práticas de respeito ao paciente, em relação à sua autonomia e privacidade a partir de um arcabouço ético, deontológico e jurídico. Objetivo. Analise as percepções e práticas dos cirurgiões em relação ao respeito à autonomia do paciente durante o processo de tomada do IC em um hospital na cidade de Santo Domingo de los Tsáchilas/Equador. Metodologia. Qualitativo. A amostra foi por saturação aplicando uma entrevista semiestruturada. Os dados foram analisados utilizandose o programa Atlas Ti 8.0 ® utilizando rastreamento estruturado de categorias. Resultado. A maioria dos médicos toma o consentimento como documento legal e obrigatório, por medo de sancionar processos. Além disso, eles geralmente delegem sua responsabilidade a outros profissionais ignorando componentes estruturais e éticos de obter consentimento informado. Conclusão. É evidente que a falta de conhecimento sobre o QI leva a percepções e, portanto, a práticas que violam autonomia e confidencialidade, além do respeito ao recebimento de informações do médico que realizou a intervenção.

Diseño e implementación del Programa de Bienestar Profesional del Colegio Médico del Uruguay

Son múltiples los estudios que informan de una alta prevalencia de problemas de salud mental en médicos y médicas. Aunque los médicos presentan resistencias a la hora de solicitar ayuda profesional cuando están aquejados de trastornos mentales, los servicios especializados desarrollados específicamente para tratar sus problemas de salud mental han reportado resultados prometedores. El propósito de este artículo es describir el diseno y la implementación del Programa de Bienestar Profesional del Colegio Médico del Uruguay. El contexto, los insumos, las actividades y algunos de los productos se describen de acuerdo con el diseno de un estudio de caso. También se sefñalan los principales hitos en la puesta en marcha del programa, así como los elementos facilitadores, los obstáculos y los principales logros. Se enfatizará la importancia de la colaboración internacional para compartir experiencias y modelos, cómo articular el proceso asistencial para fomentar el acceso de los médicos a la atención psiquiátrica y psicológica, la necesidad de que sean flexibles y dinámicos para adaptarse a circunstancias novedosas y cambiantes como la pandemia por COVID-19 y la necesidad de que vayan en paralelo con las exigencias de los organismos reguladores de la práctica médica. Se espera que la experiencia descrita en este trabajo pueda ser de utilidad a otros colectivos latinoamericanos interesados en desarrollar programas de salud mental para los médicos.

Multiple studies have reported a high prevalence of mental health problems among male and female physicians. Although doctors are reluctant to seek professional help when suffering from a mental disorder, specialized services developed specifically to treat their mental health problems have reported promising results. The purpose of this article is to describe the design and implementation of the Professional Wellbeing Programme (Programa de Bienestar Profesional) of the Uruguayan Medical Association (Colegio Médico del Uruguay). The context, inputs, activities and some of the outputs are described according to a case study design. The main milestones in the implementation of the programme are also outlined, as well as the enabling elements, obstacles and main achievements. Emphasis will be placed on the importance of international collaboration to share experiences and models, how to design the care process to promote doctors' access to psychiatric and psychological care, the need for them to be flexible and dynamic in adapting to new and changing circumstances, such as the COVID-19 pandemic, and to work in parallel with the medical regulatory bodies. It is hoped that the experience described in this work may be of use to other Latin American institutions interested in developing mental health programmes for doctors.

Percepções acerca das mudanças na relação médico-paciente durante a pandemia por COVID-19 à luz das narrativas médicas / Perceptions about changes in the doctor-patient relationship during the COVID-19 pandemic in the light of medical narratives / Percepciones sobre los cambios en la relación médico-paciente durante la pandemia de COVID-19 a la luz de las narrativas médicas

Introdução: A relação médico-paciente tem sido muito estudada ao longo dos anos e sua importância na prática médica é um consenso. No final do ano de 2019 o mundo começou a luta contra a pandemia causada pelo novo coronavírus. Os médicos de família e comunidade atuaram na linha de frente da pandemia. Objetivo: Este estudo teve como objetivo analisar as percepções dos médicos de família e comunidade na relação médico-paciente durante a pandemia da COVID-19. Métodos: Trata-se de um estudo qualitativo de análise do conteúdo das narrativas médicas, publicadas no blog "Causos Clínicos". O corpus de análise seguiu a metodologia proposta por Bardin. Resultados: Foram identificadas 42 narrativas com a temática de COVID-19 e relação médico-paciente. Após a análise de conteúdo, foram identificadas três categorias: emoções, contato físico e mudanças no sistema de saúde. Cada uma delas teve subcategorias específicas de acordo com as características das narrativas, podendo estar relacionada com "fortalezas e enfrentamentos": emoções conflituosas de saúde mental pessoais e também relacionadas ao papel social do médico; a necessidade do distanciamento social, reduzindo o contato físico; mudanças no sistema de saúde próprias desse período, como persistência de demandas clínicas e sociais, redução da disponibilidade de consultas presenciais e falta de insumos básicos de proteção; ou "barreiras e dificuldades": exercício da empatia; prática da escuta qualificada, do olhar atento e de habilidades de comunicação, além do uso da telemedicina. As informações obtidas na literatura corroboram os resultados encontrados nesta pesquisa. Quanto às limitações, este estudo contemplou apenas o olhar do médico e reuniu outras informações relevantes sobre a temática que não puderam ser incluídas nos resultados. Conclusões: De posse das informações obtidas neste trabalho foi possível concluir que de fato a relação médico-paciente sofreu alterações diante das variáveis identificadas, porém as narrativas revelam que mesmo em tempos de crise é possível estabelecer ligações significativas entre o médico e o paciente.

Introduction: The doctor-patient relationship (DPR) has been extensively studied over the years, and there is a consensus on its importance in medical practice. At the end of 2019, the world began to fight the pandemic caused by the new coronavirus, whose main form of transmission is direct contact between individuals. Transmission control measures were adopted, but they impacted the way DPR used to be. Family physicians, working in primary health care, served on the front lines of the pandemic. They are often committed to DPR, and some have written their pandemic narratives on the "Causos Clínicos" blog. Faced with this moment, the idea arose of scrutinizing the nuances of the DPR in the light of the narratives of those who lived this process on the front lines. Objective: This study aimed to analyze the perception of family physicians in the DPR during the COVID-19 pandemic. Methods: A qualitative study was conducted, where we evaluated medical narratives published on "Causos Clínicos" through content analysis. The corpus of analysis went through three stages: pre-analysis, analytical description and referential interpretation. Results: After the selection of the corpus, 42 narratives were considered for the analytical process, in which the codes identified were: "barriers and difficulties" and "strengths and confrontations". Some barriers were then detected, such as: conflicting emotions of personal mental health and also related to the physician's social role; the need for social distancing, reducing physical contact; and changes in the health system typical of this period, such as the persistence of clinical and social demands, reduced availability of face-to-face consultations and insufficient basic protection supplies. The ways of coping identified were: exercising empathy; qualified listening, attentive look and communication skills, in addition to the use of telemedicine. The information from the literature corroborates the results obtained in this study. As for the limitations, this study only looked at the physician's point of view and gathered other relevant information on the subject, which could not be included in the results. Conclusions: It is possible to say that the DPR changed during the pandemic, but the narratives show that even in times of crisis, it is possible to establish significant links between the doctor and the patient. These results may contribute as a coping measure for new public health crises in the future.

Introducción: La relación médico-paciente ha sido ampliamente comparada a lo largo de los años y su importancia dentro de la práctica médica es un consenso. A finales de 2019 comenzó la lucha contra la pandemia mundial por el nuevo coronavirus. Los médicos de familia y comunitarios estuvieron en la primera línea de la pandemia. Objetivo: Este estudio tiene como objetivo analizar las percepciones de los médicos familiares y comunitarios en la relación médico-paciente durante la pandemia de COVID-19. Métodos: Se trata de un estudio cualitativo de análisis de contenido de narrativas médicas, publicado en el blog "Causos Clínicos". El corpus de análisis propuesto es el propuesto por Bardin. Resultados: Se identificaron 42 narrativas con relación temática entre la COVID y la Relación Médico-Paciente. Tras el análisis de contenido, se identificaron 3 categorías: emociones, contacto y sistema de salud. Cada una de las tres categorías tuvo subcategorías específicas de acuerdo con las características de las narrativas, que pueden estar relacionadas con "fortalezas y confrontaciones": emociones conflictivas de salud mental personal y también relacionadas con el rol social del médico; la necesidad de distanciamiento social, hecho de contacto físico; dentro del sistema de salud de este período, como el mantenimiento de las necesidades clínicas y la reducción social en la disponibilidad de consultas presenciales y la falta de insumos básicos de protección; o barreras y dificultades: ejercicio de la empatía; práctica de escucha, ojo vigilante y habilidades de comunicación, además del uso de la telemedicina. Los resultados encontrados en la literatura corroboran los resultados encontrados en esta investigación. En cuanto a la información, este estudio contiene solo la opinión del médico y otra información relevante, que no se incluyeron en los resultados. Conclusiones: Es posible afirmar que la relación médico-paciente ha cambiado durante la pandemia, pero las narrativas muestran que incluso en tiempos de crisis es posible establecer conexiones significativas entre el médico y el paciente.

Development and validation of interpersonal emotion regulation questionnaire for healthcare workers / 中华行为医学与脑科学杂志

Objective:To develop the interpersonal emotion regulation questionnaire for healthcare workers and examine its reliability and validity.Methods:Based on the theory of social regulatory cycle (SRC), literatures review and semi-structured interview were used to form the item pool of the scale.Through expert consultation, project analysis and the exploratory factor analysis, the scale items were screened, and the interpersonal emotion regulation questionnaire for healthcare workers was initially formed.The convenient sampling method was adopted to select 619 healthcare workers from multiple hospitals in Anhui province to conduct the formal survey to test the reliability and validity of the questionnaire and confirmatory factor analysis (CFA) using the SPSS 24.0 and Mplus 8.0 software.Results:There were 18 items and four dimensions including emotion identification, motivation, regulation strategy and implementation strategy process in the interpersonal emotion regulation questionnaire for healthcare workers.The results of CFA showed that the questionnaire fitted the data with well construct validity.The correlation coefficients between each dimension and the scale were 0.830-0.932.The Cronbach’s α coefficient of the overall questionnaire was 0.962, the split-half reliability was 0.880 and the test-retest reliability was 0.786.The score of total questionnaire was significantly positively correlated with the score of emotional intelligence ( r=0.680, P<0.001) and empathic ability ( r=0.554, P<0.001), and was significantly negatively correlated with the doctor-patient relationship ( r=-0.353, P<0.001). Conclusion:The interpersonal emotion regulation questionnaire for healthcare workers has satisfactory reliability and validity, which can be used to measure the ability of interpersonal emotion regulation in healthcare workers.

Analysis on medication rules of Xin'an medicine for treatment of melancholia administered by physicians in the Ming and Qing dynasties based on R language data mining / 中国基层医药

Objective:To investigate the medication rules of Xin'an medicine for the treatment of melancholia and further analyze the medication ideas of Xin'an physicians in the treatment of melancholia.Methods:The documents of Xin'an physicians treating melancholia in the fifth edition of the Chinese Medical Code and the online database of ancient Chinese medicine were retrieved. Excel was used to extract the prescription information to establish the database. R language was used to analyze the data regarding the medication frequency, nature and taste, association rules, and clustering of the traditional Chinese medicine used in the prescription. Results:A total of 127 effective prescriptions were sorted out, and 177 kinds of Chinese medicines were used with a total medication frequency of 1 031 times. The top three Chinese medicines with the highest frequency of use were Poria cocos (57 times), Licorice (46 times), and Paeonia Lactiflora (40 times). The main nature of herbs was plain and warm nature. The warm herbs were the most frequently used (298 times). The first five flavors of the herbs which were the most used were pungent taste (475 times, 28.70%), bitter taste (459 times, 27.73%), and sweet taste (453 times, 27.37%). The commonly used herbs with confidence coefficient > 0.800 were Licorice + Angelica sinensis, Licorice + Angelica sinensis and Paeonia Lactiflora, Licorice + Bupleurum, Licorice + Atractylodes macrocephala, Cyperus root + Ligusticum Chuanxiong, Angelica sinensis + Atractylodes macrocephala and Licorice, Paeonia Lactiflora + Angelica sinensis and Poria cocos, Licorice + Angelica sinensis and Poria cocos, Licorice + Atractylodes macrocephala and Angelica sinensis, Licorice + Bupleurum and Paeonia Lactiflora, Licorice + Atractylodes macrocephala and Ginseng, Licorice + Ginseng and Angelica sinensis, Cyperus root + Medicated leaven, Ginseng + Astragalus mongholicus, Licorice + Astragalus mongholicus.Conclusion:Xin'an medicine for the treatment of melancholia mainly uses pungent, bitter, sweet, and warm herbs. It can adjust the chill and fever, Yin and Yang of the human body, diminishes the urgency, and regulates the flow of Qi.

Research on the application of Miller's pyramid theory combined with Bahrain's team activities in standardized residency training of burn surgeons / 中华医学教育探索杂志

Objective:To explore the application of Miller's pyramid theory combined with Bahrain's team activities in the standardized residency training (SRT) of burn surgeons.Methods:Seventy-four residents who were on the SRT program in the Department of Burns & Wound Care in The Second Affiliated Hospital of Zhejiang University were enrolled in the study. The students were divided into control group and observation group according to the teaching methods. Thirty-seven students in the control group were provided with conventional teaching, and 37 students in the observation group were provided with training based on Miller' pyramid theory combined with Bahrain's team activities. The two groups were evaluated for teaching effectiveness and doctor-patient communication skills. SPSS22.0 was used for the chi-square test and t test. Results:The evaluation outcome of teaching effectiveness in the observation group was better than that in the control group ( t=3.01, 3.47, 3.49, 3.32, and 2.54; P=0.004, 0.001, 0.001, 0.001, and 0.013). After the training, the scores of Set Elicit Give Understand End scale in the two groups increased, with significantly higher scores achieved in the observation group than in the control group ( t=3.23, 2.99, 2.07, 3.62, 3.00, and 7.89; P=0.002, 0.004, 0.042, 0.001, 0.004, and <0.001). Conclusion:The application of Miller's pyramid theory and Bahrain's team activities in the SRT of burn surgeons can improve students' evaluation of teaching effectiveness and improve their doctor-patient communication skills.

A study on using comprehensive geriatric assessment to improve the teaching level of doctor-patient communication from the perspective of Johari Window / 中华医学教育探索杂志

Based on the theory of "Johari Window", this study introduced how to stimulate information content obtained in doctor-patient communication and how to apply the comprehensive geriatric assessment creatively from the four modules of open area, blind area, hidden area and unknown area in the model. It helped students to gain the trust and cooperation of patients, rapidly narrow down the blind area, hidden area and unknown area, guide patients to actively extend the open area, improve the teaching quality of doctor-patient communication in a scientific way.

Practice and thinking of dual-cycle management system for students majoring in clinical medicine (rural doctors) / 中华医学教育探索杂志

The cultivation of students majoring in clinical medicine (rural doctors) is an important measure to promote the health construction at the grassroots level in Xinjiang. The cultivation of talents in this profession is closely related to the educational management mode. In view of the problems in the management and training of rural doctors, this paper explores the improvement methods, aiming at constructing the dual-cycle management system (big cycle management system and small cycle management system) of clinical medicine (rural doctors) from the perspective of management. The big circulation management system is the main body, the small one is the key point of the college management, and the two circulation management systems promote each other, trying to construct the talent management and training system of the trinity of college education, graduation education and continuing medical education. With the support of this system and the advantages of the same counselor in cycle management of students in different grades and different periods, the communication between the counselor and the class teachers, students and students of all grades can be increased. In this way, counselors, class teachers and students of all grades can have a more intuitive and in-depth understanding of the curriculum and internship and employment situation of this specialty, and provide reference for improving the management education level of students majoring in clinical medicine (rural doctors).

Training of public health talents in China in the new situation / 上海预防医学

The epidemic of the coronavirus disease 2019 （COVID-19） has presented great challenges to the public health throughout the world. Therefore， it is crucial to foster high-level and multi-disciplinary public health talents to further improve public health. Herein， we summarize the current situation and challenges for public health education and prospect the requirements for training public health talents in China. Colleges and universities bear the responsibility for training public health talents， which is essential for the construction of public health system. In this context， we introduce the education for public health and the Doctor of Public Health （DrPH） program at Fudan university.

Medication rules of famous Beijing TCM doctor Wang Pei in the treatment of colon cancer based on data mining / 国际中医中药杂志

Objective:To explore the medication rules of Professor Wang Pei in the treatment of colon cancer.Methods:The medical records of Professor Wang Pei's outpatient treatment for colon cancer were collected, entered into the Traditional Chinese Medicine Inheritance Computing Platform V3.0, and the laws of the prescription's nature, flavor, meridian, drug frequency, drug combination, association rules, and cluster analysis were explored.Results:A total of 65 prescriptions were collected, including 150 Chinese materia medica. The medicinal properties of these Chinese materia medica are mainly warm, cold and flat, the tastes were mainly sweet, bitter and pungent, and the meridians were mainly liver, spleen and kidney meridians. Dampness category and blood circulation promoting and blood stasis category were mainly used, and the most frequently used drugs include Poria, Polyporus, Scutellariae Barbatae Herba, Astragali Radix, Curcumae Rhizoma, and the pairs of Polyporus- Poria, Astragali Radix- Astragali Radix Praeparata cum Melle, Scutellariae Barbatae Herba- Curcumae Rhizoma. Twenty nine high-related drug pairs were obtained from association rules, including Polyporus- Astragali Radix Praeparata cum Melle- Astragali Radix, Poria- Scutellariae Barbatae Herba- Polyporus, Scutellariae Barbatae Herba- Curcumae Rhizoma- Polyporus. The cluster analysis showed the combination of 6 types of medicines mainly focuses on strengthening the spleen and removing dampness, nourishing qi and promoting blood, clearing heat and detoxifying, and astringing the intestines to stop bleeding. Conclusion:Professor Wang Pei mostly discusses the treatment of colon cancer from "spleen dampness, rectification deficiency, heat toxin, blood stasis, bleeding", and the treatment is "invigorating the spleen and removing dampness, invigorating Qi and strengthening the body, clearing away heat and detoxifying, promoting blood circulation and removing blood stasis, and astringent intestines to stop bleeding", which is in line with the thought of Traditional Chinese Medicine treatment of tumors, strengthening the righteousness and eliminating pathogenic factors, and and can be used for clinical reference.

Association between cancer fatalism and optimistic attitudes in colorectal cancer patients and the moderating effects / 国际外科学杂志

Objective:To investigate the association between cancer fatalism and optimistic attitudes among colorectal cancer patients, and how the above linkage is moderated by the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making.Methods:A cross-sectional survey was conducted on 64 patients diagnosed with colorectal cancer and awaiting radical colorectal cancer surgery in the Department of General Surgery of Beijing Friendship Hospital Affiliated to Capital Medical University, from January 2021 to December 2021. There were 38 males and 26 females, aged (61.2±13.0) years from 30 to 84 years. Cancer fatalism, optimism attitudes, and the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making were assessed. The patients′ cancer fatalism beliefs were measured by the " Chance" subscale of the Form C of the Multidimensional Health Locus of Control (MHLC-C), optimism attitudes were assessed by the Chinese version of the revised Life Orientation Test (CLOT-R), and the influence of patients′, family members′, and physicians′ opinions in the medical decision-making process was measured by a self-designed single factor scale. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s). Measurement data of skewed distribution were expressed as M( Q1, Q3). Spearman correlation analysis and Chi-square test was used to examine the association between the main outcome variable (patients′ optimistic attitudes) and demographic and clinical characteristics. Interaction was examined by hierarchical linear regression analysis combined with simple slope tests. Results:Cancer fatalism was negatively associated with patients′ optimistic attitudes ( r=-0.35, P<0.01). Optimistic attitude of patients was significantly and negatively correlated with the influence of family members′ opinions on medical decision-making ( r=-0.25, P<0.05). There were significant positive correlations between the influence of patients′ and family members′ opinions ( r=0.50, P<0.01), family members′ and physicians′ opinions ( r=0.67, P<0.01), and physicians′ and patients′ opinions ( r=0.38, P<0.01) in medical decision making. Hierarchical linear regression analysis showed a negative association between cancer fatalism and optimism ( β=-0.32, P=0.01). This association was further moderated by the involvement of family members′ opinions ( β=-0.56, P<0.01) and the involvement of physicians′ opinions ( β=-0.36, P=0.04) in medical decision-making. Simple slope tests revealed that the negative impact of fatalistic attitudes on patients′ optimism attitudes may be potentiated when family members′ opinions have high influence on medical decision-making, while the negative impact may be buffered to some extent when physicians′ opinions have high influence on medical decision-making. Conclusions:Cancer fatalism had a negative effect on patients′ optimism. The high influence of physicians in treatment decision-making buffered the negative effect of cancer fatalism on optimism; the high influence of family members in treatment decision-making potentiated the negative effect of cancer fatalism on optimism. In the process of doctor-patient communication and shared decision-making, for patients with strong fatalistic attitudes, consideration should be given to appropriately increasing direct informational communication between physicians and patients and reducing excessive family intervention in medical decision-making, so as to enhance patients′ autonomy for treatment, promote optimism, and reduce the negative effects of cancer fatalism.