Você está pensando, refletindo, analisando o que você vê e o que você faz o tempo todo: percepção de residentes de Medicina de Família e Comunidade sobre vídeo feedback / You are thinking, reflecting, analysing what you see and what you do all the time: perception of General Practice trainees about video feedback / Estás pensando, reflexionando, analizando lo que ves y lo que haces todo el tiempo: percepción de los residentes de Medicina Familiar y Comunitaria sobre vídeo feedback

Introdução: A comunicação é reconhecida como uma habilidade central por vários órgãos reguladores internacionais da educação médica. O ensino específico de habilidades de comunicação é fundamental para melhorar a comunicação dos médicos. As técnicas experienciais mostraram superioridade em comparação com os modelos tradicionais. A utilização de consultas reais ajuda os estudantes a visualizar melhor as suas competências de entrevista e a refletir sobre elas. Com os avanços da tecnologia, o uso de consultas médicas gravadas em vídeo tornou-se a abordagem padrão para o ensino da comunicação. No entanto, a eficácia dessa técnica depende do envolvimento ativo dos estudantes. As suas contribuições e comentários dos pares sobre a consulta gravada são essenciais para a aprendizagem. Contudo, a perspectiva do estudante sobre a utilidade dessa abordagem educativa recebeu pouca atenção. Objetivos: Compreender a percepção da aprendizagem dos residentes de medicina de família e comunidade resultante da atividade de vídeo feedback na sua formação profissional. Métodos: Estudo exploratório, qualitativo, realizado com residentes do primeiro ano de medicina de família e comunidade de um programa de residência estabelecido em São Paulo, Brasil. Os participantes foram entrevistados após as sessões educativas, que foram analisadas por meio de análise temática reflexiva. Resultados: A autopercepção de sua prática, o aprendizado de habilidades de comunicação e os ganhos afetivos foram identificados pelos participantes como pontos de aprendizado derivados da atividade de vídeo feedback. Além disso, sobre o aprendizado de habilidades específicas de comunicação, eles mencionaram comunicação não-verbal e verbal, conexões entre teoria e prática, estrutura de consulta e oportunidades para cristalizar conhecimentos. Os ganhos afetivos incluíram sentir-se parte de um grupo, melhora da autoestima, superação de inseguranças, percepção de consultas mais efetivas, reforço do gosto pelo trabalho e reconhecer a necessidade de mais aprendizado. Conclusões: Os ganhos de aprendizagem identificados em nosso estudo levaram a uma experiência de humanidade compartilhada, que permite aos participantes serem mais efetivos técnica e afetivamente com seus pacientes. Além disso, identificamos que a atividade educativa de vídeo feedback pode ser utilizada para outros possíveis fins educacionais além do ensino da comunicação.

Introduction: Communication is recognized as a central skill by various international medical education regulatory bodies. Specific teaching on communication skills is important to enhance doctors' communication. Experiential techniques appear to be superior compared to traditional models. Real-life consultation helps trainees visualize their interview skills and reflect on them. Upgraded by technology, the use of video-recorded medical visits became the standard approach for communication teaching. However, the effectiveness pf this technique relies on trainees' active involvement. Their inputs and peer feedback on the recorded consultation are essential to learning. Despite its importance, their perspective on the usefulness of video feedback in medical education has received limited attention. Objective: To understand the perception of learning among general practice trainees as a result of the video feedback activity in their vocational training. Methods: An exploratory, qualitative study, conducted with first-year general practice trainees from an established training program in São Paulo, Brazil. Participants were interviewed after educational session, which were analyzed using reflexive thematic analysis. Results: Self-perception of their practice, communication skills learning, and affective gains were identified by participants as learning points derived from the video feedback activity. Furthermore, for specific communication skills learning, they mentioned nonverbal and verbal communication, theory and practice connections, consultation structure and opportunities for crystallizing knowledge. Affective gains included feeling part of a group, improving self-esteem, overcoming insecurities, perception of more effective consultations, reinforcing fondness for their work, and need for more learning. Conclusions: The learning gains identified in our study led to an experience of common humanity, which allowed participants to be more technically and affectively effective with their patients. Also, we identified that the video feedback educational activity can be used for other possible educational purposes, beyond the teaching of communication.

Introducción: La comunicación es reconocida como una habilidad fundamental por varios organismos reguladores internacionales de educación médica. La enseñanza específica de habilidades de comunicación es importante para mejorar la comunicación de los médicos. Las técnicas experienciales parecen ser superiores a los modelos tradicionales. El uso de consultas reales ayuda a los estudiantes a visualizar y reflexionar mejor sobre sus habilidades de entrevista. Actualizado por la tecnología, el uso de consultas médicas grabadas en video se ha convertido en el enfoque estándar para la enseñanza de la comunicación. Sin embargo, para que la técnica funcione, la participación de los estudiantes es crucial. Sus contribuciones y comentarios de los compañeros sobre la consulta grabada son esenciales para el aprendizaje. Sin embargo, la perspectiva de los estudiantes sobre la utilidad de este enfoque educativo ha recibido poca atención. Objetivos: Comprender la percepción del aprendizaje por parte de los residentes de medicina de familia y comunitaria como resultado de la actividad de vídeo feedback en su formación profesional. Métodos: Estudio cualitativo exploratorio realizado con residentes de primer año de medicina familiar y comunitaria de un programa de residencia establecido en São Paulo, Brasil. Los participantes fueron entrevistados después de una sesión educativa, que fueron analizados mediante análisis temático reflexivo. Resultados: La autopercepción de su práctica, el aprendizaje de habilidades comunicativas y las ganancias afectivas fueron identificadas por los participantes como puntos de aprendizaje derivados de la actividad de vídeo feedback. Además, sobre el aprendizaje de habilidades comunicativas específicas, mencionaron la comunicación verbal y no verbal, las conexiones entre la teoría y la práctica, la estructura de consulta y las oportunidades para cristalizar conocimientos. En cuanto a las ganancias afectivas, relataron sentirse parte de un grupo, mejora de la autoestima, superación de las inseguridades, percepción de consultas más efectivas, refuerzo del gusto por el trabajo y necesidad de más aprendizaje. Conclusión: Los logros de aprendizaje identificados en nuestro estudio llevaron a una experiencia de humanidad compartida, que permite a los participantes ser técnica y afectivamente más efectivos con sus pacientes. Además, identificamos que la actividad educativa de vídeo feedback puede ser utilizada para otros posibles fines educativos, además de la enseñanza de la comunicación.

Standardized Informed Consent Form for Clinicians Administering Platelet-Rich Plasma.

Introduction When it comes to medico-legal malpractice suits, lawyers and insurers tend to focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for the use of platelet-rich plasma (PRP) injections, which might cause problems. This study aimed to mitigate this concern through the development of a standardized informed consent document for PRP injections, grounded in evidence-based practices. Materials and methods An examination of databases was conducted to explore the medico-legal ramifications associated with PRP injections, as well as the broader topic of informed consent, with a particular focus on the context of PRP injections. Moreover, interviews were carried out with healthcare providers and individuals who had received PRP injections within the preceding year, utilizing a semi-structured methodology. Results We developed an evidence-based informed consent document tailored for PRP injections. To guarantee its legal validity, the document underwent review by a legal specialist. Subsequently, our institutions implemented the finalized form for PRP injection procedures over one year. Conclusion A legally valid and evidence-based informed consent form for PRP injections would ensure patient's rights, and encourage open communication and transparency between them and the doctor. Moreover, if a lawsuit were to arise, it would serve as a critical document in the doctor's defense and withstand scrutiny from lawyers and the judiciary.

[The psychotrauma prevention algorithm, a paramedical pilot study]. / L'algorithme de prévention du psychotraumatisme, une étude pilote paramédicale.

The aim of the psychotrauma prevention algorithm is to limit the occurrence of psychotrauma in a subject who has experienced a serious life event, by carrying out an initial assessment to define the severity criterion and the monitoring modality best suited to his or her clinical condition. This approach is in line with the philosophy of outreach and the ethics of concern. Recontacting the patient during the course of treatment helps to maintain the therapeutic link and prevent any deterioration in his condition, thus limiting the risk of his traumatic state becoming chronic.

First Mexican Consensus on Crohn's disease.

INTRODUCTION: Crohn's disease (CD) is a subtype of chronic and incurable inflammatory bowel disease. It can affect the entire gastrointestinal tract and its etiology is unknown. OBJECTIVE: The aim of this consensus was to establish the most relevant aspects related to definitions, diagnosis, follow-up, medical treatment, and surgical treatment of Crohn's disease in Mexico. MATERIAL AND METHODS: Mexican specialists in the areas of gastroenterology and inflammatory bowel disease were summoned. The consensus was divided into five modules, with 69 statements. Applying the Delphi panel method, the pre-meeting questions were sent to the participants, to be edited and weighted. At the face-to-face meeting, all the selected articles were shown, underlining their level of clinical evidence; all the statements were discussed, and a final vote was carried out, determining the percentage of agreement for each statement. RESULTS: The first Mexican consensus on Crohn's disease was produced, in which recommendations for definitions, classifications, diagnostic aspects, follow-up, medical treatment, and surgical treatment were established. CONCLUSIONS: Updated recommendations are provided that focus on definitions, classifications, diagnostic criteria, follow-up, and guidelines for conventional medical treatment, biologic therapy, and small molecule treatment, as well as surgical management.

Molecular differentiation analysis of ten putative species of Fannia (Diptera: Fanniidae) collected in carrion-baited traps from Colombia.

The genus Fannia is the most representative of the Fannidae family of true flies with worldwide distribution. Some species are attracted to decomposing materials and live vertebrate animals, which makes them important in forensics, medical and veterinary fields. However, identifying Fannia species can be difficult due to the high similarity in the external morphology of females and limited descriptions and morphological keys. Herein, molecular markers could provide a complementary tool for species identification. However, molecular identification has still limited application since databases contain few data for neotropical species of Fannia. This study assessed the potential of two molecular markers, the COI-3' region and internal transcribed spacer 2 (ITS2), to differentiate 10 putative species of the genus Fannia from Colombia using distance-based and tree-based approaches. The partial ITS2 and/or COI-3' regions allowed molecular diagnosis of six species, while pairs of species Fannia colazorrensis + F. dodgei and F. laclara + F. aburrae are conflicting. Although these results might suggest that conflicting pair species are conspecific, consistent morphological differences between males do not support this hypothesis. The lack of differentiation at the nuclear and mitochondrial molecular markers for the conflicting species may be due to incomplete evolutionary lineage separation, hybridization, or introgression events. In addition, sexual selection on male morphological traits before species-specific differences in molecular markers emerge may partially explain the results. Our study provides a valuable dataset to identify and confirm some Fannia species molecularly. Further, they could be used to associate females and immature stages with their conspecifics as a baseline to deep into their biology, ecology, distribution and potential applications in forensic and medico-veterinary entomology.

Becoming a thrombectomy-capable stroke center: Clinical and medico-economical effectiveness at the hospital level.

INTRODUCTION: Too few patients benefit from endovascular therapy (EVT) in large vessel occlusion acute stroke (LVOS), and various acute stroke care paradigms are currently investigated to reduce these inequalities in health access. We aimed to investigate whether newly set-up thrombectomy-capable stroke centers (TSC) offered a safe, effective and cost-effective procedure. PATIENTS AND METHODS: This French retrospective study compared the outcomes of LVOS patients with an indication for EVT and treated at the Perpignan hospital before on-site thrombectomy was available (Primary stroke center), and after formation of local radiology team for neurointervention (TSC). Primary endpoints were 3-months functional outcomes, assessed by the modified Rankin scale. Various safety endpoints for ischemic and hemorragic procedural complications were assessed. We conducted a medico-economic analysis to estimate the cost-benefit of becoming a TSC for the hospital. RESULTS: The differences between 422 patients in the PSC and 266 in the TSC were adjusted by the means of weighted logistic regression. Patients treated in the TSC had higher odds of excellent functional outcome (aOR 1.77 [1.16-2.72], p = 0.008), with no significant differences in the rates of procedural complications. The TSC setting shortened onset-to-reperfusion times by 144 min (95% CI [131-155]; p < 0.0001), and was cost-effective after 21 treated LVOS patients. On-site thrombectomy saves 10.825€ per patient for the hospital. DISCUSSION: Our results demonstrate that the TSC setting improves functional outcomes and reduces intra-hospital costs in LVOS patients. TSCs could play a major public health role in acute stroke care and access to EVT.

Characteristics and type of strabismus associated to macular diplopia. Treatment outcomes.

OBJECTIVE: To study the clinical characteristics of macular diplopia, treatment, and outcome. METHODS: Retrospective descriptive study of cases referred to the ocular motility section of a tertiary hospital with diplopia, diagnosed with macular diplopia between 2022-23. The etiology of the macular pathology and the type of associated strabismus were recorded. The result was considered good if the diplopia improved or was eliminated with the medical or surgical treatment. Follow-up time from the onset of diplopia until data collection was recorded. RESULTS: a total of 19 cases comprised the sample (63.2% women), mean age: 67.16 years. Amblyopia (21.1%), high myopia (47.4%), epirretinal membrane (ERM) (36.8%), neovascular membrane (26.3%), macular hole (10.5%), and lamellar (15.8%), and age macular degeneration (5.3%) were registered. The 47.4% had vertical diplopia, horizontal: 5.3 and 47.4% mixed. The mean horizontal deviation was: 7.3 PD (prism diopters) and vertical: 6.22 PD. Ocular extorsion was observed in 26.3%, and intorsion: 5.3%. Torticollis was present in 15.8%. The treatment consisted of strabismus surgery + Botox (15.8%), strabismus surgery (47.4%), medical treatment with Fresnel prims or Scotch cellophane (36.8%). A 68.4% presented a good result at the end of the study. The mean follow-up was 55.58 months. CONCLUSIONS: Misregistration of macular photoreceptors is the most common cause of binocular diplopia in patients with ERM or other macular pathologies. Most complains of vertical or mixed diplopia. Sensorimotor evaluation of these patients should be thorough. Early diagnosis prevents unnecessary prescription of prism glasses. Surgical and/or medical treatment achieves good results in most cases.

Patient characteristics of, and remedial interventions for, complaints and medico-legal claims against doctors: a rapid review of the literature.

BACKGROUND: It is uncertain if patient's characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised. METHODS: We conducted a rapid review of recent literature to answer: Question 1 "What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?" and Question 2 "What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received from a doctor?". We used a systematic search (most recently in July 2023) of PubMed, Scopus, Web of Science and grey literature. Studies were screened against inclusion criteria and critically appraised in duplicate using standard tools. Results were summarised using narrative synthesis. RESULTS: From 8079 search results, we reviewed the full text of 250 studies. We included 25 studies: seven for Question 1 (6 comparative studies with controls and one systematic review) and 18 studies for Question 2 (14 uncontrolled pre-post studies, 2 comparative studies with controls and 2 systematic reviews). Most studies were set in hospitals across a mix of medical specialties. Other than for patients with mental health conditions (two studies), no other patient characteristics demonstrated either a strong or consistent effect on the rate of complaints or claims against their treating doctors. Risk management programs (6 studies), and communication and resolution programs (5 studies) were the most studied of 6 intervention types. Evidence for reducing complaints and medico-legal claims, costs or premiums and more timely management was apparent for both types of programs. Only 1 to 3 studies were included for peer programs, medical remediation, shared decision-making, simulation training and continuing professional development, with few generalisable results. CONCLUSION: Few patient characteristics can be reliably related to the likelihood of medico-legal complaints or claims. There is some evidence that interventions can reduce the number and costs of claims, the number of complaints, and the timeliness of claims. However, across both questions, the strength of the evidence is very weak and is based on only a few studies or study designs that are highly prone to bias.

Enfrentamento do Burnout em preceptores e residentes de medicina: explorando estratégias / Facing Burnout among medical preceptors and residents: exploring strategies / Abordando el Burnout en preceptores y residentes de medicina: explorando estrategias

A síndrome do burnout é composta por sintomas de exaustão emocional, despersonalização e redução do sentimento de conquista, estando relacionada a trabalho estressante. Médicos residentes e preceptores estão em alto risco para o surgimento do . O objetivo deste trabalho foi a revisão de estratégias institucionais e individuais para o enfrentamento do burnout por essa população. Trata-se de revisão integrativa, com coleta de dados por meio da base de dados Pubmed. Dentre as estratégias organizacionais, destacam-se a modificação dos processos de trabalho, organização das demandas dos profissionais, melhoria da comunicação, incentivo à capacitação profissional, e organização de serviços de atendimento para prevenção e manejo do burnout. Do ponto de vista individual, destacam-se os hábitos saudáveis, busca espiritual, dedicação a hobbies, meditação e coping. O burnout é um problema de saúde psíquica emergente em residentes e preceptores, sendo necessário que instituições e profissionais sejam ativos no diagnóstico e enfrentamento desse agravo

Burnout syndrome comprises symptoms of emotional exhaustion, depersonalization, and a diminished sense of achievement, associated with stressful work environments. Medical residents and preceptors are at a high risk for the emergence of burnout. This study aimed to review institutional and individual strategies for addressing burnout in this population. It is an integrative review, with data collected from the PubMed database. Among organizational strategies, emphasis is placed on modifying work processes, organizing professional demands, improving communication, encouraging professional development, and establishing support services to prevent and manage burnout. From an individual perspective, healthy habits, spiritual pursuits, dedication to hobbies, meditation, and coping are highlighted. Burnout is an emerging mental health issue in residents and preceptors, necessitating the active involvement of institutions and professionals in the diagnosis and management of this condition.

El síndrome de burnout está compuesto por agotamiento emocional, despersonalización y disminución del sentido de logro, asociado a entornos laborales estresantes. Los médicos residentes y preceptores tienen un alto riesgo de desarrollar burnout. El objetivo de este estudio fue revisar estrategias institucionales e individuales para abordar el burnout en esta población. Se trata de una revisión integradora, con datos recopilados de la base de datos PubMed. Entre las estrategias organizativas, se destaca la modificación de procesos de trabajo, organización de demandas profesionales, mejora de la comunicación, estímulo al desarrollo profesional y establecimiento de servicios para la prevención y el manejo del burnout. Desde una perspectiva individual, se resaltan hábitos saludables, búsqueda espiritual, dedicación a pasatiempos, meditación y el afrontamiento. El burnout es un problema de salud mental emergente en residentes y preceptores, lo que requiere la participación activa de instituciones y profesionales en el diagnóstico y tratamiento de esta condición.

[Optimizing the management of heart failure: structuring the care pathway]. / Optimisation de la prise en charge de l'insuffisance cardiaque : structuration du parcours de soins.

The incidence of chronic heart failure continues to rise in Western countries, justifying the implementation of an optimized multidisciplinary organization based on medical and nursing convergence. Around the main heart failure, assistance and transplantation unit at Toulouse University Hospital, several structures have been put in place to better manage heart failure patients and improve their care pathway.

A case of surgical site infection with severe spondylitis caused by Streptococcus gordonii in an adult healthy woman: how to apply medico-legal method to deny malpractice hypothesis in suspected healthcare-associated infection.

We describe a rare case of severe primary spondylitis caused by Streptococcus gordonii in a 45-year-old immunocompetent woman with no relevant comorbidities. The surgical site infection arose after a L4-L5 microdiscectomy and resulted in severe clinical disability. Allegations of possible negligence as the cause prompted a forensic review to clarify the original source and transmission of this uncommon pathogen, which dismissed its cause as due to malpractice during treatment.

Challenge of achieving truly individualised informed consent in therapeutic endoscopy.

Objective: Guidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks likely to be material to the patient must be explored, as well as alternatives to the procedure. Despite this, departments and endoscopists still struggle to meet the current standards. In this article, we explore the challenges encountered in achieving individualised consent in therapeutic endoscopy through real-life scenarios. Methods: Five realistic therapeutic endoscopy (hepatobiliary) scenarios are described, followed by presentation of possible or ideal approaches, with references related to existing literature in this field. Results: The vignettes allow consideration of how to approach difficult consent challenges, including anxiety and information overload, urgency during acute illness, failure to disclose the risk of death, the role of trainees and intraprocedural distress under conscious sedation. Conclusions: The authors conclude that a high degree of transparency is required while obtaining consent for therapeutic endoscopy accompanied by full documentation, involvement of relatives in nearly all cases, and clarity around the presence of trainees who may handle the scope. A greater focus on upskilling trainees in the consent process for therapeutic endoscopy is required.

Acesso vascular intraósseo: atitudes e práticas dos enfermeiros do serviço de urgência / Intraosseous vascular access: attitudes and practices of emergency department nurses

O Estágio de Natureza Profissional é um período fundamental do segundo ciclo de estudos pois visa completar a formação académica da componente de especialização, onde o estudante, integrado num contexto profissional, imerge em ambiente e situações clínicas complexas, desenvolvendo atividades que lhe permitam adquirir e aprimorar competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica. Pretende-se com este relatório evidenciar as oportunidades de aprendizagem e atividades realizadas no âmbito deste espaço e tempo formativo, no serviço de urgência de um hospital do norte do país, compreendendo a importância e apropriando a intervenção do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica na área da Pessoa em Situação Crítica e as suas competências para gerir cuidados de enfermagem, intervir na formação de equipas de saúde e prestar cuidados altamente qualificados à pessoa doente e família. A investigação que integra este relatório assenta num estudo descritivo-correlacional com o objetivo de analisar as atitudes e práticas dos enfermeiros do serviço de urgência, de um hospital do norte de Portugal, na utilização do acesso vascular intraósseo. Utilizou-se o questionário como instrumento de recolha de dados a uma amostra de 76 enfermeiros, distribuído e preenchido via on-line, entre 4 e 15 de maio de 2023. Os resultados evidenciaram que 97,4% dos participantes reconhecem o acesso intraósseo como importante no contexto do serviço de urgência, embora 85,5% nunca o utilizassem, sendo o acesso por veia central privilegiado por 90,8%, como alternativa à falha da inserção da veia periférica. A insatisfação com os conhecimentos sobre cateterização intraóssea é de 89,5%. Fatores como a falta de treino/formação na realização do procedimento são considerados pela maioria, como os mais condicionantes à realização do procedimento. A principal conclusão é que os enfermeiros do serviço de urgência reconhecem a importância do acesso intraósseo, no entanto, afirmam que é necessário mais formação e treino para que o número de cateterizações intraósseas possa aumentar nas situações que se justifiquem. Deste percurso formativo, destaca-se a importância da intervenção diferenciada do Enfermeiro Especialista na melhoria contínua da qualidade de cuidados, num contexto complexo como é o serviço de urgência. Salienta-se, a nível pessoal, o desenvolvimento de competências especializadas comuns e específicas, na interação com o ambiente clínico envolvente.

The Professional Internship is a fundamental period of the second cycle of studies because it aims to complete the academic training of the specialisation component, where the student, integrated in a professional context, immerses himself in complex clinical environment and diferent situations, developing activities that allow him to acquire and improve common and specific skills of the Specialist Nurse in Medical-Surgical Nursing. This report aims to highlight the learning opportunities and the activities carried out within this space and time training, in the emergency service of a hospital in the north of the country, understanding the importance and appropriate intervention of the Nurse Specialist in Medical-Surgical Nursing in the area of the Person in a Critical Situation and their skills to manage nursing care, intervene in the training of health care teams and provide highly qualified care to the sick person and their families. The research that integrates this report is based on a descriptive-correlational study with the objective of analysing the attitudes and practises of nurses in the emergency service, of a hospital in the north of Portugal, in the use of intraosseous vascular access. The questionnaire was used as a data collection tool for a sample of 76 nurses, distributed and completed online, between May 4 and 15, 2023. The results showed that 97.4% of the participants recognise intraosseous access as important in the context of the emergency service, although 85.5% never used it, and access by central vein was privileged by 90.8%, as an alternative to the failure of the insertion of the peripheral vein. Dissatisfaction with the knowledge of intraosseous catheterisation is 89.5%. Factors such as the lack of training in the realisation of the procedure are considered by most, as the most conditioning to the realisation of the procedure. The main conclusion is that the nurses of the emergency service recognise the importance of intraosseous access, however, they say that more training is necessary so that the number of intraosseous catheterisations can increase in situations that are justified. From this training path, the importance of the differentiated intervention of the Specialist Nurse in the continuous improvement of the quality of care is highlighted, in a complex context such as the emergency service. It is noteworthy, at a personal level, the development of common and specific specialised skills in the interaction with the surrounding clinical environment.

The mediating role of physician trust in the relationship between medical mistrust and health-care system distrust.

OBJECTIVE: This study was carried out to determine the mediating role of physician trust in the relationship between medical mistrust and health-care system distrust. MATERIALS AND METHODS: The "Health Care Systems Distrust Scale", which consists of 10 questions, the "Medical Mistrust Scale", which consists of 17 questions, the "Physician Trust Scale", which consists of 11 questions. The statistical analysis was performed using the SPSS 26.0 program. RESULTS: Health-care system distrust was positively correlated with medical mistrust and negatively correlated with physician trust. There was a negative relationship between medical mistrust and physician trust. Physician trust mediates the effect of medical mistrust on health-care system distrust. In other words, it was determined that the mediating effect of physician trust was significant. CONCLUSION: Addition of physician trust to medical mistrust decreases the negative effects of health-care system distrust. Medical mistrust must be addressed at multiple levels of society, including government, policy, and health-care systems.

OBJETIVO: Este estudio se llevó a cabo para determinar el papel mediador de la confianza del médico en la relación entre la desconfianza médica y la desconfianza en el sistema de salud. MATERIALES Y MÉTODOS: La "Escala de desconfianza en los sistemas de atención médica", que consta de 10 preguntas, la "Escala de desconfianza médica", que consta de 17 preguntas, la "Escala de confianza del médico", que consta de 11 preguntas. El análisis estadístico se realizó mediante el programa SPSS 26.0. RESULTADOS: La desconfianza en el sistema de salud se correlacionó positivamente con la desconfianza médica y negativamente con la confianza en los médicos. Hubo una relación negativa entre la desconfianza médica y la confianza en el médico. La confianza del médico media el efecto de la desconfianza médica en la desconfianza de los sistemas de atención médica. En otras palabras, se determinó que el efecto mediador de la confianza en el médico fue significativo. CONCLUSIÓN: La adición de la confianza del médico a la desconfianza médica disminuye los efectos negativos de la desconfianza en el sistema de atención médica. La desconfianza médica debe abordarse en múltiples niveles de la sociedad, incluido el gobierno, las políticas y los sistemas de atención médica.

Mortality in a Nationwide Practice-Based Cohort Receiving Paclitaxel-Coated Devices for Lower Limb Peripheral Artery Disease.

BACKGROUND: According to a meta-analysis of randomized clinical trials, paclitaxel-coated devices (PCDs) for lower limb endovascular revascularization may be associated with increased risk of late mortality. OBJECTIVES: The purpose of this study was to determine whether PCDs are associated with all-cause mortality in a real-world setting. METHODS: DETECT is a nationwide, exhaustive retrospective cohort study using medico-administrative data from the French National Healthcare System representing >99% of the population. The main selection criterion was the first procedure of interest: endovascular revascularization for lower limb peripheral artery disease involving ≥1 balloon and/or stent performed between October 1, 2011, and December 31, 2019. Patients with or without PCDs were compared for all-cause mortality until December 31, 2021. RESULTS: A total of 259,137 patients were analyzed, with 20,083 (7.7%) treated with ≥1 PCD. After a median follow-up of 4.1 years (Q1-Q3: 2.3-6.4 years), a total of 5,385 deaths/73,923 person-years (PY) (7.3/100 PY) and 109,844 deaths/1,060,513 PY (10.4/100 PY) were observed in the PCD and control groups, respectively. After adjustment for confounding factors, PCD treatment was associated with a lower risk of mortality in multivariable Cox analyses (HR: 0.86; 95% CI: 0.84-0.89; P < 0.001). Similar results were observed using propensity score matching approaches based on either nearest-neighbor or exact matching. CONCLUSIONS: In a nationwide analysis based on large-scale real-world data, exposure to PCDs was not associated with a higher risk of mortality in patients undergoing endovascular revascularization for lower limb peripheral artery disease. (The DETECT Project; NCT05254106).

[Working in a CSAPA, care through relationships]. / Travailler en CSAPA, le soin par la relation.

In a medical-social setting, the work of addiction care providers is somewhat unusual. Drawing on the teachings of Carl Rogers and his person-centred approach, and Hildegard Peplau and her theory of care based on the interpersonal relationship, this article explores the possibilities of welcoming a user to an addictology care, support and prevention center that is trying to rethink its operations at a time when advanced practice nurses are being deployed.

[Evaluation of healthcare for patients with diabetes in primary care: A systematic review]. / Evaluación de la asistencia sanitaria del paciente con diabetes en atención primaria: una revisión sistemática.

OBJECTIVE: Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care. METHOD: During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care¼, «Diabetes Mellitus, Type2¼. Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023. RESULTS: The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes. CONCLUSIONS: The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care.

Atención de las personas que viven con VIH en el Sistema de Salud Colombiano: perspectivas de pacientes, cuidadores y personal de salud / Caring for people living with HIV in the Colombian Health System: patients, caregivers and health workers perspectives

Fundamentos: las políticas y programas de atención en salud a las personas que viven con vih han obedecido a las políticas económicas vigentes, basadas en el modelo de desarrollo neoliberal y que configuran el actual sistema de salud. El objetivo de este trabajo fue analizar la influencia del sistema de salud colombiano en la atención de las personas que vivían con vih afiliadas a las entidades administradoras de planes de beneficio del régimen subsidiado, atendidos en neiva (colombia). Métodos: se realizó un estudio cualitativo, enmarcado en el análisis crítico del discurso. Participaron diecinueve personas entre pacientes con vih, cuidadores no formales y personal de salud, captados de dos instituciones prestadoras de servicios de salud de la ciudad de neiva, a quienes se les aplicó entrevistas en profundidad. Los datos fueron codificados, categorizados y organizados en excel para su análisis.resultados: la relación interpersonal y el funcionamiento del sistema de salud fueron dos fenómenos que interfirieron en la atención de las personas con vih, en cuanto a que favoreció o impuso barreras a las prácticas. Se encontraron fallos en el proceso informativo/educativo desde el momento del diagnóstico, estigma y discriminación, profundizado en las instituciones de salud no especializadas en vih, así como múltiples barreras de acceso a los servicios de salud. El 55,5% de los pacientes expresó haber sido discriminados por el personal de salud en algún momento desde su diagnóstico. El 100% de pacientes entrevistados identificó barre-ras de diferente tipo para los servicios de salud, contextualizados en trato indebido, inoportunidad en la atención y abuso del poder; solo el 22,2% recurrió a la interposición de quejas, derechos de petición o tutelas para reclamar su derecho a la salud.conclusiones: la praxis de atención se realiza al margen de la situación de contexto de los pacientes, olvidando que son precisamente los ubicados en un nivel socioeconómico más bajo, quienes tienen mayor vulnerabilidad estructural relacionada con la pobreza, por lo que la falta de atención de salud exacerba las inequidades sanitarias.(AU)

Background: health policies and programs for people living with hiv have been subordinated to current economic policies based on the neoliberal development model that shapes the current healthcare system. The study’s objective was to analyze the influence of the colombian health system on the care of people who lived with hiv enrolled in the subsidized regime through benefit plan administrating entities and treated in neiva (colombia).methods: a qualitative study framed within the framework of the critical discourse analysis was conducted. Nineteen people parti-cipated, including hiv patients, non-formal caregivers, and health workers. The participants were recruited from two health service provi-ders institutions in the city of neiva. In-depth interviews were conducted. Data were coded, categorized and organized in excel for analysis.results: the interpersonal relationship and the health system functioning were two phenomena that interfered with caring for people with hiv by favoring or imposing barriers to practices. Failures were found in the informative-educational process from the moment of diagnosis, stigmatization, and discrimination, particularly in non-hiv-specialized health institutions, and multiple barriers to access to health services. 55.5% of the patients expressed having been discriminated against by health personnel at some point since their diagnosis. 100% of the patients interviewed identified different types of barriers to health services, contextualized in im-proper treatment, untimely care and abuse of power; only 22.2% resorted to the filing of complaints, petition rights or guardianships to claim their right to health.conclusions: health care praxis is carried out regardless of patients’ situation, forgetting that those from a lower socioecono-mic level have greater structural vulnerability related to poverty. The lack of healthcare exacerbates health inequalities.(AU)

Day-of-the-week variation of sudden unexpected cardiac death.

Background: There has been some controversy about the day-of-the-week (septadian) variation of unexpected sudden cardiac death (SCD). Methods: We evaluated the incidence of unexpected SCD on different days of the week in a consecutive series of 5869 SCD victims from Northern Finland [the FINGESTURE study (Finnish Genetic Study of Arrhythmic Events)]. As it is mandatory in Finland, a medico-legal autopsy was performed on all unexpected sudden death victims. The autopsies were performed between the years 1998-2017. Results: The mean incidence of unexpected SCD was higher at weekends (during the days from Friday to Sunday, peaking on Saturday) than during the days from Monday to Thursday (8.54 ± 0.72 vs. 7.22 ± 0.19 SCDs per day of the week per 100,000 inhabitants per year, p < 0.001). Regardless of sex or ischemic versus non-ischemic etiology of SCD, the distribution of the occurrence of SCD among the days of the week was similar compared with the whole SCD cohort. Conclusion: The incidence of unexpected SCD was highest at weekends (during the days from Friday to Sunday, peaking on Saturday).

Medico-Legal Implications of Video Recordings of Clinic Visits in Malpractice Claims Against Medical Providers.

OBJECTIVE: Although audio-video recordings of clinic visits improve patient satisfaction and recall, the associated presumed risk of increased malpractice claims limits their use. In this study, we identified whether video recording clinic visits was associated with increases in professional liability claims. METHODS: From 2015 to 2017, the institution's loss run was analyzed, and the rates of medical malpractice claims per physician-year were compared between physicians who used video recordings of clinic visits (V-RoCs) and those who did not. The term "users" was applied to all physicians whose mean percentage of patient visits with video recording was greater than the mean percentage for the practice overall. RESULTS: Over three years, 15,254 patients used V-RoCs. The use of video recordings for clinic visits increased at a rate of 23% per year. No association was found between video recordings and increased malpractice claims. The rate of all claims between users and nonusers did not differ significantly (P=0.66). Of seven paid claims or lawsuits from 2000 to 2017, none were against physicians who used video recordings. CONCLUSION: Video recording of patient-physician encounters was not associated with an increase in malpractice lawsuits. According to federal law, a patient can legally record a clinic encounter without physician consent, which has many ethical implications. Formalizing the recording process is beneficial for both parties and allows the resource to be used to its maximum potential.