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1.
Wiad Lek ; 74(2): 362-366, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813501

RESUMEN

OBJECTIVE: The aim: Was to analyze the scientific and pedagogical heritage of N.I. Pirogov through the prism of his outstanding polymathic abilities. PATIENTS AND METHODS: Materials and methods: The authors examined the scientific and pedagogical heritage of N.I. Pirogov using the method of historiographical analysis, as well as the methods of synthesis and generalization. The study relies on research publications devoted to N.I. Pirogov's biography, as well as his epistolary and autobiographical works. CONCLUSION: Conclusions: The scientific novelty of the research is that the biography of N. Pirogov is represented with refinements and additions based on his latest work "From the Diary of an Old Doctor". The authors analyzed the epistolary heritage of N. Pirogov, which served as a valuable biographical source. Given the anthropocentrism of the current stage of the existence of society and European civilization, the authors sought to "revive" the biography of N. Pirogov. In this regard, considerable attention is paid to his personal life. As a result, the article considers this outstanding personality in a new perspective, presenting the main stages of his scientific and medical activity.


Asunto(s)
Médicos , Historia del Siglo XIX , Humanos , Personalidad , Proyectos de Investigación
2.
Transl Psychiatry ; 11(1): 169, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33723233

RESUMEN

Lack of established knowledge and treatment strategies, and change in work environment, may altogether critically affect the mental health and functioning of physicians treating COVID-19 patients. Thus, we examined whether treating COVID-19 patients affect the physicians' mental health differently compared with physicians treating non-COVID-19 patients. In this cohort study, an association was blindly computed between physiologically measured anxiety and attention vigilance (collected from 1 May 2014 to 31 May 31 2016) and self-reports of anxiety, mental health aspects, and sleep quality (collected from 20 April to 30 June 2020, and analyzed from 1 July to 1 September 2020), of 91 physicians treating COVID-19 or non-COVID-19 patients. As a priori hypothesized, physicians treating COVID-19 patients showed a relative elevation in both physiological measures of anxiety (95% CI: 2317.69-2453.44 versus 1982.32-2068.46; P < 0.001) and attention vigilance (95% CI: 29.85-34.97 versus 22.84-26.61; P < 0.001), compared with their colleagues treating non-COVID-19 patients. At least 3 months into the pandemic, physicians treating COVID-19 patients reported high anxiety and low quality of sleep. Machine learning showed clustering to the COVID-19 and non-COVID-19 subgroups with a high correlation mainly between physiological and self-reported anxiety, and between physiologically measured anxiety and sleep duration. To conclude, the pattern of attention vigilance, heightened anxiety, and reduced sleep quality findings point the need for mental intervention aimed at those physicians susceptible to develop post-traumatic stress symptoms, owing to the consequences of fighting at the forefront of the COVID-19 pandemic.


Asunto(s)
Ansiedad/psicología , Atención , Estrés Laboral/psicología , Médicos/psicología , Reflejo de Sobresalto , Sueño , Trastornos por Estrés Postraumático/psicología , Adulto , Análisis por Conglomerados , Femenino , Humanos , Aprendizaje Automático , Masculino , Salud Mental , Persona de Mediana Edad
3.
BMJ Open ; 11(3): e050223, 2021 03 22.
Artículo en Inglés | MEDLINE | ID: mdl-33753449

RESUMEN

The COVID-19 pandemic has brought unprecedented challenges to the medical workforce. This has put them at increased risk of burnout at a time when levels are already worryingly high in the profession, with recent studies consistently showing that around half of doctors meet the validated criteria for burnout. OBJECTIVES: To understand the wider factors influencing and impacting upon hospital doctors' well-being during the COVID-19 pandemic in England. DESIGN: Cross-sectional survey and mixed quantitative-qualitative analysis. SETTING: Acute National Health Service (NHS) Foundation Trust in England. PARTICIPANTS: An online survey was circulated in early June 2020 to all 449 doctors employed by the Trust. 242 doctors completed the survey (54% response rate). PRIMARY OUTCOME MEASURES: Questions assessed occupational details, self-reported changes in physical and mental health, satisfaction with working hours and patterns, availability of personal protective equipment (PPE), medication and facilities, communication and sought to identify areas seen as having a significant effect on doctors' well-being. RESULTS: 96% of respondents requiring PPE were able to access it. Nearly half of the respondents felt that their mental health had deteriorated since the start of the pandemic. Over a third stated that their physical health had also declined. Issues identified as having a negative impact on doctors included increased workload, redeployment, loss of autonomy, personal issues affecting family members, anxiety around recovery plans, inadequate access to changing and storage facilities and to rest areas that allow for social distancing. Doctors appreciated access to 'calm rooms' that were made available for staff, access to clinical psychology support, free drinks and free car parking on site. CONCLUSION: The emerging themes are suggestive of increased burnout risk among doctors during the COVID-19 pandemic and encompass factors well beyond shortage of PPE. Small organisational initiatives and the implementation of changes suggested by survey respondents can have a positive impact on doctors' well-being.


Asunto(s)
Salud Mental , Pandemias , Equipo de Protección Personal , Médicos/psicología , Estudios Transversales , Inglaterra/epidemiología , Humanos , Medicina Estatal
4.
J Law Med ; 28(2): 475-491, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33768753

RESUMEN

Should a written reflection about regrets be part of the private life of a doctor - or of any health care practitioner - or something that can be used in the public domain when things do go wrong? This article examines the tenability of reflective practice in Australia after the Bawa-Garba cases, outlining the options for the future of reflective practice, and assessing the options ranging from maintaining the current status quo to protecting the use of reflections via absolute legal privilege. In particular, this article explores the value of reflective practice in the broader context, weighing up which of the options for change to reflective practice bring with it the greatest enhancement to public safety. This work concludes by suggesting a potential method for allowing the continued safe implementation of reflective practice by stakeholder groups: briefly considering the novel proposition in the Williams Review that could be adopted in Australia.


Asunto(s)
Médicos , Australia , Prestación de Atención de Salud , Humanos
5.
J Prim Care Community Health ; 12: 21501327211000245, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33733901

RESUMEN

BACKGROUND: Health care workers (HCWs) are among the professionals at serious risk for the impact of the COVID-19 pandemic on their mental health. In this sense, the next public health challenge globally will be to preserving healthy HCWs during this pandemic. AIM: The present study has the aim of investigating the relationship among concerns, perceived impact, preparedness for the COVID-19 pandemic and the mental health of Italian physicians. METHODS: From March 29th to April 15th 2020, we conducted an online survey using snowball sampling techniques through Limesurvey platform. Data were analyzed using descriptive statistics and multiple binary logistic regressions. RESULTS: Multivariate analysis showed that the risk factors for perceived job stress were concerns about catching COVID-19 (OR = 3.18 [95% CI = 2.00-5.05] P < .001), perceived impact on job demands (OR = 1.63 [95% CI = 1.05-2.52] P < .05), perceived impact on job role (OR = 2.50 [95% CI = 1.60-3.90] P < .001), and non-working concerns (OR = 1.86 [95% CI = 1.15-3.03] P < .05). With respect to the risk factors for rumination about the pandemic emerged concerns about catching COVID-19 (OR 1.74, [95% CI = 1.12-2.71] P < .05), perceived impact on job role (OR = 1.68 [95% CI = 1.12-2.52] P < .05), and impact on personal life (OR = 2.04 [95% CI = 1.08-3.86] P < .05). Finally, the risk factors for crying at work were perceived impact on job role (OR = 2.47, [95% CI = 1.20-5.09] P < .05), rumination about the pandemic (OR = 3.027 [95% CI = 1.27-7.19] P < .01), watching colleagues crying at work (OR = 3.82 [95% CI = 1.88-7.77] P < .01), and perceived job stress (OR = 3.53 [95% CI = 1.24-10.07] P < .05). CONCLUSION: In general, our results highlighted that being concerned about being infected/infecting other people, carrying out new and unusual tasks, and witnessing colleagues crying at work were important risk factors for physicians' well-being. Additional data are necessary to advance understanding of these risk factors in a long-term perspective.


Asunto(s)
Salud Mental , Estrés Laboral/psicología , Médicos/psicología , Adulto , Anciano , Estudios Transversales , Análisis Factorial , Familia , Femenino , Humanos , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Italia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Equipo de Protección Personal , Rol del Médico , Rumiación Cognitiva , Encuestas y Cuestionarios , Carga de Trabajo , Adulto Joven
7.
Appl Clin Inform ; 12(1): 170-178, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33694142

RESUMEN

OBJECTIVE: This study examines the validity of optical mark recognition, a novel user interface, and crowdsourced data validation to rapidly digitize and extract data from paper COVID-19 assessment forms at a large medical center. METHODS: An optical mark recognition/optical character recognition (OMR/OCR) system was developed to identify fields that were selected on 2,814 paper assessment forms, each with 141 fields which were used to assess potential COVID-19 infections. A novel user interface (UI) displayed mirrored forms showing the scanned assessment forms with OMR results superimposed on the left and an editable web form on the right to improve ease of data validation. Crowdsourced participants validated the results of the OMR system. Overall error rate and time taken to validate were calculated. A subset of forms was validated by multiple participants to calculate agreement between participants. RESULTS: The OMR/OCR tools correctly extracted data from scanned forms fields with an average accuracy of 70% and median accuracy of 78% when the OMR/OCR results were compared with the results from crowd validation. Scanned forms were crowd-validated at a mean rate of 157 seconds per document and a volume of approximately 108 documents per day. A randomly selected subset of documents was reviewed by multiple participants, producing an interobserver agreement of 97% for documents when narrative-text fields were included and 98% when only Boolean and multiple-choice fields were considered. CONCLUSION: Due to the COVID-19 pandemic, it may be challenging for health care workers wearing personal protective equipment to interact with electronic health records. The combination of OMR/OCR technology, a novel UI, and crowdsourcing data-validation processes allowed for the efficient extraction of a large volume of paper medical documents produced during the COVID-19 pandemic.


Asunto(s)
/diagnóstico , Intercambio de Información en Salud , Almacenamiento y Recuperación de la Información , Colaboración de las Masas , Humanos , Médicos , Interfaz Usuario-Computador
9.
Arq Neuropsiquiatr ; 79(1): 81-83, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33656104

RESUMEN

We present a historical review, highlighting the role of Professor Derek Denny-Brown and doctor Joseph Buford Pennybacker in the development of current electromyography (EMG), of the 80 years since the publication of his original report in 1938 on fasciculation and fibrillation potentials and the subsequent studies describing most of the electrical changes necessary to perform and interpret the EMG.


Asunto(s)
Esclerosis Amiotrófica Lateral , Electromiografía/historia , Médicos , Esclerosis Amiotrófica Lateral/diagnóstico , Arritmias Cardíacas , Fasciculación/diagnóstico , Historia del Siglo XX , Historia del Siglo XXI , Humanos
12.
Vnitr Lek ; 67(1): 49-55, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33752401

RESUMEN

The issue of a patient´s competence is often solved in practice without a major theoretical concept. Such an approach, focused only on the basis of intuitions and experiences of physicians, however, may lead in some cases to an inadequate assessment of competence of a particular patient. Ultimately, it can happen that the decision of an incompetent person will be respected or that the decision of the competent person will be disrespected. Both possibilities can have ethical as well as legal consequences. This article addresses both theoretical and practical issues of competence in adult patients.


Asunto(s)
Consentimiento Informado , Médicos , Adulto , Humanos , Principios Morales
13.
Bull Cancer ; 108(3): 242-249, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33648719

RESUMEN

INTRODUCTION: To promote the early diagnosis of pediatric cancers in Ivory Coast, we have initiated a program to train local physicians in the warning signs and to raise public awareness. The aim of this work was to compare the times, stages and survival of patients before and three years after the initiation of the program. METHODS: This retrospective study involved children 0-17 years of age admitted from January to December 2014 and from May 2018 to April 2019. The Mann-Whitney non-parametric test and the Fisher's exact test were used to compare time limits, stages and survival. RESULTS: One hundred and fifty-nine doctors were trained and 1020 people were sensitized. The median age of the 216 children included was 7 years, sex ratio 1.4. For both periods, the median consultation times were 75 and 30 days (P=0.003) and the median diagnostic times were 120 and 105 days (P=0.033). High-risk lymphomas accounted for 60.5% and 58.5% (P=0.99) respectively and nephroblastoma 46.1% and 56.2% (P=0.51). The overall survival was 31% and 30.2% (P=0.92). DISCUSSION: The early diagnosis program had no impact. The diagnosis times and the proportion of cancer classified as high risk are comparable to the data reported in sub-Saharan Africa, which vary respectively from 7 to 15.8 weeks and from 60 to 71%. This program must be intensified, extended to all health workers and include improving access to care.


Asunto(s)
Detección Precoz del Cáncer , Educación Médica , Neoplasias/diagnóstico , Desarrollo de Programa , Evaluación de Síntomas/métodos , Adolescente , Niño , Preescolar , Costa de Marfil , Diagnóstico Tardío , Femenino , Humanos , Lactante , Recién Nacido , Neoplasias Renales/diagnóstico , Neoplasias Renales/mortalidad , Linfoma/diagnóstico , Linfoma/mortalidad , Masculino , Neoplasias/mortalidad , Neoplasias/patología , Médicos , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Tumor de Wilms/diagnóstico , Tumor de Wilms/mortalidad
14.
Pac Symp Biocomput ; 26: 95-106, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33691008

RESUMEN

Physicians' beliefs and attitudes about COVID-19 are important to ascertain because of their central role in providing care to patients during the pandemic. Identifying topics and sentiments discussed by physicians and other healthcare workers can lead to identification of gaps relating to theCOVID-19 pandemic response within the healthcare system. To better understand physicians' perspectives on the COVID-19 response, we extracted Twitter data from a specific user group that allows physicians to stay anonymous while expressing their perspectives about the COVID-19 pandemic. All tweets were in English. We measured most frequent bigrams and trigrams, compared sentiment analysis methods, and compared our findings to a larger Twitter dataset containing general COVID-19 related discourse. We found significant differences between the two datasets for specific topical phrases. No statistically significant difference was found in sentiments between the two datasets, and both trended slightly more positive than negative. Upon comparison to manual sentiment analysis, it was determined that these sentiment analysis methods should be improved to accurately capture sentiments of anonymous physician data. Anonymous physician social media data is a unique source of information that provides important insights into COVID-19 perspectives.


Asunto(s)
Médicos , Medios de Comunicación Sociales , Biología Computacional , Humanos , Pandemias
15.
Ter Arkh ; 93(1): 71-78, 2021 Jan 10.
Artículo en Ruso | MEDLINE | ID: mdl-33720629

RESUMEN

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.


Asunto(s)
Enfermedades Renales , Médicos , Estudios de Cohortes , Hematuria/diagnóstico , Hematuria/epidemiología , Hematuria/etiología , Humanos , Federación de Rusia
16.
Mayo Clin Proc ; 96(3): 763-769, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673923

RESUMEN

Physician burnout and other forms of occupational distress are a significant problem in modern medicine, especially during the coronavirus disease pandemic, yet few doctors are familiar with the neurobiology that contributes to these problems. Burnout has been linked to changes that reduce a physician's sense of control over their own practice, undermine connections with patients and colleagues, interfere with work-life integration, and result in uncontrolled stress. Brain research has revealed that uncontrollable stress, but not controllable stress, impairs the functioning of the prefrontal cortex, a recently evolved brain region that provides top-down regulation over thought, action, and emotion. The prefrontal cortex governs many cognitive operations essential to physicians, including abstract reasoning, higher-order decision making, insight, and the ability to persevere through challenges. However, the prefrontal cortex is remarkably reliant on arousal state and is impaired under conditions of fatigue and/or uncontrollable stress when there are inadequate or excessive levels of the arousal modulators (eg, norepinephrine, dopamine, acetylcholine). With chronic stress exposure, prefrontal gray matter connections are lost, but they can be restored by stress relief. Reduced prefrontal cortex self-regulation may explain several challenges associated with burnout in physicians, including reduced motivation, unprofessional behavior, and suboptimal communication with patients. Understanding this neurobiology may help physicians have a more informed perspective to help relieve or prevent symptoms of burnout and may help administrative leaders to optimize the work environment to create more effective organizations. Efforts to restore a sense of control to physicians may be particularly helpful.


Asunto(s)
Agotamiento Profesional/prevención & control , Neurobiología/métodos , Pandemias , Médicos/psicología , Lugar de Trabajo/psicología , Agotamiento Profesional/psicología , Humanos
17.
J Clin Ethics ; 32(1): 48-60, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656456

RESUMEN

BACKGROUND: The principal aim of this study was to investigate the function and effectiveness of an institutional policy that outlines a procedure to limit medically futile interventions. We were interested in the attitudes and opinions of careproviders and the members of the Yale New Haven Hospital Ethics Committee that use this policy, the Conscientious Practice Policy (CPP), to address questions on appropriate interventions in the setting of medical futility. METHODS: In 2019, we conducted three focus groups of members of the Yale New Haven Hospital Ethics Committee and critical care physicians, asking participants questions concerning their use of the Yale New Haven Hospital's policy on limiting futile interventions. Focus group transcript results were coded into common themes using a conventional analysis approach. RESULTS: The overarching finding was that the CPP had various levels of interpretation that prevented its effective and consistent use. This was supported by the four main themes from the focus groups: (1) Mixed perceptions regarding communication between careproviders and family members and surrogates before the CPP was invoked contributed to complexity in decision making. (2) It was ineffective to use an ethics consultation to decide whether or not to invoke the CPP. (3) It was necessary to address moral distress in the absence of a policy. (4) The use of the CPP was inconsistent for different patients, based on the degree to which family members and surrogates persisted in their resistance to limiting medically futile interventions, careproviders' comfort with directly making decisions, and bias towards members of certain groups. CONCLUSION: The CPP, as it has been used at the Yale New Haven Hospital, has been ineffective in rationally, fairly, and consistently resolving conflicts regarding the appropriateness of ending medically futile interventions. The CPP, as well as similar policies at other institutions, may benefit from restructuring the policy to more closely align with policies at other institutions where outcomes have been more successful.


Asunto(s)
Cuidados Críticos/ética , Comités de Ética Clínica , Inutilidad Médica , Política Organizacional , Médicos , Toma de Decisiones , Humanos
18.
J Clin Ethics ; 32(1): 61-68, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656457

RESUMEN

This article addresses a common yet rarely discussed aspect of hospital care-a pro-active approach to ethical dilemmas. Potential ethical conflicts often present warning signs to clinicians, analogous to the warning lights on a car's dashboard. Using a recent case study, a commonly encountered clinical decision-a conflict about whether to terminally extubate a critically ill patient versus whether to offer a tracheostomy-we describe a pro-active approach to ethical conflicts and outline three learning objectives: (1) the need for a robust understanding of the term "futility," (2) the need for an appreciation the various and often conflicting interpretations of "improved/improving," and (3) the need to understand the challenges of surrogate decision making.


Asunto(s)
Toma de Decisiones/ética , Inutilidad Médica , Principios Morales , Médicos , Humanos
19.
J Infect Dev Ctries ; 15(2): 191-197, 2021 03 07.
Artículo en Inglés | MEDLINE | ID: mdl-33690199

RESUMEN

COVID-19 spread rapidly and jeopardised the physicians with not only treatment but also with limited resources and new working style. This study aimed to investigate the experience of physicians in Pakistan as frontline workers for the treatment of COVID-19 patients. The study employed a qualitative design and used Haas's adaptation of Colaizzi method for analysis. The respondents for the interview were selected based on purposive sampling and only those physicians were contacted who were treating COVID-19 patients in Lahore, Pakistan. The results of the study revealed many challenges faced by Pakistani physicians which included physical and psychological stress due to the treatment of COVID-19 patients. Moreover, infrastructural flaws have added in the vulnerabilities of the physicians. In developing countries, the fight is much harder for physicians as evidenced by their first-hand experience. The policymakers in developing countries especially in Pakistan can direct policies facilitating physicians to reduce their physical and psychological stress as well as increasing resources for the treatment of COVID-19 patients.


Asunto(s)
Médicos , Adulto , /transmisión , Femenino , Administración Hospitalaria , Hospitales , Humanos , Unidades de Cuidados Intensivos , Masculino , Pakistán , Equipo de Protección Personal , Médicos/psicología , Estrés Psicológico , Encuestas y Cuestionarios
20.
Curr Opin Anaesthesiol ; 34(2): 176-179, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33652456

RESUMEN

PURPOSE OF REVIEW: Healthcare provider burnout is a real phenomenon. The rates of burnout are on the rise. Burnout-associated suicide amongst physicians represents a real "public health crisis." This article discusses the drivers of burnout and offers some strategies to mitigate burnout and improve well-being. RECENT FINDINGS: Measures of burnout such as stress, micro, and macro-aggression in the workplace have a psychological impact on staff. Additionally, a measurable economic price is exacted when an organization fails to address the lack of well-being burnout represents. SUMMARY: As healthcare providers struggle to survive and deal with the complex new set of problems and obstacles that the COVID-19 pandemic, the National economic crisis, and the increasing regulatory obligations have summoned forth, professional burnout rates have risen drastically. With good leadership, developing comprehensive programs to identify, track, and treat burnout symptoms and improve well-being in the work environment can result in greater work satisfaction and save resources.


Asunto(s)
Agotamiento Profesional , Agotamiento Profesional/epidemiología , Agotamiento Profesional/prevención & control , Humanos , Pandemias , Médicos
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