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2.
Artículo en Inglés | MEDLINE | ID: mdl-32370275

RESUMEN

The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious threat to the healthcare system appears on the horizon. Our study aims to evaluate preparedness of Jordanian frontline doctors to the worsening scenario. It has a questionnaire-based cross-sectional structure. The questionnaire was designed to evaluate preparedness according to knowledge about virus transmission and protective measures, adherence to protection guidelines, and psychological impacts affecting doctors. Institutional factors affecting doctors' readiness like adopting approach protocols and making protection equipment available were investigated; 308 doctors from different healthcare facilities participated (response rate: 53.9%). Approximately 25% of doctors (n = 77) previously took care of COVID-19 patients, and 173 (56.2%) have institutional COVID-19 approach protocols. Only 57 doctors (18.5%) reported all PPE (Personal Protective Equipment) available. The self-reported score of preparedness to deal with COVID-19 patients was 4.9 ± 2.4. Doctors having institutional protocols for dealing with COVID-19 cases and those with sustained availability of PPE reported higher scores of preparedness (5.5 ± 2.3 and 6.2 ± 2.1 with p < 0.001, respectively). Correlations with knowledge score, adherence to PPE score, and psychological impacts were investigated. The study revealed multiple challenges and insufficiencies that can affect frontline doctors' preparedness. Policy makers are urged to take these findings into consideration and to act promptly.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Brotes de Enfermedades , Conocimientos, Actitudes y Práctica en Salud , Médicos/psicología , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Adulto , Estudios Transversales , Femenino , Instituciones de Salud , Humanos , Jordania/epidemiología , Masculino , Pandemias , Equipo de Protección Personal/provisión & distribución , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios
3.
Emergencias (Sant Vicenç dels Horts) ; 32(2): 90-96, abr. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-188156

RESUMEN

Objetivo: Describir las principales características de todos los servicios de emergencias prehospitalarios (SEPH) existentes en Cataluña. Método: Una encuestadora profesional entrevistó a los responsables clínicos de todos los SEPH de Cataluña. La encuesta fue preparada por los autores, y abordaba diversos aspectos organizativos, profesionales, laborales, formativos, docentes y de investigación. Las preguntas contenidas en la encuesta solo permitían respuestas cerradas, y hacían referencia a la situación en 2015. Resultados: Se identificaron 13 SEPH (11 públicos, 2 privados), que recibieron 2.482.627 consultas (16,4% a SEPH privados) y realizaron 943.849 atenciones (11,8% por SEPH privados). Había 336 bases de soporte vital básico y 73 de avanzado, con instalaciones mayoritariamente consideradas de tamaño suficiente y calidad buena. Se contrataron 1.374.845 horas anuales (753.995 de médico y 620.850 de enfermero), el 23,4% de ellas por SEPH privados, que globalmente corresponderían a 815 puestos de trabajo a jornada completa (447 de médico, 368 de enfermero). La dotación de médicos/enfermeros era relativamente estable durante el día, pero decaía un 31%/9% de madrugada. La especialidad médica mayoritaria era medicina familiar y comunitaria (56,8%), el 21,3% no tenía formación especializada, y el 6,5% tenía título de doctor. Había médicos/enfermeros profesores universitarios de grado en el 61,5%/46,2% de los SEPH; y de postgrado en el 46,2%/84,6%. Recibían estudiantes de medicina/enfermería en prácticas de grado el 15,4%/15,4% de los SEPH, y de postgrado el 69,2%/76,9%. Conclusiones: La actividad de los SEPH en Cataluña es elevada; un 12% la desarrollan SEPH privados, y globalmente implica a un número alto de médicos y enfermeros, los cuales además desarrollan un rol docente y, en menor medida, investigador


Objective: To describe the main characteristics of all prehospital emergency services (SEPHs, the Catalan acronym) in Catalonia (the SEPHCAT study). Methods: A professional survey researcher interviewed the medical directors of all services in Catalonia, using a questionnaire prepared by the authors. Questions covered aspects related to organization, professional staffing and employment conditions, as well as the staff’s training, instructional activity and research. Only closed answers were collected. The survey reflected the situation in 2015. Results: We identified 13 SEPHs (11 in the public health service and 2 private companies). Together they received 2 482 627 calls (16.4% to private services) and attended 943 849 emergencies (11.8% attended by private companies). Three hundred thirty-six basic life support units and 73 advanced life support units were reported. They were mostly considered to be of sufficient size and quality. The SEPHs contracted 1 374 845 person-hours/y (753 995 physician-hours and 620 850 nurse-hours; 23.4% in private companies). These figures correspond to 815 full-time staff positions (447 for physicians and 368 for nurses). The numbers of physicians and nurses working were relatively stable during the morning, afternoon and evening shifts but decreased during the midnight-to-early-morning shift (physicians, by 31%; nurses, by 9%). A majority of the physicians employed were trained in family and community medicine (56.8%), but 21.3% had no specialized training; 6.5% had PhD degrees. SEPH physicians (61.5%) and nurses (46.2%) also taught undergraduate medical students; 46.2% of physicians and 84.6% of nurses taught postgraduate medical courses. Both undergraduate medical and nursing students were received in the same measure for practical training by 15.4% of the SEPHs; 69.2% also offered practical training for physicians at the postgraduate level and 76.9% trained postgraduate nurses. Conclusions: SEPHs in Catalonia are very active, and private companies account for nearly 12% of the activity. Together the public and private sectors employ a large number of physicians and nurses. Staff members are involved in training others but are less involved in research


Asunto(s)
Humanos , Servicios Médicos de Urgencia/estadística & datos numéricos , Atención Prehospitalaria/clasificación , Médicos/estadística & datos numéricos , Enfermeras y Enfermeros/estadística & datos numéricos , Atención Prehospitalaria/estadística & datos numéricos , Encuestas y Cuestionarios , Distribución de Chi-Cuadrado , Condiciones de Trabajo , Prestación de Atención de Salud/organización & administración
4.
Acta Med Port ; 33(4): 252-260, 2020 Apr 01.
Artículo en Portugués | MEDLINE | ID: mdl-32238239

RESUMEN

INTRODUCTION: Transgenic (genetically modified) foods are being grown, sold and eaten in Portugal. As such it is important that physicians stay up to date on any negative health consequences of such foods. This study aimed to identify their opinion, knowledge and training needs regarding transgenic foods. MATERIAL AND METHODS: A total of 278 physicians responded to a survey Results: In terms of opinion, 85.8% of physicians had a neutral position, 12.5% had a negative view and a minority (1.7%) was positive. However, 79.8% had a low level of knowledge, 17.7% had an average level of knowledge and only 2.5% showed a high level of knowledge regarding the subject. It should be noted that 91.4% of physicians consider that it is useful to carry out some kind of training during their university education and 65.1% said that it would be very useful during the professional life to have continuing education concerning the issue. Most physicians (83%) could be grouped together according to their interest in learning more. The other group (17%) showed lack of interest. DISCUSSION: Physicians are considered reliable sources, to whom the general population can turn to in order to access valuable health information, which suggests the need to stay up-to-date regarding transgenic foods. CONCLUSION: This is a pioneering study on Portuguese physicians and transgenic foods. Results point to a need for specific training concerning this issue.


Asunto(s)
Alimentos Modificados Genéticamente , Conocimientos, Actitudes y Práctica en Salud , Evaluación de Necesidades , Médicos/psicología , Adulto , Actitud del Personal de Salud , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Portugal , Encuestas y Cuestionarios
5.
BMC Health Serv Res ; 20(1): 86, 2020 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-32019562

RESUMEN

BACKGROUND: Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians' perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. METHODS: A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. RESULTS: PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients' (and their caregivers') coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians' skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. CONCLUSIONS: IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.


Asunto(s)
Actitud del Personal de Salud , Hospitalización , Cuidados Paliativos , Médicos/psicología , Derivación y Consulta , Adulto , Femenino , Alemania , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Investigación Cualitativa
6.
PLoS One ; 15(2): e0228372, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027686

RESUMEN

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® (17%), and Instagram® (17%) were the most frequently accessed social media platforms. Nearly 85% agreed or strongly agreed that social media can be an effective tool for educational purposes. Among those who had social media platforms, 43.0% use them for educational purposes. Pinterest® (30%), Facebook® (22%), LinkedIn® (16%), and Twitter® (14%) were most frequently used for education. About 50% of respondents had limited or no access to social media at work. Administrators, those with unlimited and limited work access, and respondents aged 20-29 and 30-39 years were more likely to agree that social media is an educational tool (OR: 3.41 (95% CI 1.31 to 8.84), 4.18 (95% CI 2.30 to 7.60), 1.66 (95% CI 1.22 to 2.25), 4.40 (95% CI 2.80 to 6.92), 2.14 (95% CI 1.53 to 3.01) respectively). Residents, physicians, and those with unlimited access were less likely to agree with allowing social media access at work for educational purposes only. Healthcare practitioners frequently utilize social media, and many believe it can be an effective educational tool in healthcare.


Asunto(s)
Educación Continua/métodos , Personal de Salud , Percepción , Medios de Comunicación Sociales , Adulto , Femenino , Georgia/epidemiología , Personal de Salud/educación , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , Difusión de la Información/métodos , Internado y Residencia/estadística & datos numéricos , Masculino , Maryland/epidemiología , Enfermeras Practicantes/educación , Enfermeras Practicantes/psicología , Enfermeras Practicantes/estadística & datos numéricos , Farmacéuticos/psicología , Farmacéuticos/estadística & datos numéricos , Asistentes Médicos/educación , Asistentes Médicos/psicología , Asistentes Médicos/estadística & datos numéricos , Médicos/psicología , Médicos/estadística & datos numéricos , Medios de Comunicación Sociales/normas , South Carolina/epidemiología , Encuestas y Cuestionarios , Wisconsin/epidemiología , Adulto Joven
8.
PLoS One ; 15(1): e0227439, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31945075

RESUMEN

BACKGROUND: The global burden of hypertension, currently estimated at 1 billion, is a leading Non-Communicable Disease (NCD) in Sub Saharan Africa. In Tanzania, the reported prevalence of hypertension is 25%. Inherent limitations of the healthcare system to control hypertension include inadequate provider knowledge, system capacity, medication access, and patient awareness, all of which hinder effective screening and disease management. To assess the quality of hypertension screening and patient counseling, we conducted a study in an ambulatory setting in Tanzania. METHODS: Observations of patient screening were conducted on 69 adult patients during routine outpatient care and screening camps. In addition, 33 healthcare providers participated in a pre-post knowledge assessment after observing instructional training videos. RESULTS: Patient observations indicated that blood pressure (BP) measurement was explained to 65% of patients, and 77% of the measurements were made with mercury sphygmomanometers. For several aspects of BP measurement, nurses performed better than doctors: patient's arm supported on a flat surface (doctors, 58% vs nurses 67%, p<0.05), and patient's back was supported (doctors, 50% vs nurses 88%, p<0.01). Among those diagnosed with hypertension, 7% were prescribed medications, 14% were advised on reduced salt during cooking, 29% on reduced salt consumption, 21% on reduced consumption of sodium rich foods, 21% on reducing caloric intake, 21% on increasing physical activity, and 43% were informed about follow up appointments. Provider knowledge assessments showed critical gaps in consequences of hypertension, 1st line medicines, and awareness of guidelines at baseline. Following the instructional videos there were improvements in some aspects: diagnostic criteria for hypertension (pre 45% vs post 91%, p<0.001) and counseling for controlling hypertension (pre 30% vs post 58%, p<0.01). CONCLUSION: Enhancing knowledge and performance competencies of health providers at the primary care level is a critical prerequisite for effective hypertension management in low resource settings.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Hipertensión , Educación del Paciente como Asunto , Médicos/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Determinación de la Presión Sanguínea/métodos , Consejo , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/prevención & control , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Tanzanía , Adulto Joven
9.
PLoS One ; 15(1): e0228152, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31995601

RESUMEN

BACKGROUND: The psychological health (PH) of doctors affects the quality of medical service and is related to the safety of patients. The serious problems with the doctor-patient relationship in China can lead to long-term imbalances in doctor PH, and the poor PH status of doctors has raised scholars' concern. Current research mainly focuses on how factors such as social support and the impact of the residential environment correlate with individual PH. We continue this direction of research to see how the mechanism of social support impacts physician PH, also investigating the moderating effect of demographic indicators on physician PH. METHODS: Based on a survey of 399 physicians, a descriptive analysis of measured data was done using SPSS 19.0. Pearson correlation coefficient analysis was used to examine the correlations between PH and the social support rating scale (SSRS) and the demographic variables. KMO and Bartlett methods were used to examine the correlations between PH and SDS (a scale to measure depression) and between PH and SAS (a scale to measure anxiety). The method of factor analysis was used for multicollinearity tests, and multiple stepwise regression analysis was used to explore the demographic factors correlated with PH and SSRS. Two-way interactions in moderated multiple regression were used to test the moderating effect of education level and title on SSRS, SDS, and SAS. RESULTS: Our results indicate that the level of PH is influenced by the age, education, and title of a doctor. A physician's title is significantly and positively correlated with PH, but age and education are significantly negatively related. Age, education, and title also affect the level of SSRS in physicians. SSRS is positively correlated with age, education, and title, and SSRS positively influences PH. Education and title had significant effects on the moderating influences of SSRS, SDS, SAS, and PH. CONCLUSION: The factors directly affecting PH include SSRS, age, and title, while education was found to be an indirect influencing factor. To meet goals expressed in Chinese government policy related to these issues, we suggest strengthening the guidance of the media, introducing laws and regulations on doctor-patient risk management and control, reforming the review mechanism of hospital job titles, improving the education level of doctors, building a comprehensive evaluation system of "practice performance + doctor-patient satisfaction", and strengthening doctor-patient empathy. Through such measures, the level of PH in physicians will improve.


Asunto(s)
Salud Mental , Médicos/psicología , Apoyo Social , Adulto , Factores de Edad , Ansiedad/epidemiología , China , Depresión/epidemiología , Escolaridad , Femenino , Humanos , Masculino , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Modelos Psicológicos , Inhabilitación Médica/psicología , Inhabilitación Médica/estadística & datos numéricos , Relaciones Médico-Paciente , Médicos/estadística & datos numéricos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven
10.
BMC Health Serv Res ; 20(1): 60, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31973765

RESUMEN

BACKGROUND: Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP). METHODS: A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus -Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests. RESULTS: After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group. CONCLUSION: The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].


Asunto(s)
Comunicación , Alfabetización en Salud/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Capacitación en Servicio , Relaciones Médico-Paciente , Médicos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Grupos Focales , Humanos , Irán , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Autoeficacia , Resultado del Tratamiento , Adulto Joven
11.
BMJ ; 368: l6968, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996352

RESUMEN

OBJECTIVE: To examine the distribution and patterns of opioid prescribing in the United States. DESIGN: Retrospective, observational study. SETTING: National private insurer covering all 50 US states and Washington DC. PARTICIPANTS: An annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES: Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS: In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS: Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Prescripción Inadecuada/prevención & control , Manejo de Atención al Paciente/normas , Médicos , Pautas de la Práctica en Medicina , Adulto , Prescripciones de Medicamentos/normas , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Revisión de Utilización de Seguros/estadística & datos numéricos , Masculino , Médicos/clasificación , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , Medicamentos bajo Prescripción/uso terapéutico , Mejoramiento de la Calidad , Estudios Retrospectivos , Estados Unidos/epidemiología
12.
Global Health ; 16(1): 7, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937356

RESUMEN

BACKGROUND: The past two decades have been marked by impressive growth in the migration of medical doctors. The medical profession is among the most mobile of highly skilled professions, particularly in Europe, and is also the sector that experiences the most serious labour shortages. However, surprisingly little is known about how medical doctors choose their destinations. In addition, the literature is scarce on the factors determining the sharp rise in the migration of doctors from Africa, Asia and Eastern and Southeastern Europe, and how the last economic crisis has shaped the migration flows of health professionals. METHODS: We use the new module on health worker migration provided by the Organisation for Economic Co-operation and Development (OECD) for 2000-2016 in order to examine the channels through which OECD countries attract foreign physicians from abroad. We estimate a gravity model using the Pseudo-Poisson Maximum Likelihood estimator. RESULTS: Our results reveal that a lower unemployment rate, good remuneration of physicians, an aging population, and a high level of medical technology at the destination are among the main drivers of physicians' brain drain. Furthermore, an analysis of the mobility of medical doctors from a number of regions worldwide shows that individuals react differently on a country-wise basis to various determinants present in the destination countries. Physicians from African countries are particularly attracted to destination countries offering higher wages, and to those where the density of medical doctors is relatively low. Concurrently, a higher demand for healthcare services and better medical technology in the receiving country drives the inflow of medical doctors from Central and Eastern Europe, while Asian doctors seem to preferentially migrate to countries with better school systems. CONCLUSIONS: This study contributes to a deeper understanding of the channels through which OECD countries attract foreign medical doctors from abroad. We find that, apart from dyadic factors, a lower unemployment rate, good remuneration of physicians, an aging population, and good medical infrastructure in the host country are among the main drivers of physicians' brain drain. Furthermore, we find that utility from migration to specific countries may be explained by the heterogeneity of origin countries.


Asunto(s)
Emigración e Inmigración/estadística & datos numéricos , Médicos Graduados Extranjeros/estadística & datos numéricos , Médicos/psicología , Humanos , Modelos Estadísticos , Organización para la Cooperación y el Desarrollo Económico , Médicos/estadística & datos numéricos
13.
BMC Health Serv Res ; 20(1): 7, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31900137

RESUMEN

BACKGROUND: The prevalence and detrimental effect of physician burnout requires new strategies for supporting physicians. In this project, we describe the development, and assessment, of a "Balint-like" physician support group that provided social cohesion and delivered novel didactic curricula for building resilience. METHODS: The project began with a nine-month facilitated peer-support group for physicians that met every other week. Based on input from the first group, tailored content was developed to address physician wellness needs. These curricula were delivered to participants in the second nine-month Balint-like group. We then conducted semi-structured interviews with 7 hospitalists and 2 outpatient primary care physicians who participated in the Balint-like groups to explore the intervention's value and to identify remaining unmet physician wellness needs. Using an inductive thematic analysis approach, we identified a set of institutional-, community- and individual-level factors affecting physician wellness and corresponding intervention opportunities. RESULTS: Physicians spoke of systems-level factors that contributed to distress, and proposed infrastructure, both physical and procedural, that they felt could better support physician wellness. They highlighted the emotional challenges of daily work, and the need for a forum by which to process these interactions in order to maintain their own wellness. Participants reported that participation in Balint-like groups provided this forum and served to help the physicians normalize struggles, reduce isolation and provide new strategies for navigating challenging interactions. CONCLUSIONS: Institutional infrastructure, in the form of regular, psychologically-safe forums for processing with peers and learning relational strategies for preserving wellness, may mitigate physician distress. This project provides a model for how to develop and deliver a low-cost physician wellness program that can be tailored to the needs of individual clinical units.


Asunto(s)
Agotamiento Profesional/prevención & control , Salud Laboral , Médicos/psicología , United States Department of Veterans Affairs , Curriculum , Femenino , Humanos , Masculino , Grupo Paritario , Médicos/estadística & datos numéricos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Resiliencia Psicológica , Grupos de Autoayuda , Estados Unidos
15.
PLoS One ; 15(1): e0227712, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31961883

RESUMEN

INTRODUCTION: Adverse drug reactions (ADRs) are global public health problems. In its severe form it may cause hospital admission, morbidity and mortality. Early reporting of suspected ADRs to regulatory authorities is known to be appropriate measure toinsure health and safety of public form such adverse drug reaction of drugs. In Addis Ababa, there is limited information on ADR reporting practices among medical doctors. Hence, this study aimed to assess ADR reporting practices and associated factors among doctors in government hospitals in Addis Ababa. METHODS: An institution based cross-sectional mixed-methods study design was used. Data werecollected from 407 doctors using self-administered questionnaire and five key informants using semi-structured questionnaire from October 01 to December 31, 2017. Binary logistic regression and thematic analysis methods for quantitative and qualitative data analysis were used respectively. RESULTS: Only 94(27.4%) of doctors had ever reported ADRs to national pharmacovigilance center. The study showed that sex (AOR = 3.51, 95% CI: 1.76-7.03), level ofeducation (AOR = 5.01, 95% CI: 2.23-11.28), work experience (AOR = 4.59, 95% CI: 1.21-17.40), existence of ADR reporting form (AOR = 3.96, 95% CI: 1.07-14.61) and reporting to respective marketing authorization holders (AOR = 21.41, 95% CI: 5.89-77.88) were significantly associated with ADR reporting practices. Poor awareness and training on risk of under-reporting, feeling that reporting is minor, absence of appropriate reporting tools, delay and/or absence of feedback on reported ADRs, overly burdened doctors, negligence, fear of legal liabilityand communication gap were cited by key informants as barriers for reporting practice. CONCLUSIONS: Adverse drug reaction reporting practice among doctors wasfound to be low. Sex, level of education, work experience, existence of reporting form and reporting to marketing authorization holderswere significantly associated with ADR reporting practice. In addition, there are gaps in availabilities of guidelines, reporting systems and structure, pre-service and in-service training, and awareness of doctors on impact of reporting. Hence, improving access to ADR reporting form, decentralize safety monitoring system, and conducting awareness training on ADR reporting are essential to improve the ADR reporting practice.


Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Actitud del Personal de Salud , Farmacovigilancia , Médicos/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos/normas , Competencia Clínica/estadística & datos numéricos , Estudios Transversales , Escolaridad , Etiopía , Femenino , Hospitales Públicos/normas , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Médicos/normas , Médicos/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Factores Sexuales , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto Joven
16.
Mayo Clin Proc ; 95(1): 35-43, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31902427

RESUMEN

OBJECTIVE: To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments. PARTICIPANTS AND METHODS: All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary. RESULTS: Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties. CONCLUSION: A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.


Asunto(s)
Planes de Incentivos para los Médicos/estadística & datos numéricos , Médicos , Salarios y Beneficios , Factores Sexuales , Centros Médicos Académicos/economía , Centros Médicos Académicos/estadística & datos numéricos , Competencia Clínica/economía , Grupos Étnicos , Femenino , Humanos , Liderazgo , Masculino , Modelos Econométricos , Médicos/clasificación , Médicos/economía , Médicos/estadística & datos numéricos , Médicos Mujeres/economía , Médicos Mujeres/normas , Salarios y Beneficios/clasificación , Salarios y Beneficios/estadística & datos numéricos , Estados Unidos
17.
J Altern Complement Med ; 26(1): 25-33, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31763927

RESUMEN

Objective: There are no nationally representative studies using a probability sample that have been published examining whether physicians recommend complementary health approaches (CHAs) to their patients, as previous research has focused only on selected medical specialties or a particular U.S. region. This article fills a void in the current literature for robust data on recommendations for CHAs by office-based physicians in the United States. Design: Descriptive statistics and multivariable regression analyses of physician-level data were from the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII), a nationally representative survey of office-based physicians. Weighted response rate among eligible physicians sampled for the 2012 NAMCS PII was 59.7%. Setting/Location: United States. Outcome measures: Recommendations by physicians to their patients for any CHA, and individual CHAs: massage therapy, herbs/nonvitamin supplements, chiropractic/osteopathic manipulation, yoga, acupuncture, and mind-body therapies. Differences in recommendations by physician demographic characteristics were identified. Results: Massage therapy was the most commonly recommended CHA (30.4%), followed by chiropractic/osteopathic manipulation (27.1%), herbs/nonvitamin supplements (26.5%), yoga (25.6%), and acupuncture (22.4%). The most commonly recommended CHAs by general/family practice physicians were chiropractic/osteopathic manipulation (54.0%) and massage therapy (52.6%). Of all U.S. physicians, 53.1% recommended at least one CHA to patients during the previous 12 months. Multivariable analyses found physician's sex, race, specialty, and U.S. region to be significant predictors of CHA recommendations. Female physicians were more likely than male physicians to recommend massage therapy (adjusted odds ratio [aOR] = 1.76, 95% confidence interval [CI] = 1.40-2.20), herbs/nonvitamin supplements (aOR = 1.85, 95% CI = 1.46-2.35), yoga (aOR = 2.16, 95% CI = 1.70-2.75), acupuncture (aOR = 1.65, 95% CI = 1.27-2.13), and mind-body therapies (aOR = 2.63, 95% CI = 2.02-3.41) to patients. Psychiatrists (aOR = 0.13, 95% CI = 0.07-0.23), OB/GYNs (aOR = 0.38, 95% CI = 0.24-0.60), and pediatricians (aOR = 0.26, 95% CI = 0.18-0.38) were all less likely to recommend chiropractic/osteopathic manipulation than general and family practitioners. Conclusions: Overall, more than half of office-based physicians recommended at least one CHA to their patients. Female physicians recommended every individual CHA at a higher rate than male physicians except for chiropractic and osteopathic manipulation. These findings may enable consumers, physicians, and medical schools to better understand potential differences in use of CHAs with patients.


Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos/epidemiología
18.
J Surg Res ; 245: 212-216, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421365

RESUMEN

BACKGROUND: Pulmonary embolism and deep vein thrombosis are common clinical entities, and the related malpractice suits affect all medical subspecialties. Claims from malpractice litigation were analyzed to understand the demographics of these lawsuits and the common reasons for pursuing litigation. METHODS: Cases entered into the Westlaw database from March 5, 1987, to May 31, 2018, were reviewed. Search terms included "pulmonary embolism" and "deep vein thrombosis." RESULTS: A total of 277 cases were identified. The most frequently identified defendant was an internist (including family practitioner; 33%), followed by an emergency physician (18%), an orthopedic surgeon (16%), and an obstetrician/gynecologist (9%). The most common etiology for pulmonary embolism was prior surgery (41%). The most common allegation was "failure to diagnose and treat" in 62%. Other negligence included the failure to administer prophylactic anticoagulation while in the hospital (18%), failure to prescribe anticoagulation on discharge (8%), failure to administer anticoagulation after diagnosis (8%), and premature discontinuation of anticoagulation (2%). The most frequently claimed injury was death in 222 cases (80%). Verdicts were found for the defendant in 57% of cases and for the plaintiff in 27% and settled in 16%. CONCLUSIONS: The most frequently cited negligent act was the failure to give prophylactic anticoagulation, even after discharge. The trends noted in this study may potentially be addressed and therefore prevented by systems-based practice changes. The most common allegation, "failure to diagnose and treat," suggests that first-contact doctors such as emergency physicians and primary care practitioners must maintain a high index of suspicion for deep vein thrombosis/pulmonary embolism.


Asunto(s)
Fracaso de Rescate en Atención a la Salud/estadística & datos numéricos , Mala Praxis/estadística & datos numéricos , Médicos/estadística & datos numéricos , Embolia Pulmonar/terapia , Trombosis de la Vena/terapia , Anticoagulantes/uso terapéutico , Bases de Datos Factuales/estadística & datos numéricos , Diagnóstico Tardío/economía , Diagnóstico Tardío/legislación & jurisprudencia , Diagnóstico Tardío/estadística & datos numéricos , Fracaso de Rescate en Atención a la Salud/economía , Fracaso de Rescate en Atención a la Salud/legislación & jurisprudencia , Humanos , Consentimiento Informado/legislación & jurisprudencia , Consentimiento Informado/estadística & datos numéricos , Mala Praxis/economía , Médicos/economía , Médicos/legislación & jurisprudencia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiología , Embolia Pulmonar/mortalidad , Estados Unidos/epidemiología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/mortalidad
19.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190014.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800853

RESUMEN

INTRODUCTION: A smartphone application named AtestaDO was developed to support physicians with medical certification of the cause of death. The objective of this study is to evaluate the acceptability of the app. METHODS: Physicians were invited to attend meetings on the proper certification of cause of death, and to evaluate the application in a national workshop in Natal (first stage) and in two large hospitals in Belo Horizonte (second and third stages). RESULTS: In Natal, 82% of 38 physicians had more than 20 years of experience and in Belo Horizonte, more than 67% of 58 physicians had less than 5 years of experience. The sections "Application interface", "How to certify the causes of death", "Practice with exercises" and "Other information for physicians" were positively evaluated by more than 50% of physicians in Belo Horizonte. In Natal, all sections were positively evaluated by at least 80% of participants. More than 70% of the participants in both Natal and the second stage of Belo Horizonte indicated they would possibly use AtestaDO to guide filling of a death certificate. The probability of using AtestaDO to teach classes on filling death certificates was 83.3% for Natal's physicians but less than 60% in Belo Horizonte. In the three stages, most physicians would recommend using the application to other colleagues. CONCLUSION: The evaluation of AtestaDO showed good acceptability. We expect that the use of this tool enables improvements in medical certification of causes of death.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Médicos/normas , Teléfono Inteligente/normas , Programas Informáticos/normas , Brasil , Humanos , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Mejoramiento de la Calidad , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Factores de Tiempo
20.
BMC Public Health ; 19(1): 1671, 2019 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-31830930

RESUMEN

BACKGROUND: Since 1998, China has gradually moved toward voluntary uncompensated blood donation. In some cities, the shortage of platelets has been noticeably severe. Mutual assistance that collects blood from one's family and social networks is a potential solution. The measure, however, turned out problematic. There are donors who choose to donate platelets over whole blood without compensations, and donate platelets directly to blood banks instead of via the mutual assistance system. This study explores reasons behind their choices qualitatively. METHODS: This report is based on data conducted from January to February 2018; 25 uncompensated regular platelet donors were interviewed. The blood component donation service team in Guangzhou facilitated the data collection process and referred prospectively eligible blood donors to our research team. The interviews took about 30 min to two hours to complete. The qualitative data were analyzed by using the software ATLAS.ti 8. RESULTS: Platelet donation takes a much long time than whole blood donation and requires complicated processes. It may also cause discomfort as the other blood components are returned to the body, causing physical and psychological distress due to worries about contamination. Thus, platelet donation tends to involve higher time and psychological costs than whole blood donation. Yet, it has short collection intervals that allows for more frequent donations, and urgency of a severer shortage than whole blood. Hence, regular platelet donors may feel higher significance in platelet donation than whole blood donation, with the belief that more lives would be saved. Some whole blood donors thus switched to become platelet donors. Mutual assistance blood donation was not chosen by the participants for platelet donation, because such donations may exert moral pressure to both the donors and recipients. Furthermore, "acquaintance" has been loosely defined; the system has sometimes been manipulated to become profit-making monetary transactions. It hence failed. CONCLUSIONS: The practice of platelet donation reinforces the understanding that blood donation is a gift giving process performed among strangers. A safe and sustainable voluntary blood supply can only be secured in the absence of monetary transactions and moral pressure.


Asunto(s)
Donantes de Sangre/psicología , Plaquetas , Médicos/psicología , Adulto , Donantes de Sangre/estadística & datos numéricos , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Investigación Cualitativa , Adulto Joven
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