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3.
Nurs Outlook ; 68(2): 169-183, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32044102

RESUMEN

BACKGROUND: The acute medical unit (AMU) provides early specialist care to emergency department patients before inpatient admission. The workflows and skills for successful AMU nursing comprise a hybrid of internal and emergency medicine. PURPOSE: To understand nursing work dynamics in the AMU. METHODS: AMU at a 1,250-bed tertiary academic center in Singapore with 14,000 ED presentations monthly. Retrospective mixed methods study using focus group discussions and surveys. Fifteen nurses across three focus group discussions. Thirty-two physicians and 54 nurses responded to a validated questionnaire. FINDINGS: Focus group discussions transcripts content analyzed by two researchers. Survey items factor analyzed and attitudinal differences between AMU physicians and nurses, and among nurses compared using Student's t- and one-way ANOVA tests. DISCUSSION: AMU nursing staff faced obstacles of inadequate patient information, emergency department onboarding, unbalanced workload, and coworker conflicts, which led to them to develop processes and checklists to manage patient information, patient expectations, and teamwork. CONCLUSION: AMU nursing requires a combination of specialist internal medicine and emergency medicine skills. Training should familiarize nurse workforce with managing patient expectations and multidisciplinary teamwork.


Asunto(s)
Competencia Clínica/normas , Enfermería de Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Servicios Médicos de Urgencia/normas , Personal de Enfermería en Hospital/normas , Médicos/normas , Mejoramiento de la Calidad/normas , Centros Médicos Académicos , Adulto , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Singapur
5.
PLoS One ; 15(1): e0227865, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978199

RESUMEN

INTRODUCTION: Junior residents routinely prescribe medications for hospitalised patients with only arms-length supervision, which compromises patient safety. A cardinal example is insulin prescribing, which is commonplace, routinely delegated to very junior doctors, difficult, potentially very dangerous, and getting no better. Our aim was to operationalise the concept of 'readiness to prescribe' by validating an instrument to quality-improve residents' workplace prescribing education. METHODS: Guided by theories of behaviour change, implementation, and error, and by empirical evidence, we developed and refined a mixed-methods 24-item evaluation instrument, and analysed numerical responses from Foundation Trainees (junior residents) in Northern Ireland, UK using principal axis factoring, and conducted a framework analysis of participants' free-text responses. RESULTS: 255 trainees participated, 54% women and 46% men, 80% of whom were in the second foundation year. The analysis converged on a 4-factor solution explaining 57% of the variance. Participants rated their capability to prescribe higher (79%) than their capability to learn to prescribe (69%; p<0.001) and rated the support to their prescribing education lower still (43%; p<0.001). The findings were similar in men and women, first and second year trainees, and in different hospitals. Free text responses described an unreflective type of learning from experience in which participants tended to 'get by' when faced with complex problems. DISCUSSION: Operationalising readiness to prescribe as a duality, comprising residents' capability and the fitness of their educational environments, demonstrated room for improvement in both. We offer the instrument to help clinical educators improve the two in tandem.


Asunto(s)
Prescripciones de Medicamentos/normas , Cuerpo Médico de Hospitales/normas , Seguridad del Paciente , Médicos/normas , Educación Médica , Femenino , Humanos , Insulina/uso terapéutico , Aprendizaje , Masculino , Registros Médicos , Cuerpo Médico de Hospitales/educación , Pacientes , Farmacéuticos/normas , Encuestas y Cuestionarios
6.
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
7.
Med Care ; 58(4): 368-375, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31876660

RESUMEN

OBJECTIVE: The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI. DATA SOURCES: Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; summaries of CPQI dissemination activities of regional multistakeholder alliances; and the LexisNexis Academic and Access World News databases. STUDY DESIGN/METHODS: Fixed effects regression to isolate the effect of CPQI producers' dissemination activities and the print media's CPQI coverage on chronically ill consumers' self-reported awareness and use of CPQI. PRINCIPAL FINDINGS: Direct CPQI dissemination had no overall effect on either awareness or use of CPQI. One unit increase in the media coverage of an Aligning Forces for Quality (AF4Q) multistakeholder alliance report increased consumer awareness and use of CPQI by 1.4 percentage points (P=0.049) and 1.1 percentage points (P=0.009), respectively. Similar increases for the Centers for Medicare and Medicaid Services (CMS) CPQI and for the nonalliance, non-CMS CPQI improved CPQI use by 1.6 percentage points (P<0.001) and 0.2 percentage points (P=0.041), respectively. CONCLUSION: Even though CPQI producers' direct dissemination efforts had little impact, the small but significant consumer impacts of CPQI's limited press coverage suggests that limited use of media in the dissemination of report cards may be a significant factor behind low consumer awareness and use.


Asunto(s)
Enfermedad Crónica , Comportamiento del Consumidor , Medios de Comunicación de Masas , Médicos/normas , Indicadores de Calidad de la Atención de Salud , Adulto , Anciano , Toma de Decisiones , Femenino , Humanos , Difusión de la Información , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos
9.
Isr Med Assoc J ; 12(21): 801-805, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31814343

RESUMEN

BACKGROUND: Sonographic estimation of birth weight may differ among evaluators due to its operator-dependent nature. OBJECTIVES: To compare the accuracy of estimation of fetal birth weight by sonography between ultrasound-certified physicians and registered diagnostic medical technicians. METHODS: The authors reviewed ultrasound examinations that had been performed by either technicians or ultrasound-certified obstetricians between 2010 and 2017, and within 2 days of delivery. Inclusion criteria were: singleton viable pregnancy, details of four ultrasound measurements (abdominal circumference, bi-parietal diameter, head circumference, and femur length), and known birth weight. The estimated fetal weight (EFW) was calculated according to the Hadlock formula, incorporating the four ultrasound measurements. The mean percentage error (MPE) was calculated by the formula: (EFW-birth weight) x100 / birth weight. RESULTS: Technicians performed 9741examinations and physicians performed 352 examinations. The proportion of macrosomic neonates was similar in both groups. Technicians were more accurate than physicians in terms of the MPE, absolute MPE, proportion of estimates that fell within ± 10% of birth weight, and Euclidean distance (P < 0.0001 for all comparisons). They were also more accurate in terms of sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. Furthermore, for fetuses weighing more than 4000 grams the technicians had a lower total false prediction rate. CONCLUSIONS: Medical technicians in our institute performed better than physicians in estimating fetal weight. Further studies are warranted to confirm our findings and better delineate the role of repeat physician's examination after an initial estimation by an experienced technician.


Asunto(s)
Peso al Nacer , Cefalometría/métodos , Ultrasonografía Prenatal , Adulto , Investigación sobre la Eficacia Comparativa , Precisión de la Medición Dimensional , Femenino , Macrosomía Fetal/diagnóstico , Peso Fetal , Edad Gestacional , Humanos , Recién Nacido , Médicos/normas , Valor Predictivo de las Pruebas , Embarazo , Ultrasonografía Prenatal/métodos , Ultrasonografía Prenatal/normas
10.
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
11.
Medicine (Baltimore) ; 98(51): e18491, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31861034

RESUMEN

To describe how patient characteristics influence physician decision-making about glycemic goals for Type 2 diabetes.2016 survey of 357 US physicians. The survey included two vignettes, representing a healthy patient and an unhealthy patient, adapted from a past survey of international experts and a factorial design vignette that varied age, heart disease history, and hypoglycemia history. Survey results were weighted to provide national estimates.Over half (57.6%) of physicians recommended a goal HbA1c <7.0% for most of their patients. For the healthy patient vignette, physicians recommended a goal similar to that of international experts (<6.66% (95% Confidence Interval (CI), 6.61-6.71%) vs <6.5% (Interquartile range (IQR), 6.5-6.8%)). For the unhealthy patient, physicians recommended a lower goal than international experts (<7.38% (CI, 7.30-7.46) vs <8.0% (IQR, 7.5-8.0%)). In the factorial vignette, physicians varied HbA1c goals by 0.35%, 0.06%, and 0.28% based on age, heart disease history, and hypoglycemia risk, respectively. The goal HbA1c range between the 55-year-old with no heart disease or hypoglycemic events and the 75-year-old with heart disease and hypoglycemic events was 0.65%.Despite guidelines that recommend HbA1c goals ranging from <6.5% to <8.5%, US physicians seem to be anchored on HbA1c goals around <7.0%.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Médicos/normas , Toma de Decisiones Clínicas , Diabetes Mellitus Tipo 2/sangre , Humanos , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos
12.
Mayo Clin Proc ; 94(11): 2272-2276, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31685153

RESUMEN

The International Committee of Medical Journal Editors requires authors to disclose all financial conflicts of interest (COI) that can be perceived as influencing the related trials. Undisclosed financial COI may influence the perception of the authors' scientific impartiality and erode the public trust in the reported results. Data regarding completeness of COI disclosure in high-impact-factor general medicine journals are limited. We compared payments disclosed by US-based physicians who were first or last authors of clinical drug trials published between August 2016 and August 2018 in the New England Journal of Medicine, JAMA, and Lancet, to payments reported by industry to the Centers for Medicare & Medicaid Services Open Payments Database. Of 247 included authors, 198 (80%) have not disclosed some or all received payments. The median undisclosed sum was $8409 (US Dollars) (interquartile range [IQR] $123 to $44,890). Most authors (n=170, 69%) have received more than $10,000 per year (median $120,403, IQR $58,905 to $242,014). The median undisclosed sum for these authors was $26,530 (IQR $7462 to $71,562). Median undisclosed sums for authors of papers from studies performed with and without industry funding were $20,899 (IQR $4191 to $59,883) and $149 (IQR $0 to $3276), respectively. In 10 (8%) of 125 industry-funded trials, the first or last author had not disclosed personal payments from the study sponsor (median $9741, IQR $4508 to $101,484). These findings could raise concerns about the authors' equipoise toward the trial results and influence the public perception of the credibility of reported data. Health care professionals, reviewers, and journal editors should demand more transparent reporting of financial COI.


Asunto(s)
Autoria/normas , Compensación y Reparación/ética , Conflicto de Intereses/economía , Publicaciones Periódicas como Asunto/normas , Médicos/psicología , Estudios de Cohortes , Políticas Editoriales , Humanos , Médicos/economía , Médicos/normas
13.
BMC Health Serv Res ; 19(1): 844, 2019 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-31760949

RESUMEN

BACKGROUND: Precision medicine is set to deliver a rich new data set of genomic information. However, the number of certified specialists in the United States is small, with only 4244 genetic counselors and 1302 clinical geneticists. We conducted a national survey of 264 medical professionals to evaluate how they interpret genetic test results, determine their confidence and self-efficacy of interpreting genetic test results with patients, and capture their opinions and experiences with direct-to-consumer genetic tests (DTC-GT). METHODS: Participants were grouped into two categories, genetic specialists (genetic counselors and clinical geneticists) and medical providers (primary care, internists, physicians assistants, advanced nurse practitioners, etc.). The survey (full instrument can be found in the Additional file 1) presented three genetic test report scenarios for interpretation: a genetic risk for diabetes, genomic sequencing for symptoms report implicating a potential HMN7B: distal hereditary motor neuropathy VIIB diagnosis, and a statin-induced myopathy risk. Participants were also asked about their opinions on DTC-GT results and rank their own perceived level of preparedness to review genetic test results with patients. RESULTS: The rates of correctly interpreting results were relatively high (74.4% for the providers compared to the specialist's 83.4%) and age, prior genetic test consultation experience, and level of trust assigned to the reports were associated with higher correct interpretation rates. The self-selected efficacy and the level of preparedness to consult on a patient's genetic results were higher for the specialists than the provider group. CONCLUSION: Specialists remain the best group to assist patients with DTC-GT, however, primary care providers may still provide accurate interpretation of test results when specialists are unavailable.


Asunto(s)
Competencia Clínica/normas , Pruebas Dirigidas al Consumidor/normas , Genética/normas , Personal de Salud/normas , Autoeficacia , Adulto , Anciano , Anciano de 80 o más Años , Consejeros/normas , Femenino , Pruebas Genéticas/normas , Genómica/normas , Humanos , Masculino , Persona de Mediana Edad , Médicos/normas , Atención Primaria de Salud , Derivación y Consulta , Encuestas y Cuestionarios , Confianza , Estados Unidos , Adulto Joven
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 89, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578145

RESUMEN

BACKGROUND: Making ethically sound treatment limitations in prehospital care is a complex topic. Helicopter Emergency Medical Service (HEMS) physicians were surveyed on their experiences with limitations of care orders in the prehospital setting, including situations where they are dispatched to healthcare facilities or nursing homes. METHODS: A nationwide multicentre study was conducted among all HEMS physicians in Finland in 2017 using a questionnaire with closed five-point Likert-scale questions and open questions. The Ethics Committee of the Tampere University Hospital approved the study protocol (R15048). RESULTS: Fifty-nine (88%) physicians responded. Their median age was 43 (IQR 38-47) and median medical working experience was 15 (IQR 10-20) years. All respondents made limitation of care orders and 39% made them often. Three fourths (75%) of the physicians were often dispatched to healthcare facilities and nursing homes and the majority (93%) regularly met patients who should have already had a valid limitation of care order. Every other physician (49%) had sometimes decided not to implement a medically justifiable limitation of care order because they wanted to avoid conflicts with the patient and/or the next of kin and/or other healthcare staff. Limitation of care order practices varied between the respondents, but neither age nor working experience explained these differences in answers. Most physicians (85%) stated that limitations of care orders are part of their work and 81% did not find them especially burdensome. The most challenging patient groups for treatment limitations were the under-aged patients, the severely disabled patients and the patients in healthcare facilities or residing in nursing homes. CONCLUSION: Making limitation of care orders is an important but often invisible part of a HEMS physician's work. HEMS physicians expressed that patients in long-term care were often without limitations of care orders in situations where an order would have been ethically in accordance with the patient's best interests.


Asunto(s)
Ambulancias Aéreas , Aeronaves , Servicios Médicos de Urgencia/métodos , Médicos/normas , Encuestas y Cuestionarios , Adulto , Estudios Transversales , Toma de Decisiones , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad
18.
J Leg Med ; 39(3): 229-233, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31626576

RESUMEN

Lapses in professionalism are a common cause of disciplinary action against physicians by U.S. medical boards. However, the exact definition of "professionalism" is unclear, making it likely that a physician will not train or practice under the same framing of professionalism and so may fail to develop certain skills. The goal of this study was to identify and compare the professionalism framings of medical boards. The medical board web pages for all 50 states, the District of Columbia, and four territories were examined in June 2017 for use of the word "professionalism" or "professional" in their application, rules, or laws, which was then coded as a best fit to one of six core framings of professionalism. Of the 55 states and territories, integrity was the most common professionalism framing (40.0%), followed by excellence (23.6%), behavior (12.7%), mixed (9.1%), unclear (9.1%), and absent (5.5%). Although integrity was the most common framing, diversity exists among medical boards, which could lead to board misunderstandings of incidents labeled as professionalism violations and ineffective remediation of offenses. In order to best communicate the nature of the offense and thus best facilitate remediation, the incident should be called by its true name rather than the all-encompassing term "professionalism."


Asunto(s)
Rol del Médico , Médicos/normas , Práctica Profesional/normas , Profesionalismo/normas , Consejo Directivo/legislación & jurisprudencia , Consejo Directivo/normas , Humanos , Mala Conducta Profesional , Profesionalismo/tendencias , Consejos de Especialidades/legislación & jurisprudencia , Consejos de Especialidades/normas , Estados Unidos
19.
Schmerz ; 33(5): 466-470, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31478143

RESUMEN

Since the adoption of the law of March 6, 2017, any German physician can prescribe medical cannabis flowers and cannabis-based magistral and finished medicinal products. No specific indications for prescriptions are provided in the law. The statutory health insurance companies bear the costs once an application for cost coverage has been approved by the Medical Service of the Health Funds. The German associations of psychiatry (child, adolescents, and adults), neurology, palliative care, addictology, and pain medicine are watching these developments in the media, politics, and medical world with concern due to: the option to prescribe cannabis flowers despite the lack of sound evidence and against the recommendations of the German Medical Association; the lack of distinction between medical cannabis flowers and cannabis-based magistral and finished medical products; the indiscriminately positive reports on the efficacy of cannabis-based medicines for chronic pain and mental disorders; the attempts by the cannabis industry to influence physicians; the increase in potential indications by leaders of medical opinion paid by manufacturers of cannabis-based medicines. The medical associations make the following appeal to journalists: To report on the medical benefits and risks of cannabis-based medicines in a balanced manner. To physicians: to prescribe cannabis-based medicines with caution; to prefer magistral and finished medicinal products over cannabis flowers. To politicians: to consider data according to the standards of evidence-based medicine when making decisions and provide financial support for medical research into cannabis-based medicines.


Asunto(s)
Cannabis , Dolor Crónico , Seguro de Salud , Periodismo , Marihuana Medicinal , Política , Pautas de la Práctica en Medicina , Dolor Crónico/tratamiento farmacológico , Alemania , Humanos , Seguro de Salud/ética , Seguro de Salud/normas , Marihuana Medicinal/uso terapéutico , Médicos/ética , Médicos/normas , Pautas de la Práctica en Medicina/ética , Pautas de la Práctica en Medicina/normas
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