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2.
Orv Hetil ; 161(3): 95-102, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31928062

RESUMEN

Introduction: Chronic obstructive pulmonary disease (COPD) is a health burden for the patient and the society. We have sought to find the optimal education content to alleviate this burden. Aim: (1) To create patient education content based on the pulmonologists' opinion; (2) to understand the pulmonologists' attitudes and perceptions; (3) to evaluate the options to improve patient adherence. Method: We have performed 20 interviews with pulmonologists working in inpatient, outpatient and rehabilitation settings. The structure of the interviews has been designed to determine the key elements of a patient education programme and to discover perception and therapeutic attitudes. Results: The average COPD patient is a smoker, male, under-socialized, coughs, has dyspnoea and is older than 40 years. He does not take his illness seriously, and seeks medical attention only in case of worsening of the disease, and improvement in adherence is only present in such cases. The latter phenomenon is frequently transient, and limited to worse periods. Three adherence groups can be defined: marginal good adherence (approx. 10%), the average is around 30-40%, and minimal adherence (60%). Correct inhaler use should be taught in maximum three steps, which should be easily reproduced and explained. Conclusion: The aspects defining the framework of the education programme are the adequate patient profile (tailor-making), on-the-spot education in the pulmonology centre, the relationship between the patient and the doctors, patient attitudes and lifestyle changes (smoking cessation), and choosing the adequate inhaler. Orv Hetil. 2020; 161(3): 95-102.


Asunto(s)
Educación del Paciente como Asunto , Relaciones Médico-Paciente , Enfermedad Pulmonar Obstructiva Crónica/terapia , Neumólogos/psicología , Actitud , Disnea , Humanos , Masculino , Cumplimiento de la Medicación , Percepción , Neumología , Cese del Hábito de Fumar
10.
JAMA ; 323(1): 70-81, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910284

RESUMEN

Importance: Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction. Objective: To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients. Evidence Review: Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (-4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes. Findings: The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient's emotions). Conclusions and Relevance: This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.


Asunto(s)
Relaciones Médico-Paciente , Atención Primaria de Salud , Medicina Clínica , Comunicación , Técnica Delfos , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Factores de Tiempo
12.
Lancet ; 395(10217): 24-25, 2020 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-31982047
14.
JAMA ; 323(2): 192, 2020 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-31935016
18.
Urologe A ; 59(1): 87-98, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31728563

RESUMEN

The juridification of medicine affects all disciplines, including urology. Therefore, in this discipline it can well happen that patients not only feel wrongly treated or complain that a treatment was not performed lege artis but also demand compensation or even bring criminal charges. From the patient point of view, the doctor is often more likely to blame for a complication that has arisen or for a hoped for but failed treatment success, than that it is accepted that a complication is typical for the intervention, which, despite the greatest medical care, unfortunately can become reality and is a fateful course. Insurance against claims for damages can be taken out. Not to be underestimated, however, is the personal burden of the accusations with which doctors are confronted by patients, relatives, expert witnesses and courts and against which one must defend oneself. This can mean additional work in addition to the normal medical workload. Therefore, the legal pitfalls in urology should be known.


Asunto(s)
Mala Praxis/legislación & jurisprudencia , Urología/legislación & jurisprudencia , Compensación y Reparación/legislación & jurisprudencia , Testimonio de Experto/legislación & jurisprudencia , Humanos , Seguro de Responsabilidad Civil/economía , Seguro de Responsabilidad Civil/legislación & jurisprudencia , Responsabilidad Legal/economía , Mala Praxis/economía , Aceptación de la Atención de Salud , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Urología/economía
19.
World Neurosurg ; 133: 457-465, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31881580

RESUMEN

Clinical neurosurgery is a complex specialty with multiple participants, including a variety of providers, patients, family members, and administrators, who interact in complex fashions. Modern-day patient care requires near-constant team communication of vital, detailed clinical information; any breakdown in this process can result in patient harm. Medical communication practices with patients impact mutual rapport as well as the overall physician-patient relationship. Enhanced relationship-centered communication techniques have been shown to improve patient compliance and may positively influence malpractice litigation rates. Neurosurgeons frequently interact with other health care providers and members of the hospital administration on matters relating to billing, compliance, and quality. Communication among the stakeholders is complicated, however, by the fact that the participants may be speaking a variety of different, mutually unintelligible "languages." We discuss the details of the various types of information exchanges in neurosurgery, the key players involved, and the vulnerabilities to breakdowns in the system. In addition, we review the multifaceted, systems-level issues in neurosurgical communication and related weaknesses.


Asunto(s)
Comunicación , Neurocirugia , Grupo de Atención al Paciente , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Humanos , Neurocirujanos , Atención Dirigida al Paciente
20.
World Neurosurg ; 133: 466-473, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31881581

RESUMEN

Communication issues play a major role within neurosurgery. There has been a growing awareness of the necessity of enhanced patient-centered communication between the physician and patient to improve patient satisfaction, compliance, and outcomes. In addition, the threat of malpractice litigation within neurosurgery is of particular concern, and improved communication may lead to some degree of risk mitigation. Within the neurosurgical and medical team, effective transmittal of vital clinical data is essential for patient safety. Despite the recent recognition of the critical role that communication plays in all aspects of medical care, multiple impediments hinder the improvement and use of effective techniques. We have identified 8 unique barriers to the advancement of communication practices: lack of recognition of the importance of communication skills; cognitive bias; sense that it "takes too much time"; cultural hierarchy within medicine; lack of formal communication skill training; fear that disclosure of medical errors will lead to malpractice litigation; the electronic medical record; and frequent shift changes and handoffs.


Asunto(s)
Comunicación , Neurocirugia , Seguridad del Paciente , Satisfacción del Paciente , Relaciones Médico-Paciente , Humanos
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