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1.
Pol Merkur Lekarski ; 48(287): 375-378, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33130803

RESUMEN

Poland is a country with an increasing number of claims based on medical errors, especially in the following surgical disciplines: obstetrics and gynaecology, orthopaedics and emergency medicine, general surgery. This problem raises the need to seek out-of-court dispute solutions beneficial to the physician, the patient and the national health care system. Mediation - a procedure commonly used and well-established in Polish law, however, not widespread, as far as medical claims are concerned - creates this opportunity. The purpose of this article is to summarize international experiences in mediation in physician-patient disputes, and to try to popularize them in Poland. An analysis of foreign literature has provided evidence that mediation is an effective tool to resolve disputes by compromise, while reducing the costs and time of proceedings, and preventing burnout among physicians and the patients' loss of trust in medical care.


Asunto(s)
Disentimientos y Disputas , Médicos , Femenino , Humanos , Negociación , Relaciones Médico-Paciente , Polonia , Embarazo
2.
Int J Pediatr Otorhinolaryngol ; 138: 110383, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33152974

RESUMEN

INTRODUCTION: Virtual outpatient clinics (VOPC) have been integrated into both paediatric and based adult outpatient services due to a multitude of factors, including increased demand for services, technological advances and rising morbidity secondary to ageing populations. The novel coronavirus disease (COVID-19) has accentuated pressures on the National Health Service (NHS) infrastructure, particularly elective services, whilst radically altering patterns of practice. AIM: To evaluate the impact of the COVID-19 pandemic on paediatric otolaryngology outpatient services whilst collating patient feedback to elicit long-term sustainability post COVID-19. METHOD: A retrospective analysis of VOPCs was undertaken at a tertiary paediatric referral centre over a 3-month capture period during the COVID-19 pandemic. Demographic, generic clinic (presenting complaint, new vs. follow-up, consultation type), as well as outcome data (medical or surgical intervention, discharge vs. ongoing review, onward referral, investigations, and conversion to face-to-face) was collated. Additionally a modified 15-point patient satisfaction survey was created. The Paediatric Otolaryngology Telemedicine Satisfaction survey (POTSS), was an adaptation of 4 validated patient satisfaction tools including the General Medical Council (GMC) patient questionnaire, the telehealth satisfaction scale (TESS), the telehealth usability questionnaire (TUQ), and the telemedicine satisfaction and usefulness questionnaire (TSUQ). RESULTS: Of 514 patients reviewed virtually over a 3-month period, 225 (45%) were randomly selected to participate, of which 200 met our inclusion criteria. The most common mode of consultation was telephony (92.5%, n = 185). Non-attendance rates were reduced when compared to face-to-face clinics during an equivalent period prior to the COVID-19 pandemic. A significant proportion of patients (29% compared to 26% pre-VOPC) were discharged to primary care. Nine percent were listed for surgery compared to 19% pre-VOPC. A subsequent face-to-face appointment was required in 10% of participants. Overall, the satisfaction when assessing the doctor-patient relationship, privacy & trust, as well as consultation domains was high, with the overwhelming majority of parents' content with the future integration and participation in VOPCs. CONCLUSION: An evolving worldwide pandemic has accelerated the need for healthcare services to reform in order to maintain a steady flow of patients within an elective outpatient setting without compromising patient care. Solutions must be sustainable long-term to account for future disruptions, whilst accounting for evolving patient demographics. Our novel survey has demonstrated the vast potential that the integration of VOPCs can offer paediatric otolaryngology services within a carefully selected cohort of patients.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus , Pandemias , Satisfacción del Paciente , Pediatría/estadística & datos numéricos , Neumonía Viral , Telemedicina , Adolescente , Atención Ambulatoria/métodos , Instituciones de Atención Ambulatoria/organización & administración , Betacoronavirus , Niño , Preescolar , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Pediatría/métodos , Relaciones Médico-Paciente , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Medicina Estatal , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Reino Unido
4.
JMIR Mhealth Uhealth ; 8(10): e23148, 2020 10 29.
Artículo en Inglés | MEDLINE | ID: mdl-33006944

RESUMEN

BACKGROUND: Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app-TraceTogether-in March 2020 to augment Singapore's contact tracing capabilities. OBJECTIVE: This study aims to compare the performance of the contact tracing app-TraceTogether-with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. METHODS: All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians' 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. RESULTS: RTLS tags had a high sensitivity of 95.3% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5% and performed significantly better on Android phones than iPhones (Android: 9.7%, iPhone: 2.7%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9% and specificity of 83.1%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. CONCLUSIONS: TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic.


Asunto(s)
Sistemas de Computación , Trazado de Contacto/instrumentación , Infecciones por Coronavirus/prevención & control , Aplicaciones Móviles , Pandemias/prevención & control , Neumonía Viral/prevención & control , Dispositivos Electrónicos Vestibles , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Registros Electrónicos de Salud , Humanos , Relaciones Médico-Paciente , Neumonía Viral/epidemiología , Reproducibilidad de los Resultados , Singapur/epidemiología
6.
Tex Med ; 116(10): 4-5, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33126274

RESUMEN

In the era of COVID-19, clinicians face myriad new communication challenges: muffling masks; glaring face shields; heightened anxiety and fear amongst patients, families, and clinicians; and increased use of telehealth and virtual communication.


Asunto(s)
Comunicación , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Equipo de Protección Personal , Relaciones Médico-Paciente , Neumonía Viral/prevención & control , Betacoronavirus , Humanos
7.
Tex Med ; 116(10): 38-39, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33126269

RESUMEN

Now that Texas prescribers must check a patient's history in the state's prescription monitoring program (PMP) before prescribing opioids, plus three other drug classes, the errors are becoming more apparent.


Asunto(s)
Analgésicos Opioides , Prescripciones de Medicamentos , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina , Programas de Monitoreo de Medicamentos Recetados , Prescripciones , Humanos , Texas
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5868-5871, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33019309

RESUMEN

Long waiting time has attracted public attention significantly due to the negative effects on patients' satisfaction with health systems. In the United States, waiting time of a patient to see a physician for the first time has been increased by 30% since 2014. This is in part due to the ineffective allocation between physicians and patients, and in part due to growing population needing healthcare and the restriction introduced by insurance policies. There is an urgent need to develop matching mechanisms with the consideration of preferences from both patients and physicians to improve matching results. This paper presents a new allocation framework between physicians and patients to shorten the patient waiting time as well as improve the allocation effectiveness. We leverage the matching theory and extend the conventional deferred acceptance algorithm to a discrete-time stable marriage framework (i.e., discrete deferred acceptance algorithm, DDA) with the consideration of uncertainty constraints introduced by insurance types. We benchmark our proposed algorithm with the current practice (i.e., continuous deferred acceptance scheme, CDA) under different scenarios when the demand-supply ratio (DSR) varies. Experimental results show that when the DSR is more than 1.25, DDA outperforms traditional CDA practices in terms of waiting time and matching regret. The proposed framework shows strong potential to tackle the problem of long waiting time in the healthcare system.


Asunto(s)
Relaciones Médico-Paciente , Médicos , Algoritmos , Humanos , Satisfacción del Paciente , Estados Unidos
17.
PLoS One ; 15(9): e0238542, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32886733

RESUMEN

OBJECTIVES: Simulation-based training (SBT) is increasingly used to teach clinical patient-doctor communication skills (CS) to medical students. However, the long-lasting impact of this training has been poorly studied. METHODS: In this observational study we included all fourth-year undergraduate medical students from a French medical school who undertook a CS objective structured clinical examination (OSCE) and who answered a post-examination survey. OSCE scores and students' feedback were compared by whether students had received a specific CS-SBT or not 12 months prior to the OSCE. RESULTS: A total of 173 students were included in the study. Of them, 97 (56%) had followed the CS-SBT before the OSCE. Students who had undergone CS-SBT had significantly higher CS-OSCE scores in the multivariate analysis compared to untrained students (mean score 7.5/10 ±1.1 vs. 7.0/10 ±1.6, respectively, Cohen's d = 0.4, p<0.01). They also tended to experience less nervousness during the OSCE (p = 0.09) and increased motivation to further train in "real-life" internships (p = 0.08). However, they overall expressed a general lack of CS in therapeutic patient education, delivering bad news, and disclosing medical errors. CONCLUSIONS: Fourth-year medical students who benefited from a CS-SBT 12 months before examination displayed higher CS-OSCE scores than their counterparts. PRACTICE IMPLICATIONS: These results support the early introduction of practical training to improve communication skills in undergraduate medical curricula. Studies are required to assess the sustainability of this improvement over time and its effect on further real doctor-patient communication.


Asunto(s)
Relaciones Médico-Paciente , Entrenamiento Simulado/métodos , Competencia Clínica , Comunicación , Evaluación Educacional , Femenino , Humanos , Masculino , Simulación de Paciente , Examen Físico/métodos , Estudiantes de Medicina
19.
Ann Emerg Med ; 76(3S): S73-S77, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32928466

RESUMEN

STUDY OBJECTIVE: The mutual distrust, in part caused by misunderstanding and bias, between sickle cell disease (SCD) patients and their emergency department (ED) providers has been widely documented in the SCD literature. This study seeks to illustrate the perceptions and experiences of adult sickle cell patients who have had at least 1 ED experience in the last 2 years. METHODS: Qsource, a nonprofit health care consultancy based in Tennessee, used photovoice, a qualitative research method, to facilitate the representation of patients' experiences in living with SCD. Photovoice has participants document their experiences through photography and then, as a group, discuss and analyze the emotional state behind the photographs. Eight participants with SCD took 25 photographs during 4 weeks. Then, in a 2-hour critical dialogue, participants identified recurring themes through consensus. RESULTS: Participants identified 6 themes that emerged from their discussion: unpredictability of SCD, fickleness of time, coping with pain, proximity to death, avoidance of the ED, and need for improved communication. They expressed their wish to be active participants in their care, and many described a fear of death, which is exacerbated by a lack of control in the ED setting. CONCLUSION: Factors such as poor patient experience and misunderstanding may contribute to delays in seeking care for SCD patients. This may, in turn, escalate pain crises and increase the likelihood of hospital admission. We believe that photovoice may be a new means to educate ED providers on SCD patient perceptions, ultimately resulting in better ED care.


Asunto(s)
Anemia de Células Falciformes/terapia , Servicio de Urgencia en Hospital , Adulto , Anemia de Células Falciformes/psicología , Comunicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Fotograbar , Relaciones Médico-Paciente , Investigación Cualitativa
20.
S Afr Med J ; 110(6): 461-462, 2020 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-32880552

RESUMEN

Given the increasing numbers of ethical and legal issues arising from the COVID-19 epidemic, particularly in respect of patient-doctor confidentiality, doctors must explain to patients how the measures taken to combat the spread of the virus impact on their confidentiality. Patients must be reassured that doctors are ethically bound to continue to respect such confidentiality, but it should be made clear to them that doctors must also comply with the demands of the law. While the Constitution, statutory law and the common law all recognise a person's right to privacy, during extraordinary times such as the COVID-19 pandemic, confidentiality must be breached to a degree to halt the spread of the virus.


Asunto(s)
Confidencialidad/legislación & jurisprudencia , Infecciones por Coronavirus/epidemiología , Ética Médica , Relaciones Médico-Paciente/ética , Neumonía Viral/epidemiología , Confidencialidad/ética , Infecciones por Coronavirus/prevención & control , Humanos , Pandemias/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control
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