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1.
Bull World Health Organ ; 99(1): 8-9, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33658731

RESUMEN

Fadi Meroueh talks to Andréia Azevedo Soares about ensuring health equity and harm reduction services in prisons, and the challenges presented by the COVID-19 pandemic.


Asunto(s)
/epidemiología , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Rol del Médico , Prisioneros , Francia/epidemiología , Reducción del Daño , Humanos , Pandemias , Poblaciones Vulnerables
3.
J Prim Care Community Health ; 12: 21501327211000245, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33733901

RESUMEN

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


Asunto(s)
Salud Mental , Estrés Laboral/psicología , Médicos/psicología , Adulto , Anciano , Estudios Transversales , Análisis Factorial , Familia , Femenino , Humanos , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Italia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Equipo de Protección Personal , Rol del Médico , Rumiación Cognitiva , Encuestas y Cuestionarios , Carga de Trabajo , Adulto Joven
4.
Anesthesiology ; 134(4): 526-540, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33630039

RESUMEN

Health care is undergoing major transformation with a shift from fee-for-service care to fee-for-value. The advent of new care delivery and payment models is serving as a driver for value-based care. Hospitals, payors, and patients increasingly expect physicians and healthcare systems to improve outcomes and manage costs. The impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical and procedural practices further highlights the urgency and need for anesthesiologists to expand their roles in perioperative care, and to impact system improvement. While there have been substantial advances in anesthesia care, perioperative complications and mortality after surgery remain a key concern. Anesthesiologists are in a unique position to impact perioperative health care through their multitude of interactions and influences on various aspects of the perioperative domain, by using the surgical experience as the first touchpoint to reengage the patient in their own health care. Among the key interventions that are being effectively instituted by anesthesiologists include proactive engagement in preoperative optimization of patients' health; personalization and standardization of care delivery by segmenting patients based upon their complexity and risk; and implementation of best practices that are data-driven and evidence-based and provide structure that allow the patient to return to their optimal state of functional, cognitive, and psychologic health. Through collaborative relationships with other perioperative stakeholders, anesthesiologists can consolidate their role as clinical leaders driving value-based care and healthcare transformation in the best interests of patients.


Asunto(s)
Anestesiólogos/estadística & datos numéricos , Anestesiología/métodos , Prestación de Atención de Salud/métodos , Atención Perioperativa/métodos , Rol del Médico , Humanos
5.
J Am Board Fam Med ; 34(Suppl): S33-S36, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33622815

RESUMEN

Despite first trimester abortion being common and safe, there are numerousrestrictions that lead to barriers to seeking abortion care. The COVID-19 pandemic hasonly exacerbated these barriers, as many state legislators push to limit abortion accesseven further. During this pandemic, family physicians across the country haveincorporated telemedicine into their practices to continue to meet patient needs.Medication abortion can be offered to patients by telemedicine in most states, andmultiple studies have shown that labs, imaging, and physical exam may not beessential in all cases. Family physicians are well-poised to incorporate medicationabortion into their practices using approaches that limit the spread of the coronavirus,ultimately increasing access to abortion in these unprecedented times.


Asunto(s)
Abortivos/administración & dosificación , Aborto Inducido/métodos , Medicina Familiar y Comunitaria/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Rol del Médico , Telemedicina/organización & administración , /epidemiología , Medicina Familiar y Comunitaria/métodos , Femenino , Humanos , Pandemias , Embarazo , Primer Trimestre del Embarazo , Autoadministración , Telemedicina/métodos , Estados Unidos/epidemiología
6.
Tex Med ; 117(2): 22-25, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33641119

RESUMEN

Not long after COVID-19 hit Texas last March, pediatricians at Austin Regional Clinic (ARC) began screening patients for food insecurity. The timing was coincidental but fortunate given the pandemic's economic toll.


Asunto(s)
/epidemiología , Rol del Médico , Humanos , Desnutrición/diagnóstico , Desnutrición/prevención & control , Texas/epidemiología
8.
Curr Urol Rep ; 22(3): 15, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33534013

RESUMEN

PURPOSE OF REVIEW: Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS: Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.


Asunto(s)
Rol del Médico , Procedimientos Quirúrgicos Reconstructivos , Disrafia Espinal/complicaciones , Transición a la Atención de Adultos , Anomalías Urogenitales/cirugía , Procedimientos Quirúrgicos Urológicos , Adolescente , Adulto , Niño , Femenino , Humanos , Hipospadias/cirugía , Masculino , Reoperación , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Sistema Urinario/cirugía , Anomalías Urogenitales/terapia , Enfermedades Urológicas/etiología , Enfermedades Urológicas/cirugía , Urólogos
9.
AIDS Educ Prev ; 33(1): 33-45, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33617324

RESUMEN

Pre-exposure prophylaxis (PrEP) uptake has been suboptimal despite its demonstrated efficacy in reducing the risk of HIV acquisition. Medical education is one distal determinant that shapes medical providers' perceived role in the PrEP care continuum. However, there is limited understanding of how osteopathic medical students and those wanting to practice in rural areas perceive their role in the PrEP care continuum in the domains of PrEP awareness, uptake, and adherence and retention. Twenty-one semistructured interviews were conducted (March 2019-April 2020) to assess what shapes osteopathic medical students' perceived role in the PrEP care continuum. Participants noted a lack of adequate sexual health training, personal perceptions concerning PrEP use, and ambiguity concerning which of the medical specialties should deliver PrEP. Osteopathic medical schools can incorporate more inclusive and holistic sexual health and PrEP curricula to address these barriers and better prepare osteopathic medical students for their future role in the PrEP care continuum.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Continuidad de la Atención al Paciente , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Profilaxis Pre-Exposición , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Oklahoma , Medicina Osteopática , Percepción , Rol del Médico , Investigación Cualitativa , Salud Sexual , Estudiantes de Medicina
10.
Community Ment Health J ; 57(3): 438-441, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33400048

RESUMEN

The COVID-19 pandemic has disrupted community mental health center (CMHC) operations by limiting in-person access to patients and contributing to staff absenteeism. States adjust social distancing levels over time in response to changes in economic needs, healthcare system utilization, and COVID-19 virus transmission levels. Community mental health centers also need to balance service needs with infection risk, which requires adjusting social distancing levels in response to changes in the local conditions. This article will: (1) briefly describe epidemiological indicators most useful for judging the local infection trends, (2) describe a strategy for organizing specific agency clinical functions on a social distancing level scale, (3) propose a set of agency phases to inform administrative responses to changes in the risk to operations, and (4) discuss the role of psychiatrists as physicians in a mental health agency during a pandemic.


Asunto(s)
/psicología , Psiquiatría Comunitaria , Pandemias/prevención & control , Rol del Médico , Médicos/psicología , Psiquiatría , Adulto , /prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad
11.
Int J Med Educ ; 12: 1-11, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33491661

RESUMEN

Objectives: This study aimed to identify the factors that support or inhibit medical teachers as healthy role models in medical school to conduct healthy behavior. Methods: This qualitative study involved semi-structured in-depth interviews with medical teachers categorized as healthy role models in a medical school from a previous survey. Ten medical teachers were selected using purposive sampling. Three medical teachers were interviewed by direct meetings, and the remaining were phone interviewed, with one interview facilitated by chat using WhatsApp. Transcribed interviews were coded openly. Themes were finalized through discussion and debate to reach a consensus. Results: Two themes were identified: perceived facilitators and perceived barriers, which were classified into four categories and 13 subcategories: intrinsic facilitators (motivation, conscious awareness, having physical limitations, knowledge, and economic reasons); extrinsic facilitators (the impact on doing a particular job, feedback, time, and environment); intrinsic barriers (the lack of self-motivation and having physical limitations); and extrinsic barriers (the burden of responsibilities for being medical teachers and environment). Conclusions: Factors that support and inhibit medical teachers as healthy role models in medical school are influenced by intrinsic and extrinsic factors. This result could be used by medical schools to design appropriate interventions to help medical teachers as healthy role models in conducting healthy behavior. More studies are needed to explore other factors that influence medical teachers to conduct healthy behavior. During the COVID-19 pandemic, healthy role models in medical schools are vitally important and significantly contribute to the overall health of a nation.


Asunto(s)
Docentes Médicos , Conductas Relacionadas con la Salud , Estilo de Vida Saludable , Rol del Médico , Facultades de Medicina , Dieta Saludable , Personas con Discapacidad , Femenino , Instituciones de Salud/provisión & distribución , Humanos , Masculino , Motivación , Investigación Cualitativa , Estudiantes de Medicina
12.
Ital J Pediatr ; 47(1): 10, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33451342

RESUMEN

Opioid-related mortality in adolescents is spreading in the US, with prescription opioids playing a crucial role in the development of addiction. We traced back to the process leading to the so called "opioid overflow", trying to identify any modifiable attitude.Since the late 1990s, pain was labelled as the "fifth vital sign" and its proper management was prompted, encouraging the use of opioids for any pain scored at a Numerical Rating Scale (NRS) of 7 or higher. This assumption has some remarkable limitations. NRS is a proxy of pain severity in children, and pain measurement should be strengthened by a more comprehensive pain evaluation. Moreover, while remaining a fundamental therapeutic right of patients suffering postoperative or chronic severe pain, opioids show no evidence of superiority respect to non-opioid regimens in the management of pain from several acute conditions.Italy, as other European countries, is often reluctant to the use of opioids, even when highly recommendable, missing the opportunity of properly treating those selected patients with severe pain. Both attitudes can be viewed as the result of an extreme simplification of the complex process of pain evaluation and treatment, by means of a 'one-size-fits-all' approach.This highlights the need for a systematic and patient-tailored attitude to children in pain, avoiding applying guidelines without question. Good clinical practice must rely on guidelines, which, however, as often based on partial and insufficient data, can be questioned by emerging new evidence, and should not substitute our rational thinking, and capability to understand each patient, avoiding excessive conformism.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Actitud del Personal de Salud , Trastornos Relacionados con Opioides/epidemiología , Dolor/tratamiento farmacológico , Rol del Médico , Pautas de la Práctica en Medicina , Adolescente , Niño , Humanos , Trastornos Relacionados con Opioides/prevención & control , Dolor/diagnóstico , Dimensión del Dolor
15.
N Engl J Med ; 384(2): 101-103, 2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33502832
16.
Adv Mind Body Med ; 35(1): 4-8, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33513580

RESUMEN

There is substantial evidence that spiritual well-being is an important determinant of overall health, longevity and quality of life, especially in patients with severe illness. While most physicians would agree that spiritual well-being is an important factor in their patients' health, the spiritual needs and well-being of patients are largely ignored and rarely addressed by healthcare providers, representing a significant gap in care. Physicians often cite a lack of training or comfort in assessing and/or addressing patients' spiritual needs, and a lack of research on the safety and efficacy of spiritual interventions as barriers to care. In this review, we discuss the effects of spiritual well-being on health, and the importance of assessing and addressing patients' spiritual needs, highlight the need for methodic, rigorous high-quality studies and improved physician education in identifying and addressing patients' spiritual needs.


Asunto(s)
Actitud del Personal de Salud , Cuidado Pastoral , Rol del Médico , Médicos/psicología , Calidad de Vida , Espiritualidad , Personal de Salud , Humanos , Relaciones Médico-Paciente , Religión y Medicina
17.
Clin Interv Aging ; 16: 43-56, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33442244

RESUMEN

Background: SARS-CoV-2 infection is currently the most significant public health challenge. Its presentation ranges from mild to severe respiratory failure and septic shock. Rapid transmission of the virus is dangerous with a high possibility of life-threatening complications. Lack of treatment standards for SARS-CoV-2 is responsible for the current dilemma in clinical medicine. Methods: An electronic literature search was done using PubMed to gather information on the pathogenesis, transmission of infection, clinical symptoms, diagnosis, and therapeutic options for COVID-19. Search items included "SARS-CoV-2", "COVID-19" and "coronavirus infection". Results: In light of the current global crisis caused by SARS-CoV-2, the exchange of information within the scientific community should be quick and extremely transparent. Thus, this review presents the available information necessary for a general practitioner. Such presentation of data should allow the reader quick access to basic and crucial information related to epidemiology, viral transmission, clinical symptoms, diagnostics, treatment, and complications that may occur in the course of COVID-19. Conclusion: Rapidly increasing amounts of information about the diagnosis and treatment of patients with SARS-CoV-2 allow a better understanding of the etiology and course of the infection. In the current epidemiological situation, readily accessible information helps minimize the time to acquire knowledge and focus on prevention methods, diagnostic and treatment options. Thus, this review highlights key issues related to SARS-CoV-2 infection and contains the most useful data for daily medical practice.


Asunto(s)
/epidemiología , Médicos Generales/organización & administración , Difusión de la Información , Rol del Médico , /estadística & datos numéricos , Humanos
18.
J Drugs Dermatol ; 20(1): 10-16, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33400419

RESUMEN

The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the "lessons learned" with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.5803.


Asunto(s)
/prevención & control , Defensa Civil/métodos , Planificación en Desastres/métodos , Desastres/prevención & control , Manejo de la Enfermedad , Rol del Médico , /epidemiología , Defensa Civil/tendencias , Planificación en Desastres/tendencias , Humanos , Admisión y Programación de Personal/tendencias
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