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2.
GMS J Med Educ ; 39(4): Doc46, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36310883

RESUMO

Introduction: Telemedicine is a significant component of healthcare in most disciplines, giving great importance to the education of young physicians in this field. However, the topic of telemedicine has not yet been implemented in medical schools' curricula. This paper makes an important contribution to closing this gap by designing, implementing and evaluating a course with telemedical components. Using the example of a clinical traineeship preparation course, we investigated the extent to which integrated telemedical modules can contribute to the subjective confidence of students with regard to knowledge and confidence in performing practical telemedical skills, such as doctor-patient communication, taking medical histories, and applying handover techniques. Project description: The course evaluation was descriptive. Subjective confidence in clinical telemedicine skills was assessed before and after completion of the course using an online questionnaire and calculated in a pre-post design using Wilcoxon's signed-rank test. Results: The course was rated "very good" (31%) and "good" (54.2%) by the vast majority of students. The results of the Wilcoxon test show significant increases in students' feelings of confidence in performing practical telemedicine skills for all items. Discussion: This study shows that telemedicine modules integrated in a digital preparatory course contribute positively to students' subjective confidence in terms of knowledge and confidence in performing practical telemedicine skills. Specifically, this paper illustrates that professional digital doctor-patient communication, digital documentation of a medical history, and handoff techniques can be learned through telemedicine course content. Conclusion: Telemedicine modules increase students' subjective confidence in performing practical telemedicine skills. Practical telemedicine course content can thus reduce uncertainty in the use of telemedicine and prepare future physicians for its use.


Assuntos
Educação de Graduação em Medicina , Educação Médica , Estudantes de Medicina , Telemedicina , Humanos , Currículo , Apoio ao Desenvolvimento de Recursos Humanos
3.
J Am Board Fam Med ; 35(5): 1015-1025, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36113997

RESUMO

BACKGROUND: Nearly every state offers loan repayment (LRP) and some offer loan forgiveness to clinicians who commit to work in safety net practices. The effectiveness of these programs from the perspective of safety net practices is largely unknown. OBJECTIVES: To assess safety net practice administrators' assessments of key outcomes for the 3 principal types of state service programs: LRPs funded by states, LRPs funded jointly by states and National Health Service Corps, and loan forgiveness programs. SUBJECTS: Administrators of safety net sites where primary care, behavioral health and dental health clinicians began serving in 26 state service programs in 14 states from 2011 to 2018. Survey responses were received from 455 administrators reporting on 754 of 1380 clinicians (54.6%). OUTCOME MEASURES: Administrators' ratings of their sites' difficulty recruiting clinicians; relative ease, quickness and cost of recruiting the participating (index) clinician with the service program; program expected effects on participants' retention; participants' job performance. RESULTS: Most administrators (66.1%) reported that recruiting clinicians of the index clinician's discipline is generally difficult but made easier (81.7%) and quicker (65.4%) with the service program, but only sometimes less expensive (34.8%). 78.8% of administrators anticipate that the clinicians will remain longer because of program participation. Participants are perceived to practice good quality care (96.9%) and be positive contributors (92.4%). Administrators' assessments are generally similar for the 3 types of programs. CONCLUSIONS: Administrators of safety net practices generally perceive states' loan repayment and loan forgiveness programs succeed in helping them recruit and retain good clinicians.


Assuntos
Perdão , Apoio ao Desenvolvimento de Recursos Humanos , Humanos , Estados Unidos , Medicina Estatal , Área Carente de Assistência Médica
5.
Rev. APS ; 25(Supl. 2): 219-237, 16/08/2022.
Artigo em Português | LILACS | ID: biblio-1393295

RESUMO

Esta revisão sistemática aborda o uso de Sistemas de Suporte à Decisão Clínica (SADC) nos atendimentos realizados na Atenção Primária à Saúde (APS), identificando relações existentes entre o uso dos sistemas e os desfechos clínicos. Foram selecionados trabalhos, estudos em português e inglês, sem restrição ao cenário brasileiro, encontrados em diferentes bases de dados. Os resultados demonstram que os SADC ainda se encontram em estágio de desenvolvimento e refinamento, com aplicação ainda incipiente nas mais diversas patologias e condições clínicas. São raros os ensaios clínicos que tracem os desfechos clínicos primários, levando ao acúmulo de dados apenas sobre desfechos secundários ou compostos, dificultando a avaliação dos sistemas. Há indicativos de relativa eficiência no uso dos SADC para situações de diagnóstico e prevenção, com eficiência limitada na fase de tratamento. Finalmente, não existem dados suficientes para afirmar se os SADC geram desfechos clínicos primários mais favoráveis ou desfavoráveis na APS.


This systematic review addresses the use of Clinical Decision Support Systems (CDSS) in Primary Health Care (PHC), identifying relationships between the use of the Systems and clinical outcomes. The research employed selected studies in Portuguese and English, with no restriction to the Brazilian scenario, found in different databases. Results demonstrate that CDSS are still in the development and refinement stage, and their application is still incipient for the most diverse pathologies and clinical conditions. Clinical trials that trace the primary clinical outcomes are rare, leading to the accumulation of data only on secondary or compound outcomes, making it difficult to evaluate the systems. There are indications of relative efficiency in the use of CDSS for diagnosis and prevention situations, with limited efficiency in the treatment phase. Finally, there is insufficient data to establish whether CDSS generates more favorable or unfavorable primary clinical outcomes in PHC.


Assuntos
Atenção Primária à Saúde , Sistemas de Apoio a Decisões Clínicas , Apoio ao Desenvolvimento de Recursos Humanos
6.
Psychiatr Pol ; 56(2): 405-416, 2022 Apr 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-35988083

RESUMO

OBJECTIVES: According to some theoretical interpretations of the olfactory training effects, the training may indirectly exert positive influence on cognitive functioning in patients with Alzheimer's dementia. The mechanism of action is stimulation of cerebral blood flow in areas of brain which are shared by olfactory and memory processes. The aim of this article is to verify a hypothesis that the olfactory training improves memory and attention functions in patients with amnestic mild cognitive impairment. METHODS: Participants with amnestic mild cognitive impairment (N = 35; 17 males and 18 females) constituted their own control group. During the first 12 weeks from the baseline evaluation no therapeutic actions were performed. The subjects underwent control neuropsychological assessment and entered in the second stage of the study. In that stage they were subjected to a daily olfactory training, which included two a few-minute-long sessions per day, which were performed for the following 3 months. Subject's memory functioning was measured at three time points: at the baseline, after 3 months and after 6 months (from the baseline). Cross-over assignment was used as the intervention method -which means that the participants constituted their own control group. The scales employed in the study to measure memory and attention were: ACE-III, CVLT, and MMSE. RESULTS: Statistically significant improvement in memory functions measured with the CVLT, MMSE, ACE-III Memory, and ACE-III Total Score was obtained. It is considered an artefact related to practice effects, not true training results. Moreover, trend suggesting improvement on the ACE-III Attention was noted as well. CONCLUSIONS: The authors review theoretical implications of the conducted study. Methodological challenges pertaining to the study design are discussed and future research directions are proposed.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/complicações , Doença de Alzheimer/terapia , Cognição , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Apoio ao Desenvolvimento de Recursos Humanos
7.
J Nephrol ; 35(8): 2077-2086, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36040565

RESUMO

INTRODUCTION: Burnout was already found to be an important factor in the professional landscape of nephrology prior to the COVID-19 outbreak and is expected to worsen during the pandemic. OBJECTIVES: The aim of our study was to assess pandemic experiences, perceptions, and burnout among Polish dialysis unit professionals in the COVID-19 period. PARTICIPANTS AND METHODS: A survey, which consisted of a Pandemic Experiences and Perceptions Survey (PEPS) and a Maslach Burnout Inventory was distributed online to Polish dialysis units. The study group comprised 379 participants (215 nurses, 148 physicians, and 16 respondents of other professions). RESULTS: The pandemic largely affected or completely dominated the work of dialysis units according to 53.4% and 25.5% of nurses responding to the PEPS, respectively. Among physicians, the prevalence was 55.5% and 15.4% of participants, respectively. Serious or life-threatening risk was perceived by 72.1% and 11.9% of dialysis healthcare professionals, respectively. Furthermore, 74.6% of the study participants stated that their work in a dialysis setting amidst the pandemic was felt to be associated with serious risk for their relatives. Adequate personal protective equipment and information from management decreased burnout among dialysis staff. Burnout was lower in all dimensions among those participants who felt more in control of their exposure to infection, provided by proper training, equipment, and support (p = 0.0004 for emotional exhaustion, p = 0.0007 for depersonalization, and p < 0.0001 for feelings of personal accomplishment). CONCLUSIONS: The COVID-19 pandemic has largely affected the work in dialysis units. Providing proper training, equipment, and support may decrease burnout among dialysis staff.


Assuntos
Esgotamento Profissional , COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Diálise Renal , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Esgotamento Psicológico , Apoio ao Desenvolvimento de Recursos Humanos , Atenção à Saúde
8.
Am J Prev Med ; 63(2): 151-159, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35868814

RESUMO

INTRODUCTION: Student loan debt has become common for young adults in the U.S. and is correlated with poor physical and mental health. It is unclear how the accumulation or repayment of student debt is associated with longer-term cardiovascular risks and chronic inflammation. METHODS: Nationally representative data collected between 1994 and 2018 from >4,000 participants of a U.S. cohort study were analyzed in 2021 to assess the associations among change in student debt between young adulthood and early mid-life, 30-year Framingham cardiovascular disease risk scores, and C-reactive protein levels. RESULTS: Ordinary least squares regression revealed higher cardiovascular disease and C-reactive protein risks among those in households who became indebted or were consistently in debt between young adulthood and early mid-life than among those in households who were either never in debt or repaid their loans. This pattern persisted after adjustments for degree completion, socioeconomic measures, and other sources of debt. CONCLUSIONS: These findings provide a benchmark for widening health inequalities among a cohort bearing more student debt than any other in U.S. HISTORY: As student debt accumulates, within-cohort disparities in cardiovascular disease and related morbidities may undermine the health benefits of postsecondary education.


Assuntos
Doenças Cardiovasculares , Adulto , Proteína C-Reativa , Doenças Cardiovasculares/epidemiologia , Escolha da Profissão , Estudos de Coortes , Humanos , Estudantes , Apoio ao Desenvolvimento de Recursos Humanos , Adulto Jovem
9.
Med Educ Online ; 27(1): 2075303, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35583298

RESUMO

High educational debt is prevalent among resident physicians and correlates with adverse well-being outcomes, including symptoms of stress and burnout. Residents also report low financial literacy levels, affecting financial well-being. Understanding resident viewpoints toward financial well-being initiatives is crucial to develop targeted resident financial well-being programs. This study aims to examine residents' experiences financing their medical education and how these experiences influence well-being and attitudes toward financial education in residency. We recruited residents from a Southern California health system with residency programs in Family Medicine, Internal Medicine, General Surgery, Orthopaedic Surgery, and Psychiatry. We contacted residents by email and text message to participate in semi-structured interviews. We conducted interviews from October 2020 to March 2021 and analyzed 59 resident interviews using reflexive thematic analysis. Among residents, 76% (45/59) had ≥ $200,000 in student loans. Residents perceived mounting medical education debt as unfairly burdensome for trainees engaged in socially beneficial work, leaving residents feeling undervalued - a feeling heightened by the stressors of the COVID-19 pandemic - and hampering well-being. Compartmentalizing debt attenuated financial stressors but often made financial education seem less pressing. A subset of residents described how financial planning restored some agency and enhanced well-being, noting that protected didactic time for financial education was crucial. Resident interviews provide practical guidance regarding designing financial education sessions. Desired education included managing debt, retirement planning, and the business of medicine. How residents framed educational debt and their degree of financial literacy impacted their well-being and sense of agency. Residents proposed that residency programs can aid in stress mitigation by providing residents with skills to help manage debt and plan for retirement. To reduce clinician indebtedness, this approach needs to occur in tandem with systemic changes to financing medical education.


Assuntos
COVID-19 , Internato e Residência , Ortopedia , Humanos , Pandemias , Apoio ao Desenvolvimento de Recursos Humanos
10.
J Health Care Poor Underserved ; 33(2): 790-805, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35574877

RESUMO

OBJECTIVES: Determine if United States graduates of the Latin American Medical School in Cuba: 1) provide primary health care to disadvantaged populations; 2) complete licensing exams and obtain residencies; and 3) accrue additional debt during their medical education. METHODS: A Qualtrics secure web-based survey was provided to 158 graduates via email, completed anonymously. Responses were compiled and descriptive statistics generated. RESULTS: Fifty-six valid surveys were returned, for a response rate of 35.4%. Chi-square analysis showed no statistically significant differences between survey respondents and the sampling frame. Most graduates are people of color; 68% work in clinical medicine; of these, 90% are in primary care, with 100% serving disadvantaged populations. Most accrued no further educational loan debt. CONCLUSIONS: United States graduates of the Latin American Medical School work in primary care with disadvantaged populations. Graduates accrue little additional student loan debt.


Assuntos
Escolha da Profissão , Faculdades de Medicina , Cuba , Humanos , América Latina , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos
11.
J Am Vet Med Assoc ; 260(9): 1063-1068, 2022 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-35460549

RESUMO

OBJECTIVE: To determine whether career choice and starting salary of new DVM graduates in the US were associated with their educational debt accrued during veterinary school. SAMPLE: Up to 48,527 fourth-year students at US veterinary schools who responded to the AVMA Senior Survey in 2001 through 2021 and accepted a full-time position or advanced education opportunity. PROCEDURES: To determine whether career choice was associated with educational debt, multiple linear regression was performed, controlling for graduation year, gender, age, marital status, having children, tuition level, and school location. The correlation between educational debt and starting salary was also determined. RESULTS: On average, mean educational debt increased by $6,110 each successive year. A mean of 60.5% of respondents accepted positions in private practice (public practice, 3.3%; advanced education, 36.2%). Respondents choosing public practice had a mean of $24,913 less debt than those choosing advanced education, controlling for other factors. Respondents choosing public practice also had less debt than those choosing private practice, but debt did not differ significantly between private practice and advanced education. The correlation between educational debt and starting salary was significant but low (r = 0.177). CLINICAL RELEVANCE: Findings suggested that the amount of debt incurred during veterinary school was associated with new veterinarians' career paths. Notably, graduates with higher debt levels appeared to seek higher paying jobs or clinical training that might lead to higher paying jobs, leaving public practice-a field in which critical needs have been identified-underrepresented despite the availability of loan forgiveness programs and other incentives.


Assuntos
Estudantes de Medicina , Médicos Veterinários , Animais , Escolha da Profissão , Humanos , Prática Privada , Faculdades de Medicina Veterinária , Apoio ao Desenvolvimento de Recursos Humanos
12.
Pediatr Dent ; 44(1): 45-54, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35232536

RESUMO

Purpose: The purpose of this study was to investigate the interest in practice ownership among pediatric dentistry residents and influencing factors, particularly educational debt. Methods: An invitation to participate in an anonymous survey was sent to 933 pediatric dentistry residents training in the United States in the spring of 2020. Results: The survey response rate was 32.9 percent. Of the respondents, 61.2 percent reported being extremely or very interested in practice ownership and 49.8 percent anticipated becoming a practice owner within five years of graduation. An inverse relationship was seen between one's level of comfort in assuming a business loan to acquire a practice and having an educational debt burden of $400,000 or greater (P=0.002). Practice management preparation was the most common concern related to future practice ownership. Those feeling completely, very, or moderately prepared to manage a dental practice were over 40 percent more likely to be extremely or very interested in practice ownership than were those who felt slightly or not at all prepared (P<0.001). Conclusions: There appears to be broad interest in practice ownership among pediatric dentistry residents. Relatively high educational debt may negatively influence future practice ownership, but it may be less influential than other factors.


Assuntos
Intenção , Internato e Residência , Escolha da Profissão , Criança , Humanos , Propriedade , Odontopediatria/educação , Inquéritos e Questionários , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos
16.
J Am Dent Assoc ; 153(5): 429-439, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35123775

RESUMO

BACKGROUND: When attracting talent to dentistry, graduates need educational costs justified by future financial outcomes. The authors provide insights into how career choices (employee versus practice owner) and student loan repayment plans (principal-based versus income-driven) can be made to work. METHODS: Five loan repayment and career choice combinations were assessed using spreadsheets (Microsoft Excel) to rationally model monthly budgets and financial decisions during a projected 40-year work life. RESULTS: Even with high levels of student loan debt ($292,169 average for new graduates), it is still possible, but increasingly difficult, to achieve desirable career, lifestyle, and financial outcomes. Outcomes are highly sensitive to rates of investment returns and inflation. On the basis of the 5 scenarios of projections of debt and income levels to 2060, assuming reasonable levels of investment return and stable inflation, career and repayment choices can make a difference of more than $5 million in lifetime earnings and more than $3 million in retirement savings (2020 dollars). CONCLUSIONS: The new reality of high educational debt requires graduates to budget and plan before beginning their careers. Use of loan servicers, consultants, brokers, attorneys, certified public accountants, and financial advisors is needed. Working for a dental service organization is a valid option for developing dental and practice management skills. Owning a practice is still a viable career path. PRACTICAL IMPLICATIONS: Dental graduates should choose a student loan repayment that minimizes the size of monthly payments, balance budgets, practice frugality, obtain a practice purchase loan at lowest rates, and heed financial advisors.


Assuntos
Escolha da Profissão , Apoio ao Desenvolvimento de Recursos Humanos , Emprego , Humanos , Renda , Estudantes
19.
Acad Psychiatry ; 46(1): 45-49, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31900876

RESUMO

OBJECTIVE: A pilot survey was created to sample early career child and adolescent psychiatrists (CAPs) and fellows to identify factors contributing to recruitment, satisfaction, and general practice trends. METHOD: A 44-item survey was developed based on a previous study of early career CAPs and discussion at an early career forum. Participants were recruited at a professional meeting and through emails sent to all 125 US training program directors. RESULTS: Only 184 out of 2209 responses were received. Approximately two-thirds were female and one-third had completed fellowship. Most decided to pursue a career in child psychiatry during medical school and expected full time salaries between $175,000 and $250,000 after fellowship. Forty-five percent owed more than $150,000 in educational debt. The top reasons for pursuing a career in child psychiatry included the following: working with children, working in an interesting field, and helping society. Males (x = 85.7, SD 22.9) compared with females (x = 77.5, SD 25.3) were more interested in pursuing full time work. A higher proportion of participants were confident in prescribing medications (x = 79.9, SD 17.1) compared with providing psychotherapy (X = 63.3, SD 23.9). CONCLUSIONS: The vast majority of early career CAPs were recruited during medical school, motivated by altruistic reasons, and rated high confidence in their career choice despite significant student loan debt. Training directors should consider increasing competency in psychotherapeutic skills. Early child psychiatry exposure and a means of addressing physician debt are needed to improve recruitment to this specialty.


Assuntos
Psiquiatria Infantil , Psiquiatria , Adolescente , Escolha da Profissão , Criança , Psiquiatria Infantil/educação , Bolsas de Estudo , Feminino , Humanos , Masculino , Inquéritos e Questionários , Apoio ao Desenvolvimento de Recursos Humanos
20.
Health Soc Care Community ; 30(5): 1944-1950, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34542208

RESUMO

An area for concern in public health research is the extent to which USA student loans are associated with poor health. This study's objective examines whether falling behind on student loans may compound ill-health by deterring people from seeking healthcare. The results of this study confirm that borrowers behind or in collections on student loans are forgoing healthcare after self-reporting general physical ill-health. This study used the 2019 Survey of Household Economics and Decision-making (SHED) questionnaire that measures the economic well-being of USA households. There were 337 participants behind or in collections on student loans. The size effects for forgoing mental healthcare and seeing a specialist were observed. Respondents behind on student loans were more likely to forgo mental healthcare (adjusted odds ratio (AOR) = 1.66, 95% confidence interval [CI] = 1.18, 2.33) and seeing a doctor/specialist (AOR = 1.53, 95% CI = 1.13, 2.07) even when controlling for sociodemographic variables, health insurance, childcare and eldercare payments, and medical debt. The implications for enlarging access to healthcare among people behind on student loans are discussed.


Assuntos
Especialização , Apoio ao Desenvolvimento de Recursos Humanos , Atenção à Saúde , Características da Família , Humanos , Inquéritos e Questionários
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