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1.
Br J Anaesth ; 124(2): 206-213, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839255

RESUMO

BACKGROUND: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings. METHODS: This mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. RESULTS: The ANTS total scores improved from pre- (11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. CONCLUSIONS: VAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Treinamento por Simulação/métodos , Anestesistas , Países em Desenvolvimento , Seguimentos , Humanos , Estudos Prospectivos , Ruanda
2.
J Surg Res ; 245: 510-515, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446193

RESUMO

BACKGROUND: The increasing use of review websites by consumers has become a crucial first step in choosing a physician with more than half of Americans consulting review sites before physician selection. We sought to identify whether differences exist in the quality and content of online reviews for men versus women surgeons. METHODS: Using a deliberate sampling algorithm of the two most populated physician review websites, RateMDs.com and Yelp.com, we purposefully sampled reviews for the top 20 surgeons per tercile from the four most populated urban areas in the United States: New York, Houston, Los Angeles, and Chicago. A grounded theory qualitative assessment was performed of major and minor thematic elements including global rating, communication, technical skills, and comments on ancillary elements. RESULTS: Four-hundred and thirty-one online patient reviews of 238 surgeons were identified from RateMDs.com (51%) and Yelp.com (49%) with available information on gender for analysis. Seventy-six percent of reviews were of male surgeons. Reviewers were more likely to mention a global rating and technical skill for men compared with women surgeons. Most reviews were positive with no difference in global rating by gender (83.7% positive for men and 74.3% positive for women, P = 0.08). Women surgeons were more likely to have positive comments on social interactions as compared with men (94.7% versus 88.0%, P = 0.03); whereas men surgeons were more likely to have a positive rating on technical skill compared with women (88.2% versus 76.2%, P = 0.04). CONCLUSIONS: The content and quality of online surgeon reviews differ by gender. There is no difference in global rating between men and women. Women are rated higher for social interaction domains and men are rated higher on technical skill domains.


Assuntos
Competência Clínica/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Cirurgiões/estatística & dados numéricos , Comunicação , Feminino , Humanos , Internet/estatística & dados numéricos , Masculino , Pesquisa Qualitativa , Fatores Sexuais , Estados Unidos
3.
Presse Med ; 48(12): e382-e388, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31757737

RESUMO

BACKGROUND: Rare diseases are defined by a prevalence of less than one out of 2000 persons. In clinical practice, their management is difficult, due to their diversity, their complexity and a lack of adapted physician training. OBJECTIVE: The aims of this study were to identify rare skin diseases in a reference center, to describe the difficulties encountered by general practitioners (GPs) in management of these uncommon cases, and to pinpoint the characteristics of the GPs having the most problems. METHODS: A survey conducted from March to June 2017 involving GPs at least one of whose rare skin disease patients was being monitored in a reference center. RESULTS: All in all, 96/195 (49.2%) of the GPs contacted completed the questionnaire, and virtually all of them (95%) reported five main categories of difficulties: giving a diagnosis, monitoring treatment, coordinating care, providing support, and ensuring management of intercurrent pathologies. The most widely reported difficulties were related to diagnosis (88.5%) and care coordination (76%). The GPs most in need of assistance were those practicing in rural areas (11 times more likely to experience difficulties), those with over 10 years of experience (up to 9.8 times more risk) and those not considering their role in the management of patients with rare diseases as instrumental (2.28 times more risk). CONCLUSIONS: This study brought to light the difficulties encountered by GPs in management of patients with rare skin diseases. We identified those the most in need of assistance, who are to be targeted for actions aimed at improving the care and treatment of patients suffering from rare skin diseases.


Assuntos
Competência Clínica , Clínicos Gerais , Padrões de Prática Médica , Doenças Raras/terapia , Dermatopatias/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , França/epidemiologia , Medicina Geral/educação , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Doenças Raras/epidemiologia , Dermatopatias/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
Medicina (B Aires) ; 79(5): 384-390, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671388

RESUMO

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.


Assuntos
Docentes de Medicina/estatística & dados numéricos , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Corpo Clínico Hospitalar/organização & administração , Corpo Clínico Hospitalar/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Adulto , Argentina , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Masculino , Valores de Referência , Inquéritos e Questionários , Adulto Jovem
5.
Br J Anaesth ; 123(6): 887-897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591019

RESUMO

BACKGROUND: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training. METHODS: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre- and post-curriculum assessments in first-year postgraduate trainee doctors (residents). RESULTS: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P=0.013). After training, patients rated the residents as more empathetic (31 [4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7-12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9-16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10-18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P=0.001; 95% CI: 0.8-2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P=0.010; 95% CI: 0.4-2.8). CONCLUSIONS: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Currículo , Humanismo , Internato e Residência , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Empatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina/psicologia , Adulto Jovem
6.
Rev Col Bras Cir ; 46(4): e2146, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508733

RESUMO

OBJECTIVE: to evaluate the perception of surgeons, members of the Brazilian College of Surgeons (CBC), on safety and quality issues in surgery, based on projects of Brazilian Ministry of Health (MS), CBC, World Health Organization (WHO), and American College of Surgeons (ACS). METHODS: a questionnaire based on WHO, CBC, and ACS initiatives was sent to all active and non-active CBC members, using Survey Monkey, in March 2018. RESULTS: out of 7,100 members, 171 professionals answered the questionnaire. Out of these, the majority (63.2%) declared to perform general surgery, 88.9% indicated knowing the project called Safe Surgery developed by MS, 73.1%, the CBC manual, and 14.6%, the ACS Strong for Surgery. Among those who indicated knowing the MS project, 73.1% said that they were accustomed to use it as a routine, and, among those who indicated knowing the CBC manual, 46.2% said that they were accustomed to use it. Most of the surgeons (81.3%) indicated that they had experienced severe surgical failures, being failures related to surgical material (49.7%) and presence of foreign bodies (8.2%) the most common ones. There were distinct opinions on who was responsible for checking over the checklist. CONCLUSION: the importance of safety and quality in surgery is well known by surgeons, but the practice is varied. Serious adverse events had been experienced by many surgeons, mainly related to surgical material and foreign bodies. The concept of interdisciplinarity did not seem to be common practice. Data indicated the need to develop education projects and the obligation of audits.


Assuntos
Competência Clínica , Cirurgia Geral , Cirurgiões , Atitude do Pessoal de Saúde , Brasil , Competência Clínica/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Near Miss , Qualidade da Assistência à Saúde , Sociedades Médicas , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários
7.
Br J Anaesth ; 123(5): 679-687, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31561883

RESUMO

BACKGROUND: While increased surgical-provider volume has been associated with improved outcomes, research regarding volume-outcome relationships within high-volume institutions and the role of anaesthesiologists is limited. Further, the effect of anaesthesia-care-team composition remains understudied. This analysis aimed to identify the impact of anaesthesiologist and surgeon volume on adverse events after total joint arthroplasties. METHODS: We retrospectively identified 40 437 patients who underwent total joint arthroplasties at a high-volume institution from 2005 to 2014. The main effects of interest were anaesthesiologist and surgeon volume and experience along with anaesthesia-care-team composition. Multivariable logistic regression models were used to evaluate three outcomes: any complication, cardiopulmonary complication, and length of stay (>5 days). Odds ratios (ORs) and 99.75% confidence intervals (CIs) were reported. RESULTS: Across all three models, anaesthesiologist volume and experience, and anaesthesia-care-team composition were not significant predictors. Surgeon annual case volume >50 was associated with significantly reduced odds of any complication (annual case volume: 50-149; OR: 0.80; CI: 0.66-0.98) and prolonged length of stay (OR: 0.69; CI: 0.60-0.80). Surgeon experience >20 yr was associated with significantly reduced odds of prolonged length of stay (OR: 0.85; CI: 0.75-0.95). CONCLUSIONS: Anaesthesiologist volume and experience, and anaesthesia-care-team composition did not impact the odds of an adverse outcome, although a higher surgeon volume was associated with decreased odds of complications and prolonged length of stay. Further study is necessary to determine if these findings can be extrapolated to less specialised, lower volume surgical settings.


Assuntos
Anestesiologia/estatística & dados numéricos , Artroplastia de Quadril/normas , Artroplastia do Joelho/normas , Competência Clínica/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Idoso , Anestesia/métodos , Anestesia/normas , Anestesia/estatística & dados numéricos , Anestesiologia/organização & administração , Anestesiologia/normas , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Comorbidade , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
BMC Health Serv Res ; 19(1): 602, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455377

RESUMO

BACKGROUND: Primary health care (PHC) is usually the initial point of contact for individuals seeking to access health care and providers of PHC play a crucial role in the healthcare model. However, few studies have assessed the knowledge, ability, and skills (capacity) of PHC providers in delivering care. This study aimed to identify the capacity of PHC providers in countries of the Southeast and East Asian Nursing Education and Research Network (SEANERN). METHODS: A multi-national cross-sectional survey was performed among SEANERN countries. A 1-5 Likert scale was used to measure eight components of knowledge, ability, and skill of PHC providers. Descriptive statistics were employed, and radar charts were used to depict the levels of the three dimensions (knowledge, skill and ability) and eight components. RESULTS: Totally, 606 valid questionnaires from PHC providers were returned from seven countries of SEANERN (China, Myanmar, Indonesia, Thailand, Vietnam, Cambodia, and Malaysia), with a responsive rate of 97.6% (606/621). For the three dimensions the ranges of total mean scores were distributed as follows: knowledge dimension: 2.78~3.11; skill dimension: 2.66~3.16; ability dimension: 2.67~3.06. Furthermore, radar charts revealed that the transition of PHC provider's knowledge into skill and from skill into ability decreased gradually. Their competencies in four areas, including safe water and sanitation, nutritional promotion, endemic diseases prevention, and essential provision of drugs, were especially low. CONCLUSIONS: The general capacity perceived by PHC providers themselves seems relatively low and imbalanced. To address the problem, SEANERN, through the collaboration of the members, can facilitate the appropriate education and training of PHC providers by developing feasible, practical and culturally appropriate training plans.


Assuntos
Competência Clínica , Pessoal de Saúde/normas , Atenção Primária à Saúde , Adulto , Ásia Sudeste , China , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Emprego , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
J Grad Med Educ ; 11(4 Suppl): 158-164, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428274

RESUMO

Background: Postgraduate medical education (PGME) has become increasingly individualized, and entrustable professional activities (EPAs) have been adopted to operationalize this. At the same time, the process and content to determine residents' progress using high-stakes summative entrustment decisions by clinical competency committees (CCCs) is not yet well established. Objective: We evaluated the experiences with a structured process for assessment of EPAs to attain uniform summative entrustment decisions for a national sample of pediatric residents. Methods: An EPA-based national PGME program for pediatric residents was introduced in the Netherlands, including a process of uniform summative entrustment decisions, termed the Evaluation and Assessment of Residents by Supervisors (EARS) procedure. To evaluate the program, we assessed survey data and information from invitational conferences. Results: Beginning in January 2017, 125 pediatric residents in all 8 Dutch residency regions started training in the EARS program. The program enabled robust summative entrustment decisions. Preliminary data suggested that faculty, despite increased preparation time, appreciated the comprehensive appraisal of resident qualifications. The EPA-based program was well accepted by residents. Fifty-one percent (57 of 112) had at least 2 EARS procedures per year, and for 75% (84 of 112) the level of supervision was often or always adjusted to their level of training. Conclusions: A national EPA-based program provided a structured process for summative entrustment decisions by CCCs and enabled individualized stepwise progression of residents toward unsupervised practice. Broader application of these concepts may require adaptations to accommodate different health care systems and specialties.


Assuntos
Competência Clínica/estatística & dados numéricos , Internato e Residência , Pediatria/educação , Avaliação de Programas e Projetos de Saúde , Educação Baseada em Competências/normas , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Docentes de Medicina , Humanos , Países Baixos , Inquéritos e Questionários
10.
Prev Vet Med ; 170: 104717, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421495

RESUMO

Antimicrobial use (AMU) in humans and animals facilitates the emergence of antimicrobial resistance (AMR). With increasing AMR being recognised as a major global threat for public health, responsible AMU is strongly advocated in both human and veterinary medicine. Knowledge on factors influencing antimicrobial prescribing behaviour of companion animal veterinarians is needed to promote responsible AMU in companion animals and to improve compliance with current legislation and guidelines. The present study aimed to quantitively investigate attitudes and perceptions of companion animal veterinarians towards AMU and AMR and to identify associations with demographic characteristics as possible explanatory variables. A self-administered questionnaire was developed based upon an earlier qualitative interview study, and 1608 potential participants (i.e. practising companion animal veterinarians) were invited. The questionnaire included questions addressing general descriptives of the respondents and questions with 6-point Likert scale statements, to assess attitudes towards AMU, AMR, factors influencing antimicrobial prescribing, and possible options to support responsible AMU. The response rate was 32% (22% when complete questionnaires considered). Categorical Principal Component Analysis (CATPCA) was conducted on 76 Likert scale questions. This resulted in a final model with 37 questions explaining 38.7% of the variance of the question scores, with three underlying dimensions ("attitudinal profiles"). Additionally, general descriptives were added to the CATPCA as possible explanatory variables. The first dimension, related to "social responsibility" was positively associated with veterinarians working in clinics dedicated to companion animals, with veterinarians working in a referral clinic, and with more experienced veterinarians. The second dimension was related to "scepticism", which was positively associated with being a male veterinarian and with more experienced veterinarians. The third dimension was related to "risk avoidance", especially regarding surgical procedures, and was negatively associated with veterinarians working in clinics in urban areas and with veterinarians working part-time. Antimicrobial prescribing behaviour was self-reported to be well considered, and respondents did not see economic drivers as important influencing factors. The unwillingness of owners and financial constraints were perceived as important barriers for performing further diagnostics. To improve AMU, a multifaceted approach, taking differences between companion animal veterinarians (e.g., in experience and gender) and differences in work situation (e.g., full-time versus part-time) into account, should be directed at companion animal veterinarians and owners. Moreover, a joint and comprehensive effort of several stakeholders, like veterinary nurses, guideline developers, pharmaceutical industry, and providers of diagnostics, is needed to optimise AMU in companion animals.


Assuntos
Anti-Infecciosos/uso terapêutico , Atitude , Competência Clínica/estatística & dados numéricos , Resistência Microbiana a Medicamentos , Percepção , Médicos Veterinários/psicologia , Animais , Países Baixos , Animais de Estimação , Médicos Veterinários/estatística & dados numéricos
11.
Malar J ; 18(1): 260, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362736

RESUMO

BACKGROUND: Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana. METHODS: A cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering. RESULTS AND DISCUSSION: Of the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their anti-malarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002-0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40-245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists. CONCLUSION: Dispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.


Assuntos
Antimaláricos/efeitos adversos , Competência Clínica/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmacêuticos/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/estatística & dados numéricos , Adulto Jovem
12.
BMC Res Notes ; 12(1): 485, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387624

RESUMO

OBJECTIVES: The aim of this study was to determine the level of knowledge and performance of nursing students in regard to the standards of nosocomial infections control. RESULTS: The average score of knowledge and performance of the subjects was 12.49 ± 2.3 from 18 and 43.07 ± 0.67 from 54, respectively. There was a direct and significant correlation between the knowledge and performance of students (r = 0.46, p < 0.0001). There was no statistically significant relationship between the knowledge of students and variables such as gender and academic year of the students, but there was a significant relationship between students' performance, and gender (p = 0.014) and academic year (p = 0.015).


Assuntos
Competência Clínica/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Enfermagem/estatística & dados numéricos , Competência Clínica/normas , Infecção Hospitalar/diagnóstico , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Inquéritos e Questionários
13.
J Laparoendosc Adv Surg Tech A ; 29(10): 1334-1341, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313947

RESUMO

Purpose: This study aimed to evaluate the learning effects of continuous training with a disease-specific endoscopic surgical simulator for young pediatric surgeons. Materials and Methods: Participants trained with a laparoscopic fundoplication simulator for 1 hour every 10 days. At the start of each training session, we assessed the participant's surgical technique using the surgical skill evaluation system, which evaluates the following items: (1) task time, (2) right-left balance of suturing, (3) suture spacing between the three ligatures, (4) total path length traveled by forceps, (5) velocity of the forceps tips, (6) length of the wrap, (7) number of ligature failures, and (8) comparison of improvements according to assessment point. We examined the learning effects of this continuous training program. Results: Task time, right-left balance of suturing, and sum of the distance traveled by each forceps showed significant progressive improvements (P < .05). Suture spacing and average velocity of forceps tips did not change significantly with training (P = .5781, P = .0781, respectively). However, the ratio of traveled distance between left and right forceps significantly improved (P < .05). There was a significant trend for the wrap length to approach the target value (P < .05). According to the linear mixed-effects model, the number of training sessions required for learning was not uniform and varied depending on the skill. Conclusion: This simulator training program can help pediatric surgeons to acquire surgical skills easily, economically, and safely. In the future, we need to evaluate how surgical skills acquired during this continuous training are reflected in clinical operations.


Assuntos
Fundoplicatura/educação , Laparoscopia/educação , Pediatria/educação , Treinamento por Simulação/métodos , Criança , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Laparoscopia/métodos , Curva de Aprendizado , Estudos Longitudinais , Masculino
14.
J Nurses Prof Dev ; 35(5): 261-267, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268922

RESUMO

This modified Delphi study determined consensus on core nurse competency program components that apply across the continuum of transition to initial practice, to new specialty practice, to a new role, or within general nursing orientation. The literature review found no published agreement on support and systems for universal transition programs. This broad-based study addressed this gap by identifying core elements within a competency or transition program and then ranking their importance within program structure.


Assuntos
Competência Clínica/estatística & dados numéricos , Currículo , Técnica Delfos , Capacitação em Serviço/normas , Humanos , Inquéritos e Questionários
15.
Rev Bras Enferm ; 72(3): 788-794, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269147

RESUMO

OBJECTIVE: Evaluate the contribution of debriefing after clinical simulations for nursing students. METHOD: Quantitative study, conducted with 35 nursing students who participated in five clinical simulation scenarios with planned debriefings based on the model of the National League Nursing/Jeffries Simulation Theory. After the fifth scenario, students answered the Debriefing Evaluation Scale associated with the Simulation. RESULTS: The items evaluated involved the psychosocial, cognitive, and affective values, and within a scale from one to five, the highest mean was found in cognitive value with 4.23 (±0.56) points, then in psychosocial value with 3.77 (±0.53), and finally in affective value with 3.71 (±0.63) points. CONCLUSION: The debriefing conducted after the clinical simulation scenarios was a reflective exercise that contributed to the student integrating multiple knowledges in affective, cognitive and psychosocial values, and thus develop the competencies required.


Assuntos
Avaliação Educacional/normas , Retroalimentação , Treinamento por Simulação/métodos , Treinamento por Simulação/normas , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Brasil , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Bacharelado em Enfermagem/métodos , Bacharelado em Enfermagem/normas , Avaliação Educacional/métodos , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Masculino
16.
Nurse Educ Pract ; 38: 45-51, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31176243

RESUMO

With increasing needs for evidence-based practice, the well-designed EBP education is necessary to enhance the critical thinking and decision-making skills of nursing undergraduates. This study is to evaluate the effectiveness of an evidence-based practice education program with blended learning on undergraduate nursing students. In this preliminary experimental study, 45 senior nursing undergraduates were recruited from a university in Seoul, Korea. Self-selection was used to create two groups: an intervention group and a control group consisting of 21 and 24 students, respectively. The intensive 30-hours evidence-based practice education program was provided to the intervention group. Evidence-based practice knowledge, self-efficacy, and evidence utilization were evaluated as outcome variables at baseline and two months after the intervention. There were no significant differences between the intervention and control groups on the background characteristics and outcome variables (p > .05). There were significant increases in evidence-based practice knowledge (Z = -5.28), self-efficacy (t = -6.42), resource utilization (Z = -2.60), and databases utilization (t = -2.98) in the intervention group, when compared with the control group (p < .01). Further studies are recommended to develop the evidence-based practice train-the-trainer program for nursing educators and to maximize the effectiveness of utilizing blended learning in evidence-based practice education.


Assuntos
Bacharelado em Enfermagem/métodos , Enfermagem Baseada em Evidências/educação , Distribuição de Qui-Quadrado , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Currículo/normas , Currículo/tendências , Feminino , Humanos , Masculino , República da Coreia , Autoeficácia , Estatísticas não Paramétricas , Adulto Jovem
17.
Nurse Educ Today ; 80: 85-90, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31253442

RESUMO

BACKGROUND: Workplace learning in hospitals consists mostly of informal learning processes that take place during specific work situations. Informal learning and effective learning transfer are expected to have a positive impact on nurses' clinical performance. OBJECTIVES: The purpose of this study was to examine the influence of informal learning and learning transfer on nurses' clinical performance. DESIGN: A cross-sectional, descriptive survey study. METHODS: The study was conducted by 200 nurses, two tertiary university hospitals in South Korea. Characteristics of the participants, informal learning, learning transfer, and clinical performance of nurses were collected, using self-reported questionnaires, from February to March 2018. Data were analyzed by t-test or analysis of variance, Pearson's correlation coefficient, and hierarchical multiple regression analysis. RESULTS: The factors related to the nurse's clinical performance were clinical career, voluntary participation in clinical performance-related education, and the explanatory power of the model was 22.4%. When informal learning was added to the model, clinical career, informal learning, and voluntary participation in education were significantly related to clinical performance and the explanatory power increased by 4.9%. Finally, when learning transfer was added, learning transfer and clinical career level were determined to be influencing factors on clinical performance, and the explanatory power increased by 10.3%. The total explanatory power of the model was 37.6% (F=11.906, p<.001). CONCLUSIONS: This study found that significant correlations have been confirmed between the variables and learning transfer was an influential factor in clinical performance. Based on these results, the researchers suggest encouraging informal learning and developing learning transfer programs that consider the nurses' careers.


Assuntos
Competência Clínica/normas , Enfermeiras e Enfermeiros/normas , Atitude do Pessoal de Saúde , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Humanos , Enfermeiras e Enfermeiros/estatística & dados numéricos , República da Coreia , Inquéritos e Questionários , Pesquisa Médica Translacional/métodos
18.
Eur J Radiol ; 116: 14-20, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153555

RESUMO

PURPOSE: To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS: We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS: The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS: IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.


Assuntos
Terapia Biológica/métodos , Pulmão/patologia , Pneumotórax/epidemiologia , Pneumotórax/prevenção & controle , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/efeitos adversos , Tubos Torácicos/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Afr J Prim Health Care Fam Med ; 11(1): e1-e10, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31170792

RESUMO

BACKGROUND: In primary care, patients present with multimorbidity and a wide spectrum of undifferentiated illnesses, which makes the application of evidence-based practice (EBP) principles more challenging than in other practice contexts. AIM: The goal of this study was to explore the experiences and understanding of family physicians (FP) in primary care with regard to EBP and the implementation of evidence-based guidelines. SETTING: The study was conducted in Cape Town primary care facilities and South African university departments of Family Medicine. METHODS: For this phenomenological, qualitative study, 27 purposefully selected FPs from three groups were interviewed: senior academic FPs; local FPs in public-sector practice; and local FPs in private-sector practice. Data were analysed using the framework method with the assistance of ATLAS.ti, version 6.1. RESULTS: Guideline development should be a more inclusive process that incorporates more evidence from primary care. Contextualisation should happen at an organisational level and may include adaptation as well as the development of practical or integrated tools. Organisations should ensure synergy between corporate and clinical governance activities. Dissemination should ensure that all practitioners are aware of and know how to access guidelines. Implementation should include training that is interactive and recognises individual practitioners' readiness to change, as well as local barriers. Quality improvement cycles may reinforce implementation and provide feedback on the process. CONCLUSION: Evidence-based practice is currently limited in its capacity to inform primary care. The conceptual framework provided illustrates the key steps in guideline development, contextualisation, dissemination, implementation and evaluation, as well as the interconnections between steps and barriers or enablers to progress. The framework may be useful for policymakers, health care managers and practitioners in similar settings.


Assuntos
Competência Clínica/estatística & dados numéricos , Prática Clínica Baseada em Evidências/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Humanos , Pesquisa Qualitativa , África do Sul
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