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1.
Rev Epidemiol Sante Publique ; 67(3): 201-204, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31006583

RESUMO

INTRODUCTION: The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48hours. A specific medical cover was organized in a particular "post-attacks" context and with harsh constraints due to delimitation of an inner zone under the sole UN authority ("blue zone"). OBJECTIVE: To evaluate medical means involved and medical activity. METHODS: Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the "blue zone". End-points: engaged workforce, number of visits, including transfers and medicalized transfers. RESULTS: In "France zone" (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In "blue zone": 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43±1 years. Trauma patients were most numerous (20%). CONCLUSION: Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required.


Assuntos
Mudança Climática , Medicina de Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Nações Unidas/organização & administração , Adulto , Aeroportos/organização & administração , Congressos como Assunto/organização & administração , Feminino , França , Humanos , Masculino , Corpo Clínico/organização & administração , Pessoa de Meia-Idade , Encaminhamento e Consulta/organização & administração , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Transporte de Pacientes/organização & administração
3.
Ir J Med Sci ; 187(2): 447-452, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28735501

RESUMO

INTRODUCTION: Systematic review and meta-analysis are statistical tools used to review researches performed on a same topic. They extract the collective effect of the studies performed on the topic of interest after statistically analysing the data of all the studies included. AIMS AND OBJECTIVES: Systematic reviews and meta-analysis are getting more and more popular in the medical field. Statistics is never the strong aspect of medical professionals, and facing a large number of statistical tests and values could be quite confusing for them. The aim of this article is to simplify these two very important research modalities for medical professionals. CONCLUSION: This article will provide a step-to-step guide for the medical colleagues to perform a meta-analysis if they are interested.


Assuntos
Pesquisa Biomédica/métodos , Corpo Clínico/organização & administração , Humanos
4.
Gac. sanit. (Barc., Ed. impr.) ; 31(6): 459-465, nov.-dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-168534

RESUMO

Objetivo: Analizar, desde la perspectiva del personal médico, las condiciones laborales de los consultorios adyacentes a farmacias privadas (CAF), así como sus elementos organizativos. Método: Estudio cualitativo exploratorio consistente en entrevistas semiestructuradas a 32 médicos/as de los CAF en Ciudad de México. Se utilizó la técnica de análisis de contenido dirigido basado en códigos previamente construidos y emergentes, relacionados con la experiencia vivida de los sujetos en su campo laboral. Resultados: El personal médico percibió que trabajar en los CAF no cumple con sus expectativas profesionales por la baja remuneración, la informalidad en la contratación y la ausencia de garantías laborales establecidas en la ley. Esto les impide disfrutar de los beneficios asociados con el empleo formal y sustenta el deseo de laborar en los CAF solo de manera temporal. Consideraron que los incentivos económicos por número de consultas, procedimientos y ventas alcanzadas por la farmacia les permiten aumentar su ingreso sin influir en su conducta prescriptiva. Señalaron que los sistemas de supervisión y presión en los CAF buscan afectar su autonomía para activar la venta de medicamentos en la farmacia. Conclusiones: El personal médico que labora en CAF enfrenta una difícil situación laboral. Los elementos gerenciales usados para inducir la prescripción y activar las ventas de las farmacias conforman un entorno laboral que genera retos en materia de regulación, y subraya la necesidad de monitorear la calidad de los servicios brindados en estos consultorios y los posibles riesgos a los usuarios (AU)


Objective: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. Methods: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. Results: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. Conclusions: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Condições de Trabalho , Consultórios Médicos/organização & administração , Farmácias , Prescrições de Medicamentos/normas , México/epidemiologia , 25783/métodos , Corpo Clínico/organização & administração , Análise de Dados/métodos
5.
Artigo em Inglês | MEDLINE | ID: mdl-28566135

RESUMO

The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic Systemtm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Laparoscopia/educação , Corpo Clínico/educação , Procedimentos Cirúrgicos Robóticos/educação , Centros Cirúrgicos/organização & administração , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Laparoscopia/métodos , Corpo Clínico/organização & administração , Procedimentos Cirúrgicos Robóticos/métodos
6.
BMJ Open ; 7(6): e015134, 2017 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-28600370

RESUMO

INTRODUCTION: In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. METHODS AND ANALYSIS: This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. ETHICS AND DISSEMINATION: The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government.


Assuntos
Corpo Clínico/organização & administração , Profissionais de Enfermagem/organização & administração , Casas de Saúde/organização & administração , Assistentes Médicos/organização & administração , Atenção Primária à Saúde/organização & administração , Humanos , Modelos Organizacionais , Países Baixos , Casas de Saúde/normas , Qualidade da Assistência à Saúde/normas
7.
PLoS One ; 12(6): e0179355, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28622379

RESUMO

BACKGROUND: Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. METHODS AND FINDINGS: Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. CONCLUSIONS: The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde , Demência , Corpo Clínico , Assistência Terminal , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Feminino , Humanos , Masculino , Corpo Clínico/organização & administração , Corpo Clínico/normas , Guias de Prática Clínica como Assunto , Assistência Terminal/métodos , Assistência Terminal/organização & administração , Assistência Terminal/normas , Reino Unido
8.
Qual Manag Health Care ; 25(2): 85-91, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27031357

RESUMO

This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement-drivers. Each group's profile was then analyzed on the basis of concept of professional culture.


Assuntos
Corpo Clínico/organização & administração , Corpo Clínico/psicologia , Recursos Humanos de Enfermagem no Hospital/organização & administração , Recursos Humanos de Enfermagem no Hospital/psicologia , Melhoria de Qualidade/legislação & jurisprudência , Atitude do Pessoal de Saúde , Comunicação , Comportamento Cooperativo , Humanos , Cultura Organizacional , Equipe de Assistência ao Paciente , Papel Profissional , Suécia
9.
J Psychoactive Drugs ; 48(2): 101-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26940870

RESUMO

"Drug-free" outpatient programs deliver treatment to the largest number of patients of all treatment modalities in the U.S., providing a significant opportunity to expand access to medication treatments for substance use disorders. This analysis examined staff perceptions of organizational dynamics associated with the delivery of buprenorphine maintenance within three formerly "drug-free" outpatient treatment programs. Semi-structured interviews (N = 15) were conducted with counseling and medical staff, and respondents were predominantly African American (n = 11) and female (n = 12). Themes and concepts related to medical staff integration emerged through an inductive and iterative coding process using Atlas.ti qualitative analysis software. Two treatment clinics incorporated buprenorphine maintenance into their programs using a co-located model of care. Their staff generally reported greater intra-organizational discord regarding the best ways to combine medication and counseling compared to the clinic using an integrated model of care. Co-located program staff reported less communication between medical and clinical staff, which contributed to some uncertainty about proper dosing and concerns about the potential for medication diversion. Clinics that shift from "drug-free" to incorporating buprenorphine maintenance should consider which model of care they wish to adapt and how to train staff and structure staff communication.


Assuntos
Assistência Ambulatorial/métodos , Buprenorfina/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Afro-Americanos , Assistência Ambulatorial/organização & administração , Comunicação , Aconselhamento/organização & administração , Feminino , Pessoal de Saúde/organização & administração , Humanos , Entrevistas como Assunto , Masculino , Corpo Clínico/organização & administração , Modelos Teóricos , Pacientes Ambulatoriais , Centros de Tratamento de Abuso de Substâncias/organização & administração , Estados Unidos
11.
Am J Infect Control ; 44(1): 8-13, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-26341402

RESUMO

BACKGROUND: Standard precautions (SPs) aim to reduce the risk of cross-transmission of microorganisms. The objectives of the present study were to assess institutional policies for SPs promotion, available resources for SPs implementation, and education of health care workers (HCWs) and their compliance with SPs. METHODS: A multisite mixed-methods audit was conducted in 2011. Self-assessment questionnaires were administered at institution, ward, and HCW levels in French health care facilities (HCFs). Results were given as percentage of objectives achieved (POA) or percentage of "never or sometimes," "often," and "always" responses for each question. RESULTS: A total of 1599 HCFs participated, including 14,968 wards and 203,840 HCWs. At an institutional level, the POA was 88%, covering SPs promotion (91%), procedures (99%), and SPs evaluation (63%). At the ward level, the POA was 94%, covering procedures (95%) and resources (93%). HCWs reported the best compliance for changing gloves between patients (94.5% "always"), and the worst compliance for the use of gloves for intramuscular injection and the use of eye protection in cases of blood exposure risk (34.5% and 24.4% of "always," respectively). CONCLUSIONS: A literature review found no other study of SPs that included such a large study group. These results led to SPs promotion actions at local and regional levels. Reinforcement of SPs observance will be prioritized in the next national program from the French Ministry of Health.


Assuntos
Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes , Instalações de Saúde , Controle de Infecções , Corpo Clínico/organização & administração , Dispositivos de Proteção dos Olhos , França , Luvas Protetoras , Desinfecção das Mãos , Pessoal de Saúde , Hospitais , Humanos , Masculino , Exposição Ocupacional , Inquéritos e Questionários , Precauções Universais
13.
Rev. psicol. trab. organ. (1999) ; 31(3): 207-213, dic. 2015. tab
Artigo em Inglês | IBECS | ID: ibc-146254

RESUMO

Work stress has extremely significant consequences to the individual and to the organization (Barling, Kelloway, & Frone, 2005). This study examined the relationship between perceived work stress, burnout, satisfaction at work, and turnover intentions. We hypothesized that a positive relationship would be found between work stress and burnout, and negative relationships would be found between burnout and satisfaction, and between satisfaction and turnover intentions. The sample included 124 hospital physicians. As expected, all our hypotheses were corroborated. Structural Equation Modeling (SEM) found that beyond the assumed direct relationships, burnout partially mediated between work stress and work satisfaction, and work satisfaction partially mediated the relationship between burnout and turnover intentions. The paper reviews the theoretical consequences and suggests ideas for future research (AU)


El estrés laboral tiene consecuencias muy importantes para la persona y para la organización (Barling, Kelloway y Frone, 2005). Este estudio analiza la relación entre estrés laboral percibido, agotamiento (burnout), satisfacción laboral e intención de abandono. Planteamos las hipótesis de que habría una relación positiva entre estrés laboral y agotamiento y negativa entre este último y satisfacción y entre esta y la intención de abandono. La muestra estaba compuesta por 124 médicos de hospital. Según lo esperado, se corroboraron todas las hipótesis. El modelo de ecuaciones estructurales demostró que más allá de las supuestas relaciones directas, el agotamiento mediaba parcialmente entre el estrés laboral y la satisfacción laboral y esta mediaba parcialmente la relación entre agotamiento e intención de abandono. El trabajo revisa las consecuencias teóricas y propone ideas para la futura investigación (AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Corpo Clínico/organização & administração , Corpo Clínico/psicologia , Esgotamento Profissional/fisiopatologia , Esgotamento Profissional/psicologia , Psicometria/normas , Modelos Estruturais
14.
CJEM ; 17(4): 411-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25858016

RESUMO

INTRODUCTION: The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. METHODS: An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. RESULTS: During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. CONCLUSIONS: Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/organização & administração , Corpo Clínico/organização & administração , Satisfação Pessoal , Triagem/métodos , Adulto , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Retrospectivos
17.
J Med Pract Manage ; 29(6): 373-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25108986

RESUMO

Unfortunately, cliques aren't a problem that you left behind in high school. Workplace cliques can be just as or even more troubling for you today, especially if they have the potential to affect your career, employee morale and performance, and your medical practice more broadly. This article describes workplace cliques in detail. It provides examples of exclusionary and ostracizing behaviors that are often associated with cliques. And it describes the prevalence and effects of cliques in today's workplace. This article also provides practice managers with 10 tips for discouraging and managing cliques. It describes five common workplace cliques: management, veteran, prior relationship, status, and homophily. It offers medical staff employees 10 strategies for working effectively alongside of a clique. Finally this article describes the pitfalls and risks of belonging to a workplace clique.


Assuntos
Moral , Administração de Recursos Humanos/métodos , Administração da Prática Médica/organização & administração , Rejeição em Psicologia , Identificação Social , Hierarquia Social , Humanos , Relações Interpessoais , Corpo Clínico/organização & administração , Negociação
19.
BMC Health Serv Res ; 14: 244, 2014 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-24903706

RESUMO

BACKGROUND: To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff. METHODS: We conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases. RESULTS: Participants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these 'local interaction strategies'. We categorized these two sets of local interaction strategies as the 'common pattern' and the 'positive pattern' and summarize the results in two models of local interaction. CONCLUSIONS: The findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.


Assuntos
Corpo Clínico/organização & administração , Casas de Saúde/organização & administração , Cultura Organizacional , Melhoria de Qualidade , Adulto , Feminino , Administradores de Instituições de Saúde , Humanos , Relações Interprofissionais , Masculino , Auditoria Médica , Pessoa de Meia-Idade , North Carolina , Casas de Saúde/normas , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa , Recursos Humanos , Adulto Jovem
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