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JAMA ; 323(1): 33-34, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910264

Médicos , Humanos
Br J Gen Pract ; 70(690): 12-13, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31879293
Einstein (Sao Paulo) ; 18: eRW4852, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618287


The objective of this study was to identify the variables that influence physicians to implement Advance Directives and assess their impact on end-of-life care. It is a narrative literature review of 25 articles published between 1997 and 2018, in the following databases: CAPES, EBSCOhost, BDTD, VHL, Google Scholar, MEDLINE®/PubMed. The keywords utilized were: "advance directives", "living wills", "physicians", "attitude", "decision making", "advance care planning". The main factors that influenced physicians to implemente the directives were patients prognosis, medical paternalism, and patients understanding of their medical condition. Respect for autonomy, lack of knowledge and experience with directives, legal concerns, family influence, cultural and religious factors also contributed to medical decision. Most studies (86%) showed that having a directive led to lower rates of invasive interventions in the last days of patient´s life. Physicians were interested in respecting their patients' autonomy and agreed that having an advance directive helped in the decision-making process; however, they stated other factors were also taken into account, mainly prognosis and reversibility conditions. Having directives contributed to reducing the use of life support therapies and adoption of comfort measures.

Adesão a Diretivas Antecipadas/psicologia , Médicos/psicologia , Assistência Terminal , Diretivas Antecipadas , Atitude do Pessoal de Saúde , Tomada de Decisões , Humanos , Paternalismo , Autonomia Pessoal
Ann Otol Rhinol Laryngol ; 129(1): 23-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31409114


OBJECTIVE: National guidelines recommend lung cancer screening (LCS) using low-dose computed tomography (LDCT) for high-risk patients, including survivors of other tobacco-related cancers like head and neck cancer (HNC). This qualitative study investigated clinicians' practices and attitudes toward LCS with LDCT with patients who have survived HNC, in the context of mandated requirements for shared decision making (SDM) using decision aids. METHODS: Thematic analysis of transcribed semi-structured clinician interviews and focus group. RESULTS: Clinicians recognized LCS' utility for some HNC survivors with smoking histories. However, they identified many challenges to SDM in diverse clinic settings, including time, workflow, uncertainty about guidelines and reimbursement, decision aids, competing patient priorities, unclear evidence, potentially heightened patient receptivity and stress, and the complexity of discussions. They also identified challenges to LCS implementation. CONCLUSIONS: While clinicians feel that LDCT LCS may benefit some HNC survivors, there are barriers both to implementing LCS SDM for these patients in primary care as currently recommended and to integrating it into cancer clinics. Challenges for SDM across settings include a lack of decision aids tailored to patients with cancer histories. Given recommendations to broaden LCS eligibility criteria, more research may be required before refinement of current guidelines.

Atitude do Pessoal de Saúde , Sobreviventes de Câncer , Neoplasias de Cabeça e Pescoço , Neoplasias Pulmonares/diagnóstico por imagem , Médicos , Detecção Precoce de Câncer , Humanos , Oncologistas , Médicos de Atenção Primária , Padrões de Prática Médica , Pesquisa Qualitativa , Tomografia Computadorizada por Raios X
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 246-251, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047990


Objetivo: identificar o conhecimento de profissionais de saúde de unidades básicas de saúde da família sobre o manejo clínico da suspeita de febre de Chikungunya. Método: realizou-se um estudo transversal com 31 profissionais de saúde de unidades básicas e saúde da família, localizadas no Município de Quixadá-Ceará, nos meses de janeiro e fevereiro de 2018. Resultados: quase todos relatam que ao avaliar sinais de gravidade, critérios de internação e grupos de risco, se o paciente não apresentar sinais de gravidade, não tiver critérios de internação e/ou condições de risco, o mesmo deve permanecer em acompanhamento ambulatorial; se o paciente for apenas do grupo de risco, o mesmo deve receber acompanhamento ambulatorial em observação; e se o paciente apresentar sinais de gravidade e/ou tiver critérios de internação, ele deve receber acompanhamento em internação. Conclusão: os profissionais de saúde possuem conhecimento satisfatório sobre o manejo clínico da doença baseado nas orientações do Ministério da Saúde

Objective: to identify the knowledge of health professionals of family health basic units on the clinical management of suspected chikungunya fever. Method: a cross-sectional study with 31 healthcare professionals of basic units and family health, located in the city of Quixadá - Ceará, in the months of January and February 2018. Results: almost all report to evaluate signs of severity, admission criteria and risk groups, if the patient does not show signs of seriousness does not meet criteria for hospitalization and risk conditions/or should stay in outpatient follow-up; If the patient is only a risk group, he/she must be referred to outpatient follow-up for observation; and if the patient shows signs of severity and/or admission criteria, he should receive follow-up in hospital. Conclusion: health professionals have satisfactory knowledge on the clinical management of the disease based on the guidelines of the Ministry of Health

Objetivo: identificar el conocimiento de la salud profesionales de unidades básicas de salud de la familiaenel manejo clínico de só pecha Chikungunya fiebre. Método: estudio transversal con 31 profesionales de la salud de unidades básicas y de salud familiar, ubicado em la ciudad de Quixadá - Ceará, em los meses de enero y febrero de 2018. Resultados: informe casi todos para evaluar signos de gravedad, grupos de criterios de admisión y el riesgo, si el paciente no no mostrar signos de seriedad no tienen criterios para las condiciones de la hospitalización y el riesgo/unidad organizativa, debe mantenerse en seguimiento ambulatorio; Si el paciente es sóloel grupo de riesgo, el mismo debe recibir seguimento ambulatorio de observación; y si el paciente muestra signos de criterios de severidad y/o admisión, deben recibir seguimento em hospitalización. Conclusión: profesionales de la salud tienen conocimiento satisfactorio em el manejo clínico de la enfermedad basada en las directrices del Ministerio de Salud

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Médicos , Conhecimentos, Atitudes e Prática em Saúde , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/terapia , Enfermeiras e Enfermeiros , Atenção Primária à Saúde , Vírus Chikungunya , Estudos Transversais , Estratégia Saúde da Família
Wiad Lek ; 72(11 cz 1): 2172-2181, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31860867


The development of medical sciences is associated with conducting medical experiments. However, they raise social concerns. Every year in Poland, medical experiments are carried out with the participation of man and doctors participate in them. Clinical trials are a special type of medical experiment. The law regulates the principles of performing medical experiments. The purpose of the article is to present the legal conditions for conducting medical experiments in the Polish healthcare system.

Médicos , Humanos , Consentimento Livre e Esclarecido , Masculino , Polônia
J Opioid Manag ; 15(6): 479-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850509


INTRODUCTION: In response to the US opioid epidemic, the Centers for Disease Control and Prevention issued a guideline (CDCG) for prescribing opioids for chronic pain. Successful implementation of the CDCG requires identification of the information, skills, and support physicians need to carry out its recommendations. However, such data are currently lacking. METHODS: The authors performed one-on-one interviews with nine practicing physicians regarding their needs and perspectives for successful CDCG implementation, including the perceived barriers, focusing on communication strategies. Interviews were audio recorded, transcribed, and a thematic qualitative analysis was performed. FINDINGS: Three major themes were identified: communication, knowledge, and information technology (IT). Physicians reported that open communication with patients about opioids was difficult and burdensome, but essential; they shared their communication strategies. Knowledge gaps included patient-specific topics (eg, availability of/insurance coverage for non-opioid treatments) and more general areas (eg, opioid dosing/equivalencies, prescribing naloxone). Finally, physicians discussed the importance of innovation in IT, focusing on the electronic medical record for decision support and to allow safer opioid prescribing within the time constraints of clinical practice. DISCUSSION: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain.

Analgésicos Opioides , Comunicação , Registros Eletrônicos de Saúde , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Tomada de Decisões , Humanos , Naloxona , Médicos , Pesquisa Qualitativa
BMJ ; 367: l6354, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852682


OBJECTIVE: To determine whether fast driving, luxury car ownership, and leniency by police officers differ across medical specialties. DESIGN: Observational study. SETTING: Florida, USA. PARTICIPANTS: 5372 physicians and a sample of 19 639 non-physicians issued a ticket for speeding during 2004-17. MAIN OUTCOME MEASURES: Observed rates of extreme speeding (defined as driving >20 mph above the speed limit), luxury car ownership, and leniency of the speeding ticket by police officers, by physician specialty, after adjustment for age and sex. RESULTS: The sample included 5372 physicians who received 14 560 speeding tickets. The proportion of drivers who were reported driving at speeds greater than 20 mph was similar between physicians and a sample of 19 639 non-physicians who received a ticket for speeding (26.4% v 26.8% of tickets, respectively). Among physicians who received a ticket, psychiatrists were most likely to be fined for extreme speeding (adjusted odds ratio of psychiatry compared with baseline specialty of anesthesia 1.51, 95% confidence interval 1.07 to 2.14). Among drivers who received a ticket, luxury car ownership was most common among cardiologists (adjusted proportion of ticketed cardiologists who owned a luxury car 40.9%, 95% confidence interval 35.9% to 45.9%) and least common among physicians in emergency medicine, family practice, pediatrics, general surgery, and psychiatry (eg, adjusted proportion of luxury car ownership among family practice physicians 20.6%, 95% confidence interval 18.2% to 23.0%). Speed discounting, a marker of leniency by police officers in which ticketed speed is recorded at just below the threshold at which a larger fine would otherwise be imposed, was common, but rates did not differ by specialty and did not differ between physicians and a sample of non-physicians. CONCLUSIONS: Rates of extreme speeding were highest among psychiatrists who received a ticket, whereas cardiologists were the most likely to be driving a luxury car when ticketed. Leniency by police officers was similar across specialties and between physicians and non-physicians.

Condução de Veículo/psicologia , Médicos/psicologia , Adulto , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade
Medicine (Baltimore) ; 98(51): e18491, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861034


To describe how patient characteristics influence physician decision-making about glycemic goals for Type 2 diabetes.2016 survey of 357 US physicians. The survey included two vignettes, representing a healthy patient and an unhealthy patient, adapted from a past survey of international experts and a factorial design vignette that varied age, heart disease history, and hypoglycemia history. Survey results were weighted to provide national estimates.Over half (57.6%) of physicians recommended a goal HbA1c <7.0% for most of their patients. For the healthy patient vignette, physicians recommended a goal similar to that of international experts (<6.66% (95% Confidence Interval (CI), 6.61-6.71%) vs <6.5% (Interquartile range (IQR), 6.5-6.8%)). For the unhealthy patient, physicians recommended a lower goal than international experts (<7.38% (CI, 7.30-7.46) vs <8.0% (IQR, 7.5-8.0%)). In the factorial vignette, physicians varied HbA1c goals by 0.35%, 0.06%, and 0.28% based on age, heart disease history, and hypoglycemia risk, respectively. The goal HbA1c range between the 55-year-old with no heart disease or hypoglycemic events and the 75-year-old with heart disease and hypoglycemic events was 0.65%.Despite guidelines that recommend HbA1c goals ranging from <6.5% to <8.5%, US physicians seem to be anchored on HbA1c goals around <7.0%.

Diabetes Mellitus Tipo 2/terapia , Médicos/normas , Tomada de Decisão Clínica , Diabetes Mellitus Tipo 2/sangue , Humanos , Médicos/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
J Law Med ; 27(1): 20-28, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682338


In three judgments in favour of New South Wales medical practitioners between 2017 and 2019 the Supreme Court awarded ordinary and aggravated damages for harm done to professional reputations. The decisions in Al Muderis v Duncan (No 3) [2017] NSWSC 726, O'Neill v Fairfax Media Publications Pty Ltd (No 2) [2019] NSWSC 655 and Tavakoli v Imisides (No 4) [2019] NSWSC 7 are considered in the context of international decisions and analysis of doctors taking defamation action arising from online publications. Reflections are provided about the repercussions of the phenomenon, its commercial justification and the inhibitions that should be experienced before defamation and injurious falsehood actions are taken by medical practitioners.

Difamação , Médicos , Humanos , New South Wales
JAMA ; 322(18): 1832, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31714978
Rev Med Suisse ; 15(673): 2205-2208, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778051


With the development of new technologies, smartphones are now ubiquitous and occupy a growing place in the medical world. More and more applications are developed in the medical field, either for medical education or as knowledge resources to help physicians guide their treatment, and have been regrouped under the name of mobile-learning or m-learning. Because of an increasing demand of students from the Faculty of Medicine in Geneva University, we developed a smartphone and tablet application, called Head To Toe, which is a mobile medical knowledge distribution platform. After successful implementation for students, the platform is now extending to postgraduate formation and to hospital physicians. We describe here how the application works, its role for students and physicians, with examples related to urology.

Educação Médica , Aplicativos Móveis , Smartphone , Urologia/métodos , Humanos , Médicos , Estudantes de Medicina
BMJ ; 367: l6541, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31732513
Pan Afr Med J ; 33: 225, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692825


Drawing up the medical certificate is a crucial step in the judicial process. This judicial document should be drafted during a medical legal consultation. This study aims to evaluate the quality of medical certificates in a medico-judicial consultation and to study interpretative criteria of medical certificate validity. We conducted a retrospective study of patient's victims of intentional wounds and blows receiving a medico-judicial consultation at the Grand Yoff General Hospital, from April 2012 to February 2015. The whole of medical certificates were recorded on a survey form analyzed by Epi Info Version 6.04. The whole of the 249 certificates studied was printed in legible and understandable "Arial police 12". All the studied medical certificates included complete identification of the physician and the victim. The date and the time of aggression were written in 248 certificates (99.6%). The type of abuse suffered was specified on the whole of the 249 certificates: 164 brawls (65.9%), 64 unilateral aggressions (25.7%). The precise description and nature of the lesions was written in 246 certificates. The site of the lesions was established based on fixed anatomical landmarks in the various body plans. Medico-judicial consultation, coordinated by the forensic physician, helped to significantly improve the quality of the documents issued. The dissemination of these drafting practices and of the practices concerning the issuing of certificates is essential in particular in the regional hospital as part of an ongoing training or postgraduate training.

Documentação/normas , Medicina Legal/legislação & jurisprudência , Violência/legislação & jurisprudência , Adolescente , Adulto , Idoso , Agressão , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Médicos/organização & administração , Estudos Retrospectivos , Senegal , Adulto Jovem
Rev Med Suisse ; 15(670): 2053-2055, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696681


Openly talking with caregivers and physicians about medical decisions to prolong life, such as cardiopulmonary resuscitation, offers patients the opportunity to ensure that these decisions will be in line with their values and expectations, and thereby promote their autonomy and responsibility in health care. In order to support -informed and shared decision-making, it is important to share with the patient relevant information concerning their life-threatening condition (including risks of cardiac arrest, risks associated with the resuscitation procedure, immediate and long-term survival, and the impact of the procedure on quality of life), and encourage a -holistic discussion of the goals of care.

Reanimação Cardiopulmonar , Tomada de Decisões , Médicos , Idoso , Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca , Humanos , Relações Médico-Paciente , Qualidade de Vida
BMJ ; 367: l6208, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666221
Rev Med Suisse ; 15(672): 2145-2149, 2019 Nov 20.
Artigo em Francês | MEDLINE | ID: mdl-31746571


The electrocardiogram, chest x-ray, and skin lesion interpretation are a diagnostic process that applies image analysis. Knowledge and sufficient clinical experience are necessary to achieve expertise in these fields. However, recent advances in medical informatics, particularly in deep learning, are challenging this diagnostic process and physicians' performance. Only a fraction of clinical diagnostic support based on artificial intelligence (AI) has been validated in a clinical environment, limiting its use at the patient's bedside. Gradual AI integration into medical practice will require that the physicians remain able to assess the strengths and limitations of these new algorithms.

Inteligência Artificial , Competência Clínica , Educação Médica , Informática Médica/métodos , Informática Médica/tendências , Médicos , Humanos