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1.
Einstein (Sao Paulo) ; 18: eRW4852, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618287

RESUMO

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.


Assuntos
Adesão a Diretivas Antecipadas/psicologia , Médicos/psicologia , Assistência Terminal , Diretivas Antecipadas , Atitude do Pessoal de Saúde , Tomada de Decisões , Humanos , Paternalismo , Autonomia Pessoal
2.
BMJ ; 367: l6208, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666221
3.
Ther Umsch ; 76(5): 231-238, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31577188

RESUMO

The importance of communication between physicians and patients Abstract. The communication between physician and patient is the basement of good medical care. That is why communication skills are seen as a core competence of medical professionals. Communication has an impact on medical treatment and patient outcomes, creates confidence and prevents medical errors. Both, patient and physician centred communication, enables the physician to establish a diagnosis by history taking alone in up to 80 % of all consultations. Alongside collecting medical information, disclosure of complex information or breaking bad news play an important role in medical communication. Good communication not only leads to better patients' and relatives' satisfaction but may also improve their outcome.


Assuntos
Comunicação , Relações Médico-Paciente , Humanos , Médicos/psicologia , Encaminhamento e Consulta , Revelação da Verdade
6.
J Clin Ethics ; 30(3): 201-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573962

RESUMO

Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians' and parents' decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child's basic needs or primary goods, and both physicians and parents should be guided by a commitment to protect a child's basic needs and primary goods. In contrast, we argue that no principle-neither Ross's CPA, nor the best interest standard or the harm threshold-can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments.


Assuntos
Tomada de Decisões , Pediatria , Médicos , Criança , Diversidade Cultural , Humanos , Pais
7.
J Clin Ethics ; 30(3): 232-239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573967

RESUMO

In their thoughtful critiques of my article "Better than Best (Interest Standard) in Pediatric Decision Making," my colleagues make clear that there is little consensus on what is (are) the appropriate guidance and intervention principles in pediatric decision making, and disagree about whether one principle can serve both functions. Hester proposes his own unitary principle, the reasonable interest standard, which, like the best interest standard from which it is derived, encourages parents to aim for the great, although Hester tempers it with a pragmatic principle that allows consideration of cultural and family values and practical, financial, social, or psychological circumstances. I reject the aspirational guidance principle because it is too demanding, and I also reject the notion that this pragmatic condition "gives permission for others to extol parents to give reasons" for their decisions, because it allows too much interference into the family and its decision making. Whereas the other respondents and I focus on whether and when third parties should intervene in the doctor-patient (surrogate) relationship, Navin and Wasserman mistakenly redefine intervention to include physicians' behaviors that attempt to influence parents, ignoring the integral role of shared decision making-a bidirectional discussion in which physicians help patients (surrogates) select among reasonable medical options through education, and, when necessary, motivation or persuasion. Diekema and Salter focus on the harm principle for intervention, ignoring other conditions in which intervention may be appropriate and institutions other than the state that may intervene. Paquette's overly narrow interpretation of who has positive obligations to children fails to ensure that a child's basic interests and needs are met. Finally, Bester claims that the "need to choose the available option that best promotes or protects the child's basic interests" is akin to a focus on best interests. But constrained parental autonomy does not require parents to choose the option that best promotes a child's basic interests. Rather, it requires respect for broad parental discretion about how they raise their child unless their decisions fail to promote the child's basic needs and interests.


Assuntos
Tomada de Decisões , Pais , Pediatria , Médicos , Criança , Humanos , Pediatria/ética , Relações Médico-Paciente
8.
Am J Bioeth ; 19(10): 59-60, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31566492
12.
Harefuah ; 158(10): 635-638, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576707

RESUMO

AIMS: In our article we seek to describe the initiation of new medical specialty fields in Israel, including the different considerations in the decision-making process and recent trends. BACKGROUND: Physicians' specialization by postgraduate training and specialty certification satisfies the publics' need for high quality medical treatment, supports medical institutions confidence in their medical staff qualifications, guarantees physicians' social accountability and is also linked with positive medical results. Nevertheless, fragmentation of medicine enfolds a hazard to continuity of medical care and loss of holistic perspectives, as well as hazards of systematic malfunction such as brain drain in vital basic specialties and high costs. METHODS: Information was gathered from the protocols of relevant deliberations conducted at the Scientific Council of the Israeli Medical Association, dealing with the initiation of new medical specialty fields and from relevant regulations. Numerical data was extracted from the IMA database. The information gathered was qualitatively analyzed by Template Analysis. RESULTS: Over two decades ranging between 1999 and 2019, three new medical specialties were initiated, including Emergency Medicine (1999), Pain Relief Medicine (2008) and Palliative Medicine (2012). The initiation of two other specialties, Invasive Neuro-Radiology and Metabolic Diseases, is still under process. The field of Child Development has joined an existing specialty in Pediatric Neurology, becoming a new specialty in Pediatric Neurology and Child Development in 2008, a new route for Pediatric Emergency Medicine branched out of Emergency Medicine (2008) and a new route for Pediatric Rheumatology branched out of Rheumatology (2013). We describe the different considerations taken into account, the prerequisites to initiation and milestones of the process, including grandfathering and accreditation. CONCLUSIONS: The trend of specialization in more medical fields will probably continue in the foreseen future. It will therefore continue to challenge the Scientific Council of the Israeli Medical Association with complex decision-making regarding the initiation of new medical professions or new routes within exciting professions.


Assuntos
Médicos , Especialização , Criança , Medicina de Emergência , Humanos , Israel , Neurologia
13.
Harefuah ; 158(10): 639-642, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576708

RESUMO

INTRODUCTION: Examinations are an integral part of the process of medical specialization in the State of Israel and a resident cannot receive an expert degree without passing the exams. The Scientific Council is the body responsible for the physician's training process, and the Higher Examinations Committee for the exams. Professional examinations committees are subject to the professional guidance by the Higher Examinations Committee. The residency exams are performed in two phases: Stage A (written examination) and Stage B (oral examination). Changes in Stage A exams, Stage B exams, and in the process of appeals to the exam results, are conducted after thorough thinking and testing procedures and under the guidance of professionals. During the course of the current Higher Examinations Committee, a number of significant changes were made in Stage A exams, including: 1. Reducing the number of questions in the surgical fields exams; 2. Consolidating the two parts of the exam in General Surgery, Urology, Vascular Surgery, Plastic Surgery, and Pediatric Surgery. 3. Exposing the questions and answers after the examination and altering the appeals process. There have also been changes in some specialties in Stage B exams according to the following rules: 1. Aspiration for multi-test stations; 2. Two examiners in each station; 3. Structured and unified content on all exam stations; 4. Structured evaluation forms; 5. Filling out the evaluation form by the examiners without consulting between them; 6. Automatic calculation of scores based on the percentage of accumulated points that the examinees accumulated from the maximum possible points; 7. An upfront decision on the passing score. The Higher Examinations Committee of the Scientific Council works, and will act constantly, for the construction of professional, fair, reliable and valid residency examinations.


Assuntos
Internato e Residência , Médicos , Faculdades de Medicina , Criança , Competência Clínica , Avaliação Educacional , Humanos , Israel , Especialização , Cirurgia Plástica
14.
Harefuah ; 158(10): 643-647, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576709

RESUMO

INTRODUCTION: During the last decades the dominant paradigm, in which the duration of a rotation/course, the required content to be learnt (the material covered) and a test (usually a multiple choice one) evaluating the knowledge of the content, were paramount, is being replaced by a new paradigm: outcome/competency based medical education (CBME, OBME). In this paper the reasons for adopting this change in the developed world are presented, its nature and basic assumptions enumerated and national examples of its adoption from Scotland, Canada, UK and USA described. We will present in some detail the changes this approach entails, the new definitions it adopts, the learning outcomes it aspires to and how to evaluate them. Finally, we will present a draft outcomes proposal adapted to the Israeli reality. Since the Medicine Deans Forum and the Scientific Council of the Israeli Medical Association have adopted the new paradigm for the training of Israeli physicians, it is an opportune moment to expose the readership of Harefuah (i.e. Israel's physicians and medical students) to this relatively new paradigm.


Assuntos
Educação Médica , Médicos , Estudantes de Medicina , Educação Baseada em Competências , Humanos , Israel
15.
Harefuah ; 158(10): 648-653, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576710

RESUMO

INTRODUCTION: The digital age has profoundly transformed our lives, including health and healthcare. The computer, the smart cellphone, digital communication, social networks, applications, the Electronic Medical Record, web-based medical knowledge availability, tele-medicine and a host of additional tools progress rapidly and seem to leave physicians behind, while the public adapts them willingly. This article enumerates the characteristics of the digital era in healthcare, Israel's leadership in health care application of information technology, the different domains of impact, additional competencies they mandate presently and, in the future, as well as associated ethical dilemmas. Subsequently, a road map is outlined to achieving the additional skills in all stages of the professional life cycle and through competency-based medical education, together with a vision of future medicine and the future physician. In conclusion, the hope that Israel's' doctors will resume a leadership role in the digital transformation of healthcare is expressed.


Assuntos
Comunicação , Liderança , Médicos , Humanos , Israel
16.
Harefuah ; 158(10): 654-655, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576711

RESUMO

INTRODUCTION: Post-Graduate Medical Education in the surgical professions, as in other medical professions as well, has gone through an organizational revolution during the past 10-15 years. Catalyzers of this change were the information revolution, technological changes, life-work balance needs of residents, legalization of the medical system and different duty hours' restrictions that followed. These changes require rethinking traditional Post-Graduate Medical Education and adaptation of teaching methods, quality measurement methods, new definition of program director's role and more. In this article we review these changes as they appear in updated literature and the significance of the changes in the Israeli health system since the last physicians' bargaining agreement of 2011.


Assuntos
Internato e Residência , Cirurgiões , Humanos , Admissão e Escalonamento de Pessoal , Médicos , Carga de Trabalho
17.
Harefuah ; 158(10): 680-684, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576717

RESUMO

INTRODUCTION: The Israeli Society of Internal Medicine (ISIM) has joined a journey led by the Scientific Council of the Israeli Medical Association (IMA) to improve the residency of physicians in Israel. The process of transformation from time and place-based residency to an outcome-oriented, competencies and assessment-based residency is a multi-step, complex process. We describe the theoretical basis of the need for transformation, examples of specific competencies (basic, relating to all residencies and unique, specific for internal medicine) and their means of assessment. Furthermore, we present several examples of similar processes being conducted worldwide. We describe the process so far and the future anticipated challenges. We foresee the residency transformation resulting in elevated professional excellence amongst internists in Israel. Also, we anticipate that residents' satisfaction will rise and eventually, patients will receive better diagnostic and treatment outcomes in our wards.


Assuntos
Medicina Interna , Internato e Residência , Médicos , Ultrassonografia , Competência Clínica , Humanos , Israel , Sistemas Automatizados de Assistência Junto ao Leito
18.
JAAPA ; 32(2): 52, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31579253

RESUMO

PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.1.


Assuntos
Profissionais de Enfermagem , Assistentes Médicos , Médicos , Idoso , Assistência Ambulatorial , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos , Estados Unidos
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