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1.
Artigo em Inglês | MEDLINE | ID: mdl-34063533

RESUMO

Occupational and non-occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in healthcare workers (HCWs), but studies evaluating risk factors for infection among physician trainees are lacking. We aimed to identify sociodemographic, occupational, and community risk factors among physician trainees during the first wave of coronavirus disease 2019 (COVID-19) in New York City. In this retrospective study of 328 trainees at the Mount Sinai Health System in New York City, we administered a survey to assess risk factors for SARS-CoV-2 infection between 1 February and 30 June 2020. SARS-CoV-2 infection was determined by self-reported and laboratory-confirmed IgG antibody and reverse transcriptase-polymerase chain reaction test results. We used Bayesian generalized linear mixed effect regression to examine associations between hypothesized risk factors and infection odds. The cumulative incidence of infection was 20.1%. Assignment to medical-surgical units (OR, 2.51; 95% CI, 1.18-5.34), and training in emergency medicine, critical care, and anesthesiology (OR, 2.93; 95% CI, 1.24-6.92) were independently associated with infection. Caring for unfamiliar patient populations was protective (OR, 0.16; 95% CI, 0.03-0.73). Community factors were not statistically significantly associated with infection after adjustment for occupational factors. Our findings may inform tailored infection prevention strategies for physician trainees responding to the COVID-19 pandemic.


Assuntos
Médicos , Teorema de Bayes , Pessoal de Saúde , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(22): e25833, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087826

RESUMO

ABSTRACT: The current status of the diagnosis and management of poststroke aphasia (PSA) in China is unknown.To analyze the physicians' strategy and knowledge about the management of PSA in clinical practice and the needs for standardization of diagnosis and treatment.This survey was conducted in March-August 2019 at 32 tertiary hospitals in 16 provinces/municipalities in China. The attending physicians from the Neurology and Neuro-rehabilitation/Rehabilitation Departments were included. The online questionnaire inquired about patient information, physicians' diagnosis and treatment behavior for PSA, and physicians' understanding of PSA.A total of 236 physicians completed the survey. Regarding PSA assessment, 99.2% of the physicians reported using medical history and physical examination, 93.2% reported using neuroimaging, and 76.3% reported using dedicated scales. Most physicians used a combination of drug and non-drug treatment. Neuro-regenerators/cerebral activators and anti-dementia drugs were the most common pharmacotherapies; butylphthalide, edaravone, and memantine were most frequently prescribed. Six months poststroke was rendered as a spontaneous language recovery period, and a ≥6-month treatment for PSA was suggested by many physicians. The lack of standardized treatment regimen/clinical guidelines and the limited number of approved drugs for PSA were the primary challenges encountered by physicians during practice. The majority of the physicians agreed with the necessity of guidelines or consensus for the diagnosis and treatment of PSA.The knowledge gaps exist among physicians in China regarding the assessment and management of PSA. The improved awareness of the available guidelines/consensus could improve the performance of the physicians.


Assuntos
Afasia/etiologia , Afasia/terapia , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Acidente Vascular Cerebral/complicações , Afasia/diagnóstico , Afasia/reabilitação , China , Inibidores da Colinesterase/uso terapêutico , Humanos , Fármacos Neuroprotetores/uso terapêutico , Médicos/psicologia , Padrões de Prática Médica
3.
Kardiologiia ; 61(5): 41-50, 2021 May 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34112074

RESUMO

Aim      To evaluate the frequency of off-label prescription of medicines in practice of clinical specialists and the awareness of respondents of the procedure of justified off-label prescription.Material and methods  The sample included 542 clinical specialists who worked in definite medical organizations in 26 entities of the Russian Federation. The respondents were proposed to fill in remotely an anonymous questionnaire to evaluate the experience of prescribing medicines off-label to adult patients.Results Prescribing medicines not in consistence with the officially approved instruction for medical use (off-label or "outside instruction") is a relevant issue of global medical care since convincing scientific evidence for safety of such use is scarce. Analysis of information about off-label prescription is one of current tasks of national medical research centers according to the Federal Project "Development of a network of national medical research centers and implementation of innovative medical technologies". According to the responses about the frequency of off-label prescriptions 67.5 % of respondents reported of no experience of off-label prescription, 27.7 % said "rarely" or "sometimes", and 4.8 % said "frequently" and "very frequently". Specialties of physicians who have more often used medicines off-label (50% and more) included obstetrics and gynecology, pediatrics, rheumatology, hematology, and pulmonology. Cardiologists, neurologists and clinical pharmacologists use medicines off-label relatively rarely (19.6%, 28.6 %, and 22.2 %, respectively). 40 % of medicines used off-label were those designed for the treatment of coronavirus infection SARS-CoV-2. The medicines most frequently used off-label included metformin, rituximab, and thioctic acid. 65 % of respondents assessed their knowledge of off-label prescription as insufficient. In addition, 75 % of respondents consider it useful to receive additional information about risks and benefits of off-label prescription in clinical practice.Conclusion      The survey revealed the need of physicians for information about risks of the off-label use of medicines in clinical practice.


Assuntos
COVID-19 , Preparações Farmacêuticas , Médicos , Adulto , Criança , Feminino , Humanos , Uso Off-Label , Padrões de Prática Médica , Gravidez , Federação Russa , SARS-CoV-2
4.
BMC Med Inform Decis Mak ; 21(1): 173, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059025

RESUMO

BACKGROUND: The promotion of early diagnosis is undoubtedly effective in reducing the burden of disease. Contrast-enhanced ultrasound (CEUS) is a diagnostic technology for liver cancer, but its implementation faces some challenges. Understanding the influencing factors of CEUS utilization is crucial for its successful implementation. However, such research is rare. The aims of this study were to investigate the status of CEUS utilization and its predictors in China. METHODS: Through multistage random sampling, a cross-sectional study design was conducted among physicians in charge of direct use of CEUS working at liver disease-related departments of sampled health institutions. To access the potential influencing factors of physicians' CEUS utilization, a structured questionnaire was developed based on the theoretical model, which was developed by integration of the Theory of Planned Behavior (TPB) and Technology Acceptance Model (TAM). Structural equation modeling was used to verify the proposed hypotheses, and analyze the relationship and mechanism between the factors. RESULTS: A total of 309 physicians were enrolled. The mean score of utilization behavior was 2.04 (SD = 1.07), and 37.22% above the mean. The favorable fitting results demonstrated that the integration of TAM and TPB was an acceptable model. SEM results also identified physicians' intentions to use CEUS was directly associated with utilization behavior (ß = 0.287, P < 0.001). Attitude (ß = 0.272, P < 0.001), subjective norm (ß = 0.172, P = 0.013), perceived behavioral control (ß = 0.491, P < 0.001) and perceived usefulness (ß = 0.108, P = 0.027) significantly influenced physicians' intentions. Besides, subjective norm (ß = 0.065, P = 0.021), perceived behavioral control (ß = 0.141, P = 0.003), and perceived ease of use (ß = 0.022, P = 0.033) indirectly affected physicians' CEUS utilization. CONCLUSIONS: The findings provide a reference for understanding the factors associated with physicians' utilization of CEUS. Additionally, the proposed measures such as building innovative and incentive environment, providing high quality and adequate training, etc., will help promote the utilization of CEUS, thereby increasing the detection rate of liver cancer, and improving the survival rate and the quality of life for liver cancer patients.


Assuntos
Médicos , Qualidade de Vida , Atitude do Pessoal de Saúde , China , Estudos Transversais , Humanos , Intenção , Análise de Classes Latentes , Inquéritos e Questionários , Tecnologia
5.
BMC Med Inform Decis Mak ; 21(1): 178, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082719

RESUMO

BACKGROUND: Artificial Intelligence has the potential to revolutionize healthcare, and it is increasingly being deployed to support and assist medical diagnosis. One potential application of AI is as the first point of contact for patients, replacing initial diagnoses prior to sending a patient to a specialist, allowing health care professionals to focus on more challenging and critical aspects of treatment. But for AI systems to succeed in this role, it will not be enough for them to merely provide accurate diagnoses and predictions. In addition, it will need to provide explanations (both to physicians and patients) about why the diagnoses are made. Without this, accurate and correct diagnoses and treatments might otherwise be ignored or rejected. METHOD: It is important to evaluate the effectiveness of these explanations and understand the relative effectiveness of different kinds of explanations. In this paper, we examine this problem across two simulation experiments. For the first experiment, we tested a re-diagnosis scenario to understand the effect of local and global explanations. In a second simulation experiment, we implemented different forms of explanation in a similar diagnosis scenario. RESULTS: Results show that explanation helps improve satisfaction measures during the critical re-diagnosis period but had little effect before re-diagnosis (when initial treatment was taking place) or after (when an alternate diagnosis resolved the case successfully). Furthermore, initial "global" explanations about the process had no impact on immediate satisfaction but improved later judgments of understanding about the AI. Results of the second experiment show that visual and example-based explanations integrated with rationales had a significantly better impact on patient satisfaction and trust than no explanations, or with text-based rationales alone. As in Experiment 1, these explanations had their effect primarily on immediate measures of satisfaction during the re-diagnosis crisis, with little advantage prior to re-diagnosis or once the diagnosis was successfully resolved. CONCLUSION: These two studies help us to draw several conclusions about how patient-facing explanatory diagnostic systems may succeed or fail. Based on these studies and the review of the literature, we will provide some design recommendations for the explanations offered for AI systems in the healthcare domain.


Assuntos
Médicos , Confiança , Inteligência Artificial , Pessoal de Saúde , Humanos , Satisfação Pessoal
6.
Zhonghua Yi Shi Za Zhi ; 51(2): 111-116, 2021 Mar 28.
Artigo em Chinês | MEDLINE | ID: mdl-34098704

RESUMO

Ruishou Ben'i Zenkushuu(,The Nine Tenths of the the Differnetiation of Similar Syndromes) was compiled by Doctor Yuehu, a Japanese monk, in 1452. This book had important implications for the spread to Japan of Chinese medical ideas and theories by Li Dongyuan and Zhu Danxi. This paper analyzed the citation of Chinese medical books in Ruishou Ben'i Zenkushuu and found that the name of Zhu Danxi appeared frequently in this book.Based on the data from the sources of Danxi's medical ideas and theories cited in the book, this paper illuminates the close connection with the medicine ideas and theories of Danxi, and clarifies the story that Yuehu once studied Chinese medicine from Yu Tuan. Research on the sources of the ideas in Ruishou Ben'i Zenkushuu is helpful tracing back historically the spread of the ideas and theories of Danxi in Japan.


Assuntos
Escrita Médica , Medicina , Médicos , China , Humanos , Japão , Medicina Tradicional Chinesa
7.
Zhonghua Yi Shi Za Zhi ; 51(2): 122-125, 2021 Mar 28.
Artigo em Chinês | MEDLINE | ID: mdl-34098706

RESUMO

The concept of "Xing & Shen"(Body and spirit) and their relationship are important philosophical categories and basic issues in life cognition. The view of "body and spirit" in Chinese medicine is the inheritance and development of the concept of "form and spirit" in ancient Chinese philosophy; the view of body-spirit syncretism is one of the elements of the original thinking mode in traditional Chinese medicine, which reflects the holism of TCM. This article selects interpretations of "body and spirit" form the works of the four great physicians of the Jin and Yuan period as the starting point to find out the internal connection between their academic innovation and their identities of Confucian physician, as well as their classic study, based on the social background of the Jin and Yuan Period.


Assuntos
Medicina Tradicional Chinesa , Médicos , China , Humanos , Filosofia
8.
Zhonghua Yi Shi Za Zhi ; 51(2): 126-128, 2021 Mar 28.
Artigo em Chinês | MEDLINE | ID: mdl-34098707

RESUMO

Wenre Jingwei(,Warp and Weft of Warm and Hot Disorders) is believed the masterpiece written by Wang Mengying, who was a famous physician in the Qing Dynasty. It represents the essence of Wang's theory in terms of Epidemic Febrile Diseases. It has been interpreted and analyzed by seven critics. However, these seven critics have not been widely known up to now. This paper introduces the life history of the critics and their medical achievements, in order to clarify their contributions to this book and enrich the content of medical history.


Assuntos
Epidemias , Médicos , Livros , China , Humanos , Redação
9.
BMC Med Educ ; 21(1): 328, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098907

RESUMO

BACKGROUND: Complex healthcare systems increasingly demand influential nurse leaders adept at managing changes in unstable environments. The doctor of nursing practice (DNP) prepares the nurses for the most advanced level of clinical practice. The aim of this study was to explore the necessity of establishing a DNP program in Iran from experts' views. METHODS: The study used a qualitative descriptive approach. The participants consisted of 13 faculty members and Ph.D. candidates selected using purposive sampling. Data were collected through focus group and semi-structured interviews, and analyzed using qualitative content analysis. RESULTS: The content analysis led to the extraction of two main categories: "providing infrastructures" and "DNP as an opportunity to make positive outcomes." CONCLUSIONS: It is concluded that it is not necessary to establish a DNP program for Iran's nursing education system. Supplying infrastructures is a crucial component to establishing a new program in Iran. Although DNP, as an opportunity to drive positive changes, is recommended, in the current situation, using alternative solutions may yield better outcomes than establishing a DNP program.


Assuntos
Educação de Pós-Graduação em Enfermagem , Educação em Enfermagem , Enfermeiras e Enfermeiros , Médicos , Humanos , Irã (Geográfico)
10.
BMC Health Serv Res ; 21(1): 563, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098938

RESUMO

BACKGROUND: To assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work. METHODS: Data on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality. RESULTS: There were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94-1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme. CONCLUSION: There was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.


Assuntos
Admissão do Paciente , Médicos , Mortalidade Hospitalar , Hospitalização , Hospitais , Humanos
11.
BMC Health Serv Res ; 21(1): 560, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098942

RESUMO

BACKGROUND: Medical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping, aiming to inform pre-vocational medical education curriculum development. METHODS: Group Concept Mapping is a mixed methods consensus building methodology whereby ideas are generated using qualitative techniques, sorted and grouped using hierarchical cluster analysis, and rated to provide further quantitative confirmation of value. Health service providers from varied disciplines (including medicine, nursing, allied health), health profession educators, health managers, and service users contributed to the conceptual model's development. They responded to the prompt 'An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...' and grouped the synthesized responses according to similarity. Data were subjected to hierarchical cluster analysis. Junior doctors rated competencies according to importance to their practice and preparedness at graduation. RESULTS: Sixty-seven contributors generated 338 responses which were synthesised into 60 statements. Hierarchical cluster analysis resulted in a conceptual map of seven clusters representing: value-led professionalism; attributes for self-awareness and reflective practice; cognitive capability; active engagement; communication to build and manage relationships; patient-centredness and advocacy; and systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: leadership and systems thinking; learning and cognitive processes; and interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out. CONCLUSION: The domains that have been identified highlight the competencies necessary for effective practice for those who work within and use health-care systems. Three overarching domains relate to leadership in systems, learning, and interpersonal competencies. The model is a useful adjunct to broader competencies frameworks because of the focus on generic competencies that are crucial in modern complex adaptive health-care systems. Explicating these will allow future investigation into those that are currently well achieved, and those which are lacking, in differing contexts.


Assuntos
Competência Clínica , Médicos , Atenção à Saúde , Humanos , Liderança , Profissionalismo
12.
BMC Health Serv Res ; 21(1): 561, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098973

RESUMO

BACKGROUND: Although risk prediction has become an integral part of clinical practice guidelines for cardiovascular disease (CVD) prevention, multiple studies have shown that patients' risk still plays almost no role in clinical decision-making. Because little is known about why this is so, we sought to understand providers' views on the opportunities, barriers, and facilitators of incorporating risk prediction to guide their use of cardiovascular preventive medicines. METHODS: We conducted semi-structured interviews with primary care providers (n = 33) at VA facilities in the Midwest. Facilities were chosen using a maximum variation approach according to their geography, size, proportion of MD to non-MD providers, and percentage of full-time providers. Providers included MD/DO physicians, physician assistants, nurse practitioners, and clinical pharmacists. Providers were asked about their reaction to a hypothetical situation in which the VA would introduce a risk prediction-based approach to CVD treatment. We conducted matrix and content analysis to identify providers' reactions to risk prediction, reasons for their reaction, and exemplar quotes. RESULTS: Most providers were classified as Enthusiastic (n = 14) or Cautious Adopters (n = 15), with only a few Non-Adopters (n = 4). Providers described four key concerns toward adopting risk prediction. Their primary concern was that risk prediction is not always compatible with a "whole patient" approach to patient care. Other concerns included questions about the validity of the proposed risk prediction model, potential workflow burdens, and whether risk prediction adds value to existing clinical practice. Enthusiastic, Cautious, and Non-Adopters all expressed both doubts about and support for risk prediction categorizable in the above four key areas of concern. CONCLUSIONS: Providers were generally supportive of adopting risk prediction into CVD prevention, but many had misgivings, which included concerns about impact on workflow, validity of predictive models, the value of making this change, and possible negative effects on providers' ability to address the whole patient. These concerns have likely contributed to the slow introduction of risk prediction into clinical practice. These concerns will need to be addressed for risk prediction, and other approaches relying on "big data" including machine learning and artificial intelligence, to have a meaningful role in clinical practice.


Assuntos
Inteligência Artificial , Médicos , Atitude , Atitude do Pessoal de Saúde , Pessoal de Saúde , Humanos , Pesquisa Qualitativa
13.
Medicina (Kaunas) ; 57(5)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34065845

RESUMO

Background and Objectives: The first clusters of SARS-CoV-2 infection were identified in an occupational setting, and to date, a significant portion of the cases may result from occupational exposure; thus, COVID-19 should also be considered a new occupational risk that both directly and indirectly impacts the health of workers. Given the significance of occupational-exposure-related infections and deaths, this study aims to assess the roles and tasks of occupational physicians (OPs) in countering the spread of the infection. Indeed, despite the OP's centrality in risk management in the workplace, its activity in the current epidemic context has rarely been mentioned. Materials and Methods: Three different databases (PubMed, Google Scholar, and Embase) were questioned using the main keywords "COVID-19" and "SARS-CoV-2" that were crossed, according to different needs, with the terms "occupational medicine", "occupational physician", "workplace", and "risk assessment" using, when possible, the MeSH database research. Additionally, a systematic research of the regulatory changes of workplaces health surveillance was performed on reference sites of international, European, and Italian authorities. Results: Fundamental tasks and duties of OPs in the current COVID-19 outbreak are highlighted by examining their clinical activity and technical action. A risk assessment and management workflow is proposed, and medico-legal implications in case of infection at work are also discussed in the light of recent regulatory changes that clearly attribute to OPs an important role in safeguarding public health. Conclusion: The proposed approach can provide new instruments to contrast the spread of the infection as part of a comprehensive system response to the current pandemic, for which OPs are called to assume full responsibility.


Assuntos
COVID-19 , Médicos , Humanos , Itália , Pandemias , SARS-CoV-2
14.
Korean J Med Educ ; 33(2): 87-96, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34062640

RESUMO

PURPOSE: With the ongoing coronavirus disease 2019 (COVID-19) pandemic, health institutions and hospitals are increasingly relying on e-learning for continuing education. However, in many countries there is still limited data on the effectiveness of online learning particularly in the healthcare field. This study aims to evaluate whether webinar as a form of online educational intervention is satisfactory and effective for the continuing education of health professionals in Indonesia. METHODS: We collected participants' demographic information including health profession, place of work, work unit, and year of graduation. There were six independent webinars included in this study. Webinar outcomes included satisfaction and learning scores. Regarding satisfaction, participants were told to complete a satisfaction survey and asked whether they would recommend the webinar to their colleagues. Regarding learning, information on their mean pre-test and post-test scores was collected. RESULTS: A total of 3,607 health professionals were enrolled, with the highest participation in webinars about emergency cases and COVID-19 management. The response towards satisfaction was overwhelmingly positive. In all six webinars, post-test scores were statistically significantly higher than pre-test scores. Recently graduated physicians scored higher in learning than senior physicians, while place of work and work unit did not significantly affect the scores. CONCLUSION: The use of webinar for health professionals training in Indonesia was well-received amid the ongoing pandemic. In the future, health institutions and teaching hospitals should optimize the implementation of webinar training as it is associated with low cost, high flexibility, and less time commuting.


Assuntos
COVID-19 , Educação Continuada/métodos , Educação à Distância , Pessoal de Saúde , Pandemias , Análise Custo-Benefício , Gerenciamento Clínico , Avaliação Educacional , Hospitais de Ensino , Humanos , Indonésia , Aprendizagem , Satisfação Pessoal , Médicos , SARS-CoV-2 , Ensino
16.
BMC Med Educ ; 21(1): 332, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34103030

RESUMO

BACKGROUND: Teaching is an important professional skill for physicians and providing feedback is an important part of teaching. Medical students can practice their feedback skills by giving each other peer feedback. Therefore, we developed a peer feedback training in which students observed a peer that modelled the use of good feedback principles. Students then elaborated on the modelled feedback principles through peer discussion. This combination of peer modelling and discussing the modelled feedback principles was expected to enhance emulation of the feedback principles compared to (1) only peer modelling and (2) discussing the feedback principles without previous modelling. METHODS: In a quasi-experimental study design, 141 medical students were assigned randomly to three training conditions: peer modelling plus discussion (MD), non-peer modelled example (NM) or peer modelling without discussion (M). Before and after the training, they commented on papers written by peers. These comments served as a pre- and a post-measure of peer feedback. The comments were coded into different functions and aspects of the peer feedback. Non-parametrical Kruskall-Wallis tests were used to check for pre- and post-measure between-group differences in the functions and aspects. RESULTS: Before the training, there were no significant between-group differences in feedback functions and aspects. After the training, the MD-condition gave significantly more positive peer feedback than the NM-condition. However, no other functions or aspects were significantly different between the three conditions, mainly because the within-group interquartile ranges were large. CONCLUSIONS: The large interquartile ranges suggest that students differed substantially in the effort placed into giving peer feedback. Therefore, additional incentives may be needed to motivate students to give good feedback. Teachers could emphasise the utility value of peer feedback as an important professional skill and the importance of academic altruism and professional accountability in the peer feedback process. Such incentives may convince more students to put more effort into giving peer feedback.


Assuntos
Educação de Graduação em Medicina , Médicos , Estudantes de Medicina , Competência Clínica , Retroalimentação , Humanos , Grupo Associado
17.
BMC Med Inform Decis Mak ; 21(1): 183, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34103041

RESUMO

BACKGROUND: Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? METHODS: This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). RESULTS: Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. CONCLUSION: This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.


Assuntos
Registros Eletrônicos de Saúde , Médicos , Pessoal de Saúde , Humanos , Medição de Risco , Fluxo de Trabalho
18.
Artigo em Inglês | MEDLINE | ID: mdl-34069754

RESUMO

INTRODUCTION: To date, a universal validated and specific tool for assessing coronavirus disease 2019 (COVID-19) stigma among healthcare workers is lacking. We adapted a SARS stigma scale that was developed using the Berger HIV scale for use as a COVID-19 stigma scale and evaluated its psychometric properties among Egyptian physicians. METHODS: We administered the 17-item SARS stigma scale in an anonymous online questionnaire among 509 Egyptian physicians recruited via convenience sampling during a cross-sectional study in June 2020. Exploratory factor analysis was performed on half of the sample. Confirmatory factor analysis of the resulting model was done using structural equation modeling on the other half. Scale reliability was examined using Cronbach's alpha for internal consistency. Convergent construct validity was assessed using regression models to examine the association between the adapted COVID-19 stigma scale and relevant factors. RESULTS: Exploratory factor analysis yielded 16 items (E16-COVID19-S) that supported a three-factor structure: personalized stigma (8 items); concerns of disclosure and public attitudes (5 items); and negative experiences (3 items). Cronbach's α was 0.909 for the total scale and 0.907, 0.663, and 0.789 for the three subscales. E16-COVID19-S was confirmed to have good model fit (comparative fit index = 0.964; root mean squared error of approximation = 0.056). E16-COVID19-S was independently associated with physicians' younger age, lower qualification, working in an isolation hospital, and self-stigma, whether the scale was treated as categorical or continuous. CONCLUSIONS: E16-COVID19-S exhibited good internal consistency and construct validity among this sample of Egyptian physicians. These adequate psychometric properties make the E16-COVID19-S scale appropriate for use by researchers and practitioners.


Assuntos
Médicos , Estudos Transversais , Egito , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Estigma Social , Inquéritos e Questionários
19.
Rev Med Suisse ; 17(741): 1092-1097, 2021 Jun 02.
Artigo em Francês | MEDLINE | ID: mdl-34077042

RESUMO

Medical practitioners are frequently confronted with social insurance as well as with their patients' health and safety issues. Through the journey of Pierre, an employee, victim of an accident at work, we propose to address some common problems by specifying certain aspects relating to the legal and administrative framework in order to better guide clinical practice on the means of intervention and their limits.


Assuntos
Médicos , Previdência Social , Procedimentos Clínicos , Humanos
20.
Artigo em Inglês | MEDLINE | ID: mdl-34068291

RESUMO

(1) Background: The COVID-19 pandemic has dramatically and rapidly changed the overall picture of healthcare in the way how doctors care for their patients. Due to the significant strain on hospitals and medical facilities, the popularity of web-based medical consultation has drawn the focus of researchers during the deadly coronavirus disease (COVID-19) in the United States. Healthcare organizations are now reacting to COVID-19 by rapidly adopting new tools and innovations such as e-consultation platforms, which refer to the delivery of healthcare services digitally or remotely using digital technology to treat patients. However, patients' utilization of different signal transmission mechanisms to seek medical advice through e-consultation websites has not been discussed during the pandemic. This paper examines the impact of different online signals (online reputation and online effort), offline signals (offline reputation) and disease risk on patients' physician selection choice for e-consultation during the COVID-19 crisis. (2) Methods: Drawing on signaling theory, a theoretical model was developed to explore the antecedents of patients' e-consultation choice toward a specific physician. The model was tested using 3-times panel data sets, covering 4231 physicians on Healthgrades and Vitals websites during the pandemic months of January, March and May 2020. (3) Results: The findings suggested that online reputation, online effort and disease risk were positively related to patients' online physician selection. The disease risk has also affected patients' e-consultation choice. A high-risk disease positively moderates the relationship between online reputation and patients' e-consultation choice, which means market signals (online reputation) are more influential than seller signals (offline reputation and online effort). Hence, market signals strengthened the effect in the case of high-risk disease. (4) Conclusions: The findings of this study provide practical suggestions for physicians, platform developers and policymakers in online environments to improve their service quality during the crisis. This article offers a practical guide on using emerging technology to provide virtual care during the pandemic. This study also provides implications for government officials and doctors on the potentials of consolidating virtual care solutions in the near future in order to contribute to the integration of emerging technology into healthcare.


Assuntos
Médicos , Humanos , Pandemias , Encaminhamento e Consulta
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