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1.
BMJ ; 368: l6968, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996352

RESUMO

OBJECTIVE: To examine the distribution and patterns of opioid prescribing in the United States. DESIGN: Retrospective, observational study. SETTING: National private insurer covering all 50 US states and Washington DC. PARTICIPANTS: An annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES: Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS: In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS: Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrição Inadequada/prevenção & controle , Administração dos Cuidados ao Paciente/normas , Médicos , Padrões de Prática Médica , Adulto , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Médicos/classificação , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Medicamentos sob Prescrição/uso terapêutico , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
J Surg Res ; 245: 212-216, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421365

RESUMO

BACKGROUND: Pulmonary embolism and deep vein thrombosis are common clinical entities, and the related malpractice suits affect all medical subspecialties. Claims from malpractice litigation were analyzed to understand the demographics of these lawsuits and the common reasons for pursuing litigation. METHODS: Cases entered into the Westlaw database from March 5, 1987, to May 31, 2018, were reviewed. Search terms included "pulmonary embolism" and "deep vein thrombosis." RESULTS: A total of 277 cases were identified. The most frequently identified defendant was an internist (including family practitioner; 33%), followed by an emergency physician (18%), an orthopedic surgeon (16%), and an obstetrician/gynecologist (9%). The most common etiology for pulmonary embolism was prior surgery (41%). The most common allegation was "failure to diagnose and treat" in 62%. Other negligence included the failure to administer prophylactic anticoagulation while in the hospital (18%), failure to prescribe anticoagulation on discharge (8%), failure to administer anticoagulation after diagnosis (8%), and premature discontinuation of anticoagulation (2%). The most frequently claimed injury was death in 222 cases (80%). Verdicts were found for the defendant in 57% of cases and for the plaintiff in 27% and settled in 16%. CONCLUSIONS: The most frequently cited negligent act was the failure to give prophylactic anticoagulation, even after discharge. The trends noted in this study may potentially be addressed and therefore prevented by systems-based practice changes. The most common allegation, "failure to diagnose and treat," suggests that first-contact doctors such as emergency physicians and primary care practitioners must maintain a high index of suspicion for deep vein thrombosis/pulmonary embolism.


Assuntos
Falha da Terapia de Resgate/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Médicos/estatística & dados numéricos , Embolia Pulmonar/terapia , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Bases de Dados Factuais/estatística & dados numéricos , Diagnóstico Tardio/economia , Diagnóstico Tardio/legislação & jurisprudência , Diagnóstico Tardio/estatística & dados numéricos , Falha da Terapia de Resgate/economia , Falha da Terapia de Resgate/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/estatística & dados numéricos , Imperícia/economia , Médicos/economia , Médicos/legislação & jurisprudência , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estados Unidos/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/mortalidade
5.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190014.supl.3, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31800853

RESUMO

INTRODUCTION: A smartphone application named AtestaDO was developed to support physicians with medical certification of the cause of death. The objective of this study is to evaluate the acceptability of the app. METHODS: Physicians were invited to attend meetings on the proper certification of cause of death, and to evaluate the application in a national workshop in Natal (first stage) and in two large hospitals in Belo Horizonte (second and third stages). RESULTS: In Natal, 82% of 38 physicians had more than 20 years of experience and in Belo Horizonte, more than 67% of 58 physicians had less than 5 years of experience. The sections "Application interface", "How to certify the causes of death", "Practice with exercises" and "Other information for physicians" were positively evaluated by more than 50% of physicians in Belo Horizonte. In Natal, all sections were positively evaluated by at least 80% of participants. More than 70% of the participants in both Natal and the second stage of Belo Horizonte indicated they would possibly use AtestaDO to guide filling of a death certificate. The probability of using AtestaDO to teach classes on filling death certificates was 83.3% for Natal's physicians but less than 60% in Belo Horizonte. In the three stages, most physicians would recommend using the application to other colleagues. CONCLUSION: The evaluation of AtestaDO showed good acceptability. We expect that the use of this tool enables improvements in medical certification of causes of death.


Assuntos
Causas de Morte , Atestado de Óbito , Médicos/normas , Smartphone/normas , Software/normas , Brasil , Humanos , Médicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Melhoria de Qualidade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo
6.
Medicine (Baltimore) ; 98(51): e18491, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861034

RESUMO

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%.


Assuntos
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
7.
Crit Care Resusc ; 21(4): 299-302, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31778637

RESUMO

OBJECTIVE: To develop a library of delirium-suggestive words. DESIGN: Cross-sectional survey. SETTING: Single tertiary referral hospital. PARTICIPANTS: Medical, nursing and allied health staff and medical coders. MAIN OUTCOME MEASURES: Frequency of graded response on a 5-point Likert scale to individual delirium-suggestive words. RESULTS: Two-hundred and three complete responses were received from 227 survey respondents; the majority were medical and nursing staff (42.4% and 43.8% respectively), followed by allied health practitioners and medical coders (10.3% and 3.4%). Words that were "very likely" to suggest delirium were "confused/ confusion", "delirious", "disoriented/disorientation" and "fluctuating conscious state". Differences in word selection were noted based on occupational background, prior knowledge of delirium, and experience in caring for intensive care unit patients. Distractor words included in the survey were rated as "unlikely" or "very unlikely" by respondents as expected. Textual responses identified several other descriptors of delirium-suggestive words. CONCLUSION: A comprehensive repertoire of delirium-suggestive words was validated using a multidisciplinary survey and new words suggested by respondents were added. The use of natural language processing algorithms may allow for earlier detection of delirium using our delirium library and be deployed for real-time decision making and clinical care.


Assuntos
Codificação Clínica , Cuidados Críticos/normas , Delírio/diagnóstico , Linguagem , Inquéritos e Questionários , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Unidades de Terapia Intensiva , Corpo Clínico/estatística & dados numéricos , Médicos/estatística & dados numéricos
8.
BMC Health Serv Res ; 19(1): 777, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666059

RESUMO

BACKGROUND: Generic drugs and generic substitution belong to the tools by which healthcare costs may be reduced. However, low awareness and reluctance among healthcare professionals towards generic drugs may negatively affect the rational use of generic substitution. METHODS: The study aimed to analyze opinions and attitudes towards generic drugs and generic substitution among Czech physicians including their understanding of generic substitution legislative rules and the physicians´ previous experience in this field. Using random allocation, 1551 physicians practicing in the Czech Republic were asked to participate in the sociological representative survey conducted from November to December 2016, through face-to-face structured interviews comprising 19 items. Factor analysis as well as reliability analysis of items focused on legal rules in the context of physicians' awareness were applied with p-value of < 0.05 as statistically significant. RESULTS: Of a total of 1237 (79.8%) physicians (43.7% males; mean age 47.5 ± 11.6 years, 46.3% general practitioners) 24.8% considered generic drugs to be less safe, especially those with specialized qualification (p < 0.01). However, only 4.4% of the physicians noticed any drug-related problems, including adverse drug reactions associated with generic substitution. The majority of physicians felt neutrally about performing generic substitution in pharmacies, nor they expressed any opinion on characteristics of generics, even though a better understanding of the legislation and higher need of accordance of substituted drugs were associated with more positive attitudes towards generic substitution (p < 0.05). Physicians showed low knowledge score of legislative rules (mean 3.9 ± 1.6 from maximum 9), nevertheless they overestimated the law, as they considered some rules valid, even if the law does not require them. Cronbach alpha of all legislative rules that regulate generic substitution increased from 0.318 to 0.553 if two optional rules (physician consent and strength equivalence) would be taken into account. CONCLUSIONS: There is no sufficient awareness of generic drugs and generic substitution related issues among Czech physicians, although a deeper knowledge of legislation improves their perception about providing generic substitution.


Assuntos
Substituição de Medicamentos , Medicamentos Genéricos , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Adulto , República Tcheca , Medicamentos Genéricos/economia , Feminino , Humanos , Legislação de Medicamentos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Inquéritos e Questionários
9.
Pneumologie ; 73(10): 586-591, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622997

RESUMO

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.


Assuntos
Escolha da Profissão , Infectologia/educação , Infectologia/organização & administração , Médicos , Estudos Transversais , Alemanha , Humanos , Médicos/organização & administração , Médicos/estatística & dados numéricos , Sociedades Médicas , Inquéritos e Questionários
10.
Nurs Outlook ; 67(6): 707-712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607371

RESUMO

BACKGROUND: The research findings about nurse practitioner (NP) patient experiences (satisfaction) are limited to small sample sizes from local community clinics. No national studies with large sample sizes were found. PURPOSE: To analyze responses from the Consumer Assessment of Healthcare Providers and Systems survey and compare the patient experiences from four different provider categories. METHODS: Secondary data analysis was completed on survey responses from 53,885 patients. FINDINGS: In the sample, medical doctor providers were disproportionately represented in greater number than NPs, doctor of osteopathy, or physician assistant. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues. DISCUSSION: Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care. CONCLUSION: Policy makers should find opportunities to employ NP in primary care settings and achieve greater patient satisfaction that can influence outcomes associated with patient-centered care initiatives.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Relações Enfermeiro-Paciente , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
11.
Medicine (Baltimore) ; 98(39): e17373, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574886

RESUMO

Ionizing radiation can induce deoxyribonucleic acid (DNA) methylation pattern change, and ionizing radiation-induced oxidative damage may also affect DNA methylation status. However, the influence of low-dose ionizing radiation, such as occupational radiation exposure, on DNA methylation is still controversial.By investigating the relationship between occupational radiation exposure and DNA methylation changes, we evaluated whether radiation-induced oxidative damage was related to DNA methylation alterations and then determined the relationship among occupational radiation level, DNA methylation status, and oxidative damage in interventional physicians.The study population included 117 interventional physicians and 117 controls. We measured global methylation levels of peripheral blood leukocyte DNA and expression level of DNA methyltransferase (Dnmts) and homocysteine (Hcy) in serum to assess the DNA methylation status of the body. We measured 8-hydroxy-2'-deoxyguanosine (8-OHDG) and 4-hydroxynonenal (4-HNE) levels as indices of oxidative damage. Relevance analysis between multiple indices can reflect the relationship among occupational radiation exposure, DNA methylation changes, and oxidative damage in interventional physicians.The expression levels of Dnmts, 4-HNE, and 8-OHDG in interventional physicians were higher than those in controls, while there was no statistical difference in total DNA methylation rate and expression of Hcy between interventional physicians and controls. Total cumulative personal dose equivalent in interventional physicians was positively correlated with the expression levels of Dnmts, 8-OHDG, and 4-HNE. The expression levels of 8-OHDG in interventional physicians were negatively correlated with global DNA methylation levels and positively correlated with the expression levels of Hcy.Occupational radiation exposure of interventional physicians has a certain effect on the expression of related enzymes in the process of DNA methylation, while ionizing radiation-induced oxidative damage also has a certain effect on DNA methylation. However, there was no evidence that dose burden of occupational exposure was associated to changes of DNA methylation status of interventional physicians, since it is rather unclear which differences are observed among the effects produced by radiation exposure and oxidative damage.


Assuntos
Dano ao DNA/efeitos da radiação , Metilação de DNA/efeitos da radiação , Exposição Ocupacional/análise , Estresse Oxidativo/efeitos da radiação , Exposição à Radiação/análise , Radiologia Intervencionista/estatística & dados numéricos , Adulto , Aldeídos/sangue , Desoxiguanosina/análogos & derivados , Desoxiguanosina/sangue , Feminino , Homocisteína/sangue , Humanos , Leucócitos/metabolismo , Masculino , Metiltransferases/sangue , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Médicos/estatística & dados numéricos , Exposição à Radiação/efeitos adversos
12.
Medicine (Baltimore) ; 98(38): e17265, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568003

RESUMO

BACKGROUND: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design. METHODS: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders. RESULTS: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]). CONCLUSIONS: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.


Assuntos
Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Religião e Medicina , Adulto , Austrália , Brasil , Dinamarca , Feminino , Alemanha , Humanos , Índia , Indonésia , Masculino , Médicos/psicologia , Religião , Inquéritos e Questionários , Estados Unidos
13.
Clín. investig. arterioscler. (Ed. impr.) ; 31(5): 203-209, sept.-oct. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184162

RESUMO

Aim: To describe the management of atherogenic dyslipidemia (AD) in routine clinical practice in the Primary Care (PC) setting in Spain. Methods: Observational, descriptive, cross-sectional study based on a structured questionnaire designed for this study and addressed to PC physicians. The questionnaire content was based on a literature review and was validated by 3 experts in AD. Results: A total of 1029 PC physicians participated in the study. 96.99% indicated that AD is determinant for cardiovascular risk, even if LDL-C levels are appropriate. 88.43% evaluated residual cardiovascular risk in their clinical practice, however, only 27.89% of them evaluated it in secondary prevention. Regarding diagnosis, 82.22% reported that TC, TG, HDL-C and non-HDL-C are essential measures when evaluating AD. Almost all physicians reported that they can request fractionated cholesterol to assess HDL-C and LDL-C, however 3.69% could not. Physicians (95.63%) considered that the first step in AD treatment should be diet, regular exercise, smoking cessation and pharmaceutical treatment, if necessary. 19.1% agreed partially or completely that gemfibrozil is the most suitable fibrate to associate with statins. 74.83% completely agreed that fenofibrate is the most suitable fibrate to combine with statins. Conclusions: Physicians have access to general Spanish guidelines and recommendations associated with AD management, however, it is necessary to continue rising awareness about the importance of early detection and optimal control of AD to reduce patients' cardiovascular risk


Objetivo: Describir el manejo de la dislipemia aterogénica (DA) en la práctica clínica, en el ámbito de la atención primaria (AP) en España. Métodos: Estudio observacional, descriptivo y transversal, por medio de un cuestionario ad-hoc estructurado, dirigido a médicos de AP. El contenido del cuestionario se basó en una revisión de la literatura y fue validado por 3 expertos en DA. Resultados: Participaron en el estudio 1.029 médicos de AP. El 96,99% coincidió en que la DA constituye un factor determinante del riesgo cardiovascular aunque los niveles de cLDL sean adecuados. Un 88,43% indicó que evaluaba el riesgo residual cardiovascular en su práctica clínica habitual, aunque un 27,89% lo evaluaba solo en prevención secundaria. Un 82,22% consideró que para la valoración de un paciente con DA es imprescindible conocer el colesterol total, los triglicéridos, el cHDL, el cLDL y el no-cHDL. La mayoría indicó que podía solicitar fraccionamiento del colesterol total para valorar el cHDL y el cLDL, de forma rutinaria sin restricciones, pero el 3,69% indicó que no. Un 95,63% consideró que el primer paso en el tratamiento implica un control de la dieta, ejercicio físico, abandono del tabaco y si se precisa, tratamiento farmacológico. Un 19,1% estaba parcial o completamente de acuerdo en que el gemfibrozilo es el fibrato más adecuado para asociar con estatinas. El 74,83% estaba completamente de acuerdo en que el fenofibrato es el fibrato más apropiado para combinar con estatinas. Conclusiones: Los médicos tienen acceso a las guías y recomendaciones clínicas sobre el manejo de la DA, pero es necesario continuar concienciando de la importancia de su detección precoz y control óptimo para limitar su riesgo cardiovascular


Assuntos
Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/terapia , Atenção Primária à Saúde , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Espanha , Estudos Transversais , Inquéritos e Questionários , Médicos/estatística & dados numéricos , Prevenção Secundária
14.
Artigo em Inglês | MEDLINE | ID: mdl-31505840

RESUMO

Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility. The purpose of this study was to determine patient satisfaction with healthcare services and encompass the physician's behavior as moderation between patient satisfaction and healthcare services. The study seeks to measure the health care services, like a laboratory and diagnostic care, preventive healthcare and prenatal care, to patient satisfaction in the public health sectors of Pakistan. A descriptive survey research design was used for this study. The target population was patients from the out-patient department (OPD) of three public hospitals from Pakistan. By using the convenient sampling technique, 290 sample participants were selected from the target population. The reliability scales were tallied by using Cronbach's Alpha. The findings of the study are gleaned by using regression to explore patient satisfaction with the health care services, and whether or not the physician's behavior moderates the link of patient satisfaction and healthcare services. SPSS Hayes process was used for the moderation effect of the physician's behavior. The main results of the regression analysis validate that health care services, such as laboratory and diagnostic care, preventive healthcare, and prenatal care, have a significant and positive effect on patient satisfaction. Specifically, the study suggests that the physician's behavior significantly moderates the effect of health care services on the satisfaction of patients. The overall opinions about the satisfaction level of patients for the availability of health services in the hospitals were good. The degree of satisfaction was satisfactory with respect to laboratory and diagnostic care, preventive healthcare, and prenatal care services. Based on the outcomes, the study confirms that the proposed hypotheses are statistically significant. Furthermore, the directions for future research of the study are offered.


Assuntos
Serviços de Saúde , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Paquistão , Médicos/psicologia , Adulto Jovem
15.
West J Emerg Med ; 20(5): 818-821, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31539340

RESUMO

INTRODUCTION: Suicide is the 10th leading cause of death in the United States. An estimated 50% of these deaths are due to firearms. Suicidal ideation (SI) is a common complaint presenting to the emergency department (ED). Despite these facts, provider documentation on access to lethal means is lacking. Our primary aim was to quantify documentation of access to firearms in patients presenting to the ED with a chief complaint of SI. METHODS: This was a cross-sectional study of consecutive patients, nearly all of whom presented to an academic, urban ED with SI during July 2014. We collected data from all provider documentation in the electronic health record. Primary outcome assessed was whether the emergency physician (EP) team documented access to firearms. Secondary outcomes included demographic information, preexisting psychiatric diagnoses, and disposition. RESULTS: We reviewed 100 patient charts. The median age of patients was 38 years. The majority of patients had a psychiatric condition. EPs documented access to firearms in only 3% of patient charts. CONCLUSION: EPs do not adequately document access to firearms in patients with SI. There is a clear need for educational initiatives regarding risk-factor assessment and counseling against lethal means in this patient cohort.


Assuntos
Documentação , Serviço Hospitalar de Emergência/legislação & jurisprudência , Armas de Fogo/legislação & jurisprudência , Médicos/estatística & dados numéricos , Ideação Suicida , Suicídio/prevenção & controle , Adulto , Idoso , Aconselhamento , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suicídio/legislação & jurisprudência , Estados Unidos , Adulto Jovem
16.
Medicine (Baltimore) ; 98(37): e17117, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517849

RESUMO

BACKGROUND: Burnout negatively impacts the mental and physical health doctors. More seriously, it leads to poor patient care. In China, the situation is severe and more efforts are needed to reveal the epidemiological characteristics of doctor burnout to develop improved strategies of alleviating it. Due to the large number of heterogeneous and sample size-restricted surveys currently published, meta-analysis and systematic reviews are critical to a thorough understanding of burnout among Chinese doctors. METHODS: The Cochrane Collaboration criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) will be followed to conduct and report the systematic review. We will conduct a comprehensive search on the data bases of China National Knowledge Infrastructure (CNKI), WanFang, PubMed, EMBASE, PsycINFO, and the Cochrane Library from their inception to December 2018. Prospective cohort and cross-sectional studies that described the prevalence of Chinese doctors' prevalence will be eligible for inclusion. The risk of bias and methodological quality of the included studies will be assessed using a risk of bias tool and the Cochrane guidelines for observational studies. A generalized linear mixed model framework with the Poisson likelihood and the log link function will be used to access the incidence rate ratio. Multivariate Poisson regression framework will be conducted to adjust modeling heterogeneity and confounders, like difference regions and time periods. The risk of bias, heterogeneity, and quality of evidence will be assessed in accordance with the aforementioned guidelines. RESULTS: The primary outcome will be the prevalence and distribution of 3 dimension of burnout in Chinese doctors, and the second will be the difference of prevalence between difference regions and time periods. DISCUSSION: This systematic review and meta-analysis will help us to reveal the prevalence, characteristics, timeline, and correlation between these factors in burnout; we expect our work may provide a scientific basis for further prevention and intervention of burnout in Chinese doctors, eventually to improve the quality of health care. PROSPERO REGISTRATION NUMBER: CRD42018104249.


Assuntos
Esgotamento Profissional/complicações , Médicos/psicologia , Esgotamento Profissional/psicologia , China , Humanos , Médicos/estatística & dados numéricos
17.
BMC Health Serv Res ; 19(1): 677, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533699

RESUMO

BACKGROUND: The psychological and professional impact of adverse events on doctors and nurses is well-established, but limited data has emerged from low- and middle-income. This article reports the experiences of being involved in a patient safety event, incident reporting and organisational support available to assist health professionals in Viet Nam to learn and recover. METHOD: Doctors and nurses (1000) from all departments of a 1500-bed surgical and trauma hospital in Viet Nam were invited to take part in a cross-sectional survey. The survey explored respondents' involvement in adverse events and/or near miss, their emotional, behavioural and coping responses, experiences of organisational incident reporting, and the learning and/or other consequences of the event. Survey items also assessed the availability of organisational support including peer support and mentorship. RESULTS: Of the 497 respondents, 295 (59%) experienced an adverse event in which a patient was harmed, of which 86 (17%) resulted in serious patient harm. 397 (80%) of respondents experienced a near miss, with 140 of these (28%) having potential for serious harm. 386 (77%) reporting they had been affected professionally or personally in some way, with impacts to psychological health (416; 84%), physical health (388; 78%), job satisfaction (378; 76%) and confidence in their ability (276; 56%) commonly reported. Many respondents were unable to identify local improvements (373; 75%) or organisation-wide improvements following safety events (359; 72%) and 171 (34%) admitted that they had not reported an event to their organisation or manager that they should have. CONCLUSIONS: Health professionals in Viet Nam report impacts to psychological and physical health as a result of involvement in safety events that reflect those of health professionals internationally. Reports of limited organisational learning and improvement following safety events suggest that patient safety culture is underdeveloped in Viet Nam currently. In order to progress work on patient safety cultures and incident reporting in Viet Nam, health professionals will need to be convinced not only that they will not be exposed to punitive action, but that learning and positive changes will occur as a result of reporting safety events.


Assuntos
Erros Médicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Adaptação Psicológica , Adolescente , Adulto , Criança , Pré-Escolar , Aconselhamento , Estudos Transversais , Emoções , Feminino , Pessoal de Saúde/psicologia , Hospitais , Humanos , Lactente , Recém-Nascido , Aprendizagem , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Gestão de Riscos , Inquéritos e Questionários , Vietnã , Adulto Jovem
18.
J Drugs Dermatol ; 18(9): 880-886, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524343

RESUMO

BACKGROUND: Poly-L-lactic acid (PLLA) is increasingly used for a range of indications, from HIV lipodystrophy to gluteal augmentation; however, there is no clear consensus on appropriate product preparation and use. OBJECTIVE: To establish current practices for PLLA reconstitution and usage in the USA. METHODS AND MATERIALS: A 19-question survey pertaining to the reconstitution and use of PLLA was distributed to members of the American Board of Cosmetic Surgery and American Board of Facial Cosmetic Surgery and at several cosmetic conferences. 410 questionnaires were returned anonymously over a 3-month period. The results were collated and analyzed. RESULTS: The commonest indication for PLLA was HIV lipodystrophy (46.8%), followed by gluteal augmentation (42.4%). For the face, the majority used a dilution of 9-10 mL (60.4%). For the gluteal region, the majority used a dilution greater than 21 mL (51.3%). Most respondents reconstituted PLLA in sterile water (59.8%) more than 21 hours before use (51.0%) and added lidocaine to the solution (94.7%). Most physicians used topical anesthetic cream (83.2%), manual agitation (85.8%) and recommended self-massage post-treatment (99.6%). CONCLUSION: There is considerable variation in PLLA reconstitution and use. Further well-designed studies are needed to establish the safest, most effective ways to use this product. J Drugs Dermatol. 2019;18(9):880-886.


Assuntos
Técnicas Cosméticas/estatística & dados numéricos , Preenchedores Dérmicos/administração & dosagem , Revisão de Uso de Medicamentos/estatística & dados numéricos , Poliésteres/administração & dosagem , Anestésicos Locais , Nádegas , Preenchedores Dérmicos/efeitos adversos , Composição de Medicamentos/métodos , Composição de Medicamentos/estatística & dados numéricos , Face , Humanos , Injeções Subcutâneas , Médicos/estatística & dados numéricos , Poliésteres/efeitos adversos , Padrões de Prática Médica/estatística & dados numéricos , Envelhecimento da Pele/efeitos dos fármacos , Soluções , Solventes , Inquéritos e Questionários/estatística & dados numéricos
19.
Artigo em Inglês | MEDLINE | ID: mdl-31480401

RESUMO

Background: The use of electronic cigarettes (e-cigarettes) is gaining popularity, so it is important to evaluate physicians' understanding of e-cigarettes. This study assessed the beliefs, attitudes, and confidence in e-cigarette counseling among Chinese physicians and explored the factors related to asking patients about e-cigarette use. Methods: Physicians from across China were invited to participate in a questionnaire survey using the platform provided by DXY (www.dxy.cn) in 2018. In total, 1023 physicians completed the online survey. Descriptive analyses were used to characterize the participants, and multivariate logistic regression analyses were applied to identify predictors of physicians' asking about patients' e-cigarette use. Results: Only 46.3% of respondents agreed that e-cigarettes had adverse health effects, and 66.8% indicated that e-cigarettes can be regarded as a type of smoking cessation treatment. We found that 61.3% thought it was important to discuss e-cigarettes with patients, and 71.7% reported feeling confident about their ability in counseling about e-cigarettes. Respondents who had used e-cigarettes (OR = 2.05; 95% CI: 1.16-2.63), had received training about e-cigarettes (OR = 3.13; 95% CI: 2.17-4.52), or were confident about their ability to answer patients' question about e-cigarettes (OR = 2.45; 95% CI: 1.65-3.65) were more likely to ask patients about e-cigarette use. Physicians who showed a supportive attitude toward using e-cigarettes to quit smoking (OR = 0.79; 95% CI: 0.63-0.99) were less likely to ask about patients' e-cigarettes use frequently. Conclusions: Chinese physicians appeared to ignore the adverse health effects of e-cigarettes, and considered e-cigarettes as a smoking cessation treatment. Comprehensive training and regulations are needed to help physicians incorporate the screening of e-cigarette use into routine practice and provide patients truthful information as new data emerge.


Assuntos
Atitude do Pessoal de Saúde , Aconselhamento , Sistemas Eletrônicos de Liberação de Nicotina , Médicos/psicologia , Vaping/psicologia , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Competência Profissional
20.
BMC Health Serv Res ; 19(1): 624, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481042

RESUMO

BACKGROUND: A physician shortage is a worldwide problem and foreign-born physicians fill in the shortage of physicians in many developed countries. One problem that is associated with the physician shortage is increased physician turnover. Also, regarding foreign-born physicians, migration can be costly. The present study aimed to examine the turnover intentions and intentions to leave the country of foreign-born physicians. We examined how demographics, discrimination, language problems, perceived employment barriers, satisfaction with living in Finland, team climate, job satisfaction and patient-related stress were associated with these factors. METHODS: The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland that were aged between 26 and 65 (65% women). Binary logistic regression analyses were conducted to examine the associations. RESULTS: Half of the respondents had turnover intentions and 14.5% had considered leaving the country. High satisfaction with living in Finland was associated with a lower likelihood of both turnover intentions and intentions to leave the country. High levels of discrimination and employment barriers were associated with a high likelihood of turnover intentions whereas good team climate was associated with a low likelihood of turnover intentions. High levels of language problems were associated with a high likelihood of intentions to leave the country. CONCLUSIONS: The present study showed the importance of satisfaction with living in the host country, the prevention of discrimination and employment barriers, language skills and a good team climate for the retention of foreign-born physicians in their current job and in the host country. Thus, to keep their foreign-born physicians, health care organisations should implement measures to tackle these challenges. Organisations could arrange, for example, diversity training, self-assessment, team reflections, leadership coaching and culturally-specific networks. Moreover, internships associated with the qualification process could be utilised better in order to give a thorough introduction to the host country's health care environment and the possibilities for learning the language.


Assuntos
Médicos Graduados Estrangeiros/estatística & dados numéricos , Reorganização de Recursos Humanos/estatística & dados numéricos , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Emigração e Imigração/estatística & dados numéricos , Emprego/psicologia , Emprego/estatística & dados numéricos , Feminino , Finlândia , Médicos Graduados Estrangeiros/psicologia , Humanos , Intenção , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/etiologia , Satisfação Pessoal , Médicos/psicologia , Médicos/estatística & dados numéricos , Preconceito/psicologia , Preconceito/estatística & dados numéricos , Inquéritos e Questionários
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