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1.
BMC Public Health ; 21(1): 118, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430852

RESUMO

BACKGROUND: Ensuring safety and wellbeing of healthcare providers is crucial, particularly during times of a pandemic. In this study, we aim to identify the determinants of anxiety in physicians on duty in coronavirus wards or quarantine centers. METHODS: We conducted a cross-sectional quantitative survey with an additional qualitative item. Five constructs of workload, exhaustion, family strain, feeling of protection, and anxiety were measured using items from two validated tools. Modifications were made for regional relevance. Factor analysis was performed showing satisfactory Cronbach alpha results. Overall, 103 physicians completed the questionnaire. RESULTS: T-test results revealed significant associations between gender and anxiety. Structural equation modeling identified that high workload contributed to greater exhaustion (ß = 0.41, R2 = 0.17, p < 0.001) and greater family strain (ß = 0.47, R2 = 0.22, p < 0.001). Exhaustion (ß = 0.17, p < 0.005), family strain (ß = 0.34, p < 0.001), and feelings of protection (ß = - 0.30, p < 0.001) significantly explained anxiety (R2 = 0.28). Qualitative findings further identified specific needs of physicians with regard to protective equipment, compensation, quarantine management, resource allocation, security and public support, governance improvement, and health sector development. CONCLUSIONS: It is imperative to improve governmental and social support for physicians and other healthcare providers during the corona pandemic. Immediate attention is needed to reduce anxiety, workload, and family strain in frontline practitioners treating coronavirus patients, and to improve their (perceptions of) protection. This is a precondition for patient safety.


Assuntos
Ansiedade/epidemiologia , Médicos/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Paquistão/epidemiologia , Médicos/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários
2.
Yonsei Med J ; 62(1): 50-58, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381934

RESUMO

PURPOSE: Critical care medicine continues to evolve. However, critical care cases require increasing amount of medical resources. Intensive care unit (ICU) mortality significantly impacts the overall efficiency of healthcare resources within a system of limited medical resources. This study investigated the factors related to ICU mortality using long-term nationwide cohort data in South Korea. MATERIALS AND METHODS: This retrospective cohort study used data of 14905721 patients who submitted reimbursement claims to the Korean Health Insurance Service between January 1, 2011 and December 31, 2015. A total of 1498102 patients who were admitted to all ICU types, except neonatal and long-term acute care hospitals, were enrolled. RESULTS: Of the total 1498102 participants, 861397 (57.5%) were male and 636705 (42.5%) were female. The mean age at admission was 63.4±18.2 years; most of the subjects were aged over 60 years. During the 5-year period, in-hospital mortality rate was 12.9%. In Cox analysis, both in-hospital and 28-day mortality rates were significantly higher in male patients and those of lower socioeconomic status. As age increased and the number of nursing staff decreased, the mortality risk increased significantly by two or three times. The mortality risk was lower in patients admitted to an ICU of a tertiary university hospital and an ICU where intensivists worked. CONCLUSION: The number of nursing staff and the presence of an intensivist in ICU were associated with the ICU mortality rate. Also, increasing the number of nursing staff and the presence of intensivist might reduce the mortality rate among ICU patients.


Assuntos
Estado Terminal/mortalidade , Estado Terminal/enfermagem , Unidades de Terapia Intensiva/estatística & dados numéricos , Recursos Humanos de Enfermagem/estatística & dados numéricos , Médicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária
4.
BMJ ; 371: m4453, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328192

RESUMO

OBJECTIVE: To examine occupational heritability in medicine and changes in heritability over time, with Swedish population wide administrative data that allowed mapping family trees of physicians spanning up to three generations. DESIGN: Retrospective observational study. SETTING: Individual level administrative registry data from Sweden. PARTICIPANTS: Physicians born in 1950-90 and living in Sweden at some time during 2001-16 (n=47 400). MAIN OUTCOME MEASURES: The proportion of individuals with a completed medical degree with at least one parent who also trained in medicine, and the change in this proportion across birth cohorts. Additional analyses were conducted among other relatives (grandparents, aunts and uncles, and siblings) and for individuals with a law degree. RESULTS: For 27 788 physicians, where the educational background for both parents was known, 14% had a parent who was also a physician and 2% had two parents who were physicians. The proportion of physicians with at least one physician parent increased significantly over time, from 6% for physicians born in 1950-59 to 20% for physicians born in 1980-90 (P<0.001). The same pattern of increasing occupational heritability was not seen for individuals with law degrees. CONCLUSIONS: In recent cohorts of physicians in Sweden, one in five had a parent who was also a physician, more than triple the proportion seen for physicians born three decades earlier. A similar pattern was not seen in lawyers, suggesting that increasing occupational heritability in medicine does not reflect intergenerational persistence of high paying degrees alone. Rather, for physicians in Sweden, medicine might increasingly run in families.


Assuntos
Escolha da Profissão , Características da Família , Médicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Suécia
5.
PLoS One ; 15(12): e0242007, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370307

RESUMO

PURPOSE: Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers. METHOD: We conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents' facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites. RESULTS: Surveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans' preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice. CONCLUSION: Results suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans' need for and interest in PTM, including delivery by telehealth modalities.


Assuntos
Medicina Baseada em Evidências/organização & administração , Implementação de Plano de Saúde/organização & administração , Hospitais de Veteranos/organização & administração , Zumbido/terapia , Audiologia/organização & administração , Progressão da Doença , Medicina Baseada em Evidências/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Serviços de Saúde Mental/organização & administração , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade de Vida , Inquéritos e Questionários/estatística & dados numéricos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Zumbido/psicologia , Estados Unidos , United States Department of Veterans Affairs/organização & administração , Veteranos/psicologia
7.
MMWR Morb Mortal Wkly Rep ; 69(44): 1622-1624, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151919

RESUMO

Preventive care or follow-up care have the potential to improve health outcomes, reduce disease in the population, and decrease health care costs in the long-term (1). Approximately one half of persons in the United States receive general recommended preventive services (2,3). Missed physician appointments can hinder the receipt of needed health care (4). With electronic health record (EHR) systems able to improve interaction and communication between patients and providers (5), electronic reminders are used to decrease missed care. These reminders can improve various types of preventive and follow-up care, such as immunizations (6) and cancer screening (7); however, computerized capability must exist to make use of these reminders. To examine this capability among U.S. office-based physicians, data from the National Electronic Health Records Survey (NEHRS) for 2017, the most recent data available, were analyzed. An estimated 64.7% of office-based physicians had computerized capability to identify patients who were due for preventive or follow-up care, with 72.9% of primary care physicians and 71.4% of physicians with an EHR system having this capability compared with surgeons (54.8%), nonprimary care physicians (58.5%), and physicians without an EHR system (23.4%). Having an EHR system is associated with the ability to send electronic reminders to increase receipt of preventive or follow-up care, which has been shown to improve patient health outcomes (8).


Assuntos
Assistência ao Convalescente , Registros Eletrônicos de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Consultórios Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Serviços Preventivos de Saúde , Sistemas de Alerta/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
BMC Public Health ; 20(1): 1811, 2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33246426

RESUMO

BACKGROUND: This study aimed to investigate psychological distress among infectious disease (ID) physicians during the coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea. METHODS: Using an online-based survey link sent via text message and email, we conducted a survey from April 21 to 25, 2020, targeting all ID physicians currently working in ID (n = 265). The questionnaire was based on the Maslach Burnout Inventory-Human Services Survey and the Depression, Anxiety, and Stress Scales, and information was collected on factors protecting against psychological distress and difficulties in relation to COVID-19. RESULTS: Of 265 ID physicians, 115 (43.3%) responded, showing burnout (97, 90.4%), depression (20, 17.4%), anxiety (23, 20.0%), and stress (5, 4.3%). There were no differences in terms of distress between ID physicians who were directly involved in the care of patients with COVID-19 or not. Greater than 50% of physicians valued their work and felt recognized by others, whereas < 10% indicated that sufficient human and financial support and private time had been provided during the outbreak. The most challenging issues concerned a lack of attending physicians caring for COVID-19 patients or infection control practitioners, a shortage of personal protective equipment or airborne infection isolation rooms, pressure for research, and lack of guidelines for COVID-19 management. CONCLUSIONS: During the COVID-19 outbreak in the Republic of Korea, most respondents reported psychological distress. Preparing strategies to secure human resources are crucial to prepare effectively for future epidemics and pandemics.


Assuntos
Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Infectologia , Pandemias/prevenção & controle , Médicos/psicologia , Pneumonia Viral/prevenção & controle , Angústia Psicológica , Adulto , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , República da Coreia/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-33031651

RESUMO

Objective: Amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, health care workers of multiple disciplines have been designated as frontline doctors. This unforeseen situation has led to psychological problems among these health care workers. The objective of this study was to evaluate the mental health status of pan-Indian frontline doctors combating the COVID-19 pandemic. Methods: A cross-sectional, observational study was conducted among frontline doctors of tertiary care hospitals in India (East: Kolkata, West Bengal; North: New Delhi; West: Nagpur, Maharashtra; and South: Thiruvananthapuram, Kerala) from May 23, 2020, to June 6, 2020. Doctors involved in clinical services in outpatient departments, designated COVID-19 wards, screening blocks, fever clinics, and intensive care units completed an online questionnaire. The 9-item Patient Health Questionnaire and the Perceived Stress Scale were used to assess depression and perceived stress. Results: The results of 422 responses revealed a 63.5% and 45% prevalence of symptoms of depression and stress, respectively, among frontline COVID-19 doctors. Postgraduate trainees constituted the majority (45.5%) of the respondents. Moderately severe and severe depression was noted in 14.2% and 3.8% of the doctors, respectively. Moderate and severe stress was noted in 37.4% and 7.6% of participants, respectively. Multivariate regression analysis showed working ≥ 6 hours/day (adjusted odds ratio: 3.5; 95% CI, 1.9-6.3; P < .0001) to be a significant risk factor for moderate or severe perceived stress, while single relationship status (adjusted odds ratio: 2.9; 95% CI, 1.5-5.9; P = .002) and working ≥ 6 hours/day (adjusted odds ratio: 10.3; 95% CI, 4.3-24.6; P < .0001) significantly contributed to the development of moderate, moderately severe, or severe depression. Conclusions: The pandemic has taken a serious toll on the physical and mental health of doctors, as evident from our study. Regular screening of medical personnel involved in the diagnosis and treatment of patients with COVID-19 should be conducted to evaluate for stress, anxiety, and depression.


Assuntos
Infecções por Coronavirus , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Pandemias , Médicos/psicologia , Pneumonia Viral , Estresse Psicológico/epidemiologia , Adulto , Betacoronavirus , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Internato e Residência , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Admissão e Escalonamento de Pessoal , Médicos/estatística & dados numéricos , Prevalência , Características de Residência , Fatores de Risco , Carga de Trabalho , Adulto Jovem
11.
JMIR Mhealth Uhealth ; 8(10): e20099, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33064102

RESUMO

BACKGROUND: Digitalization is a disruptive technology that changes the way we deliver diagnostic procedures and treatments in medicine. Different stakeholders have varying interests in and expectations of the digitalization of modern medicine. Many recent digital advances in the medical field, such as the implementation of electronic health records, telemedical services, and mobile health apps, are increasingly used by medical professionals and patients. During the current pandemic outbreak of a novel coronavirus-caused respiratory disease (COVID-19), many modern information and communication technologies (ICT) have been used to overcome the physical barriers and limitations caused by government-issued curfews and workforce shortages. Therefore, the COVID-19 pandemic has led to a surge in the usage of modern ICT in medicine. At the same time, the eHealth literacy of physicians working with these technologies has probably not improved since our study. OBJECTIVE: This paper describes a representative cohort of German physicians before the COVID-19 pandemic and their eHealth literacy and attitude towards modern ICT. METHODS: A structured, self-developed questionnaire about user behavior and attitudes towards eHealth applications was administered to a representative cohort of 93 German physicians. RESULTS: Of the 93 German physicians who participated in the study, 97% (90/93) use a mobile phone. Medical apps are used by 42% (39/93). Half of the surveyed physicians (47/93, 50%) use their private mobile phones for official purposes on a daily basis. Telemedicine is part of the daily routine for more than one-third (31/93, 33%) of all participants. More than 80% (76/93, 82%) of the trial participants state that their knowledge regarding the legal aspects and data safety of medical apps and cloud computing is insufficient. CONCLUSIONS: Modern ICT is frequently used and mostly welcomed by German physicians. However, there is a tremendous lack of eHealth literacy and knowledge about the safe and secure implementation of these technologies in routine clinical practice.


Assuntos
Atitude do Pessoal de Saúde , Letramento em Saúde , Médicos/psicologia , Telemedicina , Adulto , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Médicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Inquéritos e Questionários
12.
Clin Med (Lond) ; 20(6): e253-e254, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33067187

RESUMO

The COVID-19 pandemic has impacted the training of foundation doctors across the UK. A survey of foundation year 1 doctors across several district general hospitals in the East of England and East Midlands deaneries was carried out to investigate their perceptions of the impact on their training.


Assuntos
Infecções por Coronavirus , Educação de Pós-Graduação em Medicina , Hospitais de Distrito/organização & administração , Hospitais Gerais/organização & administração , Pandemias , Médicos/estatística & dados numéricos , Pneumonia Viral , Betacoronavirus , Competência Clínica , Inglaterra , Humanos
13.
Global Health ; 16(1): 92, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993696

RESUMO

BACKGROUND: In all epidemics, healthcare staff are at the centre of risks and damages caused by pathogens. Today, nurses and physicians are faced with unprecedented work pressures in the face of the COVID-19 pandemic, resulting in several psychological disorders such as stress, anxiety and sleep disturbances. The aim of this study is to investigate the prevalence of sleep disturbances in hospital nurses and physicians facing the COVID-19 patients. METHOD: A systematic review and metanalysis was conducted in accordance with the PRISMA criteria. The PubMed, Scopus, Science direct, Web of science, CINHAL, Medline, and Google Scholar databases were searched with no lower time-limt and until 24 June 2020. The heterogeneity of the studies was measured using I2 test and the publication bias was assessed by the Egger's test at the significance level of 0.05. RESULTS: The I2 test was used to evaluate the heterogeneity of the selected studies, based on the results of I2 test, the prevalence of sleep disturbances in nurses and physicians is I2: 97.4% and I2: 97.3% respectively. After following the systematic review processes, 7 cross-sectional studies were selected for meta-analysis. Six studies with the sample size of 3745 nurses were examined in and the prevalence of sleep disturbances was approximated to be 34.8% (95% CI: 24.8-46.4%). The prevalence of sleep disturbances in physicians was also measured in 5 studies with the sample size of 2123 physicians. According to the results, the prevalence of sleep disturbances in physicians caring for the COVID-19 patients was reported to be 41.6% (95% CI: 27.7-57%). CONCLUSION: Healthcare workers, as the front line of the fight against COVID-19, are more vulnerable to the harmful effects of this disease than other groups in society. Increasing workplace stress increases sleep disturbances in the medical staff, especially nurses and physicians. In other words, increased stress due to the exposure to COVID-19 increases the prevalence of sleep disturbances in nurses and physicians. Therefore, it is important for health policymakers to provide solutions and interventions to reduce the workplace stress and pressures on medical staff.


Assuntos
Infecções por Coronavirus/terapia , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Pneumonia Viral/terapia , Transtornos do Sono-Vigília/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Estudos Transversais , Humanos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pandemias , Médicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Prevalência
14.
PLoS One ; 15(9): e0238159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915818

RESUMO

BACKGROUND: COVID-19 is a pandemic disease and questions rise about the coronavirus 2 (Sars-CoV-2) effect on nervous system. This involvement could help explaining the pathogenesis of this condition and lead to novel therapeutic approaches. OBJECTIVE: To assess the occurrence of neurological symptoms in COVID-19 patients during the Italian pandemic outbreak, as reported by physicians. MATERIALS AND METHODS: In the early days of pandemic emergence we developed an online survey open to all Italian clinicians involved in the diagnosis and management of COVID-19 patients. The survey was structured in three sections, with nine different items concerning the presence of different specific clinical abnormalities. Each item was graded from "absent" to "severe" in a 4-point Likert's scale. MAIN OUTCOMES AND MEASURES: Likert's scale data were analyzed by studying the distribution of responses by using medians and bar charts-relative frequencies. Also, in order to analyze differences in symptoms findings depending on the group of specialty, Likert's scale data were combined into two nominal categories ("absent"/"low" and "moderate"/"high"/") and a contingency table chi-square test was used. RESULTS: 126 physicians of 9 different medical specialties, from 10 regions of Italy, filled the online survey. The results show that 87.3% of practitioners reported neurological symptoms. In most cases these were mild and non-specific, but they were severe in a minority of patients. The most common symptoms observed were headache, myalgia and taste and smell abnormalities. Whilst there was no difference between neurologists and non-neurologists, we found that experienced clinicians (defined as clinicians that evaluated more than 30 patients) reported neurological symptoms more frequently than non-expert. CONCLUSIONS: Neurological symptoms have frequently been ported during the Italian COVID-19 pandemic, and thus should be monitored for all affected patients. Whilst some of the disturbances reported may be non-specific and common to other infectious diseases, smell and taste abnormalities might indicate nervous system as entry door for SARS-CoV-2 virus. This interpretation should promote research trials to avoid nervous system involvement.


Assuntos
Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/epidemiologia , Médicos/estatística & dados numéricos , Pneumonia Viral/complicações , Inquéritos e Questionários/estatística & dados numéricos , Infecções por Coronavirus/patologia , Humanos , Incidência , Itália , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/patologia , Pandemias , Pneumonia Viral/patologia , Olfato , Paladar
15.
BMC Public Health ; 20(1): 1474, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993603

RESUMO

BACKGROUND: As the Coronavirus disease 2019 (COVID-19) pandemic continues to evolve, physicians must be equipped with adequate knowledge, skills on the prevention measures, and confidence in diagnosing and treating COVID-19 patients. Therefore, it is of great interest to assess the knowledge and practices of Physicians to identify existing gaps and improve occupational safety and viral surveillance. METHODS: A cross-sectional study was conducted in Lebanon between 28th March and 11th April 2020. Data was collected through an online survey that included information on socio-demographic characteristics, knowledge, practice, physicians fear towards COVID-19 as well as their perceptions regarding actions/policies implemented by the Ministry of Public Health (MOPH) and their health care facilities. Multivariable logistic regression analyses were carried out to identify the factors associated with good knowledge of COVID-19 and good practice toward its prevention. Adjusted odds ratio and their 95% confidence intervals were reported. RESULTS: Our survey revealed that the majority of Lebanese physicians had good knowledge about the disease (89.5%) while approximately half of the respondents adopted good preventive practices (49.7%). The odds of having good knowledge was 2.16 times higher among physicians aged 40 and above (adjusted OR = 2.16 with a 95% confidence interval (CI) of 1.08 to 4.34) compared to their counterparts aged less than 40 years old. Our results also showed that the odds of good practice was 2 times higher among frontline compared to the second line workers (adjusted OR = 2.01 with 95% CI of 1.21 to 3.34). Physicians with an experience of 10 years and above were 3.35 times more likely to have good practice compared to their counterparts (adjusted OR = 3.35 with 95% CI of 1.60 to 7.02). Finally, participants with good knowledge of COVID-19 were 2.04 times more likely to have a good practice (OR = 2.04 with 95% CI of 1.01 to 4.12). CONCLUSION: Lebanese physicians revealed a good level of knowledge; however, they had limited comprehension of the precautionary measures that protect them from this virus. Our findings have important implications for the development of strategies suitable for improving the level of practice among physicians and enhance prevention programs.


Assuntos
Infecções por Coronavirus/terapia , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Médicos/psicologia , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Inquéritos e Questionários , Adulto Jovem
18.
Intern Emerg Med ; 15(8): 1445-1456, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32889687

RESUMO

COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.


Assuntos
Arritmias Cardíacas/diagnóstico , Infecções por Coronavirus/complicações , Eletrofisiologia/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/complicações , Adulto , Idoso , Arritmias Cardíacas/epidemiologia , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Eletrofisiologia/métodos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Médicos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Inquéritos e Questionários
19.
Medicine (Baltimore) ; 99(32): e21462, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769876

RESUMO

BACKGROUND: Physician burnout has been a global problem that affects severely the mental status among doctors, especially in emergency medicine (EM). However, few studies have focused on emergency medicine physicians, and the published data are inconsistent. Thus, this meta-analysis is performed to systematically evaluate the prevalence of burnout among emergency medicine physicians. METHODS: We systematically searched databases including PubMed, Embase, PsychINFO and the Cochrane Library from inception to September, 2019 for English-language articles. We selected all the original articles those used Maslach Burnout Inventory to assess the prevalence of burnout and its 3 dimensions emotional exhaustion (EE), depersonalization, and personal accomplishment (PA) in emergency medicine physicians. After literature screening, quality evaluation was performed for eligible studies by using the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data; then, Begg test and Egger test was used to assess publication bias. Pooled prevalence rates were assessed by conducting a meta-analysis using random effects models. Then sensitivity analysis followed to test the stability of the result and detected the source of heterogeneity. RESULTS: A total of 1943 EM physicians provided burnout data. The pooled prevalence rates of high levels of emotional exhaustion, high levels of depersonalization and low levels of PA were 40% (95% CI: 26%-55%; I = 97.4%), 41% (95% CI: 30%-52%; I = 94.5%) and 35% (95% CI: 19%-52%; I = 99.0%), respectively. The mean burnout scores were 23.95 (SD = 11.88) for emotional exhaustion, 11.63 (SD = 6.85) for depersonalization, and 34.69 (SD = 7.71) for PA. CONCLUSIONS: This meta-analysis demonstrate a high level of burnout prevalent in EM physicians that approximately 40% experience high levels of EE and depersonalization. Our findings also suggest that EM physicians are more susceptible to burnout compared with physicians in other departments and other medical staffs in EM. More attention should be payed to mental status of EM physicians and further investigation concerning how to reduce burnout would be beneficial for EM physicians.Registration: INPLASY202060060 in inplasy.com (doi.org/10.37766/inplasy2020.6.0060).


Assuntos
Esgotamento Profissional/epidemiologia , Medicina de Emergência , Médicos/psicologia , Humanos , Médicos/estatística & dados numéricos , Prevalência
20.
Medicine (Baltimore) ; 99(32): e21495, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769885

RESUMO

The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients' health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients' health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Mellitus/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Assistência Ambulatorial/psicologia , Bases de Dados Factuais , Diabetes Mellitus/psicologia , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Taiwan
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