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1.
Methodist Debakey Cardiovasc J ; 15(3): 234-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687108

RESUMO

Through the generosity of Charles R. Millikan, DMin, vice president for Spiritual Care and Values Integration, an annual award competition was established at Houston Methodist Hospital among the resident staff. To enter the writing competition, residents must submit a poem or essay of 1,000 words or less on the topic, "On Being a Doctor." A committee of seven was selected from Houston Methodist Hospital Education Institute to establish the judging criteria and select the winning entries. The following is the second-place winning entry for 2019; the third-place entry will be published in the next issue of this journal.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Médicos/organização & administração , Carga de Trabalho , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência , Médicos/psicologia , Triagem
2.
Pan Afr Med J ; 33: 225, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692825

RESUMO

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


Assuntos
Documentação/normas , Medicina Legal/legislação & jurisprudência , Violência/legislação & jurisprudência , Adolescente , Adulto , Idoso , Agressão , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Médicos/organização & administração , Estudos Retrospectivos , Senegal , Adulto Jovem
3.
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
4.
Am J Health Syst Pharm ; 76(16): 1238-1247, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369113

RESUMO

PURPOSE: The purpose of this study was to identify and describe strategies that have successfully achieved collaboration among physicians and pharmacists providing comprehensive medication management (CMM) to support development of CMM services. METHODS: A 2-phase, mixed-methods approach was employed to identify successful strategies for building pharmacist-physician relationships in primary care clinic settings. Phase I used a qualitative approach to identify strategies deemed successful in building relationships with physicians. An advisory group of pharmacists with experience building CMM practices assisted in the development of minimum criteria characterizing pharmacists as having strong collaborative relationships. Semi-structured interviews were conducted with 10 interviewees meeting established criteria. Researchers coded interview transcripts and identified the resulting strategies. Phase II employed a survey instrument to determine how frequently identified strategies are used and evaluate the relative level of perceived impact of each strategy, which was distributed to a national audience of pharmacists practicing in ambulatory care settings. Responses from pharmacists meeting prespecified criteria were included in the analysis. RESULTS: Thirty-three strategies were identified and grouped into 8 themes. In phase II, 104 survey respondents met defined criteria and were eligible to endorse use of identified strategies and rate their relative influence. CONCLUSIONS: Thirty-three strategies were identified and grouped into 8 themes to aid pharmacists practicing CMM in developing stronger collaborative relationships with physician colleagues. A national sampling found many of these strategies were employed by a majority of pharmacists, who had found them to be influential in creating collaborative relationships.


Assuntos
Assistência Ambulatorial/organização & administração , Relações Interprofissionais , Farmacêuticos/organização & administração , Médicos/organização & administração , Atenção Primária à Saúde/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Humanos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos
6.
Med Care ; 57(9): 680-687, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295166

RESUMO

BACKGROUND: Properties of social networks and shared patient networks of physicians are associated with important outcomes, including costs, quality, information exchange, and organizational effectiveness. OBJECTIVES: To determine whether practice consolidation affects size, strength, and stability of US practice-based physician shared patient networks. RESEARCH DESIGN: We used a dynamic difference-in-differences (event study) design to determine how 2 types of vertical consolidation (hospital and health system practice acquisition) and 2 types of horizontal consolidation (medical group membership and practice-practice mergers) affect individual shared patient network characteristics, controlling for physician fixed effects and geographic market (metropolitan statistical area). SUBJECTS: Practice-based US physicians whose practices consolidated 2009-2014 are identified via health system, hospital, and medical group affiliation information and appearance/disappearance of listed practice affiliations in the SK&A Physician Database. MEASURES: Outcomes measured were network size (number of individual physicians with whom a physician shares patients within 30 d), strength (average number of shared patients within those relationships), and stability (percent of shared patient relationships that persist in the current and prior year), all generated from Medicare Shared Patient Patterns (30-d) data. RESULTS: Shared patient network stability increases significantly after acquisition of practices by horizontal practice-practice mergers [ßt=1=0.041 (P<0.001), ßt=2=0.047 (P<0.001), ßt=3=0.041 (P<0.001), ßt=4=0.031 (P<0.05), where t is the number of years after the consolidation event]. These effects were robust to sensitivity analyses. Shared patient network size and strength are not observably associated with practice consolidation events. CONCLUSIONS: Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/organização & administração , Redes Comunitárias/organização & administração , Humanos , Médicos/organização & administração , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde/organização & administração , Estados Unidos
7.
Recenti Prog Med ; 110(6): 269-270, 2019 06.
Artigo em Italiano | MEDLINE | ID: mdl-31282481

RESUMO

In the opening lecture of the congress of the American Society of Clinical Oncology (ASCO), the famous US surgeon Atul Gawande addressed the issue of the role of the doctor, focusing on the care of patients with terminal illnesses. Prolonging life should not represent the goal of the doctor's decision-making, who must instead pay attention to preserving the patient's quality of life as much as possible. The relationship between doctor and patient must be based on some fundamental questions that the clinician must address to the patient in order to know his goals. The lecture was one of the key moments of the ASCO congress, very attentive to issues concerning the sustainability of care and the experiences of patients. It is surprising, however, that such a patient-centered conference was not disseminated and commented on by patient advocates on social media as it deserved.


Assuntos
Relações Médico-Paciente , Qualidade de Vida , Assistência Terminal/métodos , Tomada de Decisões , Humanos , Papel do Médico , Médicos/organização & administração
8.
J Oncol Pharm Pract ; 25(8): 1945-1967, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31288634

RESUMO

INTRODUCTION: Although many oncology pharmacists are embedded members within the healthcare team, data documenting their contributions to optimal patient outcomes are growing. The purpose of this paper is to demonstrate the value of the oncology pharmacist within the healthcare team and describe the knowledge, skills, and functions of the oncology pharmacist. METHODS: A systematic literature review of articles that were published on PubMed between January 1951 and October 2018 was completed. Identified abstracts were reviewed and included if they focused on measuring the value or impact of the oncology pharmacist on provider/patient satisfaction, improvement of medication safety, improvement of quality/clinical care outcomes, economics, and intervention acceptance. Review articles, meta-analysis, and studies not evaluating oncology pharmacist activities were excluded. Studies were thematically coded into four themes (clinical care, patient education, informatics, and cost savings) by 10 oncology pharmacists. RESULTS: Four-hundred twenty-two articles were identified, in which 66 articles met inclusion criteria for this review. The selected literature included 27 interventional and 38 descriptive studies. The value of the oncology pharmacist was demonstrated by published articles in four key themes: clinical care, patient education, informatics, and cost savings. CONCLUSION: With an expected shortage of oncology physicians and the ongoing development of complex oncology therapies, the board-certified oncology pharmacist is well suited to serve as a physician extender alongside nurse practitioners and/or physician assistants as the medication expert on the oncology care team. The demonstrated value of the oncology pharmacist supports their role as frontline providers of patient care.


Assuntos
Oncologia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Redução de Custos , Humanos , Médicos/organização & administração , Papel Profissional
9.
Dtsch Med Wochenschr ; 144(11): 764-769, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31163478

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/organização & administração , Médicos , Adulto , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/organização & administração , Médicos/estatística & dados numéricos , Sociedades Médicas , Inquéritos e Questionários
10.
Clin Ter ; 170(3): e177-e180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31173046

RESUMO

BACKGROUND: In the wound care field, effective communication within the interdisciplinary staff is essential and the use of tools that foster it is important. The use of a common language among professionals in the assessment and monitoring process, along with documentation of the outcome, avoids the useless repetition of performances by professionals, with a considerable save of time. OBJECTIVE: One year after its publication, we wanted to evaluate the effectiveness of the Toven Evaluation Form as an interdisciplinary communication tool, for the assessment of cutaneous lesions, according to the Toven Method. MATERIAL: The instrument got under observation also allows the graphic recording of the characteristics of the skin lesions (size, wound conditions, undermining and perilesional skin) according to specific pre-established rules, in an easy and intuitive way for the evaluator and the rest of the multidisciplinary team. It is an integral part of the Toven File. An anonymous, specially created questionnaire containing 20 questions was used for its evaluation. METHODS: A fact-finding inquiry was initiated by recruiting a multidisciplinary sample of 101 professionals who managed skin lesions in their activity. Before completing the form, all the participants attended a two-hour training course, which took place through a lecture and a practical session. RESULTS: Sample composition: 76.2% females, 23.8% males; 63.4% nurses, 10.9% Wound Care Specialist nurses; 16,8% doctors; 8.9% physiotherapists. Of these, 69.3% had work experience >5 years. The technical quality of the instrument was considered excellent by 83.2% of professionals and good by 16.8% of them. The data recorded with the aid of the instrument were considered complete by 100% of the sample. Furthermore, 99% of the sample interviewed declared that the tool is easy to use and would be interested in including it in daily practice; 100% declares that the use of the form can facilitate its work, which can be easily understood and used by the entire multidisciplinary team and which can be an effective tool for the improvement of interdisciplinary communication.


Assuntos
Comunicação , Assistência à Saúde/organização & administração , Comunicação Interdisciplinar , Pele/patologia , Feminino , Humanos , Masculino , Médicos/organização & administração
11.
Clin Ter ; 170(3): e216-e222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31173053

RESUMO

BACKGROUND: Early detection of oral cancer improves survival after treatment and the quality of life. The adoption of standardized methodological protocols of screening has increased the possibilities for early identification and appropriate treatment. The informed consent must be obtained by patients before any treatment and/or surgical procedure. The clinical and surgical details must be discussed with the patient, as well as potential risks and benefits. Consent must be documented in the medical record and consent forms may serve to document the physician's discussion with the patient. OBJECTIVES: all dentists are trained to detect the early signs of oral cancer. The health professional have a key role in identify the early signs of oral cancer in order to plan the treatment and management of the disease. The work aims to provide simple practical information to collect the patient's consent and encouraging him to improve healthy behaviors. MATERIALS AND METHODS: are analyzed the critical issues of clinical practice in order to improve the management of oral cancer. RESULTS AND CONCLUSIONS: Identify effective information approaches documented in the medical record as a tool of close communication between the patient and the physician.


Assuntos
Tomada de Decisão Clínica , Neoplasias Bucais/terapia , Qualidade de Vida , Comunicação , Humanos , Consentimento Livre e Esclarecido , Registros Médicos , Relações Médico-Paciente , Médicos/organização & administração
12.
Gac Med Mex ; 155(2): 202-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056602

RESUMO

Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.


Assuntos
Ética Médica , Médicos/organização & administração , Padrões de Prática Médica/normas , Comitês Consultivos , Humanos , México , Médicos/ética , Padrões de Prática Médica/ética
15.
Recenti Prog Med ; 110(4): 155, 2019 04.
Artigo em Italiano | MEDLINE | ID: mdl-31066359

RESUMO

In the article by John Mandrola, Adam Cifu, Vinay Prasad and Andrew Foy translated below, the principles of being a medical "conservative" in the practice of contemporary medicine are exposed. In times projected towards progress, a manifesto to conservatism could seem an oxymoron, but today it is necessary to verify that every innovation is really such and that it contains scientific evidences to support what it claims.


Assuntos
Assistência à Saúde/métodos , Médicos/organização & administração , Padrões de Prática Médica , Humanos
17.
Recenti Prog Med ; 110(4): 168-187, 2019 04.
Artigo em Italiano | MEDLINE | ID: mdl-31066363

RESUMO

Scientific issues. An effective pre-hospital emergency care needs trained health care professionals, technological and therapeutic resources, but not always the emergency systems performance is data-driven. There are three fundamental models of pre-hospital care. The first one (Anglo-American) is based on the professional paramedic provision of care. Another model (Franco-German) is built on the physician-led approach. The last one, derived from the franco-german model, is the nurse-led model described as the new profession in the pre-hospital care setting. Many studies compare the benefits of having physicians or nurses or paramedics on the field. The findings of this narrative literature review show that: 1) there is no a better model than the other; 2) the best performance depends on one hand on the expertise required case by case of those responding, on the other on the quality of dispatching process, contrary to what the Bologna's General Medical Council held; 3) regardless of the adopted model, the task shifting (the skills and expertise passed from physicians on other specialized health care workers) is considered around the world as the best way to balance health care demand and supply in the pre-hospital emergency setting. Professional ethics and legal issues. By means of the transformation of principles of medical ethics in rules binding for professionals, the code of medical ethics (CME) gains relevance within the legal system, especially through case law and disciplinary responsibility. Moreover, the CME is gaining growing attention, both at the normative and judicial levels, due to its ability to regulate important aspects of professional conduct, which may have consequences for medical practice and for the patient's fundamental rights. Notwithstanding this role, the interrelations between law and medical ethics, the binding value of the CME and the related position in the hierarchy of norms are still controversial, lacking a proper regulation and a proper set of safeguards measures. A disciplinary action against doctors acting outside the professional activities, namely as a council member proposing a legal act, must be based on solid grounds relating to the protection of fundamental rights. Such a disciplinary authority requires legal definitions, safeguards and judicial remedies beyond those being met at present. The analysis shows how specific elements and devices should still be taken into consideration from both procedural and content perspectives to shape a more coherent model of relationships between law and medical ethics.


Assuntos
Serviços Médicos de Emergência/organização & administração , Ética Médica , Pessoal de Saúde/organização & administração , Serviços Médicos de Emergência/ética , Serviços Médicos de Emergência/legislação & jurisprudência , Auxiliares de Emergência/organização & administração , Humanos , Itália , Enfermeiras e Enfermeiros/organização & administração , Médicos/organização & administração
18.
Recenti Prog Med ; 110(5): 212-214, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31140452

RESUMO

Recently, John Mandrola et al. established the tenets of medical conservativism. We endorse this approach to patient care, and we believe that, in order to have this perspective incorporated into medical reasoning, the foundations for being medical conservatives should be taught since medical school. In this Perspective, through an analogy between medicine's and criminal law's approaches to uncertainty, we suggest that the precautionary principle of in dubio pro reo could be adapted to medicine as a decisional strategy for medical conservatives. This principle would represent a cognitive and decisional filter that allows physicians to counterbalance the currently widespread propensity toward interventions with a conservative and precautionary attitude.


Assuntos
Assistência à Saúde/métodos , Assistência ao Paciente/métodos , Médicos/organização & administração , Atitude do Pessoal de Saúde , Tomada de Decisões , Humanos
19.
Health Care Manag (Frederick) ; 38(2): 146-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932928

RESUMO

Private hospitals and medical institutions play an important role in bridging the health care delivery gap in India. In addition to prescribing physicians, various stakeholders such as nurses, pharmacists, and hospital administrators working in these institutions contribute to the efficient delivery of health care services. The current survey was conducted with the aim of evaluating work-related challenges faced by these individual hospital stakeholders and gauging potential engagement opportunities with industry to improve the quality health care services delivered. This survey included 60 private hospitals with more than 250 beds, located in 12 Indian cities. A 2-stage approach involving in-depth qualitative discussions followed by structured quantitative interviews of all the internal stakeholders was adopted. The study delineated the roles assayed by individual hospital stakeholders as well as the major challenges encountered by them. The responses of major classes of hospital workforce on possible solutions to bridge these need gaps were also recorded. The survey identified significant gaps existing in hospitals in areas of cross-functional collaboration, scientific and technical knowledge upgrade, training of staff, and communication and coordination with internal and external stakeholders. Value-based hospital-industry partnerships can go a long way in addressing the scientific and training needs of private hospitals.


Assuntos
Comunicação , Hospitais Privados , Melhoria de Qualidade , Participação dos Interessados/psicologia , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Administradores Hospitalares/organização & administração , Humanos , Índia , Enfermeiras Administradoras/organização & administração , Recursos Humanos em Hospital/educação , Médicos/organização & administração , Inquéritos e Questionários
20.
Eur J Clin Pharmacol ; 75(7): 1017-1023, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30899989

RESUMO

PURPOSE: Potentially inappropriate medications (PIMs) have been associated with a greater risk of adverse drug events and hospitalizations. To reduce PIMs use, a family health team (FHT) implemented a knowledge translation (KT) strategy that included a pharmacist-physician intervention model based on alerts from a computerized alert system (CAS). METHODS: Our pragmatic, single-site, pilot study was conducted in an FHT clinic in Quebec, Canada. We included community-dwelling older adults (≥ 65 years), with at least 1 alert for selected PIMs and a medical appointment during the study period. PIMs were selected from the Beers and STOPP criteria. The primary outcome was PIMs cessation, decreased dose, or replacement. The secondary outcome was the clinical relevance of the alerts as assessed by the pharmacists. RESULTS: During the 134 days of the study, the CAS screened 369 individuals leading to the identification of 65 (18%) patients with at least 1 new alert. For those 65 patients, the mean age was 77 years, men accounted for 29% of the group and 55% were prescribed 10 or more drugs. One or more clinically relevant alerts were generated for 27 of 65 included patients for an overall clinical relevance of the alerts of 42%. Of the 27 patients with at least 1 relevant alert, 17 (63%) had at least 1 medication change as suggested by the pharmacist. CONCLUSION: An interdisciplinary pharmacist-physician intervention model, based on alerts generated by a CAS, reduced the use of PIMs in community-dwelling older adults followed by an FHT.


Assuntos
Prescrição Inadequada/prevenção & controle , Farmacêuticos/organização & administração , Médicos/organização & administração , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Projetos Piloto , Atenção Primária à Saúde , Quebeque
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