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

RESUMO

The objective of this study was to identify the variables that influence physicians to implement Advance Directives and assess their impact on end-of-life care. It is a narrative literature review of 25 articles published between 1997 and 2018, in the following databases: CAPES, EBSCOhost, BDTD, VHL, Google Scholar, MEDLINE®/PubMed. The keywords utilized were: "advance directives", "living wills", "physicians", "attitude", "decision making", "advance care planning". The main factors that influenced physicians to implemente the directives were patients prognosis, medical paternalism, and patients understanding of their medical condition. Respect for autonomy, lack of knowledge and experience with directives, legal concerns, family influence, cultural and religious factors also contributed to medical decision. Most studies (86%) showed that having a directive led to lower rates of invasive interventions in the last days of patient´s life. Physicians were interested in respecting their patients' autonomy and agreed that having an advance directive helped in the decision-making process; however, they stated other factors were also taken into account, mainly prognosis and reversibility conditions. Having directives contributed to reducing the use of life support therapies and adoption of comfort measures.


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

RESUMO

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


Assuntos
Comunicação , Relações Médico-Paciente , Humanos , Médicos/psicologia , Encaminhamento e Consulta , Revelação da Verdade
3.
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
6.
Orv Hetil ; 160(43): 1706-1710, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31630551

RESUMO

Introduction: The term "spam" is applied to unwanted commercial e-mails sent to all whose e-mail addresses have been acquired by the spammers. The number of undesirable e-mails is growing in the health-care related areas as well. The targets of health-care related spams are laymen, physicians and academic researchers alike. Method: On the basis of 12,986 unwanted letters received in one year, the authors concluded that percentage of health-related spam is the second most common spam (27%) in relation to all spam. Most of the spam (63%) aggressively promoted purchasing of various consumer goods, but health-related spam are far ahead of the rest. The collected data were grouped by year and topic and they are analyzed by simple descriptive statistics. Spam form of cyber attacks on health care issues were divided into two: spam what is jeopardized individuals' health (e.g. medical compounds without any curing effect, misleading statement on medical device, fraudulent panacea offers, and cheating cure methods, etc.) and onslaught on medical scientific activity (pseudo-scientific congress invitation, predator journal invitation etc.). Results: The topics of spams addressed to laymen are offered for perfect healing by strange treatments, cures (31%), panaceas (19%), lifestyle advice (19%), massage (16%), brand new health-care devices (4%) and drugs for sexual dysfunction (11%). The topics of spams addressed to physicians and researchers are deluged by pseudoscientific materials: invitation for articles to be sent to no-name/fake open-access journals (68%), invitation to participate at an obscure congress (27%) or newsletters on miscellanous medical topics (5%). Conclusion: The spams offer very often relief or solution to medical problems that the present-day medical practice cannot solve perfectly (oncological, musculo-sceletal, endocrin or metabolic problems). Understandably, the patients would hold on to fake hopes - and the authentic patient education and health promotion will be neglected. These unwanted messages practically cannot be unsubscribed, and - while the spam filters are far from perfection - the victim must go through the filtered spam-dustbin in order not to miss some real messages. Unfortunately no legal regulation (neither local, nor GDPR) can block or stop the spams. The spams are misleading the laymen and jeopardise the effects of professional and responsible health promotion and health education. Orv Hetil. 2019; 160(43): 1706-1710.


Assuntos
Segurança Computacional , Correio Eletrônico/normas , Educação em Saúde , Internet/normas , Médicos/psicologia , Registros Eletrônicos de Saúde , Promoção da Saúde , Humanos , Pesquisadores
8.
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
9.
Curr Urol Rep ; 20(10): 62, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478112

RESUMO

Physician burnout-a constellation of depersonalization, emotional exhaustion, reduced feelings of personal attachment, and a low sense of accomplishment-is a term that has been around since the 1980s. Burnout rates among residents and fellows are higher than medical students, attending physicians, and age-matched college graduates, with rates ranging from 40-80% of trainees across subspecialties. Unfortunately, burnout among residents and trainees has been linked to lower scores on in-service examinations for internal medicine residents as well as poorer overall health and exercise habits. The purpose of this review is to quantify the extent of burnout among urology residents and examine effective techniques and measures to prevent burnout and practically what can be done to combat this growing epidemic.


Assuntos
Esgotamento Psicológico/etiologia , Esgotamento Psicológico/terapia , Internato e Residência , Médicos/psicologia , Urologia/educação , Adulto , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/terapia , Esgotamento Psicológico/diagnóstico , Esgotamento Psicológico/prevenção & controle , Feminino , Humanos , Masculino , Inquéritos e Questionários
10.
Z Gastroenterol ; 57(9): 1059-1066, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31525798

RESUMO

BACKGROUND: In Germany, colorectal cancer (CRC) screening includes a fecal blood test or colonoscopy, but not a sigmoidoscopy, which has been shown to reduce CRC incidences and mortality. Our aim was to compile physicians' experiences with sigmoidoscopy and their assessments of this procedure being an additional, possible screening method for early CRC detection. METHODS: At the end of 2015, gastroenterologists and internists in Lower Saxony and North Rhine-Westphalia who regularly perform screening colonoscopies in outpatient care were contacted per mail. Standardized telephone interviews consisting of 17 questions and lasting 10-15 minutes were conducted. RESULTS: Nearly two-thirds (56/87) of the respondents reject sigmoidoscopy as an acceptable early detection method. Compared to colonoscopy, key features of the sigmoidoscopy include more favorable patient-related aspects, while procedural aspects, except sedation, clearly rate in favor of the colonoscopy. In the instance that colonoscopy is rejected, 75 % of the physicians consider a sigmoidoscopy to be a possible alternative. CONCLUSIONS: The survey provides important practical insights into outpatient sigmoidoscopy. A majority of the physicians does not support evidence-based sigmoidoscopy for CRC screening. However, individuals who reject a colonoscopy are, in line with the current guideline, identified as a target group for a screening sigmoidoscopy. The benefit from an additionally offered sigmoidoscopy in CRC screening should be further analyzed with special consideration given to the preferences of insurees within the German healthcare system.


Assuntos
Atitude do Pessoal de Saúde , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/métodos , Médicos/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Sigmoidoscopia , Colonoscopia , Detecção Precoce de Câncer , Alemanha , Humanos , Sangue Oculto
11.
Z Gastroenterol ; 57(9): 1124-1130, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31525803

RESUMO

INTRODUCTION: The specific support of medical students is indispensable in gastroenterology. The aim of this study was to identify factors that influenced members of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) to choose their specialty. METHODS: Using an online survey all members of the DGVS were invited to assess the following factors: earliest time point of the decision to become a gastroenterologist, important role models and mentors, important course contents and teaching methods, the role of the doctoral thesis and other influencing aspects of the specialty gastroenterology. The evaluation included an additional subgroup analysis involving work experience (≤ 8, 9-29, ≥ 30 years) and working place (university hospital, community-based hospital, private practice). RESULTS: 1358 participants representing 24.2 % of the DGVS-members took part in the survey. Physicians with ≤ 8 years of work experience decided in 62.5 % during medical school to become a gastroenterologist compared to 37.1 % of the physicians with a work experience of ≥ 9 years (p < 0.001). Senior physicians were regarded as important role models and mentors by 40.8 % of the participants. Doctoral supervisors were regarded as important mentors that influenced the selection of the specialty by 42.8 % of the participants that completed their doctoral thesis in gastroenterology. Hands-on courses like sonography were regarded as important course contents by 42.2 % of the participants. Interventional medicine in particular endoscopy and the diversity of gastroenterology were rated as important in the selection process for the specialty. CONCLUSION: The decision to become a gastroenterologist is mainly made during medical school. The main influencing role models and mentors are senior physicians. Hands-on training in ultrasound and endoscopy were regarded as important course contents and teaching methods.


Assuntos
Gastroenterologistas/psicologia , Gastroenterologia/educação , Mão de Obra em Saúde , Médicos/psicologia , Hospitais Universitários , Humanos , Medicina , Sociedades Médicas , Inquéritos e Questionários
12.
JAMA ; 322(11): 1045-1046, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529011
14.
Health Qual Life Outcomes ; 17(1): 146, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438967

RESUMO

BACKGROUND: Cancer treatments are associated with a multitude of adverse events (AEs). While both nurses and physicians are involved in patient care delivery and AE assessment, very few studies have examined the differences between nurses' and physicians' reporting and perception of AEs. An approach was recently proposed to assess treatment burden based on reported AEs from the physician's perspective. In this paper, we use this approach to evaluate nurses' perception of burden, and compare nurses' and physicians' assessment of the overall and relative burden of AEs. METHODS: AE records for 334 cancer patients from a randomized clinical trial conducted by the SWOG Cancer Research Network were evaluated by 14 nurses at Columbia University Medical Center. Two nurses were randomly selected to assign a burden score from 0 to 10 based on their impression of the global burden of the captured AEs. These nurses did not interact directly with the patients. Scores were compared to previously obtained physicians scores using paired T-test and Kappa statistic. Severity scores for individual AEs were obtained using mixed-effects models with nurses assessments, and were qualitatively compared to physicians'. RESULTS: Given the same AEs, nurses' and physicians' perception of the burden of AEs differed. While nurses generally perceived the overall burden of AEs to be only slightly worse compared to physicians (mean average VAS score of 5.44 versus 5.14), there was poor agreement in the perception of AEs that were in mild to severe range. The percent agreement for a moderate or worse AE was 64% with a Kappa of 0.34. Nurses also assigned higher severity scores to symptomatic AEs compared to physicians (p < 0.05), such as gastrointestinal (4.77 versus 4.14), hemorrhage (5.07 versus 4.14), and pain (5.17 versus 4.14). CONCLUSIONS: These differences in the perception of burden of AEs can lead to different treatment decisions and symptom management strategies. Thus, having provider consistency, training, or a collaborative approach in follow-up care between nurses and physicians is important to ensure continuity in care delivery. Moreover, estimating overall burden from both physicians' and nurses' perspective, and comparing them may be useful for deciding when collaborations are warranted.


Assuntos
Antineoplásicos/efeitos adversos , Atitude do Pessoal de Saúde , Efeitos Psicossociais da Doença , Neoplasias/tratamento farmacológico , Qualidade de Vida , Feminino , Humanos , Masculino , Neoplasias/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Médicos/psicologia
15.
Transplant Proc ; 51(6): 1651-1654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399156

RESUMO

BACKGROUND: Singapore has had an opt-out organ donation system since the inception of the Human Organ Transplant Act in 2009. This law allows all Singapore citizens and permanent residents to donate their organs after confirmation of brain death, usually in the setting of devastating brain injury or stroke in an intensive care unit (ICU) setting, and such cases are referred to the National Organ Transplant Unit team by intensivists after the presumed clinical brain stem death testing. The further confirmatory tests, coordination with surgeons to find suitable recipients, and communication with family members is then carried out by the transplant coordinators from the National Organ Transplant Unit and not the clinicians. Despite a decade of the institution of the Act, the rates of organ donation remain low. This survey is the first aimed to assess the concerns and recommendations of the intensivists in Singapore. METHODS: This was an anonymous survey sent to 120 intensivists registered in Singapore with a 58% response rate. The survey included 14 open-ended questions. The respondents included both private and public sector intensivists. A qualitative analysis was carried out to analyze the emergent themes from the survey. RESULTS: A total of 79% of the respondents mentioned raising awareness through publicity, education, and advertising; 34% mentioned educating physicians and engaging ICU physicians in further planning of the organ transplant program in Singapore; 35% felt that publicizing more real stories of recipients would help. Generally, there was unease at the opt-out system infringing basic rights. CONCLUSION: This is the first survey to elicit the responses of the referring physicians for organ transplant. Their opinions suggest that a wider awareness and buy-in is needed both by the public and the ICU physicians, and addressing their valid moral concerns is essential in bridging this gap.


Assuntos
Atitude do Pessoal de Saúde , Transplante de Órgãos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Médicos/psicologia , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Feminino , Humanos , Masculino , Transplante de Órgãos/legislação & jurisprudência , Pesquisa Qualitativa , Singapura , Inquéritos e Questionários
16.
BMC Public Health ; 19(1): 1014, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366341

RESUMO

BACKGROUND: Many tropical countries are currently experiencing dengue (DEN), chikungunya (CHIK) and also more recently Zika (ZIKA) epidemics (particularly in Latin America). Although the risk of transmission and spread of these infections in temperate regions remains a controversial issue, vector-borne diseases have been widely reported in the media and have been the focus of preventive strategies by national and international policy-makers and public health authorities. In this context, we wanted to determine the extent of risk perception in infectious diseases (ID) physicians of the current and future risk of arboviral disease introduction, autochthonous case development and epidemic scenarios in France, Western Europe. METHODS: To this aim, we developed an original standardized questionnaire survey which was disseminated by the French Infectious Diseases Society to ID physician members. RESULTS: We found that ID physicians perceived the risk of introduction and outbreak development of DEN, CHIK and ZIKA in France to be low to medium-low. Generalized Linear Model(s) identified medical school training, the extent of professional experience, and awareness of the French national plan regarding arboviral infections as significant predictors for lower risk perception among respondents. CONCLUSION: Despite the fact that arboviral diseases are increasingly being imported into France, sometimes resulting in sporadic autochtonous transmission, French ID physicians do not perceive the risk as high. Better communication and education targeting health professionals and citizens will be needed to enhance the effectiveness of the French national plan to prepare against arboviral diseases.


Assuntos
Atitude do Pessoal de Saúde , Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Surtos de Doenças , Infectologia , Médicos/psicologia , Infecção por Zika virus/epidemiologia , Adulto , Europa (Continente)/epidemiologia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Medição de Risco , Inquéritos e Questionários
18.
Medicine (Baltimore) ; 98(32): e16693, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393371

RESUMO

To strengthen rural health services, the Chinese government has launched a series of policies to promote health workforce development. This study aims to understand the current status of village doctors and to explore the factors associated with village doctors' job satisfaction in western China. It also attempts to provide references for further building capacities of village doctors and promoting the development of rural health service policy.A multistage stratified sampling method was used to obtain data from a cross-sectional survey on village doctors across 2 provinces of western China during 2012 to 2013. Quantitative data were collected from village doctors face-to-face, through a self-administered questionnaire.Among the 370 respondents, 225 (60.8%) aged 25 to 44 years, and 268 (72.4%) were covered by health insurance. Their income and working time calculated by workloads were higher than their self-report results. Being healthy, working fewer years, and having government funding and facilities were the positive factors toward their job satisfaction. Village doctors working with government-funded village clinics or facilities were more likely to feel satisfied.Problems identified previously such as low income and lack of insurance, heavy workload and aging were not detected in our study. Instead, village doctors were better-paid and better-covered by social insurance than other local rural residents, with increased job satisfaction. Government policies should pay more attention to improving the quality of rural health services and the income and security system of village doctors, to maintain and increase their job satisfaction and work enthusiasm. Further experimental study could evaluate effects of government input to improve rural health human resources and system development.


Assuntos
Satisfação no Emprego , Médicos/psicologia , Serviços de Saúde Rural/organização & administração , Adulto , Atitude do Pessoal de Saúde , Fortalecimento Institucional , China , Estudos Transversais , Humanos , Serviços de Saúde Rural/legislação & jurisprudência , Autorrelato
19.
JAMA ; 322(1): 29, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265104
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