Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.726
Filtrar
1.
Lancet ; 398(10303): 920-930, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481571

RESUMO

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.


Assuntos
Transtornos Mentais/epidemiologia , Médicos/psicologia , Suicídio/estatística & dados numéricos , Esgotamento Profissional , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/prevenção & controle , Pandemias , Médicas/psicologia , Fatores de Risco , SARS-CoV-2 , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Suicídio/prevenção & controle , Tolerância ao Trabalho Programado
2.
JMIR Public Health Surveill ; 7(9): e27715, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468331

RESUMO

BACKGROUND: Health misinformation is a public health concern. Various stakeholders have called on health care professionals, such as nurses and physicians, to be more proactive in correcting health misinformation on social media. OBJECTIVE: This study aims to identify US physicians' and nurses' motivations for correcting health misinformation on social media, the barriers they face in doing so, and their recommendations for overcoming such barriers. METHODS: In-depth interviews were conducted with 30 participants, which comprised 15 (50%) registered nurses and 15 (50%) physicians. Qualitative data were analyzed by using thematic analysis. RESULTS: Participants were personally (eg, personal choice) and professionally (eg, to fulfill the responsibility of a health care professional) motivated to correct health misinformation on social media. However, they also faced intrapersonal (eg, a lack of positive outcomes and time), interpersonal (eg, harassment and bullying), and institutional (eg, a lack of institutional support and social media training) barriers to correcting health misinformation on social media. To overcome these barriers, participants recommended that health care professionals should receive misinformation and social media training, including building their social media presence. CONCLUSIONS: US physicians and nurses are willing to correct health misinformation on social media despite several barriers. Nonetheless, this study provides recommendations that can be used to overcome such barriers. Overall, the findings can be used by health authorities and organizations to guide policies and activities aimed at encouraging more health care professionals to be present on social media to counteract health misinformation.


Assuntos
COVID-19/epidemiologia , Comunicação , Informação de Saúde ao Consumidor/normas , Motivação , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Mídias Sociais/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Estados Unidos/epidemiologia
3.
J Infect Dev Ctries ; 15(8): 1080-1085, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34516414

RESUMO

INTRODUCTION: It has been noted that post-traumatic stress disorder symptoms could be common in physicians who have experienced a traumatic event. The aim of this study was to determine the prevalence of post-traumatic stress disorder and contributing risk factors among resident doctors working in a tertiary care hospital during the COVID-19 pandemic. METHODOLOGY: A cross-sectional study was conducted via an online survey from May to July 2020. Sociodemographic characteristics, exposure to the coronavirus, application of personal hygiene rules, presence and use of personal protective equipment, anxiety and prevalence of post-traumatic stress disorder were investigated. RESULTS: In total, 17.8% (n = 40) of 225 resident doctors who participated in the study had post-traumatic stress disorder. Working at a department serving to COVID-19 patients increased the risk of post-traumatic stress disorder by 2.9 times (OR = 2.936, p = 0.003) while contacting positive patients increased this risk by 2.6 times (OR = 2.607, p = 0.023) and lack of personal protective equipment by 3.6 times (OR = 3.656, p = 0.018). Anxiety scores were statistically significantly higher in women, married and those living with their parents or spouses and children (p = 0.049; p = 0.011; p = 0.004, respectively). CONCLUSIONS: Working in a department serving to COVID-19 patients, contact with positive patients and lack of personal protective equipment were risk factors in the emergence of post-traumatic stress disorder in resident doctors. Anxiety was also found to be greater in women, married and those living with their families.


Assuntos
COVID-19/epidemiologia , COVID-19/psicologia , Internato e Residência , Médicos/psicologia , Médicos/estatística & dados numéricos , Adulto , Ansiedade , COVID-19/prevenção & controle , Estudos Transversais , Depressão , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos , Inquéritos e Questionários , Turquia/epidemiologia , Adulto Jovem
4.
PLoS One ; 16(9): e0257109, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34478470

RESUMO

INTRODUCTION: Health care workers are the most affected part of the world population due to the COVID-19 pandemic. Countries prioritize vaccinating health workers against COVID-19 because of their susceptibility to the virus. However, the acceptability of the vaccine varies across populations. Thus, this study aimed to determine the health care worker's intentions to accept the COVID-19 vaccine and its associated factors in southwestern Ethiopia, 2021. METHODS: A facility-based cross-sectional study was conducted among health care workers in public hospitals in southwestern Ethiopia from March 15 to 28, 2021. A simple random sampling method was used to select 405 participants from each hospital. Data were collected using self-administered questionnaires. Descriptive statistics, such as frequency and percentage, were calculated. Multivariable logistic regression was also performed to identify factors associated with health care worker's intention to accept the COVID-19 vaccine. Statistically significant variables were selected based on p-values (<0.05) and the adjusted odds ratio was used to describe the strength of association with 95% confidence intervals. RESULT: Among the respondents, 48.4% [95% CI: 38.6, 58.2] of health care workers intended to accept COVID-19. Intention to accept COVID-19 vaccination was significantly associated with physicians (AOR = 9.27, 95% CI: 1.27-27.32), professionals with a history of chronic illness (AOR = 4.07, 95% CI: 2.02-8.21), perceived degree of risk of COVID-19 infection (AOR = 4.63, 95% CI: 1.26-16.98), positive attitude toward COVID-19 prevention (AOR = 6.08, 95% CI: 3.39-10.91) and good preventive practices (AOR = 2.83, 95% CI: 1.58-5.08). CONCLUSION: In this study, the intention of health care workers to accept the COVID-19 vaccine was low. Professional types, history of chronic illness, perceived degree of risk to COVID-19 infection, attitude toward COVID-19 and preventive practices were found to be factors for intention to accept COVID-19 vaccine in professionals. It is important to consider professional types, history of chronic illness, perceived degree of risk to COVID-19, attitude of professionals and preventive behaviors to improve the intention of professionals' vaccine acceptance.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/psicologia , Pessoal de Saúde/psicologia , Pandemias , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Etiópia/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Fatores de Risco , SARS-CoV-2 , Inquéritos e Questionários
5.
Ann Emerg Med ; 78(3): 453-454, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34420558
6.
JAMA Netw Open ; 4(8): e2120642, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34387678

RESUMO

Importance: As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic's association with the vitality and careers of medical school faculty. Objective: To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine. Design, Setting, and Participants: This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course's mechanisms of action. Main Outcomes and Measures: Key themes in data. Results: Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership. Conclusions and Relevance: During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.


Assuntos
COVID-19 , Docentes de Medicina/psicologia , Médicos/psicologia , Profissionalismo , Pesquisadores/psicologia , Adulto , Escolha da Profissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Estados Unidos
7.
Medicine (Baltimore) ; 100(32): e26915, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397931

RESUMO

ABSTRACT: The hospice and palliative care can improve the symptoms and signs of terminal cancer patients. The purposes of this study are how to improve terminally ill cancer patients' symptoms and signs and how the dedicated palliative care service effects on these improvements.From January 2017 to March 2019, among 919 terminally ill cancer patients admitted to the palliative care units in 11 hospitals of South Korea, we analyzed 334 patients with prospective cohort method and categorized them into non-dedicated hospice care group of 234 and dedicated hospice care group of 100.Symptoms improvement of dyspnea, fatigue, drowsiness, and dry mouth during the first week of admission were respectively 298 (89.2%), 25 (7.5%), 204 (61.1%), 76 (22.8%). Signs improvement of myoclonus, respiratory secretion, leg edema, and ascites between admission and a week after were 5 (1.5%), 41 (12.3%), 47 (14.1%), 12 (3.6%). Significant differences between dedicated hospice care physician group and non-dedicated hospice care physician group were shown in drowsiness (67.5% vs 46%, P < .001) and respiratory secretion (15% vs 6%, P < .028). Compared to non-dedicated care group, the odds ratio for more than 2 symptoms or signs was 1.78 (95% confidence interval, 1.05-3.02) in the dedicated care group after adjusting confounding variables.In conclusion, terminally ill cancer patients who received palliative or hospice service showed significant improvement in symptoms and signs. And, family doctors (dedicated hospice physician group) performed better than oncologists (non-dedicated physician group).


Assuntos
Cuidados Paliativos na Terminalidade da Vida/métodos , Neoplasias/terapia , Médicos/psicologia , Doente Terminal/psicologia , Idoso , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Neoplasias/psicologia , Estudos Prospectivos , República da Coreia/epidemiologia
8.
Eur J Gen Pract ; 27(1): 235-240, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34431427

RESUMO

BACKGROUND: In March 2020, the WHO declared the SARS CoV-2 pandemic. This had an immediate and dramatic impact on Romanian physicians. OBJECTIVES: To analyse SARS-CoV-2 risk perception among Romanian physicians following the official WHO pandemic announcement. METHODS: A questionnaire was sent to Romanian physicians (n = 319) between 13 and 27 of March 2020 to determine the perceived threat of exposure to SARS CoV-2 infection, the assessment COVID-19 sources of documentation, physicians' access to personal protective equipment and the attitude towards a prospective vaccine against SARS CoV-2. RESULTS: Confronted with a new and unknown disease, the lack of appropriate information regarding disease management, media pressure and the lack of protective equipment, physicians experiencing a highly stressful a period. We found a significant relationship between the perceived level of fear and the risk of infection with SARS CoV-2 among respondents. A relationship was also found between the perceived level of fear related to COVID-19 and the acceptance of future vaccines against SARS CoV-2. Our data show that doctors working in urban areas considered the medical research on COVID-19 as clearer than those working in rural locations did. CONCLUSION: Pandemic preparedness should focus on measures that make medical practice safe (supplies, working protocols, experience sharing with experts/colleagues from other countries).


Assuntos
Atitude do Pessoal de Saúde , COVID-19/epidemiologia , Equipamento de Proteção Individual/provisão & distribuição , Médicos/estatística & dados numéricos , Adulto , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Surtos de Doenças , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Romênia , Inquéritos e Questionários
9.
Isr J Health Policy Res ; 10(1): 48, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407864

RESUMO

Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC's activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society's vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.


Assuntos
COVID-19/prevenção & controle , Comunicação Interdisciplinar , Pandemias/prevenção & controle , Instituições Acadêmicas/organização & administração , COVID-19/epidemiologia , COVID-19/transmissão , Criança , Humanos , Israel/epidemiologia , Médicos/psicologia , Saúde Pública
10.
PLoS One ; 16(8): e0256806, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34437629

RESUMO

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants' interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.


Assuntos
COVID-19/epidemiologia , Médicos/psicologia , Adulto , Idoso , COVID-19/virologia , Tomada de Decisões , Prescrições de Medicamentos , Tratamento de Emergência , Feminino , Humanos , Interocepção , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Preparações Farmacêuticas/administração & dosagem , Assunção de Riscos , SARS-CoV-2 , Inquéritos e Questionários
11.
J Glob Health ; 11: 04043, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34326993

RESUMO

Background: While recent reviews highlight high burnout prevalence among physicians in the World Health Organization's (WHO) Eastern Mediterranean Region (EMR), there has been a limited exploration into the role of gender and related factors in this problem. Methods: We conducted a systematic review and meta-analysis of studies on the prevalence of physician burnout and its relationship to gender, physician specialties, and age in the WHO's EMR based on the Cochrane Handbook for Systematic Reviews. We searched PubMed, Embase, PsycINFO, Google Scholar, and Al Manhal databases and synthesized the findings from the included studies. Results: Among the 78 studies included, data was available from 16/22 (72.7%) countries and territories in the EMR covering a total of 16 016 physicians. The pooled prevalence of overall burnout among physicians in the region was estimated to be 24.5%. Among the sub-components of burnout, we estimated a high pooled prevalence of 44.26% for emotional exhaustion followed by 37.83% for depersonalization and 36.57% for low personal achievement. There was a statistically significant difference in the prevalence across the countries in the EMR and among the sub-categories of specialist medical practitioners. There was no statistically significant difference across the two genders at a regionally aggregated level. Conclusions: The levels of physician burnout including the three sub-components in EMR are high by any standards. Based on our review of available studies, it is difficult to ascertain gender differences with certainty in burnout levels among physicians in the EMR nations. There is a need for better quality studies in this area.


Assuntos
Esgotamento Profissional , Médicos , Esgotamento Profissional/epidemiologia , Feminino , Humanos , Masculino , Região do Mediterrâneo/epidemiologia , Médicos/psicologia , Médicos/estatística & dados numéricos , Prevalência , Fatores de Risco , Fatores Sexuais
12.
Mayo Clin Proc ; 96(8): 2067-2080, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34301399

RESUMO

OBJECTIVE: To evaluate the prevalence of suicidal ideation (SI) and attitudes regarding help seeking among US physicians relative to the general US working population. PARTICIPANTS AND METHODS: A secondary analysis of a cross-sectional survey of US physicians and a probability-based sample of the US working population was conducted between October 12, 2017, and March 15, 2018. Among 30,456 invited physicians, 5197 (17.1%) completed the primary survey. Suicidal ideation in the last year, attitudes regarding help seeking, symptoms of depression, and burnout were assessed by standardized questions. RESULTS: Among the 4833 physicians who responded regarding SI, 316 (6.5%) reported having suicidal thoughts in the last 12 months. Most physicians (3527 [72.9%]) reported that they would seek professional help if they had a serious emotional problem. Physicians with SI were less likely to report that they would seek help (203/316 [64.2%]) than physicians without SI (3318/4517 [73.5%]; P=.001). On multivariable analysis, symptoms of depression (odds ratio [OR], 4.42; 95% CI, 1.89 to 11.52), emotional exhaustion (OR, 1.07 each 1-point increase; 95% CI, 1.03 to 1.11), and self-valuation (OR, 0.84 each 1-point increase; 95% CI, 0.70 to 0.99) were associated with SI. Among individuals aged 29 to 65 years, physicians were more likely than workers in other fields to report SI (7.1% vs 4.3%; P<.001), a finding that persisted on multivariable analysis. CONCLUSION: In this national study conducted before the COVID-19 pandemic, 1 in 15 US physicians had thoughts of taking their own life in the last year, which exceeded the prevalence of SI among US workers in other fields.


Assuntos
Esgotamento Profissional/epidemiologia , Comportamento de Busca de Ajuda , Médicos/psicologia , Ideação Suicida , Adulto , Idoso , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoavaliação (Psicologia) , Inquéritos e Questionários , Estados Unidos/epidemiologia
13.
Clin Ter ; 172(4): 264-267, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34247207

RESUMO

Abstract: In the modern era, when prolonging life is not an option, the end-of-life discussions are unavoidably influenced by Neuroethics. Despite this, it is interestingly evident how the sentiments of a terminal patient of 1885 and a physician of 2020, are still comparable. This paper pre-sents the arguments behind the so-called "Therapeutic Misconception" and the aim of palliative care to provide dying patients support. It is essential to address priorities of informed consent, signed before any remedy is provided. A key component of the newest Neuroscience research is the analysis of motivation and free will. So, it is necessary to comprehend if the patient struggles to feel at peace with these aspects of his "right to die": Is he free to choose or is he influenced by the doctors? Is this confusion an example of "Therapeutic Misconception"? Is his Informed Consent totally "Informed"? In order to broaden our understanding, we account for many critical situations, such as the mentally impaired Psychiatric patients or the famous Italian case of Eluana Englaro. In addition, we suggested some current approaches such as Artificial Intelligence, useful in preserving some cognitive functions the patient may have lost. Furthermore, research in this field is very critical and in some Catholic countries like Italy, people faced difficulties accepting the idea of the "Anticipated directives". In general, whatever the mental status and whatever the terminal state, the patients seem still far from handling their own auto-determination and their Consent, even if the ultimate goal is to die with dignity.


Assuntos
Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência , Direito a Morrer/ética , Direito a Morrer/legislação & jurisprudência , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Adulto , História do Século XIX , História do Século XXI , Humanos , Consentimento Livre e Esclarecido/história , Consentimento Livre e Esclarecido/psicologia , Itália , Masculino , Direitos do Paciente/história , Autonomia Pessoal , Médicos/ética , Médicos/psicologia , Direito a Morrer/história , Federação Russa , Assistência Terminal/história , Assistência Terminal/psicologia
14.
Afr J Prim Health Care Fam Med ; 13(1): e1-e8, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34212740

RESUMO

BACKGROUND: Unnecessary blood transfusion exposes recipients to potential harms. AIM: The aim of this study was to describe blood transfusion practice and explore doctors' attitudes towards transfusion. SETTING: A hospital providing level 1 and 2 services. METHODS: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews. RESULTS: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. CONCLUSION: Most orders were for two or more units. In medical anaemia, doctors' compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Transfusão de Eritrócitos , Sobremedicalização/estatística & dados numéricos , Médicos/psicologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Gravidez , Pesquisa Qualitativa , África do Sul , Inquéritos e Questionários
15.
J BUON ; 26(3): 654-655, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34268916

RESUMO

COVID-19 pandemic has obviously affected patients' behavior towards seeking medical help as well as physicians' decision in the management of emergencies. Our recent experience as surgeons at a COVID-19 referral hospital revealed cases which share an alerting characteristic: the delay in appropriate management. Unfortunately for COVID-19 negative patients a "coronacentric" health system has been adopted. In view of measures applied to avoid spread of the disease, a significant delay in patients' presentation as well as in their in-hospital management is observed. We present cases where delay in appropriate management affected the patients' outcome and underline the fact that balancing between COVID-19 safety measures and a patient who needs urgent treatment can be very challenging and stressful.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde/normas , Neoplasias/epidemiologia , Médicos/psicologia , Padrões de Prática Médica/normas , SARS-CoV-2/isolamento & purificação , Inquéritos e Questionários/normas , COVID-19/complicações , COVID-19/virologia , Humanos , Neoplasias/complicações , Neoplasias/virologia
16.
Mayo Clin Proc ; 96(8): 2123-2132, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210511

RESUMO

OBJECTIVE: To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout. PATIENTS AND METHODS: A random sample of physicians from the American Medical Association Physician Masterfile and a probability sample from the general US population were used. Data were collected for this cross-sectional study between October 12, 2017 and March 15, 2018. Burnout was indicated by a score of 27 or higher on Emotional Exhaustion or 10 or higher on Depersonalization, using the Maslach Burnout Inventory. Self-valuation was measured with Self-valuation Scale items. RESULTS: Physicians (248/832=29.8%) more than workers in other fields (1036/5182=20.0%) "often" or "always" felt more self-condemnation than self-encouragement to learn from the experience when they made a mistake. Physicians (435/832=52.3%) more than workers in other fields (771/5182=14.9%) "often" or "always" put off taking care of their own health due to time pressure. Physicians had greater odds of burnout before (odds ratio [OR], 1.51; 95% CI, 1.30 to 1.76) but not after adjusting for SV responses (OR, 0.93; 95% CI, 0.78 to 1.11). After adjustment for SV, work hours, sex, and age, physicians had lower odds of burnout than workers in other fields (OR, 0.82; 95% CI, 0.68 to 0.99). CONCLUSION: Self-valuation is lower in physicians compared with workers in other fields and adjusting for SV eliminated the association between being a physician and higher risk for burnout. Experimental design research is needed to determine whether the association of SV with burnout is causal and the degree to which SV is malleable to intervention at individual, organization, and professional culture levels.


Assuntos
Esgotamento Profissional/epidemiologia , Satisfação no Emprego , Médicos/psicologia , Adulto , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Med Glas (Zenica) ; 18(2): 493-498, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34331437

RESUMO

Aim To evaluate and assess knowledge and perception, as well as factors related to the occurrence of anxiety among frontliners, especially resident doctors working in emergency room (ER). Methods This multivariate study was conducted with cross-sectional approach involving 80 eligible subjects (based on inclusion and exclusion criteria) that are consecutively assigned and assessed with GAD-7 questionnaire. The study was held in ER of Universitas Sumatera Utara affiliated teaching hospital from May to August 2020. Results Our study found that variables such as nuptial status (p=0.032), seniority level (p=0.037), history of direct exposure to COVID-19 patients (p=0.001) and weekly work duration(p=0.002) were all statistically significant to correlate with the occurrence of anxiety among resident doctors assigned to work in ER. Conclusion Acknowledgement of these factors might lead to proper and targeted support system strategies to address the anxiety issues among doctors, particularly those who work in ER during COVID-19 pandemic.


Assuntos
Ansiedade , COVID-19 , Serviço Hospitalar de Emergência , Médicos/psicologia , Ansiedade/epidemiologia , COVID-19/psicologia , Estudos Transversais , Hospitais de Ensino , Humanos , Indonésia , Estresse Ocupacional/epidemiologia , Pandemias
19.
Medicine (Baltimore) ; 100(22): e25833, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087826

RESUMO

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


Assuntos
Afasia/etiologia , Afasia/terapia , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Acidente Vascular Cerebral/complicações , Afasia/diagnóstico , Afasia/reabilitação , China , Inibidores da Colinesterase/uso terapêutico , Humanos , Fármacos Neuroprotetores/uso terapêutico , Médicos/psicologia , Padrões de Prática Médica
20.
Med Educ Online ; 26(1): 1929798, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34096480

RESUMO

Context: Storytelling is a powerful tool for encouraging reflection and connection among both speakers and listeners. While growing in popularity, studying the benefits of formal oral storytelling events within graduate medical education remains rare. Our research question was: could an oral storytelling event for GME trainees and faculty be an effective approach for promoting well-being and resilience among participants?Methods: We used multiple approaches to gather perspectives from physician participants (storytellers and audience members) at an annual oral storytelling event for residents, fellows, and faculty from seven academic health systems in Minnesota. Data sources included short reflections written by participants during the event, an immediate post-event survey exploring participants' experiences during the event, social media postings, and targeted follow-up interviews further exploring the themes of connection and burnout that were raised in post-event survey responses. We performed a qualitative analysis using both deductive and inductive coding to identify themes.Results: There were 334 participants, including 197 physicians. At the event, 129 real-time written reflections were collected. There were also 33 Twitter posts related to the event. Response rate for the post-event survey was 65% for physicians, with 63% of physician respondents volunteering for targeted follow-up interviews. Of those, 38% completed the follow-up interview. Themes that emerged from the multi-modal qualitative analysis included a sense of connection and community, re-connection with meaning and purpose in work, renewal and hope, gratitude, and potential impact on burnout.Conclusion: The large turnout and themes identified show how an oral storytelling event can be a powerful tool to build community in graduate medical education. Qualitative analysis from multiple sources obtained both in real-time at the event and upon deeper reflection afterwards showed the event positively impacted the well-being of participants and that oral storytelling events can be an effective approach for promoting resilience in GME.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Docentes de Medicina/psicologia , Saúde Mental , Narração , Resiliência Psicológica , Estudantes de Medicina/psicologia , Esgotamento Profissional/prevenção & controle , Comunicação , Humanos , Médicos/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...