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4.
J Headache Pain ; 21(1): 41, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349662

RESUMO

BACKGROUND: Migraine is a chronic, disabling neurological disease characterized by moderate-to-severe headache pain with other symptoms, including nausea, vomiting, and photophobia. Triptans, while generally effective, are insufficiently efficacious in 30-40% of patients and poorly tolerated by or contraindicated in others. We assessed the impact of insufficient response to triptans on health-related quality of life (HRQoL) and work productivity in patients currently receiving any prescribed triptan formulation as their only acute migraine medication. METHODS: Data were from the 2017 Adelphi Migraine Disease Specific Programme, a cross-sectional survey of primary care physicians, neurologists, and headache specialists and their consulting patients with migraine in the USA, France, Germany, Italy, Spain, and UK. Triptan insufficient responders (TIRs) achieved freedom from headache pain within 2 h of acute treatment in ≤3/5 migraine attacks; triptan responders (TRs) achieved pain freedom within 2 h in ≥4/5 attacks. Multivariable general linear model examined differences between TIRs and TRs in HRQoL and work productivity. Logistic regression identified factors associated with insufficient response to triptans. RESULTS: The study included 1413 triptan-treated patients (TIRs: n = 483, 34.2%; TRs: n = 930, 65.8%). TIRs were more likely to be female (76% vs. 70% for TIRs vs TRs, respectively; p = 0.011), older (mean age 42.6 vs. 40.5 years; p = 0.003), and had more headache days/month (7.0 vs. 4.4; p < 0.001). TIRs had significantly more disability, with higher Migraine Disability Scores (MIDAS; 13.2 vs. 7.7; p < 0.001), lower Migraine-specific Quality of Life scores, indicating greater impact (Role Function Restrictive: 62.4 vs. 74.5; Role Function Preventive: 70.0 vs. 82.2; Emotional Function: 67.7 vs. 82.1; all p < 0.001), and lower EQ5D utility scores (0.84 vs. 0.91; p = 0.001). Work productivity and activity were impaired (absenteeism, 8.6% vs. 5.1% for TIRs vs. TRs; presenteeism, 34.3% vs. 21.0%; work impairment, 37.1% vs. 23.3%; overall activity impairment, 39.8% vs. 25.3%; all p < 0.05). CONCLUSION: HRQoL and work productivity were significantly impacted in TIRs versus TRs in this real-world analysis of patients with migraine acutely treated with triptans, highlighting the need for more effective treatments for patients with an insufficient triptan response. Further research is needed to establish causal relationships between insufficient response and these outcomes.


Assuntos
Saúde Global/tendências , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/psicologia , Qualidade de Vida/psicologia , Triptaminas/uso terapêutico , Desempenho Profissional/tendências , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Médicos/tendências , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Resultado do Tratamento
5.
Med Clin North Am ; 104(3): 539-560, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312414

RESUMO

Some patients with terminal and degenerative illnesses request assistance to hasten death when suffering is refractory to palliative care, or they strongly desire to maximize their autonomy and dignity and minimize suffering. Palliative sedation (PS), voluntarily stopping eating and drinking (VSED), and physician-assisted death (PAD) are possible options of last resort. A decision to choose PS can be made by an informed surrogate decision maker, whereas intact decision-making capacity is required to choose VSED or PAD. For all palliative treatments of last resort, the risk of harm is minimized by the use of checklists, and establishment of policies and procedures.


Assuntos
Sedação Profunda/métodos , Eutanásia Ativa Voluntária/ética , Cuidados Paliativos/ética , Suicídio Assistido/ética , Idoso , Idoso de 80 Anos ou mais , Comunicação , Tomada de Decisões , Comportamento de Ingestão de Líquido/fisiologia , Eutanásia Ativa Voluntária/psicologia , Comportamento Alimentar/psicologia , Humanos , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Cuidados Paliativos/tendências , Médicos/tendências , Estados Unidos/epidemiologia
6.
South Med J ; 113(4): 147, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32239224
7.
Anesthesiology ; 133(2): 342-349, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32282430

RESUMO

BACKGROUND: Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence and outcomes of substance use disorder that resulted in either a report to a certifying body or death in physicians after the completion of anesthesiology training. METHODS: Physicians who completed training in U.S. anesthesiology residency programs from 1977 to 2013 and maintained at least one active medical license were included in this retrospective cohort study (n = 44,736). Substance use disorder cases were ascertained through records of the American Board of Anesthesiology and the National Death Index. RESULTS: Six hundred and one physicians had evidence of substance use disorder after completion of training, with an overall incidence of 0.75 per 1,000 physician-years (95% CI, 0.71 to 0.80; 0.84 [0.78 to 0.90] in men, 0.43 [0.35 to 0.52] in women). The highest incidence rate occurred in 1992 (1.79 per 1,000 physician-years [95% CI, 1.12 to 2.59]). The cumulative percentage expected to develop substance use disorder within 30 yr estimated by Kaplan-Meier analysis equaled 1.6% (95% CI, 1.4 to 1.7%). The most common substances used by 353 individuals for whom information was available were opioids (193 [55%]), alcohol (141 [40%]), and anesthetics/hypnotics (69 [20%]). Based on a median of 11.1 (interquartile range, 4.4 to 19.8) yr of follow-up, the cumulative proportion of survivors estimated to experience at least one relapse within 30 yr was 38% (95% CI, 31 to 43%). Of the 601 physicians with substance use disorder, 114 (19%) were dead from a substance use disorder-related cause at last follow-up. CONCLUSIONS: A substantial proportion of anesthesiologists who develop substance use disorder after the completion of training die of this condition, and the risk of relapse is high in those who survive.


Assuntos
Anestesiologistas/educação , Anestesiologistas/tendências , Anestesiologia/educação , Anestesiologia/tendências , Internato e Residência/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/tendências , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Estados Unidos/epidemiologia
8.
Muscle Nerve ; 61(6): 751-753, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32134131

RESUMO

BACKGROUND: Little literature exists describing resident training in peripheral electrodiagnosis (EDX). METHODS: U.S. residency programs in neurology and physical medicine and rehabilitation (PM&R) were surveyed by the AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine) on specific features of EDX training. RESULTS: Ninety-seven programs responded to the survey. Training duration was 4-8 weeks in most neurology programs; training averaged 22 weeks in PM&R programs. EDX experience was required in all PM&R and in 90% of neurology programs. Results varied greatly for the residency years of training, pulling of residents for other responsibilities, participation in continuity clinics, number of teaching physicians, number of needle examinations performed, organization of nerve conduction training, written/oral examinations, muscle/nerve biopsy reviews, and training materials. CONCLUSIONS: This survey demonstrated large variability in training of neurology and PM&R residents in peripheral EDX.


Assuntos
Eletrodiagnóstico/métodos , Internato e Residência/métodos , Neurologia/métodos , Medicina Física e Reabilitação/métodos , Médicos , Inquéritos e Questionários , Eletrodiagnóstico/tendências , Humanos , Internato e Residência/tendências , Neurologia/educação , Neurologia/tendências , Medicina Física e Reabilitação/educação , Medicina Física e Reabilitação/tendências , Médicos/tendências , Estados Unidos
9.
Pain Physician ; 23(1): E7-E18, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013284

RESUMO

BACKGROUND: The US Department of Health and Human Services has recommended that physicians performing interventional pain procedures be credentialed based on criteria based guidelines and minimum training requirements. OBJECTIVES: To quantitatively assess gaps in certification related to pain medicine fellowship requirements, we studied the distribution of such procedures in Florida between 2010 and 2016. STUDY DESIGN: This research involved a retrospective analysis with a sample size of n = 1,885,442 interventional pain procedures. SETTING: Data describing interventional pain procedures performed in Florida between January 2010 and December 2016 were obtained from the Florida Department of Health. The National Provider Identifier file and board certification lists from the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine (ABPM), and the American Board of Interventional Pain Physicians (ABIPP) corresponding to this time frame were also obtained. METHODS: The datasets were linked to determine the specialty of physicians performing interventional pain procedures, and whether or not they were pain medicine diplomates of the ABMS, the ABPM, or the ABIPP. The similarity index theta was calculated for the distribution of interventional pain procedure codes among medical specialty groups, and with respect to the practitioners' pain medicine board certification status. RESULTS: Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists 19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among procedures performed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%, and 50.4% were by ABMS pain board-certified practitioners, respectively. Practitioners without ABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitioners without such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was very large similarity (theta > 0.9) in the distribution of procedures comparing ABMS pain medicine board-certified practitioners to non-ABMS pain medicine board-certified anesthesiologists, physiatrists, or all other specialties. LIMITATIONS: In countries other than the United States, where pain medicine board certification is relatively recent, there may be a higher percentage of interventional pain procedures performed by individuals without certification than we report. In "opt-out" states, where nurse anesthetists can independently perform interventional pain procedures, the percentage of interventional pain procedures performed by individuals without physician pain medicine board certification may also be higher. The datasets we used do not contain information to allow assessment of outcomes or effectiveness resulting from pain medicine board certification. CONCLUSIONS: Approximately one-third of interventional pain procedures were performed by physicians without at least 1 of the 3 pain medicine board certifications. In addition, the practitioners performed very similar distributions of procedures (i.e., those without pain medicine board certification, overall, have not restricted their practice). These results suggest the need for additional accredited pain medicine fellowship training positions for newly graduated residents. The results also show that, for the recommendations of the Department of Health and Human Services to be satisfied, physicians without board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMS certification after completion of a full-time Accreditation Council of Graduate Medical Education pain medicine fellowship. KEY WORDS: Chronic pain, education, medical, graduate, specialty boards.


Assuntos
Certificação/tendências , Manejo da Dor/tendências , Médicos/tendências , Conselhos de Especialidade Profissional/tendências , Acreditação/normas , Acreditação/tendências , Certificação/normas , Bolsas de Estudo/normas , Bolsas de Estudo/tendências , Florida/epidemiologia , Humanos , Dor/diagnóstico , Dor/epidemiologia , Manejo da Dor/normas , Médicos/normas , Estudos Retrospectivos , Conselhos de Especialidade Profissional/normas
11.
Anesth Analg ; 130(2): 333-340, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31124801

RESUMO

BACKGROUND: Twitter in anesthesiology conferences promotes rapid science dissemination, global audience participation, and real-time updates of simultaneous sessions. We designed this study to determine if an association exists between conference attendance/registration and 4 defined Twitter metrics. METHODS: Using publicly available data through the Symplur Healthcare Hashtags Project and the Symplur Signals, we collected data on total tweets, impressions, retweets, and replies as 4 primary outcome metrics for all registered anesthesiology conferences occurring from May 1, 2016 to April 30, 2017. The number of Twitter participants, defined as users who contributed a tweet, retweet, or reply 3 days before through 3 days after the conference, was collected. We also collected influencer data as determined by mentions (number of times a user is referenced). Two authors independently verified the categories for influencers assigned by Symplur. Conference demographic data were obtained by e-mail inquiries. Associations between meeting attendees/registrants and Twitter metrics, between Twitter participants and the metrics, and between physician influencers and Twitter participants were tested using Spearman rho. RESULTS: Fourteen conferences with 63,180 tweets were included. With the American Society of Anesthesiologists annual meeting included, the correlations between meeting attendance/registration and total tweets (rs = 0.588; P = .074), impressions (rs = 0.527; P = .117), and retweets (rs = 0.539; P = .108) were not statistically significant; for replies, it was moderately positive (rs = 0.648; P = .043). Without the American Society of Anesthesiologists annual meeting, total tweets (rs = 0.433; P = .244), impressions (rs = 0.350; P = .356), retweets (rs = 0.367; P = .332), and replies (rs = 0.517; P = .154) were not statistically significant. Secondary outcomes include a highly positive correlation between Twitter participation and total tweets (rs = 0.855; P < .001), very highly positive correlations between Twitter participation and impressions (rs = 0.938; P < .001), retweets (rs = 0.925; P < .001), and a moderately positive correlation between Twitter participation and replies (rs = 0.652; P = .044). Doctors were top influencers in 8 of 14 conferences, and the number of physician influencers in the top 10 influencers list at each conference had a moderately positive correlation with Twitter participation (rs = 0.602; P = .023). CONCLUSIONS: We observed that the number of Twitter participants for a conference is positively associated with Twitter activity metrics. No relationship between conference size and Twitter metrics was observed. Physician influencers may be an important driver of participants.


Assuntos
Anestesiologia/educação , Anestesiologia/tendências , Congressos como Assunto/tendências , Disseminação de Informação , Médicos/tendências , Mídias Sociais/tendências , Anestesiologia/métodos , Humanos , Disseminação de Informação/métodos
12.
Anesth Analg ; 129(6): 1761-1766, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743198

RESUMO

With a difficult National Institutes of Health (NIH) funding climate, the pipeline of physician-scientists in Anesthesiology is continuing to get smaller with fewer new entrants. This article studies current NIH funding trends and offers potential solutions to continue the historical trend of academic innovation and research that has characterized academic Anesthesiology. Using publicly available data, specifically the NIH REPORTeR and Blue Ridge Institute for Medical Research, we examined NIH trends in funding in academic Anesthesiology departments that have Anesthesiology residency training programs. When adjusted for inflation, median NIH funding of departments of Anesthesiology declined approximately 15% between 2008 and 2017. The majority (55%) of NIH funding to academic Anesthesiology departments, including R01 and K-series grants, went to 10 departments in the United States. This trend has remained relatively constant for the 9-year period we studied (2009-2017). There is an inequitable distribution of NIH funding to Anesthesiology departments. Arguably, this may be a case of the "rich get richer," but the implications for those who are trying to become or remain NIH-funded investigators are that success may depend, in part, on securing a faculty position in one of these well-funded departments.


Assuntos
Anestesiologia/tendências , Pesquisa Biomédica/tendências , National Institutes of Health (U.S.)/tendências , Médicos/tendências , Pesquisadores/tendências , Apoio à Pesquisa como Assunto/tendências , Anestesiologia/economia , Pesquisa Biomédica/economia , Administração Financeira/economia , Administração Financeira/tendências , Humanos , National Institutes of Health (U.S.)/economia , Médicos/economia , Pesquisadores/economia , Apoio à Pesquisa como Assunto/métodos , Estados Unidos
13.
BMC Med Educ ; 19(1): 394, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660958

RESUMO

BACKGROUND: Physician Scientists (PSs) play a significant role in medical science because of their clinical practice and research expertise. Although it is important to analyze the distribution and retention trends in the number of PSs in Japan, research on this topic has been insufficient. Thus, the purpose of this study is to analyze PSs distribution and retention trends, identify factors related to their retention, and consider the policy implications. METHOD: I analyzed individual data from 1996 to 2016 from a national census survey that had been administered by the national government of Japan every 2 years. The number of PSs in 1996 and 2016 were 4930 (2.1% of all physicians) and 5212 (1.6%), respectively. I conducted a descriptive analysis and identified retention trends. I then used a multivariable logistic regression analysis to identify the factors related to the retention of PSs. RESULTS: Between 1996 and 2016, the total number of PSs in Japan increased by 6%. The number of PSs aged 39 years or younger decreased by 48%, while those aged between 55 and 69 increased by 91%, indicating a notable decrease in the number of PSs under the age of 39. From 2014 to 2016, the annual retention rate of PSs was estimated to be 75.5%, which represented a low and stable rate compared to other physicians over the study period. The odds of continuing to practice as a PS were significantly higher for those who have between 15 to 29 years of experience after qualification as a physician. CONCLUSION: This study indicates that it is likely for the total number of PSs to decrease in the future. Although the Japanese government has implemented various measures to retain PSs, these have not been effective. Possible new interventions to address this problem include increasing the knowledge of medical students and younger physicians of the role of PSs and the benefits of a career as a PS, providing specific career paths for PSs, securing specific positions for PSs, and increasing the compensation for PSs.


Assuntos
Escolha da Profissão , Médicos/provisão & distribução , Médicos/tendências , Ciência/educação , Ciência/tendências , Adulto , Idoso , Pesquisa Biomédica/tendências , Educação Médica/tendências , Feminino , Humanos , Japão , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada
15.
Glob Health Action ; 12(1): 1645558, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31362603

RESUMO

The emigration of physicians and scientists from resource-constrained countries decreases the country's ability to undertake research. Re-establishing research environments and increasing capacity reduced by these losses are important, particularly in the health sciences. One mechanism for re-establishing strong health sciences research is the introduction of an Alumni Diaspora Fellowship Programme. We define the beneficial effects of a successful single partnership in an Alumni Diaspora Programme. This Host/Alumnus collaboration demonstrates that bi-directional advantages have accrued for both the Host Institution situated in a resource-constrained country and the Alumni's Institution, located in a high-income country. In addition to expanding research in the resource-constrained country, collaborations expanded to other faculty beyond the Alumnus in the sending Institution, in multiple fields including those not readily available in the high-income country (HIV, TB, malaria). The environment at the host Institution in the resource-constrained country has been enriched by increased research publications, training of young scholars (over 200 trained in manuscript and grant application writing), and substantial advances in biomedical informatics. There has been considerable knowledge exchange and development between both Institutions, showing that 'brain circulation' and Diaspora Programmes are valuable strategies for expanding research.


Assuntos
Emigração e Imigração/tendências , Médicos/tendências , Humanos , Internacionalidade , Pobreza , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
19.
Health Care Manag (Frederick) ; 38(3): 276-281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261195

RESUMO

In today's health care industry, physicians face considerable regulatory and social trends that compel them to modify their practices-and these changes will continue throughout their careers. Emerging reimbursement systems are increasingly tying payment to quality metrics. To appropriately obtain and report patient data to payors, physician practices should adopt electronic health records. Physician practices have the opportunity to complete a clinical care redesign that meets the requirements of health care reform's focus on value-based care. With the shift toward value, patients are taking an active participation in their health care and are moving away from being patients to becoming consumers who demand transparency in their health care and costs. Social media platforms allow physician practices to market to and interact with their patients. In addition to these reforms and social trends, physician practices face the challenge of caring for an aging US population. With these challenges and trends, physicians are increasingly relying on physician practice managers to take on administrative duties. By incorporating physician practice management into health care-related programs, not only will health care programs' curriculum remain relevant to current and future health care trends, demands, and challenges, but also the programs will provide students with the competencies necessary to succeed in the health care field.


Assuntos
Currículo , Médicos/tendências , Administração da Prática Médica/organização & administração , Registros Eletrônicos de Saúde , Reforma dos Serviços de Saúde , Humanos , Administração da Prática Médica/tendências , Estados Unidos
20.
Aust J Gen Pract ; 48(1-2): 9-12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256451

RESUMO

BACKGROUND: When an error leads to possible patient harm and a complaint, the impact on doctors and patients can be profound. Doctors may respond in ways that risk harm to themselves, colleagues and patients, including withdrawing from peers, risk-avoidance practice and even suicidal ideation. OBJECTIVE: This article discusses current research and public discourse on the impact of complaints on doctors' personal and professional lives, as well as the way complaints and the fear of complaints affects doctors' clinical practice. It suggests strategies to ameliorate these effects before a complaint is made. DISCUSSION: When colleagues support one another and collectively reflect on their practice within a culture focused on patient safety, doctors facing complaints or presented with an error are less likely to isolate themselves and fear the worst. Using a common adverse event, the author discusses how analysing minor errors and near-misses can benefit patients, practitioners and practices.


Assuntos
Imperícia/legislação & jurisprudência , Padrões de Prática Médica/normas , Medicina Defensiva/métodos , Medicina Defensiva/tendências , Medicina Geral/legislação & jurisprudência , Medicina Geral/normas , Medicina Geral/tendências , Humanos , Médicos/psicologia , Médicos/tendências , Padrões de Prática Médica/tendências
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