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1.
Clin Microbiol Infect ; 25(2): 155-162, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30145398

RESUMO

BACKGROUND AND AIM: The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) aims to further develop its role in international medical and scientific guidance in the field of Clinical Microbiology and Infectious Diseases, where many types of guidance documents exist. The ESCMID Executive Committee and the Clinical Microbiology and Infection (CMI) editorial board wish to clarify the terminology and format to be used in ESCMID guidance documents submitted for publication in CMI, and to highlight the principles behind ESCMID guidance documents. TYPES OF GUIDANCE DOCUMENTS: There are five types of ESCMID guidance documents: White Papers, Clinical Practice Guidelines, Consensus Statements, State-of-the-Science Statements, and Position Papers. They differ in scope, methods of development, drafting group composition and preferred publication format. Guidance documents can be proposed, developed and published by ESCMID Study Groups, Committees and individual members; often, other scientific societies are involved. The full disclosure of potential conflicts of interest of all drafting group members is a requirement. FINAL REMARKS: Guidance documents constitute a common cultural and scientific background to people in the same and related professions. Also, they are an important educational and training tool. Developing a guidance document is a scientific endeavour, where a sound and transparent development process is needed, requiring multidisciplinary and personal skills.


Assuntos
Microbiologia/organização & administração , Sociedades Científicas/organização & administração , Medicina Clínica/organização & administração , Consenso , Europa (Continente) , Guias de Prática Clínica como Assunto
4.
Med Educ ; 52(11): 1125-1137, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30345686

RESUMO

CONTEXT: Educators must prepare learners to navigate the complexities of clinical care. Training programmes have, however, traditionally prioritised teaching around the biomedical and the technical, not the socio-relational or systems issues that create complexity. If we are to transform medical education to meet the demands of 21st century practice, we need to understand how clinicians perceive and respond to complex situations. METHODS: Constructivist grounded theory informed data collection and analysis; during semi-structured interviews, we used rich pictures to elicit team members' perspectives about clinical complexity in neurology and in the intensive care unit. We identified themes through constant comparative analysis. RESULTS: Routine care became complex when the prognosis was unknown, when treatment was either non-existent or had been exhausted or when being patient and family centred challenged a system's capabilities, or participants' training or professional scope of practice. When faced with complexity, participants reported that care shifted from relying on medical expertise to engaging in advocacy. Some physician participants, however, either did not recognise their care as advocacy or perceived it as outside their scope of practice. In turn, advocacy was often delegated to others. CONCLUSIONS: Our research illuminates how expert clinicians manoeuvre moments of complexity; specifically, navigating complexity may rely on mastering health advocacy. Our results suggest that advocacy is often negotiated or collectively enacted in team settings, often with input from patients and families. In order to prepare learners to navigate complexity, we suggest that programmes situate advocacy training in complex clinical encounters, encourage reflection and engage non-physician team members in advocacy training.


Assuntos
Medicina Clínica/organização & administração , Cuidados Críticos/organização & administração , Pessoal de Saúde/psicologia , Colaboração Intersetorial , Neurologia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Relações Médico-Paciente , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 21(1): 31-39, ene.-feb. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-171227

RESUMO

Objetivo. Presentar una experiencia de aproximación a la clínica desarrollada en la Universidad de Oviedo con estudiantes de primer curso del Grado de Medicina. Sujetos y métodos. La actividad se ha realizado durante seis cursos en una asignatura obligatoria del primer curso del Grado de Medicina, en dos seminarios (4 horas y 45 minutos). Los estudiantes (150-155 por curso) realizan la actividad en subgrupos de cuatro o cinco. En el primer seminario, el profesor comenta los objetivos general y particulares, y presenta una historia clínica con los aspectos que debe observar el estudiante. En el segundo, se exponen las historias clínicas elaboradas. Se evaluó el contenido, la organización y la expresión oral, así como la satisfacción de los estudiantes. Resultados. Se presentaron 192 historias clínicas, siendo las más frecuentes las relacionadas con varones y de edades entre 14 y 44 años. Las categorías de enfermedades según la CIE-10 más descritas fueron las del sistema nervioso y trastornos mentales y del comportamiento, enfermedades infecciosas y parasitarias, y las del aparato digestivo. Las enfermedades más descritas fueron la mononucleosis infecciosa, la diabetes mellitus y la tuberculosis pulmonar. Las calificaciones de los estudiantes oscilaron entre 0,89 ± 0,01 y 0,96 ± 0,01 puntos (máximo: 1 punto). El 93,84% de los participantes otorga a la actividad una calificación de 3,77 puntos sobre 5. Conclusión. Los estudiantes tienen una opinión favorable de la actividad y consideran que puede contribuir a la aproximación precoz a algunos aspectos de la profesión médica


Aim. To present an experience of approaching the clinic developed with first-year students in the Faculty of Medicine of Oviedo. Subjects and methods. The activity was performed over six academic years, in the form of two seminars (4 hours and 45 minutes) as part of a compulsory subject in the first year of the Medical degree of the University of Oviedo. Students (150- 155 per year) perform this activity in subgroups of 4-5. In the first seminar, the lecturer explains the general and specific aims, and presents a clinical history with the relevant aspects that the students should observe. During the second of the seminars, each group presents the clinical history selected. Contents, structure, oral presentations and student satisfaction were evaluated. Results. The number of submitted case histories was 192. The most frequent being sick males, aged between 14 and 44. The most described categories of diseases according to the ICD-10 were those of the nervous system, behavioral and mental disorders, infectious and parasitic diseases, and digestive tract diseases. The most common diseases were infectious mononucleosis, diabetes mellitus and pulmonary tuberculosis. The student scores ranged from 0.89 ± 0.01 to 0.96 ± 0.01 points (maximum score: 1 point). A survey, completed by 93.84% of participant's, gave a score of 3.77 points out of 5. Conclusion. The students had a favorable view of the same and they believe that it can contribute to an early approach to some aspects of the medical profession


Assuntos
Humanos , Masculino , Feminino , Medicina Clínica/educação , Medicina Clínica/organização & administração , Educação/organização & administração , Educação/normas , Registros Médicos/normas , Ensino/organização & administração , Ocupações em Saúde/educação , Prática Profissional/organização & administração , Estudantes/estatística & dados numéricos
14.
J Eval Clin Pract ; 23(2): 460-466, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26957287

RESUMO

RATIONALE, AIMS AND OBJECTIVES: The purpose of medical education is to produce competent and capable professional practitioners who can combine the art and science of medicine. Moreover, this process must prepare individuals to practise in a field in which knowledge is increasing and the contexts in which that knowledge is applied are changing in unpredictable ways. The 'basic sciences' are important in the training of a physician. The goal of basic science training is to learn it in a way that the material can be applied in practice. Much effort has been expended to integrate basic science and clinical training, while adding many other topics to the medical curriculum. This effort has been challenging. The aims of the paper are (1) to propose a unifying conceptual framework that facilitates knowledge integration among all levels of living systems from cell to society and (2) illustrate the organizing principles with two examples of the framework in action - cybernetic systems (with feedback) and distributed robustness. METHODS: Literature related to hierarchical and holarchical frameworks was reviewed. RESULTS: An organizing framework derived from living systems theory and spanning the range from molecular biology to health systems management was developed. The application of cybernetic systems to three levels (regulation of pancreatic beta cell production of insulin, physician adjustment of medication for glycaemic control and development and action of performance measures for diabetes care) was illustrated. Similarly distributed robustness was illustrated by the DNA damage response system and principles underlying patient safety. CONCLUSIONS: Each of the illustrated organizing principles offers a means to facilitate the weaving of basic science and clinical medicine throughout the course of study. The use of such an approach may promote systems thinking, which is a core competency for effective and capable medical practice.


Assuntos
Medicina Clínica/organização & administração , Educação Médica/organização & administração , Modelos Teóricos , Ciência/organização & administração , Teoria de Sistemas , Humanos , Análise de Sistemas
15.
Eksp Klin Gastroenterol ; (3): 51-4, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27301142

RESUMO

The article presents the biography of one wonderful doctors, who have high human, civil and professional qualities, Fyodor Ch. Gral.


Assuntos
Medicina Clínica/história , Saúde da População Urbana/história , Cidades , Medicina Clínica/organização & administração , História do Século XVIII , História do Século XIX , Rússia (pré-1917)
16.
BMC Health Serv Res ; 16 Suppl 2: 157, 2016 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-27230265

RESUMO

BACKGROUND: In the study of medicine and management, there is a strong interest in cross-country comparison. Across healthcare systems in industrialised countries, New Public Management has provided a similar reform template, but new governing arrangements exhibit significant national variations. The comparative perspective also offers a leverage to overcome the resistance focus of earlier studies. Comparison raises two overall questions: in what similar and different ways are relations between medicine and management changing across industrialised countries? Why is change occurring in different ways? The questions reflect exploration and explanation as the two basic rationales for comparison. METHODS: The aim was to provide a critical discussion of different approaches to comparing medicine and management across countries. The analysis was based on a narrative review of relevant studies from several bodies of literature. RESULTS AND DISCUSSION: The majority of studies exploring medicine and management adopt macro level approaches to comparison. Studies draw on a range of notions, including area specific ideal types of professionalism, professionalism as countervailing powers and governmentality. There are much fewer studies exploring relations between medicine and management at the meso level. Analyses treat comparison as a two-dimensional exercise looking across both countries and levels. The majority of studies draws on institutional explanations. These are variations of the path dependency argument and studies include both sector specific and broader political and administrative institutions. There is an emerging body of process-based explanations which connect macro level institutions to organisations and which promote more non-linear comparisons. CONCLUSION: The lack of meso level comparisons drawing on process explanations is problematic. Empirically, we need to know more about how relations between medicine and management are different across countries. Theoretically, we need to better understand how we can transpose analytical insights from institutional explanations at macro level to studies that are multi-level and also include the meso level of organisations. Methodologically, we need to address the challenges arising from more non-linear approaches to comparison, especially how to organise close international research collaboration over an extended period of time.


Assuntos
Medicina Clínica/organização & administração , Assistência à Saúde/organização & administração , Países Desenvolvidos , Europa (Continente) , Política de Saúde , Humanos , Pesquisa , Estados Unidos
17.
Collegian ; 23(1): 47-52, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27188039

RESUMO

Studies drawing on observational methods can provide vital data to enhance healthcare. However, collecting observational data in clinical settings is replete with challenges, particularly where multiple data-collecting observers are used. Observers collecting data require shared understanding and training to ensure data quality, and particularly, to confirm accurate and consistent identification, discrimination and recording of data. The aim of this paper is to describe strategies for preparing and supporting multiple researchers tasked with collecting observational data in a busy, and often unpredictable, hospital environment. We hope our insights might assist future researchers undertaking research in similar settings.


Assuntos
Pesquisa Biomédica/métodos , Medicina Clínica/organização & administração , Confiabilidade dos Dados , Coleta de Dados/métodos , Estudos Observacionais como Assunto , Desempenho de Papéis , Humanos , Projetos de Pesquisa
19.
Klin Med (Mosk) ; 94(9): 705-10, 2016.
Artigo em Russo | MEDLINE | ID: mdl-30302993

RESUMO

Domestic clinicism is a methodology implying the maximum use of diagnostic and therapeutic potential of the physician in combination with the optimal application of laboratory and instrumental techniques for the choice of personified means of pharmaceutical and non-pharmaceutical treatment and prophylaxis of various diseases. It can not be applied under routine working conditions of a district doctor who has only 10-15 min to handle each patient. The currently adopted principle of organization of primary medical care: "the more patients the better", negatively affects the patients' health and emotionally discourage doctors.


Assuntos
Competência Clínica/normas , Medicina Clínica , Padrões de Prática Médica , Medicina Clínica/métodos , Medicina Clínica/organização & administração , Medicina Clínica/normas , Dissidências e Disputas , Humanos , Melhoria de Qualidade , Federação Russa
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