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3.
Zhonghua Nei Ke Za Zhi ; 58(6): 435-438, 2019 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-31159522

RESUMO

Objective: To evaluate senior resident training program "resident team leader in the Department of General Internal Medicine" at Peking Union Medical College Hospital. Methods: We surveyed the residents or the fellows who had been selected as resident team leaders and received the training from October 2014 to September 2018 on their comments and suggestions. Results: Twenty-two rotated senior residents who were selected as team leaders in the Department of General Internal Medicine completed the survey. Almost all (21/22, 95.5%) of the respondents reported that they learnt more in general as team leaders by Visual Analog Scale (VAS). The mean VAS scores of clinical skills were 7.23±1.27, 7.86±1.32 in teaching abilities, 8.14±0.89 in leadership evaluation. Scales as chief resident assistants were 8.44±1.26. Sixteen respondents (72.7%) considered that pre-job training by attending doctors was necessary. Another 8 (36.4%) respondents addressed their demands on training of teaching skills. Conclusions: The senior resident training program "resident team leader in the Department of General Internal Medicine" improves the competency of rotated senior residents. It is a valuable pilot study on senior resident training and worthy of further application in other departments and hospitals.


Assuntos
Competência Clínica , Medicina Interna/educação , Internato e Residência , Hospitais , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde
6.
BMC Health Serv Res ; 19(1): 346, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151446

RESUMO

BACKGROUND: With an extensive rise in the number of acute patients and increases in both admissions and readmissions, hospitals are at times overcrowded and under immense pressure and this may challenge patient safety. This study evaluated an innovative strategy converting acute internal medicine inpatient take to an outpatient take. Here, acute patients, following referral, underwent fast-track assessment to the needed level of medical care as outpatients, directly in internal medicine wards. METHOD: The two internal medicine wards at Diagnostic Centre, Silkeborg, Denmark, changed their take of acute patients 1st of March 2017. The intervention consisted of acute medical patients being received in medical examination chairs, going through accelerated evaluation as outpatients with assessment within one hour for either admission or another form of treatment. A before-and-after study design was used to evaluate changes in activity. All referred patients for 10 months following implementation of the intervention were compared with patients referred in corresponding months the previous year. RESULTS: A total of 5339 contacts (3632 patients) who underwent acute medical assessment (2633 contacts before and 2706 after) were included. Median hospital length-of-stay decreased from 32.6 h to 22.3 h, and the proportion of referred acute patients admitted decreased with 36.3% points from 94.5 to 58.2%. The median length-of-admission time for the admitted patients increased as expected after the intervention. The risk of being admitted, being readmitted as well as having a hospital length-of-time longer than 24 h, 72 h or 7 days, respectively, were significantly lower during the after-period in comparison to the before-period. Adverse effects, unplanned re-contacts, total contacts to general practice and mortality did not change after the intervention. CONCLUSION: Assessing referred acute patients in medical examination chairs as outpatients directly in internal medicine wards and promoting an accelerated trajectory, reduced inpatient admissions and total length-of-stay considerably. This strategy seems effective in everyday acute medical patients and has the potential to ease the increasing pressure on the acute take for wards receiving acute medical patients.


Assuntos
Hospitalização/estatística & dados numéricos , Medicina Interna/estatística & dados numéricos , Idoso , Estudos Controlados Antes e Depois , Dinamarca , Feminino , Medicina Geral/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 629-632, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198153

RESUMO

OBJECTIVE: To investigate the detection and distribution of hospitalized specimens from a tertiary hospital over 5 years. METHODS: Specimens of sputum, urine, blood, secretions and puncture fluid were collected from patients admitted to the Harrison International Peace Hospital from November 2013 to November 2018. The origin of specimens, the distribution of departments and the distribution of pathogenic bacteria isolated were analyzed retrospectively. RESULTS: A total of 61 286 specimens were sent for examination during the 5 years. The top 5 specimens were sputum culture (n = 18 302, 29.9%), sputum smear (n = 11 253, 18.4%), blood culture (n = 9 713, 15.8%), urine culture (n = 6 448, 10.5%) and secretion culture (n = 6 133, 10.0%), accounting for 84.6% (51 849/61 286). Sputum specimens accounted for 48.2% (29 555/61 286) with the largest proportion. The number of specimens from medical wards was much higher than that from surgical wards (specimens: 25 468 vs. 10 521), respiratory medicine, department of critical care medicine and emergency intensive care unit (EICU) were important sources of pathogenic specimens in the hospital, accounting for 29.8% (18 243/61 286) in total. The average positive rate of all specimens was 23.5% (14 424/61 286). The positive rates of sputum culture and urine culture were 29.7% (5 428/18 302) and 35.4% (2 281/6 448), respectively, while the positive rate of blood culture was only 6.6% (643/9 713). Escherichia coli was the most common pathogen in all specimens except for sputum culture and fecal culture. Escherichia coli [40.6% (926/2 281)], Klebsiella pneumoniae [9.2% (210/2 281)], Pseudomonas aeruginosa [8.2% (188/2 281)], Enterococcus faecalis (group D) [6.6% (151/2 281)] and Candida albicans [3.2% (73/2 281)] were the most common pathogens in urine culture. Klebsiella pneumoniae [24.1% (1 309/5 428)], Acinetobacter baumannii [21.3% (1 154/5 428)], Pseudomonas aeruginosa [15.1% (818/5 428)], Escherichia coli [6.5% (351/5 428)] and Maltose oligotrophomonas maltose [5.8% (316/5 428)] were the most common pathogens in sputum culture. Escherichia coli [36.5% (235/643)], Klebsiella pneumoniae [10.9% (70/643)], Pseudomonas aeruginosa [4.8% (31/643)], Staphylococcus epidermidis [3.4% (22/643)] and Staphylococcus humanis [3.3% (21/643)] were the most common pathogens in blood culture. CONCLUSIONS: Specimens sent for examination by inpatients are mainly from internal medicine wards, mainly from sputum, blood and urine, and the detected pathogens are mainly Gram-negative bacteria.


Assuntos
Manejo de Espécimes/estatística & dados numéricos , Centros de Atenção Terciária , Sangue/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Hospitalização , Humanos , Medicina Interna/estatística & dados numéricos , Estudos Retrospectivos , Escarro/microbiologia , Urina/microbiologia
8.
Ter Arkh ; 91(1): 114-128, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31090382

RESUMO

The review presents the results of a number of experimental and clinical studies proving the prospects of using L-carnitine in the clinic of internal diseases. Due to the antioxidant and antihypoxant properties, the additional use of L-carnitine in addition to the main etiopathogenetic therapy is prescribed by cardiologists, nephrologists, neurologists, gerontologists. Experimental studies we conducted earlier showed no effect of L-carnitine on the activity of the P450 CYP 3A4 system, which reduces the likelihood of drug-drug interaction at the level of metabolism of drugs metabolized by P450 3A4. When using L-carnitine as part of complex pharmacotherapy, the drug has an increased safety profile in comorbid patients taking L-carnitine. Keywords: L-carnitine, P450 CYP 3А4, chronic heart failure, myocardial infarction, chronic renal failure, inter-drug interaction, antioxidant, antihypoxant.


Assuntos
Antioxidantes/farmacologia , Carnitina/farmacologia , Citocromo P-450 CYP3A/metabolismo , Cardiopatias/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Coração/efeitos dos fármacos , Falência Renal Crônica/metabolismo , Infarto do Miocárdio/complicações , Antioxidantes/metabolismo , Carnitina/metabolismo , Carnitina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/metabolismo , Humanos , Medicina Interna , Rim/efeitos dos fármacos , Rim/metabolismo , Masculino , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/metabolismo
11.
Harefuah ; 158(5): 294-298, 2019 May.
Artigo em Hebraico | MEDLINE | ID: mdl-31104388

RESUMO

AIMS: To examine the prevalence of antibiotic prescription errors in three medical departments. BACKGROUND: Prescription errors are common and associated with significant adverse drug events (ADEs), morbidity and mortality, and health care expenditures. METHODS: A prospective observational cohort study was conducted in three medical departments, including consecutive patients with suspected or proven infections, and/or antibiotic prescriptions. The primary outcome was the proportion of prescription errors, defined as: contraindications, inadequate dose regimen, and unnecessary antibiotic treatment. Secondary outcomes included incidence of ADEs, proportion of potential drug-drug interactions (DDIs) with clinical relevance, and prevalence of inadequate monitoring for ADEs and therapeutic drug monitoring (TDM). RESULTS: We identified 327 patient-episodes in 295 patients. The most common infectious diagnoses were urinary tract infection and pneumonia. Among 633 prescriptions, 113 (18%) contained errors in 87 (27%) patient-episodes. The most common types of error were inappropriate dose adjustment for renal function and unnecessary treatment. There were 6 prescriptions with contraindications (0.9%). Laboratory monitoring was required in 259 patient-episodes but inadequate in 40 (15%). TDM was required in 40 patient-episodes, but was not performed in 25 (63%). There were 69 ADEs in 61 patient-episodes (19%). Compared to patients without ADEs, patients who developed ADEs had more prescription errors (p=0.055), more potential DDIs (p=0.012), and received more often antibiotics that needed monitoring and TDM. CONCLUSIONS: Antibiotic prescription errors in medical departments are common and may be associated with significant ADEs. Our findings may help in prioritizing the customization of prescription computer decision support systems to improve antibiotic prescription.


Assuntos
Antibacterianos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Erros de Medicação , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Estudos de Coortes , Humanos , Pacientes Internados , Medicina Interna , Erros de Medicação/estatística & dados numéricos , Estudos Prospectivos
13.
Tex Med ; 115(3): 36-38, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30995332

RESUMO

It was an important law that gave physicians new life, greatly restricting the discrimination they can face based on their maintenance of certification status. And yet, opponents may have found a way to circumvent the 2017 legislature's Senate Bill 1148.


Assuntos
Certificação/legislação & jurisprudência , Medicina Interna/legislação & jurisprudência , Médicos , Especialização/legislação & jurisprudência , Atitude do Pessoal de Saúde , Competência Clínica , Humanos , Medicina Interna/normas , Texas , Estados Unidos
14.
San Salvador; s.n; abr. 2019. 66 p. graf, tab.
Tese em Espanhol | LILACS | ID: biblio-1007217

RESUMO

OBJETIVO: Determinar los estresores laborales presentes en el personal de enfermería de los servicios de hospitalización de medicina interna, cirugía hombres y cirugía mujeres del Hospital Nacional Zacamil "Dr. Juan José Fernández", municipio de Mejicanos, El Salvador. Marzo, 2019. DISEÑO metodológico: Estudio descriptivo, corte transversal. Población 36 profesionales de enfermería de medicina interna, cirugía mujeres y hombres, del Hospital Nacional Zacamil. Para la recolección de datos se utilizó la versión española del instrumento "The Nursing Stress Scale" (NSS), que valora siete factores físicos, el ambiente psicológico y dos relacionados con el ambiente social en el hospital a través de la entrevista a cada participante. El procesamiento de la información se hizo en Excel 2013, se utilizaron pruebas estadísticas de correlación para asociar el estrés y los datos sociolaborales. RESULTADOS: La mayoría del personal fue del género femenino, entre 31 y 40 años de edad, en las áreas hospitalarias, predominando los que tienen de 1 a 10 años de trabajar y en su mayoría personal técnico. 52,8% de la población refirió que la muerte de un paciente frecuentemente le generaba estrés, con un 55,6% dijo que no tener tiempo para apoyo emocional [frecuentemente les generaba estrés, el 52,8% mencionó que frecuentemente le genera estrés cuando el medico no está presente y el paciente se está muriendo. Los estresores laborales no estuvieron relacionados de forma significativa con los datos sociolaborales como la antigüedad laboral ni el servicio al que pertenecían los colaboradores (p >0.05) CONCLUSIONES: de los 36 profesionales la mayoría frecuentemente en los factores muerte y sufrimiento, carga laboral hubo estrés, mientras que en otros factores alguna vez, Los estresores no estuvieron correlación con los datos socio laborales de los trabajadores


Assuntos
Humanos , Esgotamento Profissional , Estresse Ocupacional , Medicina Interna , Acontecimentos que Mudam a Vida , Recursos Humanos de Enfermagem , Saúde Pública , Epidemiologia Descritiva , Estudos Transversais
16.
J Grad Med Educ ; 11(2): 132-142, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024643

RESUMO

Background: Ambulatory training in internal medicine residency programs has historically been considered less robust than inpatient-focused training, which prompted a 2009 revision of the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Internal Medicine. This revision was intended to create a balance between inpatient and outpatient training standards and to spur innovation in the ambulatory setting. Objective: We explored innovations in ambulatory education in internal medicine residency programs since the 2009 revision of the ACGME Program Requirements in Internal Medicine. Methods: The authors conducted a scoping review of the literature from 2008 to 2017, searching PubMed, ERIC, and Scopus databases. Articles related to improving educational quality of ambulatory components of US-based internal medicine residency programs were eligible for inclusion. Articles were screened for relevance and theme categorization and then divided into 6 themes: clinic redesign, curriculum development, evaluating resident practice/performance, teaching methods, program evaluation, and faculty development. Once a theme was assigned, data extraction and quality assessment using the Medical Education Research Study Quality Instrument (MERSQI) score were completed. Results: A total of 967 potentially relevant articles were discovered; of those, 182 were deemed relevant and underwent full review. Most articles fell into curriculum development and clinic redesign themes. The majority of included studies were from a single institution, used nonstandardized tools, and assessed outcomes at the satisfaction or knowledge/attitude/skills levels. Few studies showed behavioral changes or patient-level outcomes. Conclusions: While a rich diversity of educational innovations have occurred since the 2009 revision of the ACGME Program Requirements in Internal Medicine, there is a significant need for multi-institution studies and higher-level assessment.


Assuntos
Assistência Ambulatorial/métodos , Medicina Interna/educação , Internato e Residência/métodos , Currículo/normas , Docentes de Medicina/normas , Humanos , Avaliação de Programas e Projetos de Saúde/métodos , Ensino/normas , Estados Unidos
17.
J Grad Med Educ ; 11(2): 189-195, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024652

RESUMO

Background: There is an unmet need for formal curricula to deliver practice feedback training to residents. Objective: We developed a curriculum to help residents receive and interpret individual practice feedback data and to engage them in quality improvement efforts. Methods: We created a framework based on resident attribution, effective metric selection, faculty coaching, peer and site comparisons, and resident-driven goals. The curriculum used electronic health record-generated resident-level data and disease-specific ambulatory didactics to help motivate quality improvement efforts. It was rolled out to 144 internal medicine residents practicing at 1 of 4 primary care clinic sites from July 2016 to June 2017. Resident attitudes and behaviors were tracked with presurveys and postsurveys, completed by 126 (88%) and 85 (59%) residents, respectively. Data log-ins and completion of educational activities were monitored. Group-level performance data were tracked using run charts. Results: Survey results demonstrated significant improvements on a 5-point Likert scale in residents' self-reported ability to receive (from a mean of 2.0 to 3.3, P < .001) and to interpret and understand (mean of 2.4 to 3.2, P < .001) their practice performance data. There was also an increased likelihood they would report that their practice had seen improvements in patient care (13% versus 35%, P < .001). Run charts demonstrated no change in patient outcome metrics. Conclusions: A learner-centered longitudinal curriculum on ambulatory patient panels can help residents develop competency in receiving, interpreting, and effectively applying individualized practice performance data.


Assuntos
Assistência Ambulatorial/normas , Currículo , Retroalimentação , Medicina Interna/educação , Internato e Residência/normas , Educação de Pós-Graduação em Medicina/normas , Registros Eletrônicos de Saúde , Humanos , Melhoria de Qualidade , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs
18.
J Grad Med Educ ; 11(2): 202-206, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024654

RESUMO

Background: Improving continuity is challenging in residency training practices. Studies have shown that empanelment enables high-performing primary care and is foundational to improve accountability and continuity. Objective: An empanelment process was created in a large, urban, residency training practice as an effective approach to enhancing continuity among residents and their patients. Methods: In 2016, we formed an empanelment committee that included stakeholders from the department of medicine, the internal medicine residency program, and hospital and IT leadership. This committee set goal panel sizes, selected an empanelment algorithm, determined which patients needed re-empanelment, and facilitated medical record integration. Empanelment was followed and reassessed quarterly for 2 years. We measured anticipated visit demand using visits in the prior year and continuity using the continuity for physician formula. Results: Of 18 495 active patients in July 2016, 8411 (45%) were assigned a new PCP in the empanelment process. At baseline, panel sizes and expected visit demand were highly variable among residents (from 40 to 107 and 120 to 480, respectively). Empanelment led to more equivalent panel sizes and expected visit demand across same year residents (eg, PGY-3: 80-100 and 320-440, respectively). Continuity for all PCPs in the practice improved from 63% before empanelment to over 80% after empanelment, and improved from 55% to 72% for individual residents. Conclusions: In a large and complex practice environment, we were able to empanel resident clinic patients to improve continuity and maintain it over 2 years.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Medicina Interna/educação , Internato e Residência/organização & administração , Instituições de Assistência Ambulatorial , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/organização & administração , Cidade de Nova Iorque , Pacientes Ambulatoriais/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos
19.
J Grad Med Educ ; 11(2): 214-220, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024656

RESUMO

Background: A residency program's intern cohort is comprised of individuals from different medical schools that place varying levels of emphasis on Core Entrustable Professional Activities for Entering Residency (CEPAERs). Program directors have expressed concerns about the preparedness of medical school graduates. Though guiding principles for implementation of the CEPAERs have been published, studies using this framework to assess interns' baseline skills during orientation are limited. Objective: A CEPAER-based objective structured clinical examination (OSCE) was implemented with the aims to (1) assess each intern's baseline clinical skills and provide formative feedback; (2) determine an intern's readiness for resident responsibilities; (3) inform individualized education plans; and (4) address identified gaps through curricular change. Methods: During orientation, all 33 interns from internal medicine (categorical, preliminary, and medicine-psychiatry) participated in the OSCE. Six 20-minute stations evaluated 8 EPAs. Faculty completed a global assessment, and standardized patients completed a communications checklist and global assessment. All interns completed a self-assessment of baseline skills and a post-OSCE survey. Results: Stations assessing handoffs, informed consent, and subjective, objective, assessment, and plan (SOAP) note were the lowest-performing stations. Interns performed lower in skills for which they did not report previous training. Formal instruction was incorporated into didactic sessions for the lowest-performing stations. The majority of interns indicated that the assessment was useful, and immediate feedback was beneficial. Conclusions: This OSCE during orientation offers just-in-time baseline information regarding interns' critical skills and may lead to individualized feedback as well as continuous curricular improvement.


Assuntos
Competência Clínica , Medicina Interna/educação , Internato e Residência/métodos , Centros Médicos Acadêmicos , Comunicação , Currículo , Humanos , Internato e Residência/normas , Iowa , Transferência da Responsabilidade pelo Paciente , Simulação de Paciente , Autoavaliação
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