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7.
Harefuah ; 158(10): 664-668, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576714

RESUMO

INTRODUCTION: Professional burnout of physicians is common and culminates in the residency period. Burnout affects the doctor's health and quality of life, and it is associated with worse patient outcomes and an increase in the incidence of medical errors. The Israeli Ministry of Health recently conducted a survey on the burnout of health professionals in Israel and showed the extent of the phenomena, calling on health organizations to provide actions in order to reduce or prevent it. In the Department of Family Medicine at Ben-Gurion University of the Negev, there is a four-year course for family medicine residents in which we teach various clinical and psychosocial topics essential for the family medicine profession. As part of this course, we set up a program to prevent burnout. Four "mini-courses" were chosen and integrated into the course curriculum for family medicine residents: "Healers' art™", "meaning in medicine ", narrative medicine and reflective writing, mindfulness, meditation and relaxation techniques. In addition, the Balint groups continued to exist during the 3rd and 4th year of residence. Health institutions and organizations are committed, as part of the interventions to improve medical quality and patient safety, to detect and monitor the burnout of doctors and to offer changes in the work environment and interventions to prevent burnout. Although it is difficult to examine the long-term effects of these courses, the residents were very satisfied with the burnout prevention courses. There is a need to step up interventions and build a research and follow-up program to assess the short and long-term outcomes of these experiences on the physicians' well-being and patients' safety.


Assuntos
Esgotamento Profissional , Medicina de Família e Comunidade , Internato e Residência , Esgotamento Psicológico , Humanos , Israel , Qualidade de Vida
8.
Medicine (Baltimore) ; 98(40): e17459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577774

RESUMO

To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.


Assuntos
Medicina de Família e Comunidade , Internato e Residência , Erros Médicos/prevenção & controle , Pacotes de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
12.
Praxis (Bern 1994) ; 108(12): 793-798, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31530127

RESUMO

Fatigue - a Common Symptom in General Practice Abstract. When patients suffering from fatigue consult a GP surgery, GPs should understand what patients mean by fatigue, how strongly they are affected in everyday life and how they themselves explain the symptom. In a next step, dangerous diseases such as depression, addiction or sleep apnea syndrome must be excluded. The main somatic and psychiatric causes of fatigue should be explored simultaneously with a more in-depth history. A simple physical exam and a few lab examinations are sufficient to capture the major disorders that present with the isolated symptom of fatigue. For further care, a primary biopsychosocial approach with a viable physician-patient relationship is crucial. Rough conclusions based on laboratory findings should be avoided; comorbidities must be considered.


Assuntos
Fadiga , Medicina Geral , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Medicina de Família e Comunidade , Fadiga/diagnóstico , Fadiga/etiologia , Humanos , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
17.
S D Med ; 72(8): 354-360, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465640

RESUMO

INTRODUCTION: The Centers for Disease Control and Prevention updated recommendations for human papillomavirus (HPV) vaccine in 2016. National and statewide statistics indicate that HPV vaccination in the adolescent population is well below the administration rates for other vaccines. Because cancers associated with HPV infection are vaccine preventable, low administration rates are a cause for concern. METHODS: Through a two-year project funded by the South Dakota Department of Health, Sanford Health implemented a quality improvement project to address the low rate of HPV vaccine administration in their clinics in South Dakota. Evidence-based interventions included: implementation of a client reminder and recall system, vaccine education for providers and staff, a provider assessment and feedback system, and re-education on protocol (standing) orders. RESULTS: Implementation of this quality improvement project resulted in the following: 104,571 client reminders distributed, re-education on standing orders for vaccine administration, as well as feedback on missed opportunities for vaccination, and increased awareness for all providers and staff. In patients ages 11-26, HPV vaccine series completion rates increased by 13 percent in the two-year period. Zero-dose HPV vaccination dropped 22 percent in the seven pilot clinics over the two-year grant period, and by 10 percent overall when the additional clinics (n=32) were added in the second year. DISCUSSION: Implementation of the above practices provided a significant increase in awareness of the need to assess and administer HPV vaccine. The methods used are easily adaptable to any clinic system. These practices can increase HPV vaccination rates and ultimately decrease the number of HPV associated cancers.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Criança , Medicina de Família e Comunidade , Humanos , Infecções por Papillomavirus/prevenção & controle , Melhoria de Qualidade , South Dakota , Adulto Jovem
19.
Niger J Clin Pract ; 22(8): 1063-1069, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417048

RESUMO

Aim: The objective of this study was to determine the prevalence of burnout syndrome and associated factors among family physicians before and after family medicine system (FMS). Materials and Method: The first part of the study was conducted in 2008 (pre-FMS) and the second part in 2012 (post-FMS). Physician's burnout was investigated by using the Maslach Burnout Inventory (MBI). In total, 139 physicians had been participating pre-FMS and 246 physician's post-FMS. Results: The mean pre-FMS emotional exhaustion score was 15.7 ± 5.8, increasing significantly to 17.14 ± 7.5 post-FMS (P = 0.045). Mean pre-FMS and post-FMS depersonalization and reduced personal accomplishment scores were similar (P > 0.05). Age was negatively correlated with depersonalization in this study (P = 0.012) and positively correlated with personal accomplishment (P = 0.001). The primary care physicians in the post-FMS period were older, female physicians had a greater preference for primary care, and the levels of married doctors were higher. In addition, a higher level of physicians also owned their own home and cars compared to the pre-FMS period. A negative correlation has been reported between physicians' burnout levels and home or car ownership in the present study. Conclusion: Our findings suggest that physicians working under the family medicine system, a new primary care model, are at greater risk of emotional exhaustion, but that no change has occurred in terms of personal accomplishment or depersonalization, despite this new system.


Assuntos
Esgotamento Profissional/psicologia , Estresse Ocupacional/psicologia , Médicos de Família/psicologia , Carga de Trabalho , Adulto , Esgotamento Profissional/epidemiologia , Estudos Transversais , Despersonalização , Emoções , Medicina de Família e Comunidade/organização & administração , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/epidemiologia , Prevalência , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Turquia/epidemiologia
20.
S D Med ; 72(4): 164-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31436929

RESUMO

BACKGROUND: The Sioux Falls Family Medicine Residency serves a large non-English speaking and low socioeconomic status population. We designed a quality initiative to increase influenza and pneumonia vaccination rates in our elderly patients. METHODS: The main components of the project included improved clinic workflow, physician and staff education, and heightened patient awareness of vaccination importance. For the latter, we employed posters with key points about why patients should receive the vaccines, and personalized handouts with a photo of their provider discussing the importance of receiving these vaccines. The handouts were translated into the four most common non-English languages served by our clinics. RESULTS: Following implementation of the initiative, influenza vaccination rates increased from 35 to 53 percent, PPSV23 vaccination rates increased from 62.5 to 64 percent, and most impressively, PCV13 vaccination rates increased from 40 to 60 percent. CONCLUSION: This quality improvement project demonstrated meaningful change with minimal financial and logistical investment and should be sustainable in the long-term.


Assuntos
Programas de Imunização/organização & administração , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Pneumonia/prevenção & controle , Idoso , Medicina de Família e Comunidade , Humanos , Vacinas contra Influenza/administração & dosagem , South Dakota , Vacinação
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