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1.
Nat Rev Mol Cell Biol ; 21(10): 571-584, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32636524

RESUMO

The historical reliance of biological research on the use of animal models has sometimes made it challenging to address questions that are specific to the understanding of human biology and disease. But with the advent of human organoids - which are stem cell-derived 3D culture systems - it is now possible to re-create the architecture and physiology of human organs in remarkable detail. Human organoids provide unique opportunities for the study of human disease and complement animal models. Human organoids have been used to study infectious diseases, genetic disorders and cancers through the genetic engineering of human stem cells, as well as directly when organoids are generated from patient biopsy samples. This Review discusses the applications, advantages and disadvantages of human organoids as models of development and disease and outlines the challenges that have to be overcome for organoids to be able to substantially reduce the need for animal experiments.


Assuntos
Biologia/métodos , Medicina/métodos , Organoides/fisiologia , Animais , Doenças Transmissíveis/patologia , Doenças Genéticas Inatas/patologia , Engenharia Genética/métodos , Humanos , Neoplasias/patologia , Células-Tronco/fisiologia
3.
Acad Med ; 95(7): 1050-1056, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576763

RESUMO

PURPOSE: It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). METHOD: All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected. RESULTS: Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students' overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues. CONCLUSIONS: It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.


Assuntos
Variação Contingente Negativa/fisiologia , Avaliação Educacional/métodos , Internato e Residência/métodos , Aprendizagem/fisiologia , Treinamento por Simulação/métodos , Adulto , Lista de Checagem , Chicago/epidemiologia , Competência Clínica/estatística & dados numéricos , Comunicação , Currículo , Avaliação Educacional/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Medicina/métodos , Estudantes de Medicina , Universidades/estatística & dados numéricos
4.
CMAJ ; 192(15): E411-E412, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32392505
5.
Ir J Med Sci ; 189(4): 1477-1484, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32409947

RESUMO

INTRODUCTION: Clinical decision-making is a daily practice conducted by medical practitioners, yet the processes surrounding it are poorly understood. The influence of 'shortcuts' in clinical decision-making, known as heuristics, remains unknown. This paper explores heuristics and the valuable role they play in medical practice, as well as offering potential solutions to minimize the risk of incorrect decision-making. METHOD: The quasi-systematic review was conducted according to modified PRISMA guidelines utilizing the electronic databases Medline, Embase and Cinahl. All English language papers including bias and the medical profession were included. Papers with evidence from other healthcare professions were included if medical practitioners were in the study sample. DISCUSSION: The most common decisional shortcuts used in medicine are the Availability, Anchoring and Confirmatory heuristics. The Representativeness, Overconfidence and Bandwagon effects are also prevalent in medical practice. Heuristics are mostly positive but can also result in negative consequences if not utilized appropriately. Factors such as personality and level of experience may influence a doctor's use of heuristics. Heuristics are influenced by the context and conditions in which they are performed. Mitigating strategies such as reflective practice and technology may reduce the likelihood of inappropriate use. CONCLUSION: It remains unknown if heuristics are primarily positive or negative for clinical decision-making. Future efforts should assess heuristics in real-time and controlled trials should be applied to assess the potential impact of mitigating factors in reducing the negative impact of heuristics and optimizing their efficiency for positive outcomes.


Assuntos
Tomada de Decisão Clínica/ética , Cognição/fisiologia , Heurística/fisiologia , Medicina/métodos , Humanos
7.
Adv Exp Med Biol ; 1194: 437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468559

RESUMO

The fusion of artificial neural networks and fuzzy logic systems allows researchers to model real-world problems through the development of intelligent and adaptive systems. Artificial neural networks are able to adapt and learn by adjusting the interconnections between layers, while fuzzy logic inference systems provide a computing framework based on the concept of fuzzy set theory, fuzzy if-then rules, and fuzzy reasoning. The combined use of those adaptive structures is known as "neuro-fuzzy" systems. In this paper, the basic elements of both approaches are analyzed, noticing that this blending could be applied for pattern recognition in medical applications.


Assuntos
Lógica Fuzzy , Medicina , Redes Neurais de Computação , Algoritmos , Humanos , Medicina/métodos , Medicina/tendências , Modelos Biológicos
8.
Aust J Gen Pract ; 49(4): 169-174, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233341

RESUMO

BACKGROUND: Every four minutes, an Australian is diagnosed with cancer. Early detection and effective treatment means that many of these people are living with the side effects of cancer and its treatment for numerous years. OBJECTIVE: The aim of this article is to summarise the evidence examining the role of exercise in cancer care. DISCUSSION: Exercise is a safe and effective adjunct therapy in cancer care. Patients with cancer who regularly engage in moderate-intensity exercise are more likely to have: fewer and less severe treatment-related side effects; a lower relative risk of developing other chronic diseases; and, in some cases, a lower relative risk of cancer recurrence and mortality. Available evidence highlights the benefits of general practitioners (GPs) discussing and recommending exercise to their patients with cancer. To optimise the therapeutic effect of exercise, GPs may consider referring patients with cancer to an exercise physiologist or physiotherapist who has experience in cancer care.


Assuntos
Terapia por Exercício/métodos , Medicina/métodos , Neoplasias/terapia , Humanos , Medicina/tendências , Neoplasias/psicologia
9.
GMS J Med Educ ; 37(1): Doc10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32270024

RESUMO

Objective: The shortage of skilled workers and overloaded schedules make further training of health professionals difficult. In addition, child protection is not a systematic part of medical studies. The evaluation of an online course on child protection in medicine reveals positive feedback but also that the main reason for participants aborting the course is lack of time. Dissemination, as an active, targeted spreading of knowledge, can help to further spread knowledge about child protection in the target group. The aim of this article is to investigate whether and how the contents of the online course can be disseminated by professionals who have completed the online course. Methodology: The data were collected through a quantitative online evaluation and qualitative telephone interviews with doctors who had completed the online course and evaluated it using an interpretive-reductive analysis. Results: The respondents consider the need for further training and dissemination measures on the topic of child protection in medicine to be high. However, lack of time and insufficient relevance of the topic would present obstacles in the implementation of such measures. Meaningfulness and time off work or remuneration would in turn create incentives for implementation. Participants in dissemination measures could be motivated for example by further education points. In addition we were able to identify possible approaches for the implementation of such measures. Conclusion: Various parameters influence the motivation of doctors regarding the implementation/perception of dissemination measures. Based on these, recommendations for action are given for different areas of the health care system, such as supplementing the training curricula and providing ready-made materials for dissemination.


Assuntos
Serviços de Proteção Infantil/normas , Medicina/métodos , Pesquisa Médica Translacional/métodos , Serviços de Proteção Infantil/métodos , Serviços de Proteção Infantil/tendências , Humanos , Entrevistas como Assunto/métodos , Medicina/tendências , Motivação , Pesquisa Qualitativa , Inquéritos e Questionários , Pesquisa Médica Translacional/normas , Pesquisa Médica Translacional/tendências
10.
BMC Med Educ ; 20(1): 52, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066430

RESUMO

BACKGROUND: Empathy allows a physician to understand the patient's situation and feelings and respond appropriately. Consequently, empathy gives rise to better diagnostics and clinical outcomes. This systematic review investigates the level of empathy among medical students across the number of educational years and how this level relates to gender, specialty preferences, and nationality. METHOD: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors conducted a systematic search of studies published between February 2010 and March 2019 investigating the level of empathy among medical students. The databases PubMed, EMBASE, and PsycINFO were searched. Studies employing quantitative methodologies and published in English or Scandinavian language and examining medical students exclusively were included. RESULTS: Thirty studies were included of which 24 had a cross-sectional and 6 a longitudinal study design. In 14 studies, significantly lower levels of empathy were reported by increase in the number of educational years. The remaining 16 studies identified both higher, mixed and unchanged levels. In 18 out of 27 studies it was reported that females had higher empathy scores than males. Only three out of nine studies found an association between empathy scores and specialty preferences. Nine out of 30 studies reported a propensity towards lower mean empathy scores in non-Western compared to Western countries. CONCLUSION: The results revealed equivocal findings concerning how the empathy level among medical students develops among medical students across numbers of educational years and how empathy levels are associated with gender, specialty preferences, and nationality. Future research might benefit from focusing on how students' empathy is displayed in clinical settings, e.g. in clinical encounters with patients, peers and other health professionals.


Assuntos
Competência Clínica , Educação de Graduação em Medicina/métodos , Empatia , Grupos Étnicos/psicologia , Medicina/métodos , Estudantes de Medicina/psicologia , Estudos Transversais , Currículo , Feminino , Humanos , Internacionalidade , Estudos Longitudinais , Masculino , Medição de Risco , Fatores Sexuais
12.
JAMA Netw Open ; 2(12): e1917043, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31808926

RESUMO

Importance: Although palliative care (PC) historically focused on patients with cancer and those near the end of life, evidence increasingly demonstrates a benefit to patients with a broad range of serious illnesses and to those earlier in their illness. The field of PC has expanded and evolved rapidly, resulting in a need to characterize practice over time to understand whether it reflects evolving evidence and guidelines. Objective: To characterize current practice and trends among patients cared for and outcomes achieved by inpatient specialty PC services in the United States. Design, Setting, and Participants: This retrospective cohort study was performed from January 1, 2013, to December 31, 2017, at 88 US hospitals in which PC teams voluntarily participate in the Palliative Care Quality Network (PCQN), a national quality improvement collaborative. A total of 135 197 patients were referred to PCQN teams during the study period. Initial analyses of the study data were conducted from March 3 to March 21, 2018. Exposure: Inpatient PC consultation. Main Outcomes and Measures: A total of 23 standardized data elements collected by PCQN teams that provided information about the characteristics of referred patients, including age, sex, Palliative Performance Scale score, and primary diagnosis leading to PC consult; reason(s) given for the consultation; and processes of care provided by the PC team, including disciplines involved, number of family meetings held, advance care planning documentation completed, and screened for and intervened on needs. Results: A total of 135 197 patients were referred to inpatient PC (51.0% female; mean age, 71.3 years [range, 57.8-82.5 years]) and were significantly debilitated (mean Palliative Performance Scale score, 34.7%; range, 14.9%-56.8%). Cancer was the most common primary diagnosis (32.0%; range, 11.3%-93.9%), although rates decreased from 2013 to 2017 (odds ratio [OR], 0.84; 95% CI, 0.79-0.91; P < .001). Pain and other symptoms were common and improved significantly during the consultation period (pain: χ2 = 5234.4, P < .001; anxiety: χ2 = 2020.7, P < .001; nausea: χ2 = 1311.8, P < .001; dyspnea: χ2 = 1993.5, P < .001). Most patients were discharged alive (78.7%; range, 44.7%-99.4%), and this number increased over time (OR, 1.36; 95% CI, 1.27-1.46; P < .001). Compared with 2013, rates of discharge referral to clinic-based (OR, 4.00; 95% CI, 2.95-5.43; P < .001) and home-based PC (OR, 2.63; 95% CI, 1.92-3.61; P < .001) also increased significantly by 2017, whereas referrals to hospice decreased (OR, 0.56; 95% CI, 0.51-0.62; P < .001). Conclusions and Relevance: Inpatient PC teams cared for an increasing percentage of patients with diagnoses other than cancer and saw more patients discharged alive, consistent with guidelines recommending specialty PC for all patients with serious illness earlier in their illnesses. Most patients with symptoms improved quickly. Variation in practice and outcomes among PCQN members suggests that there are opportunities for further improvements in care.


Assuntos
Assistência à Saúde/tendências , Medicina/tendências , Cuidados Paliativos/tendências , Qualidade da Assistência à Saúde/tendências , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde/normas , Feminino , Humanos , Masculino , Medicina/métodos , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos
13.
Hastings Cent Rep ; 49(6): 2, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31813187

RESUMO

The November-December issue of the Hastings Center Report features a set of essays on the ethics of writing stories of patient care. The Report regularly features such stories, but some ways of telling them would be plainly unacceptable, and some in bioethics have suggested that the bar for acceptability is very high. Tod Chambers takes that position in this essay set. Drawing on the work of the literary theorist Mikhail Bakhtin, he proposes that case studies should be "polyphonic"-meaning that they contain "a diversity of voices that are unmediated and distinct." In effect, he calls for a kind of coauthoring of stories about patients. In a second essay, Arthur Frank also calls for including the patient's voice, but he builds on Bakhtin's call for "dialogic" storytelling, in which the author seeks to represent the characters in the story as having their own voices and their own lives: "they can talk back." A third essay, by Philip Rosoff, is concerned about the problem of harm and patient anonymity, which in the contemporary media environment has become harder to address.


Assuntos
Medicina/métodos , Narração , Comunicação , Humanos
15.
Rev Med Suisse ; 15(669): 1982-1986, 2019 Oct 30.
Artigo em Francês | MEDLINE | ID: mdl-31663698

RESUMO

Economists traditionally describe individuals as well-informed and rational decision-makers. Recent developments in behavioural economics, which lies at the intersection between psychology and economics, challenge these assumptions and describe the common cognitive biases that affect us all. The resulting decision errors are particularly frequent in health and health care given the predominance of uncertainty and the complexity of choices. Interventions aiming at correcting, or exploiting, these biases to improve decisions of citizens, patients, and health professionals have recently emerged. We present here a critical synthesis of findings and discuss potential applications in our health system.


Assuntos
Tomada de Decisões , Economia Comportamental , Educação em Saúde , Pessoal de Saúde/psicologia , Medicina/métodos , Pacientes/psicologia , Assistência à Saúde , Humanos
16.
J Med Internet Res ; 21(10): e16385, 2019 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661078

RESUMO

Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the "last mile problem in health care." In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission's (FCC's) Connect2Health Task Force, is the unanticipated emergence of "double burden counties," ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at "point-of-need," (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.


Assuntos
Assistência à Saúde/normas , Internet/normas , Medicina/métodos , Humanos
17.
J Eval Clin Pract ; 25(6): 1050-1054, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31502393

RESUMO

Shared decision-making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed-upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. The specialties we consider are Primary Care, Mental Health, Paediatrics, Palliative Care, Medicine, and Surgery. SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high-quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient-centred care but must be implemented with continued people centricity in order to realize its full potential.


Assuntos
Barreiras de Comunicação , Tomada de Decisão Compartilhada , Medicina , Planejamento de Assistência ao Paciente/ética , Assistência Centrada no Paciente , Relações Médico-Paciente/ética , Benchmarking/métodos , Competência Cultural , Humanos , Medicina/classificação , Medicina/métodos , Determinação de Necessidades de Cuidados de Saúde , Participação do Paciente , Satisfação do Paciente , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/tendências
20.
In Vivo ; 33(4): 1011-1026, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280189

RESUMO

Plasma medicine comprises the application of physical plasma directly on or in the human body for therapeutic purposes. Three most important basic plasma effects are relevant for medical applications: i) inactivation of a broad spectrum of microorganisms, including multidrug-resistant pathogens, ii) stimulation of cell proliferation and angiogenesis with lower plasma treatment intensity, and iii) inactivation of cells by initialization of cell death with higher plasma treatment intensity, above all in cancer cells. Based on own published results as well as on monitoring of relevant literature the aim of this topical review is to summarize the state of the art in plasma medicine and connect it to redox biology. One of the most important results of basic research in plasma medicine is the insight that biological plasma effects are mainly mediated via reactive oxygen and nitrogen species influencing cellular redox-regulated processes. Plasma medicine can be considered a field of applied redox biology.


Assuntos
Medicina , Gases em Plasma , Animais , Humanos , Medicina/métodos , Oxirredução , Gases em Plasma/farmacologia , Gases em Plasma/uso terapêutico , Cicatrização
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