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1.
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
2.
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
7.
J Manag Care Spec Pharm ; 25(8): 904-912, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31007119

RESUMO

BACKGROUND: The Biologics Price Competition and Innovation Act (BPCIA) of 2009, which included pathways for FDA approval of biosimilar products, was designed to promote more affordable, expanded patient access to biologic therapies. Achieving these BPCIA goals depends on overcoming formidable barriers to biosimilar adoption. Managed care and specialty pharmacy professionals are uniquely qualified to inform initiatives to address these barriers. OBJECTIVE: To assess perceptions regarding strategies for overcoming barriers to biosimilar adoption among managed care and specialty pharmacy professionals by conducting a survey study. METHODS: Invitations to complete the online survey were emailed by the Academy of Managed Care Pharmacy (AMCP) to members and customers and to contacts sourced from a commercial database. In addition to questions on respondent demographics and perceptions of biosimilars, the survey listed 16 strategies for overcoming key barriers to biosimilar adoption. On a 5-point scale, participants rated their opinion on the likelihood that each strategy would have the potential to assist in achieving BPCIA goals. The survey also listed 6 barriers to biosimilar adoption. On a 5-point scale, participants rated their perceived difficulty in overcoming each barrier. The survey concluded with an open-text item that asked participants to list 3 additional strategies for overcoming biosimilar adoption barriers. Response frequencies were calculated to describe participants' ratings of the strategies and barriers. Statistical analyses were conducted to assess whether the ratings differed among respondents grouped by work organization. For the open-text item, we conducted qualitative content analyses to categorize strategies by stakeholder groups that might take primary implementation roles. RESULTS: A total of 300 managed care and specialty pharmacy professionals completed the survey. There was considerable variation in the preferences, policies, and practices regarding biosimilar adoption among respondents' work organizations. Responses to several survey items reflected positive attitudes about the safety and efficacy of biosimilars; for example, 84% agreed or strongly agreed that FDA-approved biosimilars are safe and effective for patients who switch from a reference biologic. Based on pooled percentages for ratings of likely and extremely likely to overcome barriers to biosimilar adoption, the highest-rated strategies were for prescriber education about evidence from switching studies (91%) and FDA guidance on pharmacy-level substitution of reference biologics with biosimilars (90%). The lowest-rated strategies were for requiring therapeutic drug monitoring for patients who switch to biosimilars (39%) and using quotas to incentivize providers to prescribe biosimilars (40%). For the qualitative analysis, the highest numbers of respondents' suggested strategies indicated primary implementation roles of biosimilar manufacturers (40%), the federal government (26%), and managed care organizations (15%). CONCLUSIONS: Reflecting the unique knowledge, perspectives, and practices of managed care and specialty pharmacy professionals, the study findings are relevant to informing and advancing initiatives for achieving BPCIA goals. DISCLOSURES: The survey study reported in this article was part of a continuing education program funded by an independent educational grant, which was awarded by Sandoz, a Novartis Division, to PRIME Education. The Academy of Managed Care Pharmacy (AMCP) received grant funding from PRIME to assist in developing the survey and writing the manuscript. The grantor had no role in the study design, execution, analysis, or reporting. Greene and Pardo are employed by PRIME. Singh and Carden are employed by AMCP. Greene, Singh, Carden, and Pardo have no other disclosures. Lichtenstein received an honorarium from PRIME for serving as faculty for the continuing education program and has been a consultant for Pfizer, Cellceutix, and Merck.


Assuntos
Medicamentos Biossimilares/economia , Comércio/economia , Programas de Assistência Gerenciada/economia , Aprovação de Drogas/economia , Indústria Farmacêutica/economia , Metas , Humanos , Medicina/métodos , Assistência Farmacêutica/economia , Farmácias/economia , Farmácia/métodos , Inquéritos e Questionários , Estados Unidos , United States Food and Drug Administration
8.
J R Soc Med ; 112(5): 192-199, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30963774

RESUMO

OBJECTIVES: The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an 'F3' year. There is a paucity of qualitative research exploring why increasingly doctors are taking F3s. The aim of this study is to explore the reasons why F2 doctors are choosing to take a year out of training and the impact upon future career choices. DESIGN: This is an exploratory qualitative study, using in-depth interviews and content analysis. SETTING: UK. PARTICIPANTS: Fourteen participants were interviewed from one foundation school. Participants included five doctors who commenced their F3 in 2015, five who started in 2016 and finally four recently starting this in 2017. MAIN OUTCOME MEASURES: Content analysis was conducted to distill the themes which exemplified the totality of the experience of the three groups. RESULTS: There were four predominant themes arising within the data set which can be framed as 'unmet needs' arising within foundation years, sought to be fulfilled by the F3 year. First, doctors describe exhaustion and stress resulting in a need for a 'break'. Second, doctors required more time to make decisions surrounding specialty applications and prepare competitive portfolios. Third, participants felt a loss of control which was (partially) regained during their F3s. The final theme was the impact of taking time out upon return to training (for those participants who had completed their F3 year). When doctors returned to NHS posts they brought valuable experience. CONCLUSIONS: This study provides evidence to support the important ongoing initiatives from Health Education England and other postgraduate bodies, exploring approaches to further engage, retain and support the junior doctor workforce.


Assuntos
Atitude do Pessoal de Saúde , Corpo Clínico Hospitalar , Medicina , Adulto , Escolha da Profissão , Tomada de Decisões , Educação/estatística & dados numéricos , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/estatística & dados numéricos , Medicina/métodos , Medicina/estatística & dados numéricos , Pesquisa Qualitativa , Reino Unido
9.
Rev Med Interne ; 40(5): 286-290, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30902508

RESUMO

INTRODUCTION: The first computerised national ranking exam (cNRE) in Medicine was introduced in June 2016 for 8214 students. It was made of 18 progressive clinical cases (PCCs) with multiple choice questions (MCQs), 120 independent MCQs and 2 scientific articles to criticize. A lack of mark discrimination grounded the cNRE reform. We aimed to assess the discrimination of the final marks after this first cNRE. METHODS: A national Excel® file gathering overall statistics and marks were transmitted to the medical faculties after the cNRE. The mean points deviation between two papers and the percentage of points ranking 75% of students allowed us to analyse marks' discrimination. RESULTS: The national distribution sigmoid curve of the marks is superimposable with previous NRE in 2015. In PCCs, 72% of students were ranked in 1090 points out of 7560 (14%). In independents MCQs, 73% of students were ranked in 434 points out of 2160 (20%). In critical analysis of articles, 75% of students were ranked in 225 points out of 1080 (21%). The above percentages of students are on the plateau of each discrimination curve for PCCs, independent MCQs and critical analysis of scientific articles. CONCLUSION: The cNRE reduced equally-ranked students compared to 2015, with a mean deviation between two papers of 0.28 in 2016 vs 0.04 in 2015. Despite the new format introduced by the cNRE, 75% of students are still ranked in a low proportion of points that is equivalent to previous NRE in 2015 (between 15 et 20% of points).


Assuntos
Computadores , Educação Médica , Avaliação Educacional/métodos , Estudantes de Medicina/classificação , Coleta de Dados/instrumentação , Coleta de Dados/normas , Ciência de Dados/instrumentação , Ciência de Dados/métodos , Educação Médica/classificação , Educação Médica/métodos , Educação Médica/normas , Educação Médica/estatística & dados numéricos , França/epidemiologia , Humanos , Medicina/instrumentação , Medicina/métodos
10.
J Appl Microbiol ; 127(1): 12-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30828919

RESUMO

Synthetic surfactants are becoming increasingly unpopular in many applications due to previously disregarded effects on biological systems and this has led to a new focus on replacing such products with biosurfactants that are biodegradable and produced from renewal resources. Microbially derived biosurfactants have been investigated in numerous studies in areas including: increasing feed digestibility in an agricultural context, improving seed protection and fertility, plant pathogen control, antimicrobial activity, antibiofilm activity, wound healing and dermatological care, improved oral cavity care, drug delivery systems and anticancer treatments. The development of the potential of biosurfactants has been hindered somewhat by the myriad of approaches taken in their investigations, the focus on pathogens as source species and the costs associated with large-scale production. Here, we focus on various microbial sources of biosurfactants and the current trends in terms of agricultural and biomedical applications.


Assuntos
Agricultura/métodos , Microbiologia Industrial/métodos , Medicina/métodos , Tensoativos/farmacologia , Tensoativos/uso terapêutico , Humanos
11.
BMC Genomics ; 20(Suppl 1): 80, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30712512

RESUMO

The sixth International Conference on Intelligent Biology and Medicine (ICIBM) took place in Los Angeles, California, USA on June 10-12, 2018. This conference featured eleven regular scientific sessions, four tutorials, one poster session, four keynote talks, and four eminent scholar talks. The scientific program covered a wide range of topics from bench to bedside, including 3D Genome Organization, reconstruction of large scale evolution of genomes and gene functions, artificial intelligence in biological and biomedical fields, and precision medicine. Both method development and application in genomic research continued to be a main component in the conference, including studies on genetic variants, regulation of transcription, genetic-epigenetic interaction at both single cell and tissue level and artificial intelligence. Here, we write a summary of the conference and also briefly introduce the four high quality papers selected to be published in BMC Genomics that cover novel methodology development or innovative data analysis.


Assuntos
Inteligência Artificial , Biologia , Medicina , Biologia/métodos , Humanos , Medicina/métodos
12.
Sociol Health Illn ; 41(2): 378-394, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30710414

RESUMO

Researchers continue to lament the lack of organisational focus in the sociology of health and illness. Although studies have increasingly focused on boundaries between organizations, little such research has focused on the formal boundaries within the hospital itself. Given its dramatic compartmentalisation, and continuing prevalence in health systems, the lack of organisational perspective in hospital research limits insights into the effects (as well as the construction) of the order of health work and care. With a greater emphasis on 'ordering' in the concept of negotiated order, the aim of this study is to examine the manifestation and consequences of the formal boundaries of hospital departments. Fieldwork featured 12 months of ethnography, including formal and informal observations, 80 audio-recorded, semi-structured interviews, and 56 field interviews, in the Emergency Departments (EDs) of two tertiary referral hospitals. Compared with in-patient hospital departments, the ED has limited legitimacy claims of organ-specific knowledge to transfer patients out of the ED. The manifestation of specialised knowledge hierarchies in organisational structures disadvantages patients who are older and who have chronic conditions, underpinning the argument that effects as well as the negotiation of stable organisational orders deserve increased attention in the sociology of health and illness.


Assuntos
Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Hospitais , Medicina/organização & administração , Negociação , Adulto , Antropologia Cultural , Feminino , Humanos , Entrevistas como Assunto , Masculino , Medicina/métodos , Cultura Organizacional , Pesquisa Qualitativa , Sociologia Médica
14.
Am J Med Sci ; 357(2): 87-92, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30415760

RESUMO

Medicine is facing an identity crisis, one that might find resolution by revisiting a past rich in multifaceted individuals who transcended the strict definition of 'doctor', excelled in other fields of human endeavor, and showed us different ways of being physicians. This paper reviews 12 archetypes that have been part of the profession since its inception, but that, as of late, might have been forgotten. Our goal is to elicit discussion and introspection, with the premise that being a physician ought to be something larger than being a mere technician. If our premise is accepted, then the next step would be to identify those personal traits that made those archetypes possible, so that we can start both recruiting for them and then nurturing them during training.


Assuntos
Medicina/métodos , Médicos/estatística & dados numéricos , Educação Médica/métodos , Educação Médica/organização & administração , Descrição de Cargo , Medicina/estatística & dados numéricos
15.
Med Sci (Paris) ; 34(10): 865-871, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30451681

RESUMO

Modelling knowledge and medical reasoning can be an epistemological project especially now, as medicine seems to reach a scientific status. Through his work on semiotics, abductive reasoning and pragmatism, CS Peirce (1839-1914) offers a series of original solutions. These solutions can give an account of (be considered as a theorical ground for) most of the medical activity in various fields such as the evaluation of the students, the knowledge bases and expert systems, the formal descriptions languages (ontologies), and the evidence-based medicine. By mean of this article, we aim at introducing the medical doctors to this complex but lighting thought on a profession which now uses all the most modern resources of knowledge engineering.


Assuntos
Conhecimento , Lógica , Medicina/métodos , Médicos , Pensamento/fisiologia , Ontologias Biológicas/história , França , História do Século XIX , História do Século XX , Humanos , Padrões de Prática Médica/história , Padrões de Prática Médica/normas
18.
Clin Invest Med ; 41(2): E51-E54, 2018 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-29959883

RESUMO

The Leader in Medicine (LIM) Program of the Cumming School of Medicine, University of Calgary, hosted its 7th Annual LIM Research Symposium on October 30, 2015 and participation grew once again, with a total of six oral and 99 posters presentations! Over 45 of our Faculty members also participated in the symposium. This year's LIM Symposium theme was "Innovations in Medicine" and the invited guest speaker was our own Dr. Breanne Everett (MD/MBA). She completed her residency in plastic surgery at University of Calgary and holds both a medical degree and an MBA from the University of Calgary. In her inspiring talk, entitled "Marrying Business and Medicine: Toe-ing a Fine Line", she described how she dealt with a clinical problem (diabetic foot ulcers), came up with an innovation that optimized patient care, started her own company and delivered her product to market to enhance the health of the community. She clearly illustrated how to complete the full circle, from identifying a clinical problem to developing and providing a solution that both enhances clinical care and patient health as well as reduces health care costs and hospital admissions. The research symposium was an outstanding success and the abstracts are included in companion article in CIM.


Assuntos
Comércio , Medicina/métodos , Canadá , Humanos
19.
Eur J Pharmacol ; 836: 102-114, 2018 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-29936236

RESUMO

There is no evidence that Hippocrates, although being credited for it, ever literally stated 'let thy food be thy medicine and thy medicine be thy food'. However, yet in line with Hippocrates' philosophy, we are currently witnessing a reappraisal of the complementarity of nutrition and pharmacology. Recent studies not only underline the therapeutic potential of lifestyle interventions, but are also generating valuable insights in the complex and dynamic transition from health to disease. Next to this, nutritional biology can significantly contribute to the discovery of new molecular targets. It is clear that most of the current top-selling drugs used in chronic cardio-metabolic diseases modulate relatively late-stage complications, which generally indicate already longer existing homeostatic imbalances. Pharmacologists are increasingly aware that typical multifactorial disorders require subtle, multiple target pharmacological approaches, instead of the still often dominating 'one disease - one target - one drug' paradigm. This review discusses the recent developments in the pharma-nutrition interface and shows some relevant mechanisms, including receptors and other targets, and examples from clinical practice. The latter includes inflammatory diseases and progressive loss of muscle function. The examples also illustrate the potential of targeted combinations of medicines with nutrition and (or) other life-style interventions, to increase treatment efficacy and (or) reduce adverse effects. More attention to a potentially negative outcome of drug-food combinations is also required, as shown by the example of food-drug interactions. Together, the developments at the food-pharma interface underline the demand for intensified collaboration between the disciplines, in the clinic and in science.


Assuntos
Alimentos , Medicina/métodos , Animais , Interações Alimento-Droga , Humanos , Ciências da Nutrição
20.
Nervenarzt ; 89(9): 979-985, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-29947939

RESUMO

BACKGROUND: The background of this study is twofold: basic methodological differences between Western Biomedicine and Classical Chinese Medicine (CCM) and obvious parallels between the methodology of psychotherapy and CCM. OBJECTIVES: Drawing on available investigations on the methodology of CCM, the analysis of structural parallels between CCM and Western psychotherapy tries to enrich the methodological self-conception of psychotherapy in order to provide impulses for the new approaches to psychotherapeutic practice. METHODS: The reciprocal interpretation of CCM about the patient's state draws on a language of metaphors. These metaphors "mediate" between the various positions of the universal interdependency and the human being, who is able to understand the language. The constructive realistic methodology in general and the epistemological method of "alienation" in particular, provide an instrument for the decodification of these metaphors. RESULTS: In the context of CCM, the process dynamics of mental healing are based on hermeneutical principals. Every operation carried out by the CCM therapist is not organ medical in nature but a purely semantic form. These semantic operations aim to provide a meaningful integration of problematical behavior (in terms of meaning) into metaphorically logical structures in order to stimulate a coherent self-understanding of the suffering individual, which is associated with healing effects. In this context, it is crucial for CCM that there is no conceptual division between body and soul with respect to the therapy. This enables a completely different comprehensive treatment of mental problems than biomedicine is able to offer, due to its methodological presuppositions.


Assuntos
Medicina Tradicional Chinesa , Medicina , Psicoterapia , Assistência à Saúde , Humanos , Medicina/métodos , Psicoterapia/métodos
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