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1.
Bull Cancer ; 108(4): 399-414, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33707034

RESUMO

This literature review aims to explain how the emotions aroused by the announcement of bad news in pediatric oncology affect communication between parents and pediatric oncologists. In the first part, we summarize the parents' expectations regarding communication with the pediatrician at this critical time in their child's care. Then, in a second part, we specify the influence that the emotions of pediatric oncologists and parents during these announcements can have on parent-pediatrician communication. In this context, the emotions and defense mechanisms of pediatric oncologists, parental distress as expressed by parents and as perceived or feared by pediatricians, are discussed. For this synthesis, we have endeavoured to select studies including both mothers and fathers. On the basis of the observations carried out in this review, we conclude by suggesting avenues for the practical implications and for future research. The continuation of research including both parents appears necessary to allow for a closer adaptation of the reactions and needs of each parent, particularly at key moments in the child's care, such as the announcement of bad news. Encouraging exchanges on the emotions felt within the medical and care team, particularly with the department psychologist, could be an opportunity for pediatricians to question their experience of the announcement of bad news and could promote the circulation of emotions in the parent-pediatrician relationship and communication.


Assuntos
Emoções , Neoplasias/psicologia , Oncologistas/psicologia , Pais/psicologia , Pediatras/psicologia , Relações Médico-Paciente , Revelação da Verdade , Adulto , Criança , Mecanismos de Defesa , Empatia , Medo , Feminino , Humanos , Masculino , Prognóstico , Angústia Psicológica , Apoio Social
2.
BMC Infect Dis ; 21(1): 12, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407202

RESUMO

BACKGROUND: Over the last two decades, several countries have initiated universal varicella vaccination (UVV) programs in infants. In 2019, the Swiss National Immunization Technical Advisory Group (NITAG) decided to start evaluating the introduction of universal varicella vaccination. There is a theoretical concern that suboptimal vaccination coverage could lead to a shift in the varicella incidence to older age groups, thereby potentially increasing complication rates. To achieve a high vaccination coverage rate, it is important that practicing physicians comply with a potential recommendation for UVV. We studied the perception of varicella and the current vaccination behavior among Swiss pediatricians and general practitioners (GPs) who treat children. We also assessed their intention to advise parents to vaccinate their children against varicella in the event the Swiss NITAG will recommend UVV. METHODS: Primary data was collected through a structured, 20-min online survey with Swiss pediatricians and GPs who treat children. RESULTS: 150 physicians participated in the study: 40 GPs in the German-speaking part, 20 GPs in the French-speaking part, 67 pediatricians in the German-speaking part, and 23 pediatricians in the French-speaking part. The majority (64%) of all participants reported that they currently recommend varicella vaccination for risk groups according to the national immunization plan. About one third of physicians (35%) - predominantly pediatricians - currently already recommend it for all infants. In these situations, a measles, mumps, rubella, varicella combination vaccine is currently used by 58% for the first dose and by 59% for the second dose. 86% of participants stated that they would advise parents to have their children vaccinated against varicella in case of a recommendation for UVV by the Swiss NITAG. 68% responded that they expect many questions from parents and 65% agreed that they have good arguments to convey the importance of varicella vaccination. CONCLUSIONS: The survey study results show that most participating pediatricians and GPs indicated a favorable attitude towards childhood vaccination against varicella in the setting of a Swiss NITAG recommendation for UVV. This data shows the importance of NITAG recommendations in influencing vaccine education and supporting achievement of high coverage of varicella vaccination.


Assuntos
Vacina contra Varicela/uso terapêutico , Varicela/prevenção & controle , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Herpesvirus Humano 3/imunologia , Pediatras/psicologia , Vacinação/psicologia , Varicela/epidemiologia , Varicela/virologia , Vacina contra Varicela/imunologia , Feminino , Humanos , Programas de Imunização , Incidência , Masculino , Pais/psicologia , Inquéritos e Questionários , Suíça/epidemiologia , Vacinas Combinadas/imunologia , Vacinas Combinadas/uso terapêutico
5.
Arch Pediatr ; 27(8): 423-427, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33011025

RESUMO

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus , Pandemias , Pediatras/psicologia , Pediatria/tendências , Pneumonia Viral , Padrões de Prática Médica/tendências , Adulto , Camarões , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Relações Profissional-Família , Telemedicina
6.
Pediatr Emerg Care ; 36(11): e665-e669, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33125203

RESUMO

OBJECTIVE: Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing. METHODS: A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed. RESULTS: There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score. CONCLUSIONS: This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.


Assuntos
Esgotamento Profissional/epidemiologia , Medicina de Emergência Pediátrica , Pediatras/psicologia , Estudos Transversais , Bolsas de Estudo , Humanos , Estudos Longitudinais , Resiliência Psicológica , Inquéritos e Questionários , Estados Unidos/epidemiologia
7.
Isr J Health Policy Res ; 9(1): 53, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081834

RESUMO

BACKGROUND: Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. METHODS: A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. RESULTS: One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. CONCLUSIONS: The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pediatras/psicologia , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/organização & administração , Telemedicina/tendências , Adulto , Idoso , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Previsões , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Política Pública , Quarentena
11.
Curr Opin Pediatr ; 32(2): 328-335, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32068599

RESUMO

PURPOSE OF REVIEW: The current article reviews recent literature related to pediatric and adolescent vaccination, specifically focusing on social determinants of under-immunization, expanding adolescent immunization rates, and new recommendations surrounding the meningococcal serotype B vaccine (MenB). RECENT FINDINGS: Vaccine refusals and vaccine-preventable diseases have been rising in some parts of the world, and appear to be linked to household factors, such as a family's socioeconomic status. Adolescents have lower immunization rates than younger children. Newer vaccines targeted at adolescents, such as the MenB vaccine, have yet to be widely accepted by pediatric providers, parents, and patients. SUMMARY: Pediatric healthcare providers should attempt to increase local immunization rates by vaccinating children at all eligible office visits and utilizing electronic health record decision-support tools. Although the number of families who choose not to vaccinate their children may be rising, providers can be innovative (e.g. incorporate digital vaccine reminder systems) and increase their familiarity with new vaccine recommendations to continue to prevent serious vaccine-preventable diseases.


Assuntos
Imunização/estatística & dados numéricos , Vacinas Meningocócicas/administração & dosagem , Pais/psicologia , Pediatras/psicologia , Recusa de Vacinação/psicologia , Vacinação/estatística & dados numéricos , Adolescente , Criança , Pessoal de Saúde , Promoção da Saúde/métodos , Humanos , Classe Social
13.
Clin Pediatr (Phila) ; 59(4-5): 450-457, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32070135

RESUMO

Pediatricians caring for patients with child abuse or neglect (CABN) may experience secondary traumatic stress (STS) from traumatized patients, or burnout (BO) from workplace stress. This may be buffered by compassion satisfaction (CS), positive meaning from one's work. For this study, STS, BO, and CS specific to a pediatrician's care of CABN were assessed for residents, hospitalists, intensivists, and outpatient physicians. Using the Professional Quality of Life Scale modified for CABN experiences, participants (n = 62) had a mean STS score at the 84th percentile, a mean BO score at the 66th percentile, and a mean CS score at the 17th percentile. Reporting one CABN patient as most emotionally impactful predicted STS, caring for all types of CABN predicted BO, and perceived knowledge no longer predicted CS when adjusting for the experience of mandated reporting or CABN fatality. These results highlight the need to support pediatricians involved with CABN.


Assuntos
Esgotamento Profissional/psicologia , Maus-Tratos Infantis/psicologia , Fadiga por Compaixão/psicologia , Pediatras/psicologia , Adulto , Criança , Empatia , Feminino , Humanos , Satisfação no Emprego , Masculino , Notificação de Abuso , Qualidade de Vida/psicologia
14.
Epilepsy Behav ; 104(Pt A): 106889, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32028125

RESUMO

Transition from pediatric to adult care systems is a major challenge in the management of adolescents with epilepsy. The comparison of pediatric and adult physicians' points of view on this issue is scarcely described. The aim of this study was to understand pediatric and adult neurologists' experience and opinions on transition in epilepsy in France. We investigate the age at which they usually transfer patients, their opinion on the factors that positively or negatively impact transition, on the help provided during this transition period, and their propositions to improve this process. We prepared a targeted questionnaire with two versions, one adapted for neurologists and the other for child neurologists. The questionnaires were diffused through the Reference Centre for Rare Epilepsies, the French Chapter of the League Against Epilepsy, the French Association for Office-based Neurologists, and the French Pediatric Neurology Society. A total of sixty-eight physicians involved mostly in epilepsy care answered this questionnaire: 39 child neurologists and 29 neurologists. Questionnaires were filled at 96.8%. Twenty-six child neurologists followed patients aged over 18 years (70%), and 18 neurologists followed patients under the age of 12 years (66.6%). Cognitive impairment in childhood led significantly to a later transfer to adult care. The major factors believed to delay the transfer were attachment between child neurologists and families as reported in 96.3% by neurologists and in 81.1% by child neurologists, p = 0.07 and lack of adaptation of adult neurology facilities to adolescents especially with intellectual disability (59.3% neurologists, 75.7% child neurologists, p = 0.16). Factors that helped a transfer around 18-19 years were mainly pharmacoresistant epilepsy (71% for neurologists vs. 19% for child neurologists, p < 105) and pregnancy (72% for child neurologists versus 50% for neurologists, p = 0.08). Factors that negatively impacted transition were the lack of information about daily life in adulthood (driving license, contraception, sexuality, carrier guidance, etc.), the weak transition preparation in pediatric system, the lack of knowledge of pediatric epilepsy syndromes, and the lack of global support for patients with intellectual disability and multidisciplinary care needs in adult system. Both groups proposed joint clinics (>65% of providers) and development of care networks between pediatric and adult care for patients with epilepsy (>55%) to improve transition as well as introducing courses on transition. Few physicians were aware of transition and transfer recommendations. Although child and adult neurologists still have some preconceived beliefs, they were able to identify the strengths and weaknesses of both care systems paving the way for proposals to improve transition and transfer of patients with epilepsy from pediatric to adult care.


Assuntos
Epilepsia/epidemiologia , Neurologistas/tendências , Pediatras/tendências , Inquéritos e Questionários , Transição para Assistência do Adulto/tendências , Adolescente , Adulto , Criança , Pré-Escolar , Epilepsia/psicologia , Epilepsia/terapia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurologistas/psicologia , Pediatras/psicologia , Adulto Jovem
15.
PLoS One ; 15(2): e0228377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012194

RESUMO

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hospitais Pediátricos/normas , Pediatras/psicologia , Pediatria/educação , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Síndromes da Apneia do Sono/terapia , Criança , Estudos Transversais , Humanos , Itália , Análise de Classes Latentes , Pediatras/normas , Pediatras/estatística & dados numéricos , Pediatria/normas , Satisfação Pessoal , Projetos Piloto , Inquéritos e Questionários
16.
Pediatr Emerg Care ; 36(1): e25-e29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895204

RESUMO

This fifth article in our series focuses on burnout in practicing pediatric emergency medicine physicians. As opposed to a general review of burnout, we address understudied and undervalued risk factors, drivers, and individual- and organizational-level solutions applicable to the emergency medicine workplace.Conflicting studies impact our understanding of the prevalence of burnout in our field and the role of depression. This article's story is anonymously submitted and leads us to our discussion of the heightened risk of burnout in underrepresented physicians, those who identify themselves as women, as belonging to a racial, ethnic, gender and/or sexual minority group, and/or as having a physical and/or sensory disability.Thus far, our articles have described coping tools for individuals and health care organizations to prevent and/or mitigate the untoward effects of life-changing stressors on a pediatric emergency physician's life. They include staying healthy and active, cultivating outside interests, and nurturing relationships with peers, friends, and family. We have shared the techniques and benefits of constructive engagement when one is faced with challenging events or individuals. We have underscored the value of peer support, support groups, emotional debriefing, and engaging with outside organizations able to address specific stressors. We have introduced the practice of political engagement as a way of addressing systems-level pressures. Throughout this series, we have emphasized the need to ask for help from family, friends, peers, primary care providers, and mental health professionals. This article describes the benefits of Employee Assistance Programs, Physician Wellness Programs, positive psychology, and grounding behaviors as self-care strategies.


Assuntos
Esgotamento Profissional/terapia , Medicina de Emergência , Médicos/psicologia , Autocuidado/métodos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Depressão/complicações , Pessoas com Deficiência/psicologia , Feminino , Humanos , Masculino , Serviços de Saúde do Trabalhador , Pediatras/psicologia , Fatores de Risco , Minorias Sexuais e de Gênero/psicologia , Estresse Psicológico
17.
Acad Med ; 95(3): 361-364, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31625998

RESUMO

The author states that as a second-year medical student with a liberal arts degree, it was often difficult for him to reconcile his former liberal arts education with the current demands of his training. Although the medical curriculum increasingly acknowledges the importance of a biopsychosocial model, the prioritization of knowledge remains the same: know your biological, pharmacological, and anatomical facts. However, the author's experience with a social pediatrics research summer studentship moved him beyond this basic sciences mindset and provided a practical framework for the application of his liberal arts training. The experience was twofold: he worked on a research project while simultaneously shadowing a pediatrician twice a week. His project applied a Foucauldian critical discourse analysis (CDA) to an archive of texts that sought to better characterize the term social pediatrics. The author concludes that the thought-changing reflection, mentorship, and concrete clinical experiences made possible by the summer studentship expanded his worldview.The author discusses the complementary relationship between CDA, clinical experience, and self-reflection in the developing clinician. The purpose of his essay is threefold. First, by drawing on concepts from Descartes' Meditations and Plato's allegory of the cave, he establishes educational continuity between his liberal arts and medical training. Second, using clinical examples, he explores the practicality of discourse analysis and how skills regarding empathy and bias awareness are transferrable to the wards. Last, he highlights the importance of cognitive dissonance and transformative learning in the maturing physician.


Assuntos
Currículo , Educação Médica/organização & administração , Empatia , Pediatras/educação , Pediatras/psicologia , Comportamento Social , Estudantes de Medicina/psicologia , Adulto , Humanos , Masculino , Adulto Jovem
18.
Prev Med ; 130: 105855, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31644896

RESUMO

Suicide is the second-leading cause of death for adolescents in the United States. Counseling patients and families on safe storage of firearms and medications is an effective method of suicide prevention. We sought to determine the self-reported frequency of lethal means restriction (LMR) counseling among primary care pediatric providers working with adolescents who are at risk for suicide as well as factors associated with consistently employing LMR counseling. An anonymous, self-report, electronic survey was conducted of primary care pediatricians in the Washington, DC metropolitan area of LMR counseling for suicide prevention. The survey was conducted over 10 weeks in autumn of 2017. Stepwise, multivariate logistic models were used to determine factors associated with firearm screening and LMR counseling for patients at risk for suicide. Response rate was 11% (n = 1546). Over a range of suicide risk scenarios, few respondents reported consistently screening for firearms (21.9%) or employing LMR counseling (19.4%). When adjusting for confounding, five or more years in practice was associated with higher odds of screening for firearms (aOR 4.6 [1.3-16]). Previous LMR training was strongly associated with consistent LMR counseling (aOR 8.3 [1.8-38.4]). While LMR counseling can reduce risk for completed suicide, most respondents do not consistently employ it. Those who have received training are more likely to counsel. Thus, LMR counseling should be a standard part of medical education for pediatricians.


Assuntos
Aconselhamento/métodos , Armas de Fogo , Pediatras/psicologia , Suicídio/prevenção & controle , Adulto , District of Columbia , Feminino , Armas de Fogo/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pediatria , Atenção Primária à Saúde , Inquéritos e Questionários
19.
Patient Educ Couns ; 103(2): 414-417, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31455566

RESUMO

OBJECTIVES: Pediatrician-adolescent communication can improve adolescent health. We conducted a two-arm design to pilot-test an intervention that randomized adolescents to receive a Feedback Guide to promote engaged conversations. We hypothesized that adolescents who received the Guide would be more participatory. METHODS: We recruited 12 pediatricians and 29 adolescents. Clinic staff enrolled adolescents using a tablet that enabled consenting, assessment of high-risk behaviors, and audio recording of encounters. We surveyed adolescents immediately and two months after the encounter. RESULTS: Adolescents who received the intervention were more participatory than adolescents who did not. Pediatricians counseled on 20 of 32 high-risk behaviors with no significant arm differences. At follow-up, adolescents changed 9 of 32 behaviors; 6 were among 4 of adolescents in the intervention arm. Adolescents in the intervention arm were also more likely to report that counseling would help them change their behavior; these encounters were slightly longer than control arm encounters. CONCLUSIONS: We confirmed feasibility of a streamlined approach to enrolling and audio recording encounters. The Feedback Guide improved adolescent participation and might have helped them adopt healthier behaviors. PRACTICE IMPLICATIONS: Adolescents can be primed to be participatory and can change their behaviors after a meaningful encounter with their pediatrician.


Assuntos
Comunicação , Aconselhamento , Participação do Paciente/psicologia , Pediatras/psicologia , Adolescente , Instituições de Assistência Ambulatorial , Criança , Estudos de Viabilidade , Feminino , Redução do Dano , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Projetos Piloto , Assunção de Riscos , Inquéritos e Questionários
20.
Pediatr Emerg Care ; 36(4): 192-195, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29200142

RESUMO

OBJECTIVE: Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians. METHODS: We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group. RESULTS: Respondents averaged a score of 9 (95% confidence interval [CI], 8-10), 23 (95% CI, 21-25), and 39 (95% CI, 38-40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18-32). CONCLUSIONS: Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18-32), showing elevated levels of burnout.


Assuntos
Esgotamento Profissional/epidemiologia , Medicina de Emergência Pediátrica/estatística & dados numéricos , Médicos/psicologia , Adulto , Idoso , Criança , Despersonalização , Medicina de Emergência/estatística & dados numéricos , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Médicos/estatística & dados numéricos , Prevalência , Estresse Psicológico , Inquéritos e Questionários
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