Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 74.597
Filtrar
2.
Orv Hetil ; 161(3): 95-102, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31928062

RESUMO

Introduction: Chronic obstructive pulmonary disease (COPD) is a health burden for the patient and the society. We have sought to find the optimal education content to alleviate this burden. Aim: (1) To create patient education content based on the pulmonologists' opinion; (2) to understand the pulmonologists' attitudes and perceptions; (3) to evaluate the options to improve patient adherence. Method: We have performed 20 interviews with pulmonologists working in inpatient, outpatient and rehabilitation settings. The structure of the interviews has been designed to determine the key elements of a patient education programme and to discover perception and therapeutic attitudes. Results: The average COPD patient is a smoker, male, under-socialized, coughs, has dyspnoea and is older than 40 years. He does not take his illness seriously, and seeks medical attention only in case of worsening of the disease, and improvement in adherence is only present in such cases. The latter phenomenon is frequently transient, and limited to worse periods. Three adherence groups can be defined: marginal good adherence (approx. 10%), the average is around 30-40%, and minimal adherence (60%). Correct inhaler use should be taught in maximum three steps, which should be easily reproduced and explained. Conclusion: The aspects defining the framework of the education programme are the adequate patient profile (tailor-making), on-the-spot education in the pulmonology centre, the relationship between the patient and the doctors, patient attitudes and lifestyle changes (smoking cessation), and choosing the adequate inhaler. Orv Hetil. 2020; 161(3): 95-102.


Assuntos
Educação de Pacientes como Assunto , Relações Médico-Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologistas/psicologia , Atitude , Dispneia , Humanos , Masculino , Adesão à Medicação , Percepção , Pneumologia , Abandono do Hábito de Fumar
11.
Lancet ; 395(10217): 24-25, 2020 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-31982047
14.
JAMA ; 323(1): 70-81, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910284

RESUMO

Importance: Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction. Objective: To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients. Evidence Review: Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (-4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes. Findings: The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient's emotions). Conclusions and Relevance: This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.


Assuntos
Relações Médico-Paciente , Atenção Primária à Saúde , Medicina Clínica , Comunicação , Técnica Delfos , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Fatores de Tempo
18.
Urologe A ; 59(1): 87-98, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31728563

RESUMO

The juridification of medicine affects all disciplines, including urology. Therefore, in this discipline it can well happen that patients not only feel wrongly treated or complain that a treatment was not performed lege artis but also demand compensation or even bring criminal charges. From the patient point of view, the doctor is often more likely to blame for a complication that has arisen or for a hoped for but failed treatment success, than that it is accepted that a complication is typical for the intervention, which, despite the greatest medical care, unfortunately can become reality and is a fateful course. Insurance against claims for damages can be taken out. Not to be underestimated, however, is the personal burden of the accusations with which doctors are confronted by patients, relatives, expert witnesses and courts and against which one must defend oneself. This can mean additional work in addition to the normal medical workload. Therefore, the legal pitfalls in urology should be known.


Assuntos
Imperícia/legislação & jurisprudência , Urologia/legislação & jurisprudência , Compensação e Reparação/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Humanos , Seguro de Responsabilidade Civil/economia , Seguro de Responsabilidade Civil/legislação & jurisprudência , Responsabilidade Legal/economia , Imperícia/economia , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Relações Profissional-Família , Urologia/economia
19.
Internist (Berl) ; 61(1): 44-50, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31853579

RESUMO

Somatoform disorders are encountered in primary medical care with above-average frequency but are too rarely named as such in the differential diagnostics. The prevalence is approximately 30 % with a predominance of female patients. This patient group puts the physician-patient relationship to the acid test from the very beginning due to the fixation on organ-related symptoms, the expectations of repeated instrumental diagnostics and the special way of acting. The consequences are frequent changes of physicians, chronification and disappointment on both sides; however, a workable physician-patient relationship can be developed through an empathic but critically distanced fundamental attitude of the general internist based on a biopsychosocial illness concept. In the further course corrections in the understanding and expression of the illness on the part of the patient can be achieved with a pacing and leading strategy and with psychoeducative measures. The primary psychologization of functional complaints will not satisfy the affected person but outpatient psychotherapy should be initiated only after the patient has been well-prepared. Measures with medications mostly remain unspecific and serve only for relief of symptoms. For comorbidities with anxiety and/or depressive disorders the use of selective serotonin reuptake inhibitors should be considered.


Assuntos
Transtorno Depressivo/diagnóstico , Medicina Interna , Medicina Psicossomática/métodos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Assistência Ambulatorial , Assistência à Saúde , Transtorno Depressivo/psicologia , Feminino , Humanos , Pacientes Ambulatoriais , Relações Médico-Paciente , Transtornos Somatoformes/psicologia
20.
World Neurosurg ; 133: 457-465, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31881580

RESUMO

Clinical neurosurgery is a complex specialty with multiple participants, including a variety of providers, patients, family members, and administrators, who interact in complex fashions. Modern-day patient care requires near-constant team communication of vital, detailed clinical information; any breakdown in this process can result in patient harm. Medical communication practices with patients impact mutual rapport as well as the overall physician-patient relationship. Enhanced relationship-centered communication techniques have been shown to improve patient compliance and may positively influence malpractice litigation rates. Neurosurgeons frequently interact with other health care providers and members of the hospital administration on matters relating to billing, compliance, and quality. Communication among the stakeholders is complicated, however, by the fact that the participants may be speaking a variety of different, mutually unintelligible "languages." We discuss the details of the various types of information exchanges in neurosurgery, the key players involved, and the vulnerabilities to breakdowns in the system. In addition, we review the multifaceted, systems-level issues in neurosurgical communication and related weaknesses.


Assuntos
Comunicação , Neurocirurgia , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Relações Profissional-Família , Humanos , Neurocirurgiões , Assistência Centrada no Paciente
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA