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1.
Am J Epidemiol ; 191(12): i-iii, 2022 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-36451531

Assuntos
Consultores , Humanos
3.
BMJ ; 379: o2606, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36347527
5.
BMJ Open ; 12(11): e061505, 2022 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-36410837

RESUMO

OBJECTIVES: To explore the events perceived as traumatic by obstetricians and gynaecologists (O&G), and to examine factors contributing to the perception of trauma. DESIGN: Mixed methods: cross-sectional survey and in-depth interviews. SAMPLE AND SETTING: Fellows, members and trainees of the Royal College of Obstetricians and Gynaecologists (RCOG). METHODS: An online survey was distributed to 6300 fellows (May-June 2017), members and trainees of RCOG; 1095 (17%) completed surveys were returned. Of these, 728 (66%) reported work-related trauma experience, with 525 providing a brief description of an event. Forty-three participants with trauma experience were purposively sampled and completed an in-depth interview (October 2017-March 2018), which were analysed using Template Analysis. Information regarding the scale and impact of trauma experience is presented elsewhere. The present analysis provides new information describing the events and perceptions of why events were traumatic. PRIMARY OUTCOME MEASURES: The nature of traumatic events in this clinical setting, taken from survey descriptions of perceived traumatic events and information from the in-depth interviews. RESULTS: Events perceived as traumatic by O&G were similar between consultants, trainees and other RCOG members no longer working in O&G. Maternal or neonatal death/stillbirth, haemorrhage and events involving a difficult delivery were most frequently reported. Sudden and unpredictable events, perceived preventability, acute sensory experiences and high emotionality contributed to trauma perception. Respondents' trauma was compounded by an absence of support, involvement in investigation procedures and pre-existing relationships with a recipient of care. CONCLUSIONS: Identification of events most likely to be perceived as traumatic, and wider circumstances contributing to the perception of trauma, provide a basis on which to focus preventative and supportive strategies for O&G. Training on the nature of traumatic events, self-help for early stress responses, processing support and rapid access to trauma-focused psychological input (where required) are needed.


Assuntos
Consultores , Pessoal de Saúde , Gravidez , Feminino , Recém-Nascido , Humanos , Estudos Transversais , Inquéritos e Questionários , Natimorto
6.
PLoS One ; 17(10): e0276178, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36251677

RESUMO

BACKGROUND: The healthcare system is frequently subject to unpredictable conditions such as organisational changes and pandemics. In order to perform as required under these conditions (i.e. exhibiting resilient behaviour), it is necessary to know the current position of the organisation with respect to the four resilient potentials i.e. respond, monitor, learn and anticipate. The study aimed to understand and assess resilient performance of an Internal Medicine Department in a public hospital in Denmark using the resilience assessment grid (RAG). METHODS: A modified Delphi method was used to develop the context specific RAG, using interviews to generate items, two rounds of expert panel reviews and pilot testing the developed RAG questionnaire. The four sets of structured RAG questions were tested and revised until satisfactory face and content validity for application was achieved. The final version of the RAG (28-item Likert scale) questionnaire was sent electronically to 87 healthcare professionals (clinicians and managers) in January 2021 and 2022. The data was statistically analysed and illustrated in radar charts to assist in interpreting the resilience profiles. RESULTS: While the resilience profiles in 2021 and 2022 were similar, the scores in 2022 were slightly lower for some of the sub-indicators. The results indicate areas for improvement, especially related to the Internal Medicine Department's potential to respond and learn. The results from the RAG were presented to the chief clinical consultants and managers to identify initiatives for quality improvement and for planning a new workflow at the Internal Medicine Department. CONCLUSION: The RAG is a managerial tool to assess the potential resilient performance of the organisation in respect to the four resilience potentials, i.e., responding, monitoring, learning, and anticipating. It can be used to construct the resilience profile of the system over time to manage organisational changes.


Assuntos
Consultores , Melhoria de Qualidade , Humanos , Inovação Organizacional , Inquéritos e Questionários
7.
BMJ ; 379: o2463, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36257675
8.
J Pak Med Assoc ; 72(8): 1483-1490, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36280906

RESUMO

Objectives: To explore factors promoting and hampering a medical resident's journey from residency induction to role adaptation into consultant practice. METHODS: The qualitative, phenomenological study was conducted at the Fatima Memorial Hospital and Sir Ganga Ram Hospital, Lahore, Pakistan, from February to July 2019, and comprised junior residents, senior residents, newly qualified consultants and supervising consultants from four departments. Semi-structured interviews were conducted to achieve theoretical saturation. The interviews were audio-recorded, transcribed verbatim, and along with nonverbal cues notes by the researchers were analysed using Atlas.ti 7. Using interpretive phenomenological analysis protocol, codes were merged into categories to form main themes. RESULTS: Of the 16 subjects, 4(25%) each were junior residents, senior residents, senior registrars and supervising consultants. There were 7(44%) males and 9(56%) females. The mean age of the residents was 30.9±5.03 years and that of the supervisors was 55.3±0.97 years. Overall, 157 codes were developed which led to 18 categories and subsequently to 2 main themes; intrinsic factors and extrinsic factors. The former encompassed physical and emotional health, personality traits, style, personal skills, core knowledge, attribution training, self-selection of career, and previous life experiences. Extrinsic factors included physical/non-physical environment, economic stability, communication of expectations, structured residency programme, regular programme evaluation, society and culture, family, support system, preparation for transition, psychological assistance, role of supervisor, involvement into communities of practice, time for relaxation, opportunity provision, work-life boundaries, and reflective practices. CONCLUSIONS: The resident's transition through residency depended upon the interplay of extrinsic and intrinsic factors. A seven-tier resident support model is proposed to corelate the phases and provide a roadmap for resident's assistance and sustenance planning.


Assuntos
Internato e Residência , Masculino , Feminino , Humanos , Adulto , Consultores , Corpo Clínico Hospitalar , Pesquisa Qualitativa , Comunicação
9.
Artigo em Inglês | MEDLINE | ID: mdl-36294008

RESUMO

Limitations in the global anaesthesia workforce contribute to the emigration of skilled anaesthesiologists from lower-income to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aimed to explore the challenges experienced by anaesthesiologists in Punjab, Pakistan's most populous province, and the potential changes to encourage their retention. We conducted a qualitative study, conducting semi-structured interviews with 25 purposively sampled consultant anaesthesiologists working in Punjab and analysing data thematically. Reported professional challenges and reasons consultant anaesthesiologists chose to work abroad differed between public and private sectors, each sector providing distinct challenges that compromised anaesthesia workforce numbers and quality. Key concerns were security, promotion/incentive structures, and gender inequalities in public hospitals versus inadequate salary and facilities, surgeon dependency, and the lack of out-of-theatre practice in private hospitals that minimized the scope and earnings of anaesthesiologists within Pakistan. Our findings help contextualise Pakistan's anaesthesia workforce crisis, indicating public-sector improvements could include increasing security in hospital premises, performance-based incentives, and qualification-dependent promotion, while private-sector improvements could include decreasing surgeon dependency, fixing salary percentages by surgical case, and encouraging direct patient-anaesthesiologist relationships. National and subnational interventions to promote anaesthesiology, along with public awareness campaigns, could additionally raise its profile and encourage retention.


Assuntos
Anestesiologia , Humanos , Consultores , Paquistão , Anestesiologistas , Recursos Humanos
10.
Sr Care Pharm ; 37(11): 565-570, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36309764

RESUMO

Objective To describe the impact of consultant pharmacist recommendations on the frequency of pneumococcal vaccines administered to older people admitted to a long-term care facility (LTCF). Design: Retrospective observational study. Setting: LTCF with skilled and intermediate level care. Participants: Adult patients newly admitted to a LTCF in Southwestern Pennsylvania between December 1, 2016, and November 30, 2017, and between January 1, 2018, and December 31, 2019, were included. Interventions The intervention in the study was a consultant pharmacist-driven immunization screening service that was implemented as part of the admission medication review process in January 2018. To assess the impact of the service, the pneumococcal immunization rates of patients who were candidates for pneumococcal vaccination were compared between two patient cohorts who were defined by exposure to the immunization needs assessment and subsequent recommendations by a consultant pharmacist. Results A total of 468 patient admissions were included, with 68 in Cohort 1 and 400 in Cohort 2. Pneumococcal immunization rate, calculated as number of pneumococcal vaccinations administered over the number of admissions eligible for pneumococcal vaccination, had a statistically significant increase (1.9%-20.2%; P < 0.05). Conclusion The recommendations from a consultant pharmacist as a result of an immunization needs assessment upon admission to a LTCF significantly contributed to an increased rate of pneumococcal immunizations. Further investigation is warranted to evaluate future strategies to reduce vaccination refusals.


Assuntos
Farmacêuticos , Vacinas Pneumocócicas , Humanos , Idoso , Vacinas Pneumocócicas/uso terapêutico , Assistência de Longa Duração , Consultores , Vacinação/métodos
11.
J Clin Ethics ; 33(3): 189-197, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36137200

RESUMO

In the article "An Argument for Standardized Ethical Directives for Secular Healthcare Services," Abram L. Brummett and Jamie C. Watson argue that, parallel to the directives of the Roman Catholic Church, secular healthcare ethics consultants (HECs) need substantive standardized ethical guidelines (what they call SEGs) that would constitute a best practice across all HECs in the U.S. Brummett and Watson believe that the absence of such directives constitutes an important deficit in clinical ethics consultation (CEC) that needs to be rectified in order for consultation to achieve the professionalism and universality necessary for legitimacy. This is a bold argument worthy of consideration, perhaps most because it challenges the field to engage in a self-assessment about its current and future directions against the backdrop of both the concerning data on national CEC and the current intense values polarization in the U.S. As part of assessment, I will argue in this essay that such a consensus document is not only impossible in our current national climate, but undesirable given the way that it would impose liberal clinical ethics values on an extremely values-pluralistic populace and exacerbate the deep divisions that many of us fear could be our national undoing.


Assuntos
Eticistas , Consultoria Ética , Códigos de Ética , Consultores , Diversidade Cultural , Atenção à Saúde , Humanos
14.
PLoS One ; 17(9): e0275021, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36170292

RESUMO

The objective of this study is to examine associations between state-level breastfeeding support and breastfeeding practices, controlling for women's status, in the U.S. We used publicly available data on state-level breastfeeding practices and support (international board-certified lactation consultants (IBCLC), births in Baby-Friendly hospitals, and La Leche League Leaders) for births in 2015 from the CDC Breastfeeding Report Card (2018) and other CDC reported data, and indicators of women's status from the Institute for Women's Policy Research reports (2015). We conducted an ecological study to estimate incidence rate ratios of exclusive breastfeeding at six months and breastfeeding at 12 months with breastfeeding supports using bivariate and multivariable Poisson regression. Political participation, poverty, and employment and earnings were associated with breastfeeding practices, as was each breastfeeding support in bivariate analyses. After controlling for women's status, only IBCLCs were positively associated with rates of exclusive breastfeeding at 6 months and continued breastfeeding at 12 months. For every additional IBCLC per 1000 live births, the rate of exclusive breastfeeding at 6 months increased by 5 percent (95% CI 1.03, 1.07) and the rate of breastfeeding at 12 months increased by 4 percent (95% CI 1.02, 1.06). Political participation, poverty, and employment and earnings were associated with breastfeeding practices, indicating a relationship between women's political and economic status and their breastfeeding practices in the U.S. Given the influence of women's status, increasing the number of IBCLCs may improve breastfeeding practices.


Assuntos
Aleitamento Materno , Direitos da Mulher , Consultores , Feminino , Humanos , Cuidado Pós-Natal , Pobreza , Gravidez , Estados Unidos
15.
BMJ Lead ; 6(3): 199-205, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36170486

RESUMO

BACKGROUND: The drive towards engaging UK doctors in clinical leadership and management has involved many initiatives at various levels. METHODS: This paper reports on the findings of an in-depth evaluation of a national medical leadership programme for doctors in the late stages of specialty or general practitioner (GP) training or have just become consultants or GPs. RESULTS: The evaluation clearly demonstrates the impact of this programme and the benefits for the individuals and organisations involved, particularly around stimulating a shift in mood and a major mindset shift in what medical leadership is (and is not) and what they can achieve as medical leaders. The programme structure and activities allowed participants to learn from a range of senior decision-makers about policy and strategic developments and processes. However, the evaluation also highlighted that some pervasive myths still exist around medical leadership and management which, if not addressed, will hamper efforts to fully engage doctors in taking on strategic leadership roles. CONCLUSION: Clinical leadership programmes are valuable, but must be carefully managed to extract the full value from them.


Assuntos
Liderança , Médicos , Consultores , Humanos , Reino Unido
16.
BMJ Lead ; 6(3): 168-170, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36170489

RESUMO

INTRODUCTION: Clinicians enter the medical profession through a variety of routes. This paper explores how non-traditional routes into the medical profession can follow through into subsequent medical leadership practice, influencing issues of confidence, self-image and assumptions about leadership as a concept. METHOD: The first-person reflections of a doctor who entered the profession and the National Health Service from the German system and with a non-standard background are considered. We then discuss how those involved in leadership education can use diversity as a developmental tool. The article starts and ends with personal reflections and observations from a Consultant Opthalmologist, interposed with insights from the pedagogy of leadership development by a University academic. CONCLUSIONS: We conclude that medical leadership development can be enriched through recognising the value that non-traditional routes in clinical leadership can bring, and that educators can use the leverage of difference and diversity to create positive loops of development activity.


Assuntos
Liderança , Medicina Estatal , Consultores , Humanos
17.
BMJ Lead ; 6(2): 140-142, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-36170539

RESUMO

BACKGROUND: Male hospital consultants earn 13% more than their female counterparts. The intersectional effects of ethnicity and gender are not known. OBJECTIVE: To describe and analyse the mean bonus pay gap in terms of gender and ethnicity for consultants across the Shelford Group. DESIGN: Cross-sectional study. SETTING: Hospitals in the Shelford Group. PARTICIPANTS: Shelford Group hospitals. MAIN OUTCOME MEASURES: Mean bonus pay gap for male vs female and White vs Black, Asian, Minority Ethnic (BAME) consultants. RESULTS: Seven of the 10 Shelford Group hospitals provided data for financial year 2018/2019. The average mean bonus gender pay gap was in favour of male consultants (30%; range 12%-48%), and also favoured White consultants compared with BAME consultants (17%; range 7%-31%). The average mean bonus pay gap between White male and BAME male consultants was 20% (range 7%-34%) in favour of White male consultants, while that for White male and BAME female consultants was 46% (range 26%-60%) in favour of White male consultants. CONCLUSIONS: Our data show for the first time that there may be an intersectional effect of gender and ethnicity associated with mean bonus pay for consultants. Action is needed to address this imbalance.


Assuntos
Consultores , Etnicidade , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Grupos Minoritários
18.
J Clin Ethics ; 33(3): 202-209, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36137202

RESUMO

Clinical ethicists move in different environments and interface with a variety of stakeholders, and are therefore uniquely positioned to answer the call for equity and anti-racism. We describe why a clinical ethicist should contribute to anti-racism efforts and describe general approaches for addressing racism across institutional contexts, including: (1) addressing racism as bedside clinical ethics consultant, (2) addressing wider lens of anti-racism work across multiple ethics consults over time, and (3) addressing racism at the organizational level.


Assuntos
Eticistas , Consultoria Ética , Consultores , Atenção à Saúde , Ética Clínica , Humanos
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