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4.
BMC Psychiatry ; 22(1): 671, 2022 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316661

RESUMO

BACKGROUND: Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated. METHODS: We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated. RESULTS: The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach's alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed. CONCLUSION: Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects.


Assuntos
Saúde Mental , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Psicometria , Inquéritos e Questionários , Humanos , Pacientes Ambulatoriais , Satisfação Pessoal , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Noruega
5.
PLoS One ; 17(11): e0275962, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36327216

RESUMO

Lack of translation and irreproducibility challenge preclinical animal research. Insufficient reporting methodologies to safeguard study quality is part of the reason. This nationwide study investigates the reporting prevalence of these methodologies and scrutinizes the reported information's level of detail. Publications were from two time periods to convey any reporting progress and had at least one author affiliated to a Danish University. We retrieved all relevant animal experimental studies using a predefined research protocol and a systematic search. A random sampling of 250 studies from 2009 and 2018 led to 500 publications in total. Reporting of measures known to impact study results estimates were assessed. Part I discloses a simplified two-level scoring "yes/no" to identify the presence of reporting. Part II demonstrates an additional three-level scoring to analyze the reported information's level of detail. Overall reporting prevalence is low, although minor improvements are noted. Reporting of randomization increased from 24.0% in 2009 to 40.8% in 2018, blinded experiment conduct from 2.4% to 4.4%, blinded outcome assessment from 23.6% to 38.0%, and sample size calculation from 3.2% to 14.0%. Poor reporting of details is striking with reporting of the random allocation method to groups being only 1.2% in 2009 and 6.0% in 2018. Reporting of sample size calculation method was 2.4% in 2009 and 7.6% in 2018. Only conflict-of-interest statements reporting increased from 37.6% in 2009 to 90.4%. Measures safeguarding study quality are poorly reported in publications affiliated with Danish research institutions. Only a modest improvement was noted during the period 2009-2018, and the lack of details urgently prompts institutional strategies to accelerate this. We suggest thorough teaching in designing, conducting and reporting animal studies. Education in systematic review methodology should be implemented in this training and will increase motivation and behavior working towards quality improvements in science.


Assuntos
Experimentação Animal , Projetos de Pesquisa , Animais , Experimentação Animal/normas , Melhoria de Qualidade , Projetos de Pesquisa/normas
6.
J Surg Educ ; 79(6): e225-e234, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36333174

RESUMO

OBJECTIVE: The ACS/APDS Resident Skills Curriculum's Objective Structured Assessment of Technical Skills (OSATS) consists of task-specific checklists and a global rating scale (GRS) completed by raters. Prior work demonstrated a need for rater training. This study evaluates the impact of a rater-training curriculum on scoring discrimination, consistency, and validity for handsewn bowel anastomosis (HBA) and vascular anastomosis (VA). DESIGN/ METHODS: A rater training video model was developed, which included a GRS orientation and anchoring performances representing the range of potential scores. Faculty raters were randomized to rater training or no rater training and were asked to score videos of resident HBA/VA. Consensus scores were assigned to each video using a modified Delphi process (Gold Score). Trained and untrained scores were analyzed for discrimination and score spread and compared to the Gold Score for relative agreement. RESULTS: Eight general and eight vascular surgery faculty were randomized to score 24 HBA/VA videos. Rater training increased rater discrimination and decreased rating scale shrinkage for both VA (mean trained score: 2.83, variance 1.88; mean untrained score: 3.1, variance 1.14, p = 0.007) and HBA (mean trained score: 3.52, variance 1.44; mean untrained score: 3.42, variance 0.96, p = 0.033). On validity analyses, a comparison between each rater group vs Gold Score revealed a moderate training impact for VA, trained κ=0.65 vs untrained κ=0.57 and no impact for HBA, R1 κ = 0.71 vs R2 κ = 0.73. CONCLUSION: A rater-training curriculum improved raters' ability to differentiate performance levels and use a wider range of the scoring scale. However, despite rater training, there was persistent disagreement between faculty GRS scores with no groups reaching the agreement threshold for formative assessment. If technical skill exams are incorporated into high stakes assessments, consensus ratings via a standard setting process are likely a more valid option than individual faculty ratings.


Assuntos
Lista de Checagem , Currículo , Internato e Residência , Anastomose Cirúrgica , Consenso , Humanos , Internato e Residência/normas
7.
Science ; 378(6619): 459-461, 2022 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-36378986
9.
JAMA ; 328(17): 1689-1690, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36318120

RESUMO

This Viewpoint discusses the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization, describes how that decision threatens birth equity for some racial and social groups, and suggests a reproductive justice approach to address racial and social inequalities and ensure reproductive freedom and autonomy for all people.


Assuntos
Aborto Legal , Equidade em Saúde , Direitos Sexuais e Reprodutivos , Decisões da Suprema Corte , Feminino , Humanos , Gravidez , Aborto Legal/legislação & jurisprudência , Equidade em Saúde/legislação & jurisprudência , Equidade em Saúde/normas , Equidade em Saúde/tendências , Estados Unidos , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Direitos Sexuais e Reprodutivos/normas , Direitos Sexuais e Reprodutivos/tendências
11.
JAMA ; 328(17): 1697-1698, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36318119

RESUMO

This Viewpoint discusses how states' restrictions on abortion will affect medical students' training in providing reproductive health care and also create moral distress by being forced to provide care that may harm patients.


Assuntos
Educação Médica , Princípios Morais , Decisões da Suprema Corte , Humanos , Educação Médica/ética , Educação Médica/legislação & jurisprudência , Educação Médica/métodos , Educação Médica/normas , Estudantes de Medicina , Estados Unidos
12.
JAMA ; 328(17): 1747-1765, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36318128

RESUMO

Importance: It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers. Objective: To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions. Data Sources: PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022. Study Selection: English-language randomized clinical trials and prospective cohort studies of fair or good quality. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available. Main Outcomes and Measures: Morbidity and mortality related to chronic conditions; health-related quality of life. Results: Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year. Conclusions and Relevance: Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.


Assuntos
Doença Crônica , Estrogênios , Terapia de Reposição Hormonal , Pós-Menopausa , Progestinas , Feminino , Humanos , Comitês Consultivos/normas , Comitês Consultivos/tendências , Doença Crônica/epidemiologia , Doença Crônica/mortalidade , Doença Crônica/prevenção & controle , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Fraturas Ósseas/prevenção & controle , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Hormônios/efeitos adversos , Hormônios/uso terapêutico , Prevenção Primária , Progestinas/efeitos adversos , Progestinas/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Medição de Risco , Estados Unidos , Incontinência Urinária/induzido quimicamente , Tromboembolia Venosa/induzido quimicamente
13.
JAMA ; 328(17): 1691-1692, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36318126

RESUMO

This Viewpoint discusses how limited or blocked access to legal abortion will affect the provision of emergency and critical care, including negative effects on patient health, legal intrusion into the patient-physician decision-making process, and concerns about legal jeopardy.


Assuntos
Aborto Induzido , Serviços Médicos de Emergência , Acesso aos Serviços de Saúde , Decisões da Suprema Corte , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Aborto Espontâneo , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/normas , Estados Unidos
15.
JCO Glob Oncol ; 8: e2200260, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36315923

RESUMO

PURPOSE: South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. METHODS: A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. RESULTS: IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. CONCLUSION: Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.


Assuntos
Atenção à Saúde , Pessoal de Saúde , Neoplasias , Atenção Primária à Saúde , Humanos , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Neoplasias/diagnóstico , Neoplasias/terapia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Revisões Sistemáticas como Assunto , Cuidadores/normas , Assistência ao Paciente , Ásia Ocidental/epidemiologia
16.
JAMA ; 328(18): 1795-1797, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36260342

RESUMO

This Medical News article discusses new EPA advisories for a class of synthetic chemical compounds known as PFAS, which are ubiquitous in the environment and in humans, as well as new National Academies guidance on expanded testing for exposure.


Assuntos
Exposição Ambiental , United States Environmental Protection Agency , Poluentes Químicos da Água , Poluição Química da Água , Abastecimento de Água , Exposição Ambiental/prevenção & controle , Exposição Ambiental/normas , Abastecimento de Água/normas , United States Environmental Protection Agency/normas , Estados Unidos , Poluição Química da Água/prevenção & controle , Poluentes Químicos da Água/efeitos adversos , Poluentes Químicos da Água/normas
17.
JAMA ; 328(18): 1807-1808, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36279114

RESUMO

This Viewpoint proposes restructuring the WHO Essential Medicines List to remove consideration of cost and cost-effectiveness from the expert committee reviews of clinical effectiveness, safety, and public health value, and chartering a new framework for pooled global negotiation and procurement of costly medicines included in the list.


Assuntos
Medicamentos Essenciais , Saúde Global , Reforma dos Serviços de Saúde , Organização Mundial da Saúde , Medicamentos Essenciais/economia , Medicamentos Essenciais/normas , Saúde Global/economia , Saúde Global/normas , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/normas
18.
Leadersh Health Serv (Bradf Engl) ; ahead-of-print(ahead-of-print)2022 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-36205444

RESUMO

PURPOSE: The purpose of this study is to describe primary health-care managers' perceptions of management competencies at different management levels in digital health services using the management competency assessment program as a framework. DESIGN/METHODOLOGY/APPROACH: A secondary analysis study involving 21 semi-structured individual interviews was conducted among Finnish primary health-care managers at different management levels (frontline, middle and senior). The deductive framework method was used to analyze the data. FINDINGS: Similarities and differences were found in management competencies between different levels of management. Competencies related to the use of digitalization were highlighted by managers at all management levels. Managers at all management levels were involved in developing digital solutions and supporting employees in using digital solutions in their work. Frontline and middle managers emphasized more issues related to day-to-day management and communication with employees, whereas senior managers highlighted the management of large entities. RESEARCH LIMITATIONS/IMPLICATIONS: In the secondary analysis, data were used for purposes other than originally intended. Therefore, the data are subject to limitations of the methodology applied and should be transferred to other contexts with caution. PRACTICAL IMPLICATIONS: Identifying the management competencies needed to manage digital health services is important to target managers' training according to needs in the future. SOCIAL IMPLICATIONS: The results could be used to develop the management of digital health services, as well as improve digital health services and their deployment. ORIGINALITY/VALUE: Previous literature mostly examined managers' informatics competencies and paid little attention to other management competencies. This study discusses more broadly the management competencies that digital health services require from managers at different levels of management.


Assuntos
Pessoal Administrativo , Serviços de Saúde , Atenção Primária à Saúde , Competência Profissional , Pessoal Administrativo/normas , Finlândia , Humanos , Liderança , Atenção Primária à Saúde/organização & administração
19.
Integr Psychol Behav Sci ; 56(4): 884-892, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36284070

RESUMO

When they discuss the Danish academic situation, Szulevicz, Lund and Lund (2021) address three questions about the academic training of psychology researchers: (a) why do Danish master's students in psychology more frequently choose the qualitative method for their research?; (b) what are psychology students working on?; and (c) what are they interested in? These three questions have led us to reflect on researcher training and the political and educational model universities adopt for psychology master's courses, not only in the Danish context, but also in other general contexts. In this commentary, we will discuss one strictly normative issue: what should the scientific ideal be for training researchers in psychology? Or more accurately: how can psychology contribute to discussions about the scientific ideal of researcher training in this knowledge area?


Assuntos
Pesquisa Biomédica , Educação de Pós-Graduação , Psicologia , Estudantes de Ciências da Saúde , Humanos , Universidades , Psicologia/educação , Psicologia/métodos , Psicologia/normas , Pesquisa Biomédica/educação , Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Dinamarca , Educação de Pós-Graduação/métodos , Educação de Pós-Graduação/normas , Estudantes de Ciências da Saúde/psicologia , Psicologia Educacional/métodos , Modelos Educacionais , Política
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