RESUMO
Issue: Across the United States, the majority of medical schools teach physical examination using some form of peer physical examination (PPE). The process of being physically exposed in the presence of colleagues can be uncomfortable and cause students distress for myriad reasons ranging from religious and cultural practices to body dysmorphia and previous trauma experiences. This is especially problematic in educational systems which offer no other options, or make PPE a requirement of the curriculum.Evidence: Across all U.S. medical schools, trainees spent a median of 59 hours teaching physical examination skills. Of this time, 30% is dedicated to PPE practice. Despite this prevalence, there are data that show some students find this uncomfortable, especially women. Literature on best practices around PPE highlights voluntary participation, informed consent, and an available alternative to learning physical xamination skills. These are not uniformly available in all learning environments. There are little data around the impact of PPE on students who have experienced or are experiencing sexual trauma. Authors have drawn conclusions about the potential for harm given the prevalence of sexual mistreatment in US higher education.Implications: Our medical school policy required students to participate in PPE practice, undressing for the exams wearing only shorts (and a sports bra for women) an and a hospital gown. Students who could not participate in this practice for reasons ranging from mobility to religious beliefs had to seek individual formal accommodations to be exempt, putting the onus of change on potentially vulnerable individuals. We evaluated the policy around PPE, and concluded that the school's requirements could be harmful and isolating, as they required students to disclose their personal vulnerabilities while seeking exemptions from being examined by peers. At our institution, a group of students instead advocated for the school to review the policy and create a PPE procedure that was safer and more inclusive while supporting student learning. Our experience emphasized the potential for students to advocate for change, while also highlighting the need for greater research in the field of trauma-informed curricular design for medical education.
Assuntos
Infecções por Coronavirus/epidemiologia , Política de Saúde , Acessibilidade aos Serviços de Saúde , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde , Betacoronavirus , COVID-19 , Humanos , Seguro Saúde/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Determinantes Sociais da Saúde , Sociedades Médicas , Estados Unidos/epidemiologiaAssuntos
Licenciamento em Medicina/normas , Saúde Mental , Médicos/psicologia , Humanos , Estados UnidosRESUMO
OBJECTIVES: Evaluate the availability of buprenorphine/naloxone for inpatients with opioid use disorder in a state's acute care hospitals. METHODS: An audit study of all acute care hospitals in New Mexico was performed. Hospitals were surveyed on the availability of buprenorphine/naloxone on their inpatient formularies and their ability to obtain buprenorphine/naloxone within 1 day should a patient need it. RESULTS: Of the surveyed hospitals, 45.5% did not have buprenorphine/naloxone on their inpatient formularies. Of the 26 counties in New Mexico with acute care hospitals, 10 did not have buprenorphine/naloxone available for inpatients. Three of these counties have drug overdose death rates equal to or higher than the state average. CONCLUSIONS: In 1 predominately rural state with an opioid overdose death rate higher than the national average, approximately half of acute care hospitals had buprenorphine/naloxone available to patients on their inpatient formulary. Efforts to increase buprenorphine/naloxone availability in hospitals are needed, particularly in rural areas where there may not be other locations to access treatment for opioid use disorder.
Assuntos
Buprenorfina , Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Combinação Buprenorfina e Naloxona/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Hospitais , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologiaRESUMO
Caring for aggressive patients with dementia can lead to exhaustion, fear, and burnout. These strategies can help improve the welfare of both caregivers and patients.
Assuntos
Esgotamento Profissional , Demência , Sobrecarga do Cuidador , Cuidadores , Demência/terapia , Humanos , ViolênciaRESUMO
Vaccine reluctance among healthcare workers (HCW) can have widespread negative ramifications, including modeling behavior for the general population and challenges with maintaining a healthy workforce so we can respond to a resurgence of the pandemic. We previously reported that only one-third of HCW were willing to take the vaccine as soon as it became available prior to its Emergency Use Authorization (EUA). Here, we re-examine the attitude toward COVID-19 vaccines among HCW several months after the vaccines have been made widely available. In this study, only 7.9% (n = 107) of respondents were hesitant to take the first or second dose of the vaccine. Younger age (18-40 years) and lower level of education attainment (GED or less) were associated with higher vaccine hesitancy, whereas self-identified Asian racial identity was associated with greater acceptance of COVID-19 vaccination. Among the vaccine-hesitant group, more respondents noted mistrust of regulatory authorities (45.3%), government (48.6%), and pharmaceutical companies (50%) than mistrust of doctors (25.4%). Nearly two-thirds of respondents were concerned that vaccination may be ineffective against new strains and booster doses may be required; however, vaccine-hesitant respondents' acceptance of a hypothetical booster dose was only 14.3%. Overall, vaccine hesitancy was observed to have demographic predictors similar to those previously reported; the hesitancy of some US HCW to receive booster doses may reflect a general hesitancy to receive other forms of vaccination.