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  1 / 28108 MEDLINE  
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PMID:29292953
Autor:Eckerdal G
Dirección:onkologiska kliniken - Göteborg, Sweden onkologiska kliniken - Göteborg, Sweden.
Título:Läkarrollen i dödshjälpsdebatten: - Smer tillför inget nytt beträffande de medicinska aspekterna..
Fuente:Lakartidningen; 114, 2017 11 21.
ISSN:1652-7518
País de publicación:Sweden
Idioma:swe
Tipo de publicación:LETTER


  2 / 28108 MEDLINE  
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PMID:29231639
Autor:Hunnålvatn KH; Ivan D; Wisborg T
Título:Emergency medicine in the general practice internship in Finnmark county.
Título:Akuttmedisinsk turnusarbeid i Finnmark..
Fuente:Tidsskr Nor Laegeforen; 137(23-24), 2017 12 12.
ISSN:0807-7096
País de publicación:Norway
Idioma:eng; nor
Resumen:BACKGROUND: It is preferred that duty doctors in municipal health services participate in call-outs in emergency situations. The frequency of participation has previously been shown to vary. We wanted to examine the newly qualified doctors' expectations and experiences ­ both before and after the general practice internship ­ of emergency medicine and ambulance call-outs. MATERIAL AND METHOD: All 23 of the interns who were to undertake their general practice internship in Finnmark county in the period 2015­16 answered a questionnaire and participated in a focus group interview before the start of the internship. Twenty-one of the interns participated in the focus group interview after completing the internship. Each doctor took part in two interviews. We analysed the transcripts from the focus group interviews using the grounded theory method. RESULTS: The responses from the questionnaire before the general practice internship showed that the interns felt they needed more training in intravenous cannulation and in teamwork. Their expectations in connection with the challenges of call-outs are best characterised by the core category 'Can I do anything useful?' from the focus groups before the internship. After the internship, however, the core category 'It all went well in the end', was the best fit. Due to short transport times and their knowledge of certain patients, some of the doctors chose not to take part in call-outs. INTERPRETATION: During the general practice internship, the interns were initially anxious about whether they might be superfluous in call-outs, but eventually found their footing in the call-out role. The study shows that there is a need for more practice in certain practical procedures, and that doctors' non-technical skills need to be improved. This can be done through training in team leader roles before the general practice internship.
Tipo de publicación:JOURNAL ARTICLE


  3 / 28108 MEDLINE  
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PMID:28459909
Autor:Theisen-Toupal J; Ronan MV; Moore A; Rosenthal ES
Dirección:Medical Service, VA Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC; Uniformed Services University of the Health Sciences, Bethesda, MD.
Título:Inpatient Management of Opioid Use Disorder: A Review for Hospitalists.
Fuente:J Hosp Med; 12(5):369-374, 2017 May.
ISSN:1553-5606
País de publicación:United States
Idioma:eng
Resumen:The United States is experiencing an epidemic of nonmedical opioid use and opioid overdose-related deaths. As a result, there have been a number of public health interventions aimed at addressing this epidemic. However, these interventions fail to address care of individuals with opioid use disorder during hospitalizations and, therefore, miss a key opportunity for intervention. The role of hospitalists in managing hospitalized patients with opioid use disorder is not established. In this review, we discuss the inpatient management of individuals with opioid use disorder, including the treatment of withdrawal, benefits of medication-assisted treatment, and application of harm-reduction strategies. Journal of Hospital Medicine 2017;12:369-374.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  4 / 28108 MEDLINE  
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PMID:29320600
Autor:Zaugg V; Korb-Savoldelli V; Durieux P; Sabatier B
Dirección:Clinical Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, Paris, France, 75015.
Título:Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication.
Fuente:Cochrane Database Syst Rev; 1:CD012042, 2018 Jan 10.
ISSN:1469-493X
País de publicación:England
Idioma:eng
Resumen:BACKGROUND: Poor medication adherence decreases treatment efficacy and worsens clinical outcomes, but average rates of adherence to long-term pharmacological treatments for chronic illnesses are only about 50%. Interventions for improving medication adherence largely focus on patients rather than on physicians; however, the strategies shown to be effective are complex and difficult to implement in clinical practice. There is a need for new care models addressing the problem of medication adherence, integrating this problem into the patient care process. Physicians tend to overestimate how well patients take their medication as prescribed. This can lead to missed opportunities to change medications, solve adverse effects, or propose the use of reminders in order to improve patients' adherence. Thus, providing physicians with feedback on medication adherence has the potential to prompt changes that improve their patients' adherence to prescribed medications. OBJECTIVES: To assess the effects of providing physicians with feedback about their patients' medication adherence for improving adherence. We also assessed the effects of the intervention on patient outcomes, health resource use, and processes of care. SEARCH METHODS: We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, all from database inception to December 2016 and without any language restriction. We also searched ISI Web of Science, two trials registers, and grey literature. SELECTION CRITERIA: We included randomised trials, controlled before-after studies, and interrupted time series studies that compared the effects of providing feedback to physicians about their patients' adherence to prescribed long-term medications for chronic diseases versus usual care. We included published or unpublished studies in any language. Participants included any physician and any patient prescribed with long-term medication for chronic disease. We included interventions providing the prescribing physician with information about patient adherence to medication. Only studies in which feedback to the physician was the sole intervention or the essential component of a multifaceted intervention were eligible. In the comparison groups, the physicians should not have had access to information about their patients' adherence to medication. We considered the following outcomes: medication adherence, patient outcomes, health resource use, processes of care, and adverse events. DATA COLLECTION AND ANALYSIS: Two independent review authors extracted and analysed all data using standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care group. Due to heterogeneity in study methodology, comparison groups, intervention settings, and measurements of outcomes, we did not carry out meta-analysis. We describe the impact of interventions on outcomes in tabular form and make a qualitative assessment of the effects of studies. MAIN RESULTS: We included nine studies (23,255 patient participants): eight randomised trials and one interrupted time series analysis. The studies took place in primary care and other outpatient settings in the USA and Canada. Seven interventions involved the systematic provision of feedback to physicians concerning all their patients' adherence to medication, and two interventions involved issuing an alert for non-adherent patients only. Seven studies used pharmacy refill data to assess medication adherence, and two used an electronic device or self-reporting. The definition of adherence differed across studies, making comparisons difficult. Eight studies were at high risk of bias, and one study was at unclear risk of bias. The most frequent source of bias was lack of protection against contamination.Providing physicians with feedback may lead to little or no difference in medication adherence (seven studies, 22,924 patients), patient outcomes (two studies, 1292 patients), or health resource use (two studies, 4181 patients). Providing physicians with feedback on medication adherence may improve processes of care (e.g. more medication changes, dialogue with patient, management of uncontrolled hypertension) compared to usual care (four studies, 2780 patients). None of the studies reported an adverse event due to the intervention. The certainty of evidence was low for all outcomes, mainly due to high risk of bias, high heterogeneity across studies, and indirectness of evidence. AUTHORS' CONCLUSIONS: Across nine studies, we observed little or no evidence that provision of feedback to physicians regarding their patients adherence to prescribed medication improved medication adherence, patient outcomes, or health resource use. Feedback about medication adherence may improve processes of care, but due to the small number of studies assessing this outcome and high risk of bias, we cannot draw firm conclusions on the effect of feedback on this outcome. Future research should use a clear, standardised definition of medication adherence and cluster-randomisation to avoid the risk of contamination.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  5 / 28108 MEDLINE  
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PMID:29292964
Autor:Westberg G
Título:Arbetet mot kärnvapen är fortfarande en läkaruppgift..
Fuente:Lakartidningen; 114, 2017 12 04.
ISSN:1652-7518
País de publicación:Sweden
Idioma:swe
Tipo de publicación:LETTER


  6 / 28108 MEDLINE  
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PMID:28460757
Autor:Mishra S
Título:Our intellectuals have failed us - System of a Down.
Fuente:Indian Heart J; 69(2):133-135, 2017 Mar - Apr.
ISSN:0019-4832
País de publicación:India
Idioma:eng
Resumen:Medical profession is at cross-roads. On one hand are issues like medical mal-practice and negligence but on the other are loss of respect, low re-imbursement, lawsuits against medical professionals, violence against physicians all contributing to a lot of stress as also a high suicide rate among medical practitioners. While some of the problems seem related to changing societal norms, most of them seem to stem from a failure, active or passive on the part of medical intellectual, moving away from altruism, justice and self regulation to pursuance of self interest with a consequent loss of trust in doctor-patient relationship. The solution lies not only in regaining this trust by following a path of community welfare, change in medical curriculum but also recognition by society, the problems faced by medical fraternity; long hours, low re-imbursement for mental and physical effort but most importantly loss of prestige. Urgent steps to reverse this malady should be undertaken, otherwise a full-fledged commercial and profit making medical field is the only alternative.
Tipo de publicación:EDITORIAL


  7 / 28108 MEDLINE  
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PMID:29351355
Autor:Kuehn BM
Título:Physicians Join Frontline Efforts to Curb Gun Injuries, Deaths.
Fuente:JAMA; 319(5):428-430, 2018 Feb 06.
ISSN:1538-3598
País de publicación:United States
Idioma:eng
Tipo de publicación:NEWS


  8 / 28108 MEDLINE  
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PMID:27776073
Autor:; American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care
Título:Committee Opinion No. 678: Comprehensive Sexuality Education.
Fuente:Obstet Gynecol; 128(5):e227-e230, 2016 11.
ISSN:1873-233X
País de publicación:United States
Idioma:eng
Resumen:Current sexuality education programs vary widely in the accuracy of content, emphasis, and effectiveness. Data have shown that not all programs are equally effective for all ages, races and ethnicities, socioeconomic groups, and geographic areas. Studies have demonstrated that comprehensive sexuality education programs reduce the rates of sexual activity, sexual risk behaviors (eg, number of partners and unprotected intercourse), sexually transmitted infections, and adolescent pregnancy. One key component of an effective program is encouraging community-centered efforts. In addition to counseling and service provision to individual adolescent patients, obstetrician-gynecologists can serve parents and communities by supporting and assisting sexuality education. Because of their knowledge, experience, and awareness of a community's unique challenges, obstetrician-gynecologists can be an important resource for sexuality education programs.
Tipo de publicación:JOURNAL ARTICLE


  9 / 28108 MEDLINE  
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PMID:28452815
Autor:Nafiu OO; Chimbira WT; Tait AR
Dirección:From the Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Título:Pediatric Preoperative Assessment: Six Million Missed Opportunities for Childhood Obesity Education.
Fuente:Anesth Analg; 126(1):343-345, 2018 01.
ISSN:1526-7598
País de publicación:United States
Idioma:eng
Tipo de publicación:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; REVIEW


  10 / 28108 MEDLINE  
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PMID:29239574
Autor:Karjalainen K; Lintonen T
Título:DUI offenders may have multiple health and social problems - doctors play a central role in monitoring the use of medications affecting the central nervous system.
Fuente:Duodecim; 133(10):927-34, 2017.
ISSN:0012-7183
País de publicación:Finland
Idioma:eng
Resumen:While the overall number of driving under the influence (DUI) cases has reduced, the proportion of drivers under the influence of medications or illicit drugs has increased. In studies based on Finnish register data sets, the factors involved in DUI have been examined with the conclusion that drunk driving may be an indication of multiple health or social problems. According to several measures, DUI offenders who had used medications, especially benzodiazepines, were ill and disadvantaged. Doctors play a central role in reducing the number of DUI cases, e.g. by treating substance abuse problems and by monitoring the use of drugs which affect the central nervous system. It is possible that a DUI offender has accumulated a number of different problems at the same time, which is why the treatment of DUI offenders should pay attention to a comprehensive mapping of the situation and the use of multidisciplinary cooperation.
Tipo de publicación:JOURNAL ARTICLE; REVIEW



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