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  1 / 27927 MEDLINE  
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PMID:28893880
Autor:Collier R
Dirección:CMAJ.
Título:How physicians can "flex their advocacy muscles".
Fuente:CMAJ; 189(36):E1152, 2017 09 11.
ISSN:1488-2329
País de publicación:Canada
Idioma:eng
Tipo de publicación:NEWS


  2 / 27927 MEDLINE  
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PMID:28590350
Autor:Wilson SL; Gangathimmaiah V
Dirección:From the Emergency Department (S.W.), The Townsville Hospital; and Lifeflight Retrieval Medicine (V.G.), Townsville Base, Queensland, Australia.
Título:Does prehospital management by doctors affect outcome in major trauma? A systematic review.
Fuente:J Trauma Acute Care Surg; 83(5):965-974, 2017 Nov.
ISSN:2163-0763
País de publicación:United States
Idioma:eng
Resumen:BACKGROUND: There is substantial variation worldwide in prehospital management of trauma and the role of doctors is controversial. The objective of this review was to determine whether prehospital management by doctors affects outcomes in major trauma, including the prespecified subgroup of severe traumatic brain injuries when compared with management by other advanced life support providers. METHODS: EMBASE, MEDLINE(R), PubMed, SciELO, Trip, Web of Science, and Zetoc were searched for published articles. HSRProj, OpenGrey, and the World Health Organization International Clinical Trials Registry Platform were searched for unpublished data. Relevant reference lists were hand-searched. There were no limits on publication year, but articles were limited to the English language. Authors were contacted for further information as required. Quality was assessed using the Downs and Black criteria. Mortality was the primary outcome, and disability was the secondary outcome of interest. Studies were subjected to a descriptive analysis alone without a meta-analysis due to significant study heterogeneity. All searches, quality assessment, data abstraction, and data analysis was performed by two reviewers independently. RESULTS: Two thousand thirty-seven articles were identified, 49 full-text articles assessed and eight studies included. The included studies consisted of one randomized controlled trial with 375 participants and seven observational studies with over 4,451 participants. All included studies were at a moderate to high risk of bias. Six of the eight included studies showed an improved outcome with prehospital management by doctors, five in terms of mortality and one in terms of disability. Two studies found no significant difference. CONCLUSION: There appears to be an association between prehospital management by doctors and improved survival in major trauma. There may also be an association with improved survival and better functional outcomes in severe traumatic brain injury. Further high-quality evidence is needed to confirm these findings. LEVEL OF EVIDENCE: Systematic review, level III.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  3 / 27927 MEDLINE  
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PMID:28005544
Autor:Dussault G; Cobb NM
Dirección:Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
Título:A New Generation of Physicians in Sub-Saharan Africa? Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".
Fuente:Int J Health Policy Manag; 6(1):57-59, 2016 Jul 20.
ISSN:2322-5939
País de publicación:Iran
Idioma:eng
Resumen:This commentary follows up on an editorial by Eyal and colleagues in which these authors discuss the implications of the emergence of non-physician clinicians (NPCs) on the health labour market for the education of medical doctors. We generally agree with those authors and we want to stress the importance of clarifying the terminology to describe these practitioners and of defining more formally their scope of practice as prerequisites to identifying the new competencies which physicians need to acquire. We add one new competencies domain, the utilization of new communication technologies, to those listed in the editorial. Finally, we identify policy issues which decision-makers will need to address to make medical education reform work.
Tipo de publicación:JOURNAL ARTICLE


  4 / 27927 MEDLINE  
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PMID:28005543
Autor:Binagwaho A; Sarriera G; Eagan A
Dirección:Minister of Health, Kigali, Rwanda.
Título:The Evolution of the Physician Role in the Setting of Increased Non-physician Clinicians in Sub-Saharan Africa: An Insistence on Timing and Culturally-Sensitive, Purposefully Selected Skill Development Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".
Fuente:Int J Health Policy Manag; 6(1):53-55, 2016 Jul 09.
ISSN:2322-5939
País de publicación:Iran
Idioma:eng
Resumen:As Eyal et al put forth in their piece, Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians, task-shifting across sub-Saharan Africa through non-physician clinicians (NPCs) has led to an improvement in access to health services in the context of physician-shortages. Here, we offer a commentary to the piece by Eyal et al, concurring that physician's roles should evolve into specialized medicine and that skills in mentorship, research, management, and leadership may create more holistic physicians clinical services. We believe that learning such non-clinical skills will allow physicians to improve the outcome of their clinical services. However, at the risk of a local, clinical brain drain as physicians shift to explore beyond the clinical sphere, we advocate strongly for increased caution to be exercised by leadership over the encouragement of this evolution. In the context of still-present physician shortages across many developing countries, we advocate to analyze this changing role and to purposefully select each new skill according to the context, giving careful consideration to the timing and degree of its evolution.
Tipo de publicación:JOURNAL ARTICLE


  5 / 27927 MEDLINE  
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PMID:28105495
Autor:Janßen K; Greif D; Rothschild MA; Banaschak S
Dirección:Institute of Legal Medicine Medical Faculty, University of Cologne, Melatengürtel 60/62, 50823, Cologne, Germany. katharina.janssen@uk-koeln.de.
Título:Relevance of medical reports in criminal investigations of cases of suspected child abuse.
Fuente:Int J Legal Med; 131(4):1055-1059, 2017 Jul.
ISSN:1437-1596
País de publicación:Germany
Idioma:eng
Resumen:If a case of physical child abuse is suspected in Germany, the general feeling is often that "it does not matter whether you make a report or not" because, generally, no conviction is made anyway. This study investigates the juridical analysis of complaint cases of physical child abuse [criminal complaint parag. 225 StGB (German penal code) with filial victim]. It focuses on the doctor's role and the impact of their practice in relation to a later conviction. It is based on the analysis of 302 files of the enquiry from 2004-2009 from the department of public prosecution in Cologne, Germany. Besides general epidemiological data on the reporting person, the affected child and the presumed offender, the documents were reassessed for the relevance of medical reports for successful convictions. Only 7% (n = 21) of 302 complaints led to a conviction. In 38.1% (n = 8) of those cases, a medical report was mentioned as a piece of evidence, and just in two cases a (legal) medical report was quoted and mentioned as relevant for the conviction. 50% of the complaint cases with legal medical expertise led to a trial. In contrast, only 30.2% with a common medical report and 7.3% without a report led to a trial. The results show how a medical report existed in only a few cases. In those cases, the rate of performed trials was higher than for those without a medical report, but the report played a minor part when reasoning a verdict.
Tipo de publicación:JOURNAL ARTICLE


  6 / 27927 MEDLINE  
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PMID:29049111
Autor:Copenhaver DJ; Karvelas NB; Fishman SM
Dirección:From the Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, Center for Advancing Pain Relief, University of California, Davis School of Medicine, UC Davis Medical Center, Ellison Ambulatory Care Center, Sacramento, California.
Título:Risk Management for Opioid Prescribing in the Treatment of Patients With Pain From Cancer or Terminal Illness: Inadvertent Oversight or Taboo?
Fuente:Anesth Analg; 125(5):1610-1615, 2017 Nov.
ISSN:1526-7598
País de publicación:United States
Idioma:eng
Resumen:As the United States experiences an epidemic of prescription drug abuse, and guidelines on safe practices in prescribing opioids in chronic pain have subsequently emerged from professional organizations and governmental agencies, limited guidance exists for prescribers of opioids to treat pain in patients with cancer or terminal illness. Patients with active cancer or terminal illness often have pain and are frequently prescribed opioids and other controlled substances. Current studies suggest that patients with cancer have similar rates of risk for misuse, abuse, and addiction as the general public. Moreover, palliative care and hospice programs appear poorly prepared for assessing or managing patients with aberrant behaviors or evidence of drug abuse. Further research and professional consensus are needed to help address the challenges associated with misuse, abuse, and addiction in patients with cancer and terminal illness.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Analgesics, Opioid)


  7 / 27927 MEDLINE  
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PMID:28652483
Autor:Murray TJ
Dirección:Department of Medicine, Division of Neurology, Dalhousie University, Halifax, NS.
Título:Serving two masters: the medical and political careers of Sir Charles Tupper.
Fuente:CMAJ; 189(25):E866-E868, 2017 06 26.
ISSN:1488-2329
País de publicación:Canada
Idioma:eng
Tipo de publicación:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
Nombre personal como asunto:Tupper C


  8 / 27927 MEDLINE  
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PMID:28975232
Autor:Hedberg K; New C
Dirección:From Oregon Health Authority, Portland, Oregon.
Título:Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate.
Fuente:Ann Intern Med; 167(8):579-583, 2017 Oct 17.
ISSN:1539-3704
País de publicación:United States
Idioma:eng
Resumen:Twenty years ago, Oregon voters approved the Death With Dignity Act, making Oregon the first state in the United States to allow physicians to prescribe medications to be self-administered by terminally ill patients to hasten their death. This report summarizes the experience in Oregon, including the numbers and types of participating patients and providers. These data should inform the ongoing policy debate as additional jurisdictions consider such legislation.
Tipo de publicación:JOURNAL ARTICLE


  9 / 27927 MEDLINE  
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PMID:28968051
Autor:Grover HL; Higgins BG
Título:GPs have key role in improving outcomes in acute asthma.
Fuente:Practitioner; 260(1798):15-9, 2016 11.
ISSN:0032-6518
País de publicación:England
Idioma:eng
Resumen:Asthma deaths in the UK remain among the highest in Europe. The 2014 National Review of Asthma Deaths looked at detailed data over a 12-month period assessing 195 patients who died from asthma and highlighted the avoidable factors in patient deaths. Although faults were found in secondary care, many of the problems related to poor management of patients in the community, both in terms of regular surveillance and assessment and treatment at the onset of attacks. Features which indicate a high risk of severe attacks include: previous admission to intensive care, particularly if requiring mechanical ventilation; previous admission with asthma especially in the past year or repeated emergency admissions; history of worsening asthma in January or February; use of three or more classes of asthma medication; heavy use of beta-2 agonists; anxiety traits; and marital stress. Peak expiratory flow improves the recognition of severity when compared with examination alone. Oxygen should be used to maintain oxygen saturation of 94-98% and it is recommended that GP surgeries have oxygen and an oximeter available. For anything other than life-threatening asthma, a standard metered dose inhaler administered with repeated actuations via a large volume spacer is as effective as a nebuliser. If a nebuliser is used it should ideally be driven with oxygen but nebulisers should not be withheld if oxygen is not available. Oral steroids are required for all patients experiencing attacks of moderate severity or worse as they improve symptoms and reduce mortality, hospital admissions and the need for beta-2 agonists.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Adrenal Cortex Hormones); 0 (Bronchodilator Agents)


  10 / 27927 MEDLINE  
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PMID:28259143
Autor:Lewis NV; Larkins C; Stanley N; Szilassy E; Turner W; Drinkwater J; Feder GS
Dirección:Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. Nat.Lewis@bristol.ac.uk.
Título:Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention.
Fuente:BMC Fam Pract; 18(1):33, 2017 Mar 04.
ISSN:1471-2296
País de publicación:England
Idioma:eng
Resumen:BACKGROUND: Children's exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures. METHODS: We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants' knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence. RESULTS: Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children's social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants' suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children. CONCLUSIONS: The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians' knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.
Tipo de publicación:JOURNAL ARTICLE



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