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Pesquisa : H02.811 [Categoria DeCS]
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[PMID]:29189455
[Au] Autor:Ruth-Sahd LA
[Ad] Endereço:Lisa A. Ruth-Sahd is a professor of nursing at York College of Pennsylvania in York, Pa., and a nurse extern coordinator at Lancaster General Health in Lancaster, Pa.
[Ti] Título:Growing specialty area exposure with an undergraduate perioperative nursing course.
[So] Source:Nursing;47(12):19-21, 2017 Dec.
[Is] ISSN:1538-8689
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Currículo
Bacharelado em Enfermagem
Enfermagem Perioperatória/educação
Especialização
[Mh] Termos MeSH secundário: Seres Humanos
Pesquisa em Educação de Enfermagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/01.NURSE.0000526902.45745.04


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[PMID]:29200238
[Au] Autor:Niemi-Murola L
[Ti] Título:Entrustable professional activity (EPA) reshapes the practice of specialist training.
[So] Source:Duodecim;133(1):77-83, 2017.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:In addition to medical expertise, competence-based medical training comprises communication and collaboration skills, professionalism, and leadership skills. Continuous feedback is essential for learning and development, and feedback only from the medical specialist examination taken in the end of training does not ensure thorough specialist training. Entrustable professional activity (EPA) is a unit of professional practice, defined as tasks or responsibilities typical of the specialty. EPA translates competence-based training into manageable and meaningful entities and provides tools for the evaluation of medical competence.
[Mh] Termos MeSH primário: Educação Baseada em Competências
Educação de Pós-Graduação em Medicina
Prática Profissional
Especialização
[Mh] Termos MeSH secundário: Competência Clínica
Comunicação
Comportamento Cooperativo
Seres Humanos
Liderança
Confiança
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29199798
[Au] Autor:Naskali J; Lehtonen J; Palomäki A
[Ti] Título:Specialist training of Emergency Medicine in Finland.
[So] Source:Duodecim;132(24):2389-93, 2016.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:Emergency Medicine with a six-year specialist training became a main specialty in Finland in the beginning of 2013. Specialist training has developed very quickly over just a few years. In the frontline clinics, the clinical results have already reached high international quality. When developing a new specialty, not only active research and high-quality training but also good co-operation with other specialties are of utmost importance.
[Mh] Termos MeSH primário: Educação de Pós-Graduação em Medicina/organização & administração
Medicina de Emergência/educação
Especialização
[Mh] Termos MeSH secundário: Currículo
Finlândia
Seres Humanos
Internato e Residência
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29199797
[Au] Autor:Koivistoinen T; Grönroos M
[Ti] Título:Working in the emergency department.
[So] Source:Duodecim;132(24):2385-7, 2016.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:In Finland, there is a trend towards joint regional emergency departments where emergency medicine specialists work together with physicians from specialties. This collaboration will benefit the care process management and patient care. Moreover, an observation unit is an essential part of the modern emergency department.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/recursos humanos
Especialização
[Mh] Termos MeSH secundário: Comportamento Cooperativo
Medicina de Emergência
Finlândia
Seres Humanos
Relações Interprofissionais
Observação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:27776094
[Au] Autor:Wiznia DH; Zaki T; Maisano J; Kim CY; Halaszynski TM; Leslie MP
[Ad] Endereço:From the Departments of *Orthopedics and Rehabilitation and †Adult and Perioperative Anesthesiology, Yale University School of Medicine, New Haven, CT.
[Ti] Título:Influence of Medical Insurance Under the Affordable Care Act on Access to Pain Management of the Trauma Patient.
[So] Source:Reg Anesth Pain Med;42(1):39-44, 2017 Jan/Feb.
[Is] ISSN:1532-8651
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care. METHODS: Investigators phoned 443 board-certified pain specialists, securing office visits with 235 pain physicians from 8 different states. Appointments for pain management were for a patient who sustained an ankle fracture requiring surgery and experiencing difficulty weaning off opioids. Offices were phoned 4 times assessing responses to the 4 different payment methodologies. RESULTS: Fifty-three percent of pain specialists contacted (235 of 443) were willing to see new patients to manage pain medication. Within the 53% of positive responses, 7.2% of physicians scheduled appointments for Medicaid patients, compared with 26.8% for cash-paying patients, 39.6% for those with Medicare, and 41.3% with Blue Cross (P < 0.0001). There were no differences in appointment access between states that had expanded Medicaid eligibility for low-income adults versus states that had not expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement levels for new patient visits correlated with ability to schedule an appointment or influenced wait times. CONCLUSIONS: Access to pain specialists for management of pain medication in the postoperative trauma patient proved challenging. Despite the Affordable Care Act, Medicaid patients still experienced curtailed access to pain specialists and confronted the highest incidence of barriers to receiving appointments.
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde/economia
Cobertura do Seguro/economia
Manejo da Dor/economia
Patient Protection and Affordable Care Act/economia
Médicos/economia
Especialização/economia
[Mh] Termos MeSH secundário: Idoso
Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/economia
Fraturas do Tornozelo/economia
Fraturas do Tornozelo/terapia
Acesso aos Serviços de Saúde/tendências
Seres Humanos
Cobertura do Seguro/tendências
Medicaid/economia
Medicaid/tendências
Medicare/economia
Medicare/tendências
Meia-Idade
Manejo da Dor/tendências
Patient Protection and Affordable Care Act/tendências
Médicos/tendências
Especialização/tendências
Estados Unidos/epidemiologia
Ferimentos e Lesões/economia
Ferimentos e Lesões/epidemiologia
Ferimentos e Lesões/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1097/AAP.0000000000000502


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[PMID]:27772554
[Au] Autor:Maatz A; Wainwright M; Russell AJ; Macnaughton J; Yiannakou Y
[Ad] Endereço:Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, Zurich CH-8032, Switzerland. Electronic address: anke.maatz@puk.zh.ch.
[Ti] Título:What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms.
[So] Source:J Psychosom Res;90:1-9, 2016 11.
[Is] ISSN:1879-1360
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN: Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. SETTING: Three NHS trust secondary care hospitals in North-East England. PARTICIPANTS: 17 senior clinicians from seven medical and two surgical specialities. RESULTS: Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. CONCLUSIONS: This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
[Mh] Termos MeSH primário: Sintomas Inexplicáveis
Médicos/normas
Pesquisa Qualitativa
Atenção Secundária à Saúde/normas
Especialização/normas
[Mh] Termos MeSH secundário: Adulto
Assistência à Saúde
Inglaterra/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Médicos/psicologia
Atenção Secundária à Saúde/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29195577
[Au] Autor:Wu G; Consunji M; Nelson RA; Yeung K; Sun C; Kim JY; Raz DJ
[Ad] Endereço:Division of Thoracic Surgery, City of Hope, Duarte, California. Electronic address: geena.wu@mihs.org.
[Ti] Título:Perspectives on Managing Solitary Pulmonary Nodules: A Survey of Primary Care Physicians.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):391-405, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians. Responders and nonresponders did not differ by demographic characteristics. A total of 137 (55.5%) PCPs reported feeling confident in managing the workup of imaging-detected SPN. However, only 53 PCPs (21.3%) were inclined to manage the evaluation and follow-up of SPN. There was no significant difference between family practice and internal medicine physicians with regard to years in practice, size of practice, or referral to specialists. Family practitioners and internists similarly disagreed or were neutral to self-managing SPN (P = 0.60). Internists were twice as likely to express confidence as family practitioners (odds ratio 1.95, 95% confidence interval 1.09-3.48). Among all PCPs, 75.4% would refer management of these patients to a pulmonologist, 28.9% to a surgeon, and 24.2% to an oncologist. Confidence did not predict lung cancer screening practices. Although more than half of PCPs expressed confidence in the workup of SPN, most preferred referral to specialists. Additional research is needed to understand barriers to PCP management of incidental SPN in the effort to facilitate lung cancer screening.
[Mh] Termos MeSH primário: Neoplasias Pulmonares/terapia
Médicos de Atenção Primária
Padrões de Prática Médica
Avaliação de Processos (Cuidados de Saúde)
Nódulo Pulmonar Solitário/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Atitude do Pessoal de Saúde
Competência Clínica
Feminino
Pesquisas sobre Serviços de Saúde
Conhecimentos, Atitudes e Prática em Saúde
Disparidades em Assistência à Saúde
Seres Humanos
Modelos Logísticos
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Razão de Chances
Médicos de Atenção Primária/psicologia
Encaminhamento e Consulta
Nódulo Pulmonar Solitário/diagnóstico por imagem
Nódulo Pulmonar Solitário/patologia
Especialização
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:29195571
[Au] Autor:Chiu P; Sailer AM; Baiocchi M; Goldstone AB; Schaffer JM; Trojan J; Fleischmann D; Mitchell RS; Miller DC; Dake MD; Woo YJ; Lee JT; Fischbein MP
[Ad] Endereço:Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California.
[Ti] Título:Impact of Discordant Views in the Management of Descending Thoracic Aortic Aneurysm.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):283-291, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Thoracic endovascular aortic repair has a lower perceived risk than open surgical repair and has become an increasingly popular alternative. Whether general consensus exists regarding candidacy for either operation among open and endovascular specialists is unknown. A retrospective review of isolated descending thoracic aortic aneurysm at our institution between January 2005 and October 2015 was performed, excluding trauma and dissection. Two cardiac surgeons, 2 cardiovascular surgeons, 1 vascular surgeon, and 1 interventional radiologist gave their preference for open vs endovascular repair. Interobserver agreement was assessed with the kappa coefficient. k-means clustering agnostically grouped various patterns of agreement. The mean rating was predicted using least absolute shrinkage and selection operator regression. Negative binomial regression predicted the discrepancy between our panel of raters and the historical operation. Generalized estimating equation modeling was then used to evaluate the association between the extent of discrepancy and the adverse perioperative outcome. There were 77 patients with preoperative imaging studies. Pairwise interobserver agreement was only fair (median weighted kappa 0.270 [interquartile range 0.211-0.404]). Increasing age and proximal neck length predicted an increasing preference for thoracic endovascular aortic repair in our panel; larger proximal neck diameter predicted a general preference for open surgical repair. Increasing proximal neck diameter predicted a larger discrepancy between our panel and the historical operation. Greater discrepancy was associated with adverse outcome. Substantial disagreement existed among our panel, and an exploratory analysis of the effect of increasing discrepancy demonstrated an association with adverse perioperative outcome. An investigation of the effect of a thoracic aortic team with open and endovascular specialists is warranted.
[Mh] Termos MeSH primário: Aneurisma da Aorta Torácica/cirurgia
Implante de Prótese Vascular
Procedimentos Endovasculares
Disparidades em Assistência à Saúde
Padrões de Prática Médica
Radiologistas
Cirurgiões
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aneurisma da Aorta Torácica/diagnóstico por imagem
Atitude do Pessoal de Saúde
Implante de Prótese Vascular/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Masculino
Meia-Idade
Radiologistas/psicologia
Estudos Retrospectivos
Especialização
Cirurgiões/psicologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:29180382
[Au] Autor:Wilson CR; Bordman ZN
[Ad] Endereço:Department of Family Medicine (Wilson), Queen's University, Kingston, Ont.; Department of Family and Community Medicine (Bordman), University of Toronto, Toronto, Ont. ruth.wilson@dfm.queensu.ca.
[Ti] Título:What to do about the Canadian Resident Matching Service.
[So] Source:CMAJ;189(47):E1436-E1447, 2017 11 27.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Escolha da Profissão
Internato e Residência/organização & administração
Internato e Residência/normas
[Mh] Termos MeSH secundário: Canadá
Necessidades e Demandas de Serviços de Saúde
Seres Humanos
Critérios de Admissão Escolar
Especialização
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.170791


  10 / 21931 MEDLINE  
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Cavalcanti, Alessandro Leite
[PMID]:27775584
[Au] Autor:de Castro RD; Rangel ML; da Silva MA; de Lucena BT; Cavalcanti AL; Bonan PR; Oliveira JA
[Ad] Endereço:Programa de Pós-Graduação em Odontologia, Universidade Federal da Paraíba, João Pessoa 58051-900, PB, Brazil. ricardodiasdecastro@pq.cnpq.br.
[Ti] Título:Accessibility to Specialized Public Oral Health Services from the Perspective of Brazilian Users.
[So] Source:Int J Environ Res Public Health;13(10), 2016 10 19.
[Is] ISSN:1660-4601
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user's perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws.
[Mh] Termos MeSH primário: Serviços de Saúde Bucal
Acesso aos Serviços de Saúde
Saúde Bucal
Especialização
[Mh] Termos MeSH secundário: Adulto
Brasil
Cidades
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Projetos Piloto
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE



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