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  1 / 15991 MEDLINE  
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[PMID]:29419961
[Au] Autor:Marc DT; Robertson J; Gordon L; Green-Lawson ZD; Gibbs D; Dover K; Dougherty M
[Ti] Título:What the Data Say About HIM Professional Trends.
[So] Source:J AHIMA;88(5):25-31, 2017 05.
[Is] ISSN:1060-5487
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Gestão da Informação em Saúde/tendências
Prática Profissional/tendências
[Mh] Termos MeSH secundário: Codificação Clínica
Previsões
Gestão da Informação em Saúde/educação
Seres Humanos
Capacitação em Serviço
Liderança
Informática Médica
Competência Profissional
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE


  2 / 15991 MEDLINE  
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[PMID]:28465384
[Au] Autor:Haigh R
[Ad] Endereço:Rex Haigh, MA, BM, BCh, MRCGP, FRCPsych, MembInstGA, Berkshire Healthcare NHS Foundation Trust, ASSiST Office, Upton Hospital, Slough SL1 2BJ, UK. Email: rexhaigh@nhs.net.
[Ti] Título:Therapeutic communities enter the world of evidence-based practice.
[So] Source:Br J Psychiatry;210(5):313-314, 2017 05.
[Is] ISSN:1472-1465
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This editorial provides the modern-day context for a long-established psychiatric treatment, democratic therapeutic communities. As this treatment is now such a small field in psychiatry, readers may not have enough background to be able to place the research in a suitable context. This includes the previous gap in experimental research, the difference between the modern model and the one used in the 20th century and the general field of personality disorder evidence.
[Mh] Termos MeSH primário: Prática Clínica Baseada em Evidências/normas
Psiquiatria/normas
[Mh] Termos MeSH secundário: Seres Humanos
Transtornos da Personalidade/terapia
Prática Profissional
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1192/bjp.bp.116.193326


  3 / 15991 MEDLINE  
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[PMID]:29305459
[Au] Autor:Talbot C; Davis N; Majid I; Young M; Bouamra O; Lecky FE; Jones S
[Ad] Endereço:Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
[Ti] Título:Fractures of the femoral shaft in children: national epidemiology and treatment trends in England following activation of major trauma networks.
[So] Source:Bone Joint J;100-B(1):109-118, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The aim of this study was to describe the epidemiology of closed isolated fractures of the femoral shaft in children, and to compare the treatment and length of stay (LOS) between major trauma centres (MTCs) and trauma units (TUs) in England. PATIENTS AND METHODS: National data were obtained from the Trauma and Audit Research Network for all isolated, closed fractures of the femoral shaft in children from birth to 15 years of age, between 2012 and 2015. Age, gender, the season in which the fracture occurred, non-accidental injury, the mechanism of injury, hospital trauma status, LOS and type of treatment were recorded. RESULTS: A total of 1852 fractures were identified. The mean annual incidence was 5.82 per 100 000 children (95% confidence interval (CI) 5.20 to 6.44). The age of peak incidence was two years for both boys and girls; this decreased with increasing age. Children aged four to six years treated in MTCs were more likely to be managed with open reduction and internal fixation compared with those treated in TUs (odds ratio 3.20; 95% CI 1.12 to 9.14; p = 0.03). The median LOS was significantly less in MTCs than in TUs for children aged between 18 months and three years treated in both a spica (p = 0.005) and traction (p = 0.0004). CONCLUSION: This study highlights the current national trends in the management of closed isolated fractures of the femoral shaft in children following activation of major trauma networks in 2012. Future studies focusing on the reasons for the differences which have been identified may help to achieve more consistency in the management of these injuries across the trauma networks. Cite this article: 2018;100-B:109-18.
[Mh] Termos MeSH primário: Fraturas do Fêmur/epidemiologia
Fraturas Fechadas/epidemiologia
Procedimentos Ortopédicos/tendências
Centros de Traumatologia/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Distribuição por Idade
Moldes Cirúrgicos/utilização
Criança
Pré-Escolar
Inglaterra/epidemiologia
Feminino
Fraturas do Fêmur/etiologia
Fraturas do Fêmur/cirurgia
Fixação Interna de Fraturas/utilização
Fraturas Fechadas/etiologia
Fraturas Fechadas/cirurgia
Seres Humanos
Incidência
Lactente
Recém-Nascido
Tempo de Internação/estatística & dados numéricos
Masculino
Procedimentos Ortopédicos/métodos
Prática Profissional/estatística & dados numéricos
Prática Profissional/tendências
Estações do Ano
Distribuição por Sexo
Tração/utilização
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2016-1315.R3


  4 / 15991 MEDLINE  
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[PMID]:29305444
[Au] Autor:Lovelock TM; Broughton NS
[Ad] Endereço:Department of Surgery, Frankston Hospital, Peninsula Health, PO Box 52, Frankston, Victoria 3199, Australia and, Monash University, Central Clinical School, Frankston, Victoria 3800, Australia.
[Ti] Título:Follow-up after arthroplasty of the hip and knee : are we over-servicing or under-caring?
[So] Source:Bone Joint J;100-B(1):6-10, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The number of arthroplasties of the hip and knee is predicted to increase rapidly during the next 20 years. Accompanying this is the dilemma of how to follow-up these patients appropriately. Current guidelines recommend long-term follow-up to identify patients with aseptic loosening, which can occur more than a decade postoperatively. The current guidelines and practices of orthopaedic surgeons vary widely. Existing models take up much clinical time and are expensive. Pilot studies using 'virtual' clinics and advanced-practice physiotherapists have shown promise in decreasing the time and costs for orthopaedic surgeons and patients. This review discusses current practices and future trends in the follow-up of patients who have an arthroplasty. Cite this article: 2018;100-B:6-10.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Artroplastia do Joelho
Assistência à Saúde/organização & administração
Assistência de Longa Duração/organização & administração
[Mh] Termos MeSH secundário: Artroplastia de Quadril/efeitos adversos
Artroplastia do Joelho/efeitos adversos
Assistência à Saúde/tendências
Medicina de Família e Comunidade/organização & administração
Seguimentos
Seres Humanos
Assistência de Longa Duração/tendências
Guias de Prática Clínica como Assunto
Prática Profissional/estatística & dados numéricos
Prática Profissional/tendências
Falha de Prótese
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0779.R1


  5 / 15991 MEDLINE  
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[PMID]:27770772
[Au] Autor:Waddimba AC; Scribani M; Krupa N; May JJ; Jenkins P
[Ad] Endereço:Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA. waddimba@gmail.com.
[Ti] Título:Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitioners.
[So] Source:BMC Health Serv Res;16(1):613, 2016 10 22.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Widespread dissatisfaction among United States (U.S.) clinicians could endanger ongoing reforms. Practitioners in rural/underserved areas withstand stressors that are unique to or accentuated in those settings. Medical professionals employed by integrating delivery systems are often distressed by the cacophony of organizational change(s) that such consolidation portends. We investigated the factors associated with dis/satisfaction with rural practice among doctors/non-physician practitioners employed by an integrated healthcare delivery network serving 9 counties of upstate New York, during a time of organizational transition. METHODS: We linked administrative data about practice units with cross-sectional data from a self-administered multi-dimensional questionnaire that contained practitioner demographics plus valid scales assessing autonomy/relatedness needs, risk aversion, tolerance for uncertainty/ambiguity, meaningfulness of patient care, and workload. We targeted medical professionals on the institutional payroll for inclusion. We excluded those who retired, resigned or were fired during the study launch, plus members of the advisory board and research team. Fixed-effects beta regressions were performed to test univariate associations between each factor and the percent of time a provider was dis/satisfied. Factors that manifested significant fixed effects were entered into multivariate, inflated beta regression models of the proportion of time that practitioners were dis/satisfied, incorporating clustering by practice unit as a random effect. RESULTS: Of the 473 eligible participants. 308 (65.1 %) completed the questionnaire. 59.1 % of respondents were doctoral-level; 40.9 % mid-level practitioners. Practitioners with heavier workloads and/or greater uncertainty intolerance were less likely to enjoy top-quintile satisfaction; those deriving greater meaning from practice were more likely. Higher meaningfulness and gratified relational needs increased one's likelihood of being in the lowest quintile of dissatisfaction; heavier workload and greater intolerance of uncertainty reduced that likelihood. Practitioner demographics and most practice unit characteristics did not manifest any independent effect. CONCLUSIONS: Mutable factors, such as workload, work meaningfulness, relational needs, uncertainty/ambiguity tolerance, and risk-taking attitudes displayed the strongest association with practitioner satisfaction/dissatisfaction, independent of demographics and practice unit characteristics. Organizational efforts should be dedicated to a redesign of group-employment models, including more equitable division of clinical labor, building supportive peer networks, and uncertainty/risk tolerance coaching, to improve the quality of work life among rural practitioners.
[Mh] Termos MeSH primário: Satisfação no Emprego
Médicos/psicologia
Prática Profissional
[Mh] Termos MeSH secundário: Estudos Transversais
Emprego/psicologia
Feminino
Pessoal de Saúde/psicologia
Seres Humanos
Masculino
Meia-Idade
New York
Satisfação Pessoal
Assunção de Riscos
Saúde da População Rural
Inquéritos e Questionários
Carga de Trabalho/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180117
[Lr] Data última revisão:
180117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  6 / 15991 MEDLINE  
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[PMID]:29190418
[Au] Autor:Flodgren G; Gonçalves-Bradley DC; Summerbell CD
[Ad] Endereço:Division for Health Services, Norwegian Institute of Public Health, Pilestredet Park 7, Oslo, Norway, 0176.
[Ti] Título:Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity.
[So] Source:Cochrane Database Syst Rev;11:CD000984, 2017 11 30.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of overweight and obesity is increasing globally, an increase which has major implications for both population health and costs to health services. This is an update of a Cochrane Review. OBJECTIVES: To assess the effects of strategies to change the behaviour of health professionals or the organisation of care compared to standard care, to promote weight reduction in children and adults with overweight or obesity. SEARCH METHODS: We searched the following databases for primary studies up to September 2016: CENTRAL, MEDLINE, Embase, CINAHL, DARE and PsycINFO. We searched the reference lists of included studies and two trial registries. SELECTION CRITERIA: We considered randomised trials that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in children and adults with overweight or obesity. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane when conducting this review. We report the results for the professional interventions and the organisational interventions in seven 'Summary of findings' tables. MAIN RESULTS: We identified 12 studies for inclusion in this review, seven of which evaluated interventions targeting healthcare professional and five targeting the organisation of care. Eight studies recruited adults with overweight or obesity and four recruited children with obesity. Eight studies had an overall high risk of bias, and four had a low risk of bias. In total, 139 practices provided care to 89,754 people, with a median follow-up of 12 months. Professional interventions Educational interventions aimed at general practitioners (GPs), may slightly reduce the weight of participants (mean difference (MD) -1.24 kg, 95% confidence interval (CI) -2.84 to 0.37; 3 studies, N = 1017 adults; low-certainty evidence).Tailoring interventions to improve GPs' compliance with obesity guidelines probably leads to little or no difference in weight loss (MD 0.05 (kg), 95% CI -0.32 to 0.41; 1 study, N = 49,807 adults; moderate-certainty evidence).It is uncertain if providing doctors with reminders results in a greater weight reduction than standard care (men: MD -11.20 kg, 95% CI -20.66 kg to -1.74 kg, and women: MD -1.30 kg, 95% CI [-7.34, 4.74] kg; 1 study, N = 90 adults; very low-certainty evidence).Providing clinicians with a clinical decision support (CDS) tool to assist with obesity management at the point of care leads to little or no difference in the body mass index (BMI) z-score of children (MD -0.08, 95% CI -0.15 to -0.01 in 378 children; moderate-certainty evidence), CDS tools may lead to little or no difference in weight loss in adults: MD -0.095 kg (-0.21 lbs), P = 0.47; 1 study, N = 35,665; low-certainty evidence. Organisational interventions Adults with overweight or obesity may lose more weight if the care was provided by a dietitian (by -5.60 kg, 95% CI -4.83 kg to -6.37 kg) or by a doctor-dietitian team (by -6.70 kg, 95% CI -7.52 kg to -5.88 kg; 1 study, N = 270 adults; low-certainty evidence). Shared care leads to little or no difference in the BMI z-score of children with obesity (adjusted MD -0.05, 95% CI -0.14 to 0.03; 1 study, N = 105 children; low-certainty evidence).Organisational restructuring of the delivery of primary care (i.e. introducing the chronic care model) may result in a slightly lower increase in the BMI of children who received care at intervention clinics (BMI change: adjusted MD -0.21, 95% CI -0.50 to 0.07; 1 study, unadjusted MD -0.18, 95% CI -0.20 to -0.16; N=473 participants; moderate-certainty evidence).Mail and phone interventions probably lead to little or no difference in weight loss in adults (mean weight change (kg) using mail: -0.36, 95% CI -1.18 to 0.46; phone: -0.44, 95% CI -1.26 to 0.38; 1 study, N = 1801 adults; moderate-certainty evidence). Care delivered by a nurse at a primary care clinic may lead to little or no difference in the BMI z-score in children (MD -0.02, 95% CI -0.16 to 0.12; 1 study, N = 52 children; very low-certainty evidence).Two studies reported data on cost effectiveness: one study favoured mail and standard care over telephone consultations, and the other study achieved weight loss at a modest cost in both intervention groups (doctor and doctor-dietitian). One study of shared care reported similar adverse effects in both groups. AUTHORS' CONCLUSIONS: We found little convincing evidence for a clinically-important effect on participants' weight or BMI of any of the evaluated interventions. While pooled results from three studies indicate that educational interventions targeting healthcare professionals may lead to a slight weight reduction in adults, the certainty of these results is low. Two trials evaluating CDS tools (unpooled results) for improved weight management suggest little or no effect on weight or BMI change in adults or children with overweight or obesity. Evidence for all the other interventions evaluated came mostly from single studies. The certainty of the included evidence varied from moderate to very low for the main outcomes (weight and BMI). All of the evaluated interventions would need further investigation to ascertain their strengths and limitations as effective strategies to change the behaviour of healthcare professionals or the organisation of care. As only two studies reported on cost, we know little about cost effectiveness across the evaluated interventions.
[Mh] Termos MeSH primário: Obesidade/terapia
Prática Profissional/normas
[Mh] Termos MeSH secundário: Adulto
Peso Corporal
Ensaios Clínicos Controlados como Assunto
Assistência à Saúde/organização & administração
Assistência à Saúde/normas
Feminino
Seres Humanos
Masculino
Obesidade/psicologia
Sobrepeso/psicologia
Sobrepeso/terapia
Educação de Pacientes como Assunto
Prática Profissional/organização & administração
Ensaios Clínicos Controlados Aleatórios como Assunto
Perda de Peso
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180110
[Lr] Data última revisão:
180110
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD000984.pub3


  7 / 15991 MEDLINE  
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[PMID]:29206409
[Au] Autor:Koch K
[Ti] Título:Special Needs in the Field: A guide to helping patients with disabilities.
[So] Source:JEMS;42(1):50-3, 2017 01.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pessoas com Deficiência
Serviços Médicos de Emergência/métodos
Tratamento de Emergência/métodos
Prática Profissional
Relações Profissional-Paciente
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


  8 / 15991 MEDLINE  
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[PMID]:29206395
[Au] Autor:Wirth SR
[Ti] Título:Evolving Care Standards: Stay current to avoid liability risk.
[So] Source:JEMS;42(1):12-3, 2017 01.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Serviços Médicos de Emergência/legislação & jurisprudência
Serviços Médicos de Emergência/normas
Tratamento de Emergência/normas
[Mh] Termos MeSH secundário: Seres Humanos
Responsabilidade Legal
Imperícia
Prática Profissional
Garantia da Qualidade dos Cuidados de Saúde
Gestão de Riscos
Estados Unidos
[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:H
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


  9 / 15991 MEDLINE  
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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


  10 / 15991 MEDLINE  
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[PMID]:29182226
[Au] Autor:Wirth SR
[Ti] Título:Culture of Respect. Misuse of patient images isn't just about the law.
[So] Source:JEMS;41(9):16, 2016 09.
[Is] ISSN:0197-2510
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Auxiliares de Emergência/ética
Auxiliares de Emergência/legislação & jurisprudência
Cultura Organizacional
Fotografia
Privacidade/legislação & jurisprudência
Prática Profissional/ética
Prática Profissional/legislação & jurisprudência
Confiança
[Mh] Termos MeSH secundário: Health Insurance Portability and Accountability Act
Seres Humanos
Estados Unidos
[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:H
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE



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