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[PMID]:29342498
[Au] Autor:Jacobson Vann JC; Jacobson RM; Coyne-Beasley T; Asafu-Adjei JK; Szilagyi PG
[Ad] Endereço:School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, Chapel Hill, North Carolina, USA, 27599-7460.
[Ti] Título:Patient reminder and recall interventions to improve immunization rates.
[So] Source:Cochrane Database Syst Rev;1:CD003941, 2018 01 18.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. OBJECTIVES: To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. SELECTION CRITERIA: We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations, or simple practice-based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before-after studies. We present pooled results for randomized trials using the random-effects model. MAIN RESULTS: The 75 included studies involved child, adolescent, and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single-method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single-method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants). AUTHORS' CONCLUSIONS: Patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations.
[Mh] Termos MeSH primário: Imunização/utilização
Sistemas de Alerta
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Correspondência como Assunto
Seres Humanos
Programas de Imunização/organização & administração
Ensaios Clínicos Controlados Aleatórios como Assunto
Sistemas de Alerta/estatística & dados numéricos
Telefone/estatística & dados numéricos
Mensagem de Texto/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD003941.pub3


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[PMID]:28703859
[Au] Autor:Cable RG; Birch RJ; Spencer BR; Wright DJ; Bialkowski W; Kiss JE; Rios J; Bryant BJ; Mast AE
[Ad] Endereço:New England Region, American Red Cross Blood Services, Dedham, Massachusetts.
[Ti] Título:The operational implications of donor behaviors following enrollment in STRIDE (Strategies to Reduce Iron Deficiency in blood donors).
[So] Source:Transfusion;57(10):2440-2448, 2017 Oct.
[Is] ISSN:1537-2995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Donor behaviors in STRIDE (Strategies to Reduce Iron Deficiency), a trial to reduce iron deficiency, were examined. STUDY DESIGN AND METHODS: Six hundred ninety-two frequent donors were randomized to receive either 19 or 38 mg iron for 60 days or an educational letter based on their predonation ferritin. Compliance with assigned pills, response to written recommendations, change in donation frequency, and future willingness to take iron supplements were examined. RESULTS: Donors who were randomized to receive iron pills had increased red blood cell donations and decreased hemoglobin deferrals compared with controls or with pre-STRIDE donations. Donors who were randomized to receive educational letters had fewer hemoglobin deferrals compared with controls. Of those who received a letter advising of low ferritin levels with recommendations to take iron supplements or delay future donations, 57% reported that they initiated iron supplementation, which was five times as many as those who received letters lacking a specific recommendation. The proportion reporting delayed donation was not statistically different (32% vs. 20%). Of donors who were assigned pills, 58% reported taking them "frequently," and forgetting was the primary reason for non-compliance. Approximately 80% of participants indicated that they would take iron supplements if provided by the center. CONCLUSIONS: Donors who were assigned iron pills had acceptable compliance, producing increased red blood cell donations and decreased low hemoglobin deferrals compared with controls or with pre-STRIDE rates. The majority of donors assigned to an educational letter took action after receiving a low ferritin result, with more donors choosing to take iron than delay donation. Providing donors with information on iron status with personalized recommendations was an effective alternative to directly providing iron supplements.
[Mh] Termos MeSH primário: Doadores de Sangue/psicologia
Ferro/administração & dosagem
[Mh] Termos MeSH secundário: Correspondência como Assunto
Suplementos Nutricionais
Ferritinas/sangue
Fidelidade a Diretrizes
Hemoglobinas/análise
Seres Humanos
Disseminação de Informação
Ferro/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Hemoglobins); 9007-73-2 (Ferritins); E1UOL152H7 (Iron)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1111/trf.14226


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[PMID]:28543552
[Au] Autor:Butler AE; Hall H; Copnell B
[Ad] Endereço:School of Nursing and Midwifery, Monash University, Victoria, Australia.
[Ti] Título:Ethical and Practical Realities of Using Letters for Recruitment in Bereavement Research.
[So] Source:Res Nurs Health;40(4):372-377, 2017 Aug.
[Is] ISSN:1098-240X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recruitment of participants into bereavement research may present many challenges for the research team. At present, there is little consensus for researchers and ethics committees on the most appropriate method of recruitment. There is some evidence that participants prefer to be contacted about research studies via letters. However, recruitment involving the use of a letter can occur in a number of ways, each with ethical and practical benefits and limitations. In a study of the experiences of bereaved parents, we used letters in three ways: direct mailing from the research team with an opt-out option; permission to mail letters obtained by social workers from a hospital-based follow-up program during routine contact; and letters mailed from the hospital's PICU research nurse at the hospital with instruction on how to opt in. In this paper, the practical and ethical realities of each method are highlighted, using examples from our own experiences. Nineteen parents also provided reflections in follow-up phone calls. While direct researcher contact is perhaps the most feasible for researchers, ethical concerns may render it unacceptable. While contact via a known member of a follow-up program is more ethically appropriate for participants, it also presents significant practical issues. We suggest that contact via a representative of the healthcare institution provides the best balance of ethical and practical acceptability for both participants and the research team, but responsiveness to the ethical and practical requirements of the study is crucial in ensuring it can be successfully undertaken. © 2017 Wiley Periodicals, Inc.
[Mh] Termos MeSH primário: Luto
Pesquisa Biomédica/métodos
Correspondência como Assunto
Pesar
Pais/psicologia
Seleção de Pacientes/ética
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1002/nur.21800


  4 / 2114 MEDLINE  
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[PMID]:28529229
[Au] Autor:Meek H
[Ti] Título:Frances Burney's Mastectomy Narrative and Discourses of Breast Cancer in the Long Eighteenth Century.
[So] Source:Lit Med;35(1):27-45, 2017.
[Is] ISSN:0278-9671
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This paper examines Frances Burney's 1812 mastectomy letter alongside contemporaneous medical treatises on the subject of breast cancer. Burney's letter offers a critique of a medical community that misconstrues her experience and can be viewed as pathography, or disability memoir. Examining the letter and the treatises in this way illuminates the brutality of some medical practices and the frequent incongruity between the patients' and the physicians' understandings of pain. However, the letter and the treatises also share much in common; both at times emphasize the patient's words and experiences, and both reveal the impressive and contradictory range of ideas surrounding breast cancer in the long eighteenth century. The paper ends by suggesting that the complex rapport between the letter and the treatises holds particular interest for the field of disability studies in its confrontations with socio-medical tendencies to normalize the body and downplay the harsh realities of breast cancer.
[Mh] Termos MeSH primário: Neoplasias da Mama/história
Correspondência como Assunto/história
Literatura Moderna
Mastectomia/história
Medicina na Literatura
Narração/história
[Mh] Termos MeSH secundário: Inglaterra
Feminino
História do Século XVIII
História do Século XIX
Seres Humanos
[Pt] Tipo de publicação:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE
[Ps] Nome de pessoa como assunto:Burney F
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170523
[St] Status:MEDLINE
[do] DOI:10.1353/lm.2017.0001


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[PMID]:28420302
[Au] Autor:Platt TR
[Ad] Endereço:Department of Biology, Saint Mary's College, Notre Dame, Indiana 46556. Correspondence should be sent to: tplatt@saintmarys.edu.
[Ti] Título:The Genus Spirorchis MacCallum, 1918 (Digenea: Schistosomatoidea) and the Early History of Parasitology in the United States.
[So] Source:J Parasitol;103(4):407-420, 2017 Aug.
[Is] ISSN:1937-2345
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We know little about the founders of our discipline apart from their scientific contributions and brief biographical sketches, most frequently in published obituaries. A number of years ago, Ralph Lichtenfels, then Director of the National Parasite Collection, sent me photocopies of letters between Henry Baldwin Ward, Horace W. Stunkard, George A. MacCallum, and William G. MacCallum dating from the early years of the 20th century that hinted at a series of conflicts centered on the proposal of Spirorchis MacCallum, 1918 (Digenea: Schistosomatoidea). The description of a fluke that matured in the blood of a tetrapod and that was morphologically similar to the schistosomes of humans was in its time a transformative discovery; and the scientist who published it would have garnered some scholarly recognition. Herein, I provide an historical account of the issues and the motives of each individual and the eventual resolution of these matters.
[Mh] Termos MeSH primário: Parasitologia
[Mh] Termos MeSH secundário: Animais
Correspondência como Assunto
História do Século XX
Ontário
Parasitologia/história
Terminologia como Assunto
Trematódeos/classificação
Infecções por Trematódeos/história
Infecções por Trematódeos/parasitologia
Infecções por Trematódeos/veterinária
Tartarugas/parasitologia
Estados Unidos
[Pt] Tipo de publicação:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS
[Ps] Nome de pessoa como assunto:Ward HB; MacCallum GA; MacCallum WG; Stunkard HW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170818
[Lr] Data última revisão:
170818
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170420
[St] Status:MEDLINE
[do] DOI:10.1645/17-15


  6 / 2114 MEDLINE  
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Texto completo SciELO Saúde Pública
[PMID]:28380122
[Au] Autor:Janati A; Amini A; Adham D; Naseriasl M
[Ad] Endereço:Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran.
[Ti] Título:Assessing the quality of referral letters written by general practitioners: a cross-sectional study in rural Iran.
[So] Source:Cad Saude Publica;33(2):e00043016, 2017 Mar 30.
[Is] ISSN:1678-4464
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Establishing effective communication between general practitioners (GPs) and medical specialists is a key component of the referral system. Written communication between GPs and medical specialists is the most common communication tool. This study was conducted to evaluate quality (information content) of the referral letters written by GPs and addressed to gynecologists and cardiologists. We evaluated quality of the referral letters through a cross-sectional study in the villages of Sarab city, located in East Azerbaijan Province, Northwest Iran. The study was conducted during August and September 2015 in which a total of 400 referral letters were evaluated according to specific quality criteria. Cluster sampling was implemented and data were collected using an instrument designed by the Department of Family Medicine at the University of Manitoba, Canada. A specifically designed referral form was used to refer pregnant women to gynecologists. Referrals addressed to gynecologists showed better quality in comparison to cases referred to cardiologists. Legibility of referral letters was 73%. It is recommended that agreed-upon referral letters be designed cooperatively for different groups of diseases. Furthermore, primary health care providers should be trained to write proper referral letters.
[Mh] Termos MeSH primário: Continuidade da Assistência ao Paciente/normas
Correspondência como Assunto
Clínicos Gerais/normas
Registros Médicos/normas
Atenção Primária à Saúde/normas
Encaminhamento e Consulta/normas
[Mh] Termos MeSH secundário: Adulto
Continuidade da Assistência ao Paciente/estatística & dados numéricos
Estudos Transversais
Feminino
Clínicos Gerais/estatística & dados numéricos
Seres Humanos
Irã (Geográfico)
Masculino
Meia-Idade
Gravidez
Atenção Primária à Saúde/estatística & dados numéricos
Encaminhamento e Consulta/estatística & dados numéricos
População Rural
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170503
[Lr] Data última revisão:
170503
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE


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[PMID]:28378246
[Au] Autor:Dever JB; Ducom JH; Ma A; Nguyen J; Liu L; Herrin A; Groessl EJ; Ho SB
[Ad] Endereço:Medicine, Pharmacy, Nursing, and Research Services, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
[Ti] Título:Engagement in Care of High-Risk Hepatitis C Patients with Interferon-Free Direct-Acting Antiviral Therapies.
[So] Source:Dig Dis Sci;62(6):1472-1479, 2017 Jun.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND AIMS: The extent to which hepatitis C (HCV) treatment uptake is improved following introduction of interferon-free direct-acting antiviral (DAA) treatments is unknown. The purpose of this study was to determine HCV patient engagement and barriers to care for accessing DAA treatments in a real-world setting. METHODS: Patients with HCV viremia at high risk for fibrosis were identified using the Veterans Affairs (VA) registry within San Diego's VA in October 2014. Patients not enrolled in HCV clinic were systematically contacted by letter and phone. Logistic regression was used to examine patient factors associated with subsequent engagement in care over 12-20 months. RESULTS: In the local registry of 2089 patients, 481 were identified with high-risk fibrosis scores. Of those, 380 (79%) were eligible for antiviral treatment, and 178/380 (47%) patients were actively followed in clinic. The remaining 202/380 (53%) patients were never seen by a HCV clinic provider or lost to follow-up. Of these, 114/380 (30%) of the treatment-eligible cohort remained non-engaged in care following outreach. Compared with patients engaged in care, non-engaged patients were significantly more likely to have homelessness, COPD comorbidity, or active alcohol or/and drug use. Overall 74.4% of patients engaged in HCV clinic received antiviral treatment. CONCLUSIONS: A significant portion of eligible HCV patients could not be engaged in treatment after a programmatic outreach effort. These data indicate that more sustained or innovative outreach efforts are needed in order to maximize treatment access, with specific interventions targeting those with unstable housing and active alcohol/substance use disorders.
[Mh] Termos MeSH primário: Alcoolismo/epidemiologia
Antivirais/uso terapêutico
Hepatite C Crônica/tratamento farmacológico
Hepatite C Crônica/epidemiologia
Cooperação do Paciente
Doença Pulmonar Obstrutiva Crônica/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Comorbidade
Correspondência como Assunto
Feminino
Acesso aos Serviços de Saúde
Hepatite C Crônica/complicações
Habitação
Seres Humanos
Cirrose Hepática/virologia
Masculino
Meia-Idade
Educação de Pacientes como Assunto
Sistema de Registros
Fatores de Risco
Telefone
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiviral Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-017-4548-4


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[PMID]:28349246
[Au] Autor:Zainum K; Cohen MC
[Ad] Endereço:Department of Histopathology, Sheffield Children's Hospital Foundation Trust, Western Bank, S10 2TH, Sheffield, UK.
[Ti] Título:Suicide patterns in children and adolescents: a review from a pediatric institution in England.
[So] Source:Forensic Sci Med Pathol;13(2):115-122, 2017 Jun.
[Is] ISSN:1556-2891
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Suicide is a catastrophic event to both families and communities yet it is potentially preventable. This study aims to determine incidence and patterns of suicide in children and young adolescents in our region, raise awareness of this entity as a potentially preventable cause of death in this age group, and identify its possible associated risk factors. We retrospectively reviewed suicide cases presenting as sudden unexpected death in children and adolescents that underwent coronial post-mortems at our institution. This is the largest pathological review of completed suicide in children and young adolescents within a single institution in the United Kingdom. We identified 23 suicide cases during a 12 year period from 2003 to 2015, in which 18 cases (78%) were male and 5 cases (22%) were female. The age range was from 8 to 16 years (mean age 12.82 +/- 2.52 SD). With the exception of one case, all of the victims were Caucasian. The majority, 19 cases (81%), were found dead inside their place of residence, 15 of whom were discovered in their own bedrooms. Twenty-one cases (91%) died from neck compression due to hanging; 6 cases (26%) had used the cord of a dressing gown and 5 (22%) opted to use a belt as the ligature. Two cases (9%) that died from multiple-drug toxicity were female. In 7 cases (30.5%) there was evidence of self-harm and in 3 cases (13%) there was a history of previous suicide attempts. Petechial hemorrhages were found at autopsy in more than half of hanging victims and only three cases (14%) displayed dual distribution of post-mortem hypostasis (back and legs). Seven victims (30.5%) left some form of suicide message to family members and friends, 2 of which wrote the message on their arm. Parental separation, conflict with parents, and depression, were common amongst decedents prior to committing suicide. Substance abuse was uncommon in suicide within our cases. Valuable information is available from thorough review of suicide data in children and young adolescents from a single institution. Pathologists and clinicians can play crucial roles in identifying potential risk factors that may contribute to prevent future deaths.
[Mh] Termos MeSH primário: Suicídio/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Distribuição por Idade
Asfixia/mortalidade
Criança
Correspondência como Assunto
Depressão/psicologia
Divórcio/psicologia
Inglaterra/epidemiologia
Conflito Familiar/psicologia
Feminino
Seres Humanos
Masculino
Lesões do Pescoço/mortalidade
Envenenamento/mortalidade
Púrpura/patologia
Estudos Retrospectivos
Distribuição por Sexo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1007/s12024-017-9860-y


  9 / 2114 MEDLINE  
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[PMID]:28198724
[Au] Autor:Burk-Rafel J; Jones RL; Farlow JL
[Ad] Endereço:J. Burk-Rafel is a fourth-year medical student, University of Michigan Medical School, Ann Arbor, Michigan, and is primary representative, Association of American Medical Colleges Organization of Student Representatives. R.L. Jones is a fourth-year medical student, University of Nebraska College of Medicine, Omaha, Nebraska; is chair, American Medical Association (AMA) Medical Student Section Committee on Medical Education; and serves on the National Advisory Panel to the AMA Accelerating Change in Medical Education Consortium. J.L. Farlow is an eighth-year MD-PhD student, Indiana University School of Medicine, Indianapolis, Indiana, and serves on the Association of American Medical Colleges Board of Directors.
[Ti] Título:Engaging Learners to Advance Medical Education.
[So] Source:Acad Med;92(4):437-440, 2017 Apr.
[Is] ISSN:1938-808X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Learners are a pillar of academic medicine, yet their voice is seldom heard in national and international scholarly conversations on medical education. However, learners are eager to contribute: in response to a recent open call from Academic Medicine, medical students and residents representing 98 institutions across 11 countries submitted 224 Letters to the Editor on wide-ranging topics. In this Invited Commentary, the authors-three medical students serving in national leadership roles-contextualize several themes discussed in these learner-authored letters.The authors first explore the unique voice learners contribute to educational innovation, highlighting the value learners add to curricular and systemic educational reform efforts. They then turn to the broader implications of the many submitted letters addressing the culture and humanism of medicine, proposing that learners can be powerful catalysts and partners in cultural change. Despite these benefits, the authors note that learners are largely untapped change agents who are particularly underrepresented in medical education scholarship, finding that students were just 2.8% (39/1,396) of authors and 3.5% (12/340) of first authors among all print publications in Academic Medicine in 2016. The authors conclude by offering tangible steps for the academic medical community to engage learners in leadership, advocacy, and scholarship.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Educação Médica
Internato e Residência
Liderança
Médicos
Estudantes de Medicina
[Mh] Termos MeSH secundário: Correspondência como Assunto
Cultura
Currículo
Humanismo
Seres Humanos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170216
[St] Status:MEDLINE
[do] DOI:10.1097/ACM.0000000000001602


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[PMID]:28197680
[Au] Autor:Kentish-Barnes N; Chevret S; Champigneulle B; Thirion M; Souppart V; Gilbert M; Lesieur O; Renault A; Garrouste-Orgeas M; Argaud L; Venot M; Demoule A; Guisset O; Vinatier I; Troché G; Massot J; Jaber S; Bornstain C; Gaday V; Robert R; Rigaud JP; Cinotti R; Adda M; Thomas F; Calvet L; Galon M; Cohen-Solal Z; Cariou A; Azoulay E; Famirea Study Group
[Ad] Endereço:Assistance Publique, Hôpitaux de Paris, Saint-Louis University Hospital, Famiréa Research Group, Paris, France.
[Ti] Título:Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial.
[So] Source:Intensive Care Med;43(4):473-484, 2017 Apr.
[Is] ISSN:1432-1238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the closest relative a handwritten condolence letter. METHODS: Multicenter randomized trial conducted among 242 relatives of patients who died at 22 ICUs in France between December 2014 and October 2015. Relatives were randomly assigned to receiving (n = 123) or not receiving (n = 119) a condolence letter. The primary endpoint was the Hospital Anxiety and Depression Score (HADS) at 1 month. Secondary endpoints included HADS, complicated grief (ICG), and PTSD-related symptoms (IES-R) at 6 months. Observers were blinded to group allocation. RESULTS: At 1 month, 208 (85.9%) relatives completed the HADS; median score was 16 [IQR, 10-22] with and 14 [8-21.5] without the letter (P = 0.36). Although scores were higher in the intervention group, there were no significant differences regarding the HADS-depression subscale (8 [4-12] vs. 6 [2-12], mean difference 1.1 [-0.5 to 2.6]; P = 0.09) and prevalence of depression symptoms (56.0 vs. 42.4%, RR 0.76 [0.57-1.00]; P = 0.05). At 6 months, 190 (78.5%) relatives were interviewed. The intervention significantly increased the HADS (13 [7-19] vs. 10 [4-17.5], P = 0.04), HADS-depression subscale (6 [2-10] vs. 3 [1-9], P = 0.02), prevalence of depression symptoms (36.6 vs. 24.7%, P = 0.05) and PTSD-related symptoms (52.4 vs. 37.1%, P = 0.03). CONCLUSIONS: In relatives of patients who died in the ICU, a condolence letter failed to alleviate grief symptoms and may have worsened depression and PTSD-related symptoms. Trial registration Clinicaltrials.gov Identifier: NCT02325297.
[Mh] Termos MeSH primário: Ansiedade/psicologia
Luto
Correspondência como Assunto
Depressão/psicologia
Empatia
Família/psicologia
Transtornos de Estresse Pós-Traumáticos/psicologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Ansiedade/prevenção & controle
Atitude Frente à Morte
Depressão/prevenção & controle
Feminino
França
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Relações Profissional-Família
Fatores Sexuais
Transtornos de Estresse Pós-Traumáticos/prevenção & controle
Inquéritos e Questionários
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170216
[St] Status:MEDLINE
[do] DOI:10.1007/s00134-016-4669-9



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