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Physician self care

L B Amsden, P T Davidson, H B Fevrier, R Goldfien, L J Herrinton
Purpose To better understand diagnostic delay and doctor-patient communication during the diagnosis of systemic lupus erythematous in patients without malar rash, we conducted a qualitative study of primary care providers' perceptions. Methods We conducted in-depth interviews with a purposive sample of eight primary care physicians in Kaiser Permanente Northern California. Telephone interviews were recorded, transcribed, reviewed, and coded for domains and themes. Results We identified five domains related to diagnosis: initial assessment and tests, initial diagnosis and empiric treatment, timeliness of diagnosis, communicating with the patient, and opportunities for improvement...
January 1, 2018: Lupus
R M Gracia Gozalo, J M Ferrer Tarrés, A Ayora Ayora, M Alonso Herrero, A Amutio Kareaga, R Ferrer Roca
OBJECTIVE: To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. DESIGN: A longitudinal study with an intrasubject pre-post intervention design was carried out. SETTING: Intensive Care Unit of a tertiary hospital. PARTICIPANTS: A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study...
March 12, 2018: Medicina Intensiva
Felix Miedaner, Ludwig Kuntz, Christian Enke, Bernhard Roth, Anika Nitzsche
BACKGROUND: Physician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups...
March 15, 2018: BMC Health Services Research
Natalie Colaneri, Mark Sheldon, Andrew Adesman
PURPOSE OF REVIEW: Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement...
March 13, 2018: Current Opinion in Pediatrics
Michael R Kolber, Shelley Ross
BACKGROUND AND OBJECTIVES: In Canada, few family physicians (FPs) perform endoscopy. Conflicting evidence exists on the quality of endoscopy performed by Canadian FPs, which may be explained by differing skillsets of these endoscopists. The objective of this study was to perform the first exploration of the practice, skills, and knowledge of Canadian FP endoscopists. METHODS: A cross-sectional survey, including direct knowledge test, was used. RESULTS: Twenty Canadian FP endoscopists completed the survey...
March 2018: Family Medicine
Shamly Austin, Kenneth G Saag, Maria Pisu
Introduction: We examined racial/ethnic disparities in healthcare providers' recommendations for physical activity among individuals with arthritis and evaluated this association among groups of individuals who adhered to physical activity guidelines and those who did not. Methods: With a cross-sectional design based on Behavioral Risk Factor Surveillance System, we analyzed individuals with self-reported physician-diagnosed arthritis, ≥18 years of age ( n = 83,376)...
2018: Arthritis
Kristen M Brown, Shawna S Mudd, Elizabeth A Hunt, Julianne S Perretta, Nicole A Shilkofski, J Wesley Diddle, Gregory Yurasek, Melania Bembea, Jordan Duval-Arnould, Kristen Nelson McMillan
OBJECTIVES: Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training. DESIGN: Prospective pre/post interventional pilot study. SETTING: University simulation center. SUBJECTS: Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America...
March 10, 2018: Pediatric Critical Care Medicine
Marta Trapero-Bertran, Celia Muñoz, Kathryn Coyle, Doug Coyle, Adam Lester-George, Reiner Leidl, Bertalan Németh, Kei-Long Cheung, Subhash Pokhrel, Ángel Lopez-Nicolás
AIMS: To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion...
March 13, 2018: Addiction
John W Wax, Amy W An, Nicole Kosier, Timothy E Quill
Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support...
March 2018: Journal of the American Geriatrics Society
Derek S Tsang, Jennifer M Jones, Osai Samadi, Suhayb Shah, Nicholas Mitsakakis, Charles N Catton, William Jeon, Joshua To, Henriette Breunis, Shabbir M H Alibhai
PURPOSE: To evaluate the ability of a multimodal patient education initiative to improve adherence to healthy bone behaviors (HBBs) in men with prostate cancer receiving androgen deprivation therapy (ADT). METHODS: This was a pilot prospective, single-site, before-and-after clinical trial. The control arm (n = 51) received routine care. The intervention arm (n = 52) received multimodal HBB education which included a healthy bones prescription (BoneRx), focused face-to-face education with an oncology nurse or physician, and customized educational materials...
March 12, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Cynthia Cheng, Fatima Mithoowani, Thomas Ungar, Monica Lee
Background: Interaction between alcohol and certain medications can lead to adverse consequences. Individuals with mental health disorders are particularly vulnerable because of their psychotropic medications, which are typically taken over extended periods and which are known to have pharmacokinetic and pharmacodynamic interactions with alcohol. It is unknown what education these patients receive from their health care providers and how such interactions are managed. Objectives: To determine whether individuals with mental health disorders are aware of alcohol-drug interactions and if so, how they use such information...
January 2018: Canadian Journal of Hospital Pharmacy
Susanne Blödt, Maleen Kaiser, Yvonne Adam, Sandra Adami, Martin Schultze, Jacqueline Müller-Nordhorn, Christine Holmberg
OBJECTIVE: To analyse the role and meaning of health information in individuals' experiences with either breast, colorectal or prostate cancer in order to better understand unmet information needs of people with a cancer diagnosis. DESIGN: This is a secondary analysis of data from a qualitative interview study including narrative interviews and maximum variation sampling. A thematic analysis was conducted, followed by an in-depth analysis based on the principles of grounded theory...
March 12, 2018: BMJ Open
Julia Tasset, Lisa H Harris
Access to abortion in the United States has eroded significantly. Accordingly, there is a growing movement to empower women to self-induce abortion. To date, physicians' roles and responsibilities in this changing environment have not been defined. Here, we consider a harm reduction approach to first-trimester abortion as a way for physicians to honor clinical and moral obligations to care for women, negotiate ever-increasing abortion restrictions, and support women who consider abortion self-induction. Harm reduction approaches to abortion have been successfully implemented in a range of countries around the world and typically take the form of teaching women how to use misoprostol...
March 8, 2018: Obstetrics and Gynecology
Sandeep T Samuel, Anthony D Martinez, Yang Chen, Marianthi Markatou, Andrew H Talal
AIM: To understand the role of knowledge as a promoter of hepatitis C virus (HCV) screening among primary care physicians (PCP). METHODS: A 45-item online questionnaire assessing knowledge of HCV natural history, risk factors, and treatment was distributed to 163 PCP. Logistic regression, adjusted for survey responses, assessed associations between PCP knowledge of HCV natural history and treatment and birth cohort ( i.e ., birth between 1945 and 1965) screening...
February 27, 2018: World Journal of Hepatology
Catherine A Pembroke, Joanne Alfieri, Alain Biron, Carolyn Freeman, Tarek Hijal
PURPOSE: Quality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. METHODS AND MATERIALS: A QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology...
March 2018: Practical Radiation Oncology
Brigid M Gillespie, Emma Harbeck, Joanne Lavin, Therese Gardiner, Teresa K Withers, Andrea P Marshall
BACKGROUND: The surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery. Although mandated in many health care institutions around the world, challenges in implementation of the SSC continue. To use Normalisation Process Theory (NPT) to help understand how/why implementation of a complex intervention coined Pass The Baton (PTB) could help explain what facets of the Surgical Safety Checklist use led to its' integration in practice, while others were not...
March 9, 2018: BMC Health Services Research
Isabel M Leal, Lillian S Kao, Burzeen Karanjawala, Richard J Escamilla, Tien C Ko, Stefanos G Millas
BACKGROUND: Greater understanding of barriers to screening of colorectal cancer among lower socioeconomic, particularly Hispanic, patients is needed to improve disparities in care. OBJECTIVE: This study aimed to explore patients' perceptions and experiences of care seeking for colorectal cancer to identify barriers to early diagnosis and treatment. DESIGN: This explorative qualitative study was conducted as a focused ethnography of patients diagnosed with advanced-stage colorectal cancer...
April 2018: Diseases of the Colon and Rectum
Marta M Bruce, Nancy Kassam-Adams, Mary Rogers, Karen M Anderson, Kerstin Prignitz Sluys, Therese S Richmond
Trauma-informed interventions have been implemented in various settings, but trauma-informed care (TIC) has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC. This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Janet L MacNeil Vroomen, Ling Han, Joan K Monin, Kasia J Lipska, Heather G Allore
OBJECTIVES: To estimate the associations between diabetes, heart disease, and dementia, which may increase the difficulty of self-care; model functional disability trajectories jointly with attrition (death or dropout) over 5 years. DESIGN: Population-based complex survey design. SETTING: National Health and Aging Trends Study. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=7,609). MEASUREMENTS: National estimates were generated using sampling weights...
March 9, 2018: Journal of the American Geriatrics Society
Vinayak Dev, Antonio T Fernando, Anecita Gigi Lim, Nathan S Consedine
BACKGROUND: Burnout has numerous negative consequences for nurses, potentially impairing their ability to deliver compassionate patient care. However, the association between burnout and compassion and, more specifically, barriers to compassion in medicine is unclear. This article evaluates the associations between burnout and barriers to compassion and examines whether dispositional self-compassion might mitigate this association. HYPOTHESIS: Consistent with prior work, the authors expected greater burnout to predict greater barriers to compassion...
February 21, 2018: International Journal of Nursing Studies
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