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Communication and conflict in emergency medicine

Kathleen Ouellet, Robert Sabbagh, Linda Bergeron, Sandeep Kumar Mayer, Christina St-Onge
BACKGROUND: Collaboration is an important competence to be acquired by residents. Although improving residents' collaboration via interprofessional education has been investigated in many studies, little is known about the residents' spontaneous collaborative behavior. The purpose of this exploratory study was to describe how residents spontaneously collaborate. METHODS: Seven first-year residents (postgraduate year 1; three from family medicine and one each from ear, nose, and throat, obstetrics/gynecology, general surgery, and orthopedic surgery) participated in two collaborative meetings with actors performing the part of other health professionals (ie, occupational therapist, physiotherapist, nurse, or social worker)...
2016: Advances in Medical Education and Practice
Rebecca Mathew, Serena Gundy, Diana Ulic, Shariq Haider, Parveen Wasi
PURPOSE: To assess senior internal medicine residents' experience of the implementation of a reduced duty hours model with night float, the transition from the prior 26-hour call system, and the new model's effects on resident quality of life and perceived patient safety in the emergency department and clinical teaching unit at McMaster University. METHOD: Qualitative data were collected during May 2013-July 2014, through resident focus groups held prior to implementation of a reduced duty hours model and 10 to 12 months postimplementation...
September 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Jeremiah Chikovore, Natasha Gillespie, Nuala McGrath, Joanna Orne-Gliemann, Thembelihle Zuma
Men's poorer engagement with healthcare generally and HIV care specifically, compared to women, is well-described. Within the HIV public health domain, interest is growing in universal test and treat (UTT) strategies. UTT strategies refer to the expansion of antiretroviral therapy (ART) in order to reduce onward transmission and incidence of HIV in a population, through a "treatment as prevention" (TasP). This paper focuses on how masculinity influences engagement with HIV care in the context of an on-going TasP trial...
2016: AIDS Care
I García-Romera, A Danet, J C March-Cerdà
OBJECTIVE: To determine the perception and self-assessment on leadership among health care team leaders in Andalusia. MATERIAL AND METHODS: Design: Exploratory descriptive study using quantitative and qualitative methodology, developed between 2013 and 2015, using a questionnaire and semi-structured interviews. PLACE: Andalusia. PARTICIPANTS: All health managers from the Primary Care Management Units and Health Management Areas of the Departments of Paediatrics, Emergency and Internal Medicine, for the quantitative study...
June 2, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Bruce Arroll, Emily-Charlotte Frances Allen
BACKGROUND: There is a debate in medicine about the value of self-disclosure by the physician as a communication tool. AIM: To review the empirical literature of self-disclosure in primary care. DESIGN AND SETTING: Systematic review of empirical literature relating to self-disclosure by primary care physicians (including US paediatricians) from seven electronic databases (MEDLINE(®), Scopus, PsycINFO, Embase, Social Sciences Citation Index, EBSCOhost, and Cochrane Central Register of Controlled Trials [CENTRAL])...
September 2015: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Stéphane Besançon, Ibrahima-Soce Fall, Mathieu Doré, Assa Sidibé, Olivier Hagon, François Chappuis, David Beran
BACKGROUND: The World Health Organization proposes 6 building blocks for health systems. These are vulnerable to challenges in many contexts. Findings from a 2004 assessment of the health system in Mali for diabetes care found many barriers were present for the management and care of this condition. Following this assessment different projects to strengthen the healthcare system for people living with diabetes were undertaken by a local NGO, Santé Diabète. CASE DESCRIPTION: In March 2012, following a Coup in Bamako, the northern part of Mali was occupied and cut-off from the rest of the country...
2015: Conflict and Health
Amir Khorram-Manesh, Michael Ashkenazi, Ahmadreza Djalali, Pier Luigi Ingrassia, Tom Friedl, Gotz von Armin, Olivera Lupesco, Kubilay Kaptan, Chris Arculeo, Boris Hreckovski, Radko Komadina, Philipp Fisher, Stefan Voigt, James James, Elin Gursky
OBJECTIVE: Unremitting natural disasters, deliberate threats, pandemics, and humanitarian suffering resulting from conflict situations necessitate swift and effective response paradigms. The European Union's (EU) increasing visibility as a disaster response enterprise suggests the need not only for financial contribution but also for instituting a coherent disaster response approach and management structure. The DITAC (Disaster Training Curriculum) project identified deficiencies in current responder training approaches and analyzed the characteristics and content required for a new, standardized European course in disaster management and emergencies...
June 2015: Disaster Medicine and Public Health Preparedness
Fenton O'Leary
The Australasian College for Emergency Medicine (ACEM) will introduce high stakes simulation-based summative assessment in the form of Objective Structured Clinical Examinations (OSCEs) into the Fellowship Examination from 2015. Miller's model emphasises that, no matter how realistic the simulation, it is still a simulation and examinees do not necessarily behave as in real life. OSCEs are suitable for assessing the CanMEDS domains of Medical Expert, Communicator, Collaborator and Manager. However, the need to validate the OSCE is emphasised by conflicting evidence on correlation with long-term faculty assessments, between essential actions checklists and global assessment scores and variable interrater reliability within individual OSCE stations and for crisis resource management skills...
April 2015: Emergency Medicine Australasia: EMA
Robert Robinson
BACKGROUND: Most academic hospitalists fulfil the role of clinician educator and have many opportunities for the bedside clinical teaching of resident physicians; however, hospitalists are promoted at lower rates than traditional internal medicine faculty staff. The conflict between the demands of clinical productivity and time to teach may be central to understanding the lower rates of academic promotion seen in hospitalists. This investigation explores the relationship between clinical productivity and learner evaluations of hospitalist clinician educators...
February 2015: Clinical Teacher
Amy Linsky, Steven R Simon, Barbara Bokhour
OBJECTIVE: While many patients prefer fewer medications, decisions about medication discontinuation involve collaboration between patients and providers. We sought to identify patient perspectives on intentional medication discontinuation in order to optimize medication use. METHODS: We conducted 20 interviews and two focus groups with a convenience sample of patients (22 men, 5 women; mean age 66 years) at two US Veterans Affairs Medical Centers. We queried patients' experiences with and attitudes toward taking multiple medications, preferences about taking fewer medications, and communication with their providers about stopping a medicine...
February 2015: Patient Education and Counseling
Cindy Ottiger Mankaka, Gérard Waeber, David Gachoud
BACKGROUND: Doctors, especially doctors-in-training such as residents, make errors. They have to face the consequences even though today's approach to errors emphasizes systemic factors. Doctors' individual characteristics play a role in how medical errors are experienced and dealt with. The role of gender has previously been examined in a few quantitative studies that have yielded conflicting results. In the present study, we sought to qualitatively explore the experience of female residents with respect to medical errors...
2014: BMC Medical Education
Janet A Parsons, Natalie A Baker, Telisha Smith-Gorvie, Pamela L Hudak
OBJECTIVE: Encounters between patients and physicians who do not speak the same language are relatively common in Canada, particularly in urban settings; this trend is increasing worldwide. Language discordance has important effects on health outcomes, including mortality. This study sought to explore physicians' experiences of care provision in situations of language discordance in depth. DESIGN: Qualitative study based on individual interviews. Interview guides elicited physicians' perspectives on how they determined whether communication could proceed unaided...
2014: BMJ Open
E Montero Ruiz, Á Rebollar Merino, V Melgar Molero, J M Barbero Allende, A Culebras López, J López Álvarez
OBJECTIVE: Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. MATERIAL AND METHODS: A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period...
January 2014: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
B Min, L K Allen-Scott, B Buntain
In order to address the complexity inherent in researching One Health (OH) issues, we support the concept that researchers must transcend individual disciplinary and non-disciplinary boundaries, and move into the realm of transdisciplinary (TD) research approaches. For the purposes of this paper we use the term OH and the concept that OH research is conducted to solve complex health challenges at the animal-human--human-ecosystem interface. TD goes beyond interdisciplinary research to engages disciplines and communities through a unified conceptual framework...
November 1, 2013: Preventive Veterinary Medicine
F Keller, G Allert, H Baitsch, G Sponholz
Problems emerge in practical medicine because the binary ethics of the classic patient/doctor relationship has been replaced by multiagent interaction between those engaged in the process of diagnosis and treatment. New methods are required to deal with complex problems in every patient. Where and why the current practice can fail is illustrated with an example of an unspectacular routine case of cancer. The failure may result from basing the procedure on mechanistic methods or from the deficit and difficulty in communication...
December 2006: Medical Humanities
Emmanouil I Sakelliadis, Stavroula A Papadodima, Chara A Spiliopoulou
The surgeon may face in every day practice issues that may render him liable. The legal liability usually emerges due to the negligence exhibited during the preoperative, the operative and the postoperative stage. The surgeon, as any doctor, isn't liable for the result, but he is responsible for the correct diagnosis and therapeutic treatment, always according to the principles of the Medical science and to the possibilities available to him in every specific case (facilities and time). The continuous education about the issues of his speciality, the adaptation of scientifically approved techniques, the correct monitoring of the patient, both preoperatively and postoperatively, and finally the good communication with the patient are necessary for the proper practice of Medicine; but also constitute the "shield" of the surgeon against any possible legal conflict...
May 2013: Journal of Forensic and Legal Medicine
George A Jelinek, Claudia H Marck, Tracey J Weiland, Jennifer Philip, Mark Boughey, Jennifer Weil, Heather Lane
BACKGROUND: People with advanced cancer frequently present to hospital EDs. International studies report conflicting attitudes towards providing such care and difficulties with communication. The experience of Australian clinicians, however, is not described. OBJECTIVE: The present study aims to identify issues important to emergency, palliative care (PC) and oncology clinical staff in managing people with advanced cancer presenting to EDs. METHODS: We qualitatively explored views of Australian clinicians working in emergency medicine, PC and oncology, via focus groups at two major hospitals and two community PC services in Melbourne, Victoria, and emergency clinicians from all other Australian states and territories via semi-structured telephone interviews...
April 2013: Emergency Medicine Australasia: EMA
Neal I Lindeman, Philip T Cagle, Mary Beth Beasley, Dhananjay Arun Chitale, Sanja Dacic, Giuseppe Giaccone, Robert Brian Jenkins, David J Kwiatkowski, Juan-Sebastian Saldivar, Jeremy Squire, Erik Thunnissen, Marc Ladanyi
OBJECTIVE: To establish evidence-based recommendations for the molecular analysis of lung cancers that are that are required to guide EGFR- and ALK-directed therapies, addressing which patients and samples should be tested, and when and how testing should be performed. PARTICIPANTS: Three cochairs without conflicts of interest were selected, one from each of the 3 sponsoring professional societies: College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology...
July 2013: Journal of Thoracic Oncology
H Kentenich, A Tandler-Schneider
The role of the physician in the context of in vitro fertilization and preimplantation genetic diagnosis has certain distinct characteristics. Involuntary childlessness by definition of the WHO is a disease with good treatment options. As it is not considered a medical emergency, the focus lies more on intensive information giving, education, and counseling. Because the diagnosis and treatment can be a medical and psychological strain for the couple, counseling should address both medical and psychological aspects...
September 2012: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
N Jacobs, K Rourke, J Rutherford, A Hicks, S R C Smith, P Templeton, S A Adams, J O Jansen
BACKGROUND: Complex lower limb injury caused by improvised explosive devices (IEDs) has become the signature wounding pattern of the conflict in Afghanistan. Current classifications neither describe this injury pattern well, nor correlate with management. There is need for a new classification, to aid communication between clinicians, and help evaluate interventions and outcomes. We propose such a classification, and present the results of an initial prospective evaluation. PATIENTS AND METHODS: The classification was developed by a panel of military surgeons whilst deployed to Camp Bastion, Afghanistan...
September 2014: Injury
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