AVALIAÇÃO DO MANEJO PRIMÁRIO DE CASOS DE COLUNA ENTRE MÉDICOS NAS REDES DE SAÚDE DE SÃO PAULO

Executive MBA (EMBA) Degree–Oral and Maxillofacial Surgery Certificate Integrated Program at the University of Rochester: A Pathway to Earn a Specialized Finance Degree During Residency Training

Antonini et al. evaluated gynecologists', obstetricians', and family and community physicians knowledge of breast cancer screening and their adherence to recommendations defined by the BI-RADS™ system. The study demonstrated that inadequate training resulted in insufficient screening and failure to follow the protocols recommended by the BIRADS™ system. ■ Variability in screening protocols: only 42.8% of gynecologists and obstetricians follow the 40-74 years protocol, while 76.6% of family physicians follow the 50-69 years protocol. ■ High rate of incorrect BIRADS. interpretation: there were 46.3% incorrect responses among gynecologists and obstetricians and 77.9% among family physicians, highlighting significant knowledge gaps. ■ Misconception about breast ultrasound: 39.1% of gynecologists and obstetricians and 20.3% of family physicians incorrectly consider ultrasound as a screening method. ■ Impact of inadequate training: inadequate training leads to improper screening practices that do not align with the BIRADS. recommended guidelines. To evaluate the knowledge and practices of gynecologists, obstetricians, and family and community physicians in Brazil regarding breast cancer screening, mammographic findings defined by the BIRADS™ system, and their approach to suspected clinical lesions. This was an observational, cross-sectional, descriptive study conducted using an online research questionnaire distributed via email to 9,000 gynecologists and obstetricians and 5,600 family and community and preventive medicine doctors actively practicing in Brazil. Among gynecologists and obstetricians, 42.8% follow the 40-74 years screening, 33.5% follow the 50-69 years screening, and 23.6% do not follow any specific protocol. Among the family and community physicians, 76.6% follow the 50-69 years screening protocol, and 23.4% do not follow any specific protocol. When we evaluated the responses regarding the behaviors of each BIRADS™ classification, 46.3% of responses were wrong among gynecologists and obstetricians, and 77.9% were wrong among community and preventive medicine doctors, exhibiting a significant difference. The role of breast ultrasound in screening was evaluated; 39.1% of gynecologists and obstetricians and 20.3% of community and preventive medicine doctors consider it as a screening method. Among gynecologists and obstetricians who do not follow any screening protocol, 94.7% consider ultrasound as a screening method. Among community and preventive medicine doctors, only 26.5% of physicians who follow the 50-69 years screening method consider it as a screening method. Inadequate training results in gynecologists and obstetricians, and family and community physicians performing inadequate screening and not following the recommended practices outlined in the BIRADS™ system.

ObjectiveOur objective was to describe the postgraduate education trajectories of family and community physicians in Brazil, where neither primary healthcare nor family and community medicine is recognised as a knowledge...

BACKGROUND:The use of social media (SM) is unlocking infinite opportunities for healthcare disciplines and is fast becoming the preferred medium of communication. This underlines the importance of meeting the challenges of this new era. The aim of this study was to assess the readiness of Saudi family medicine physicians to the use of SM in health promotion and to explore their prospective attitudes toward its use professionally.MATERIALS AND METHODS:The two largest hospital-based primary care centers in the Eastern Province of Saudi Arabia were used for the quantitative analysis. All known physician bloggers in Saudi Arabia from seven different cities were invited to participate in the qualitative aspect of this study. The quantitative component of this study was conducted in the Eastern Province at two main hospitals. A 37-item questionnaire was distributed to all family physicians practising at these hospitals. The qualitative component of this study covered all of Saudi Arabia, and 11 in-depth interviews were held with family physician bloggers, followed by verbatim transcription, content analysis, and coding of the results. Chi-squared and independent t-tests were used. All physicians at the two largest hospitals in the Eastern Province were invited to participate in the quantitative aspect of the study. The response rate was 86.2% (n = 159).RESULTS:Study included 136 primary care physicians; majority were <50 years old (96.3%) with 58.8% females. About 60% were residents and 27.2 % consultants, and 76.5% were were family medicine physicians. Ninety-six percent physicians had SM accounts, the mean use of 3 h per day, 46.3% of the family physicians had good knowledge of SM ethics, and 69.9% used SM professionally for medical issues. Most of the responses showed a strong positive attitude; more than 60% of the participants responded as “agree” or “strongly agree” to the positive statements.CONCLUSION:Organizations urgently need to design their own bioethical guidelines and rules on the safe use of SM by healthcare professionals.

BackgroundDespite increasing prevalence, early-onset type 2 diabetes (EOT2D) has received little clinical and qualitative research attention within England. This qualitative study aimed to explore and understand the unmet needs of people living with early-onset type 2 diabetes (PEOT2D) and their diabetes care within England.MethodsUsing semi-structured interviews, data was collected, transcribed and analysed from 25 PEOT2D and 25 healthcare professionals (HCPs). Taking an abductive approach, data for both cohorts were analysed and interpreted according to four constructs of Normalisation Process Theory (NPT): coherence (sense-making), cognitive participation (engagement), collective action (enactment) and reflexive monitoring (formal and informal appraisal).ResultsOur findings revealed several unmet needs in current treatment and care for PEOT2D. The main unmet need was access to specialist care. Having GP (general practitioner) practices as their main caregivers presented a significant barrier to this population successfully carrying out their diabetes self-care. HCPs in specialist roles expressed similar views and were keen to see PEOT2D receive access to holistic and specialist care via a multidisciplinary team. Data interpretation according to the four constructs of NPT found that implementation of this approach would involve fostering an environment of support that allowed HCPs across the primary and secondary interface to do the following: (1) provide consultations incorporating person-centred care, shared decision-making, and non-judgemental and non-stigmatising behaviours and (2) work in an integrated and synchronous manner using streamlined referrals, interprofessional collaborations and team-based learning. Provision of tailored financial, human (additional staffing) and learning resources was found to be integral to allow creation of tailored multidisciplinary teams, and individual and collective skill enhancement of both specialist and primary care providers.ConclusionAlthough both PEOT2D and specialist care providers are keen for young adults with EOT2D to receive access to specialist and holistic care, there are several resource barriers that must be addressed to allow implementation of their desired approach to treatment and care. Further qualitative research with primary care providers (for example, GPs and practice nurses) involved in EOT2D care is needed to understand if (and how) their views and experiences differ from those providing specialist care.

In many parts of the world, vulnerable patient populations may be cared for by a clinical nurse specialist (CNS). Nurses desiring to develop themselves professionally in the clinical arena, within the specialty of their choice, have the opportunity to obtain the knowledge, skills, experience and qualifications necessary to attain advanced practice positions such as CNS or nurse consultant (NC). Although studies have demonstrated the benefits of such roles and while the World Health Organization (WHO) recommends it, advanced nursing practice is not yet integrated into the health care culture in Saudi Arabia. The reasons for this are multiple, but the most important is the poor image of clinical nursing throughout the country. This article aims to share a perspective on CNS practice, while casting light on some of the obstacles encountered within Saudi Arabia. A model is proposed representing specialist nurse–physician collaborative practice for implementation nationally. The model has been implemented in the care of the colorectal and stoma patient populations while taking into consideration patient population needs and local health care culture. This model is based on the concepts of holistic “patient-centered care”, specialist nurse–physician collaborative practice, and the four practice domains for NCs (expert practice, leadership, research and education) as indicated by the Department of Health in the United Kingdom. We suggest this model will enable the introduction of advanced specialist nursing and collaborative partnerships in Saudi Arabia with benefits for patients, physicians, health care organizations and the nursing profession as a whole.

West Hampshire Community Diabetes Service: re‐commissioning a sustainable model of care

Notes from Cuba: the importance of primary care.

Use of the World Health Organization Checklist—Swedish Health Care Professionals' Experience: A Mixed-Method Study

Normative ethics includes ethical behaviour health care professionals should uphold in daily practice. This study assessed the degree to which primary health care (PHC) professionals endorse a set of ethical standards from these norms. Health care professionals from an urban area participated in a cross-sectional study. Data were collected using an anonymous, self-administered questionnaire. We examined the level of ethical endorsement of the items and the ethical performance of health care professionals using a Rasch multidimensional model. We analysed differences in ethical performance between groups according to sex, profession and knowledge of ethical norms. A total of 452 Professionals from 56 PHC centres participated. The level of ethical performance was lower in items related to patient autonomy and respecting patient choices. The item estimate across all dimensions showed that professionals found it most difficult to endorse avoiding interruptions when seeing patients. We found significant differences in two groups: nurses had greater ethical performance than family physicians (p < 0.05), and professionals who reported having effective knowledge of ethical norms had a higher level of ethical performance (p < 0.01). Paternalistic behaviour persists in PHC. Lesser endorsement of items suggests that patient-centred care and patient autonomy are not fully considered by professionals. Ethical sensitivity could improve if patients are cared for by multidisciplinary teams.

The current study aimed to identify and analyze the prevalence of ethical conflicts experienced by medical students. This study is a cross-sectional and analytical research that was conducted in a public school in the state of Minas Gerais, Brazil. The instrument used for the data collection was a self-administered questionnaire. The data collected were presented in absolute and percentage values. For the analytical statistical treatment of the data, the level of significance was considered p &lt;0.05. The outcome variables were: Experiences of ethical conflicts in interpersonal relations within the medical course and Ethical conduct in health care. The identification of the prevalence of ethical conflicts in the undergraduate program adopted the perspective of different interpersonal relations (academic-teaching, academic-academic, academic-employee, academic-patient, teacher-teacher, teacher-patient, teacher-employee and employee-patient). (Importance of identifying themselves to the health services user and requesting consent to perform the physical examination, assistance without the supervision of the teacher, issuance of health documents without the signature of the professional responsible and use of social networks to share data Of patient). It was verified the association of the outcome variables with sex, year of graduation and course evaluation. A total of 281 undergraduate students enrolled in all undergraduate courses in Medicine of both sexes, with a predominance of female (52.7%). The students reported having experienced conflicting situations in interpersonal relations with teachers (59.6%), provided assistance without proper supervision of a teacher (62.6%), reported having issued health documents without the accompaniment of teachers (18, 5%). The highest frequency was observed among those enrolled in the most advanced years of the undergraduate program (p &lt;0.05). The use of social networks for the purpose of sharing patient data (25.1%) was prevalent in the most advanced years of medical graduation and among those who evaluated the course as regular (p &lt;0.05). It is concluded that undergraduate medical students experienced ethical conflicts during their medical training, with a prevalence of conflicts in the advanced years of the course. From this perspective, it is necessary to provide a space for discussion and collective reflection on the ethical problems experienced by students, during their graduation in Medicine, in order to build a professional ethical practice.

Family physicians offer first contact, comprehensive and coordinated care to patients, and refer those in need of further specialist care to specialists in other clinical departments. This referral decision-making is dependent on certain factors which can lead to variations in the pattern of referrals with impact on the coping capacity of a health facility. This study sought to assess the factors influencing referral decision-makingof family physicians in a tertiary hospital in Nigeria. This was a descriptive cross-sectionalstudy of Family physicians in a tertiary hospital in Nigeria. It utilized a semi-structured, pre-tested self-administered questionnaire to obtain information on respondents' socio-demographic characteristics and factors that influenced respondents' referral decision. IBM SPSS Statistics version 22.0 (Chicago, IL, USA) statistical software was utilized for data analysis. A p-value of less than 0.05 was considered statistically significant. The most reported factors that influenced the clinical decision of respondents to refer patients were the need for definitive treatment or surgery, 35(94.6%) and the need for a specific investigation,26 (70.3%). The least stated factors were: to save cost, patient's gender, patient's attitude and poor adherence to treatment plan, with equal proportions of 2.7% respectively. The most reported factors that influenced the clinical decision of respondents to refer patients were the need for definitive treatment or surgery, and the need for a specific investigation. Work status and the length of practice in Family medicine were also found to play a role in the clinical decision of respondents to refer a patient.

An important goal of medical education is to teach students to use an electronic health record (EHR) safely and effectively. The purpose of this study is to examine medical student accounts of EHR use during their core inpatient clinical clerkships using a national sample. Paper health records (PHRs) are similarly examined. An online survey about health record use within the inpatient component of six core clerkships was administered to medical students after they completed Step 2 Clinical Knowledge of the United States Medical Licensing Examination. The sample included 17,202 U.S. medical students graduating between 2012 and 2016. Mean percentages of clerkships in which students engaged in various health record activities were computed, and analysis of variance was used to examine differences. The mean percentages of clerkships in which a student accessed or entered information into an EHR increased from 78% to 93% and 59% to 72%, respectively. For students who used an EHR, the mean percentage of clerkships in which they entered information remained constant at 76%. Students entered notes during the majority of their clerkships, with increases over time. However, students entered orders in less than a quarter of their clerkships, with decreases over time. The percentage of clerkships in which students used PHRs was lower and declining. Although students used an EHR in the majority of their inpatient core clerkships, they received limited educational experiences related to order and note writing, which could translate into a lack of preparedness for future training and practice.

Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes. The objective was to determine the diagnostic characteristics of a clinical screening tool in combination with measuring early bedside point-of-care (POC) lactate levels in emergency department (ED) patients with suspected sepsis. This was a prospective, observational study set at a suburban academic ED with an annual census of 90,000. A convenience sample of adult ED patients with suspected infection were screened with a sepsis screening tool for the presence of at least one of the following: temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min, or altered mental status. Patients meeting criteria had bedside POC lactate testing following triage, which was immediately reported to the treating physician if ≥2.0 mmol/L. Demographic and clinical information, including lactate levels, ED interventions, and final diagnosis, were recorded. Outcomes included presence or absence of sepsis using the American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions and intensive care unit (ICU) admissions, use of vasopressors, and mortality. Diagnostic test characteristics were calculated using 2-by-2 tables with their 95% confidence intervals (CIs). The association between bedside lactate and ICU admissions, use of vasopressors, and mortality was determined using logistic regression. A total of 258 patients were screened for sepsis. Their mean (± standard deviation [SD]) age was 64 (±19) years; 46% were female, and 82% were white. Lactate levels were 2.0 mmol/L or greater in 80 (31%) patients. Patients were confirmed to meet sepsis criteria in 208 patients (81%). The diagnostic characteristics for sepsis of the combined clinical screening tool and bedside lactates were sensitivity 34% (95% CI = 28% to 41%), specificity 82% (95% CI = 69% to 90%), positive predictive value 89% (95% CI = 80% to 94%), and negative predictive value 23% (95% CI = 17% to 30%). Bedside lactate levels were associated with sepsis severity (p < 0.001), ICU admission (odds ratio [OR] = 2.01; 95% CI = 1.53 to 2.63), and need for vasopressors (OR = 1.54; 95% CI = 1.13 to 2.12). Use of a clinical screening tool in combination with early bedside POC lactates has moderate to good specificity but low sensitivity in adult ED patients with suspected sepsis. Elevated bedside lactate levels are associated with poor outcomes.

Background: The COVID-19 pandemic has taken the world by storm, with cases continuously increasing by the hour and with a shortage of information regarding the virus available to the general public. Despite the availability of trusted online sources, there are still misconceptions relating to the virus floating around. This study aimed to find out the level of misconceptions among healthcare professionals (HCPs) worldwide about the ensuing COVID-19 pandemic. Materials and Methods: A descriptive cross sectional study was conducted through a global online survey. The self-administered questionnaire was designed and registered at an online website (Kwiksurveys). A total of 652 participants from 35 different countries across the world responded. Statistical analysis was performed using SPSS version 23. Socio-demographic and discipline characteristics were compared with the help of the chi-square test and univariate and multivariate logistic regression to find significant relationships. Results: Among all HCPs, general physicians (61.2%) were the most common respondents. The responses from females (63.3%) almost doubled those of men, and nearly half of the participants were working in private institutes (49.2%). Additionally, the major source of information used by HCPs about COVID-19 was social media (55.4%). Regarding misconception assessment, 71.6% of participants had correct concepts regarding COVID-19. However, 28.4% had incorrect information. Female HCPs were 1.49 times more likely to have correct concepts compared to males (OR=1.49, 95% CI=1.04-2.14). Conclusions: The majority of the HCPs were keeping themselves up-to-date with current information concerning the knowledge, prevention, and hygiene practices of COVID-19 infection. However, some misconceptions are deeply rooted in the mindsets of HCPs worldwide and need to be addressed by the continuous professional development of HCPs. The availability of reliable sources of information on the pandemic should be encouraged, with adequate explanations also available to the general public in simple terms.