Think Human factors doesn't have an impact on clinical outcomes like infection rates? Guess again! According to the World Health Organization (2017), infections acquired in healthcare settings represent the most frequent adverse event occurring in the delivery of healthcare and no institution or country has solved the problem yet.
Full Details: https://goo.gl/Z7Mhuy
Controladores y estrategias para evitar la sobreutilización sanitaria en Aten...Javier González de Dios
Objectives: Identify the sources of overuse from the point of view of the Spanish primary care professionals, and
analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals
face these demands.
Design: A cross-sectional study.
Setting: Primary care in Spain.
Participants: A non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was
recruited during the survey.
Primary and secondary outcome measures: The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.
Results: In all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments
that patients could find on printed and digital media, contributed to the professional’s inability to adequately
counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x2 =88.8, P<0.001,
percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x2 =175.7,
P<0.001, PD=12.3).
Conclusion: Satisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.
The Transtheoretical Model also called the Stages
of Change model,7 describes how such behavior
change often occurs. The model emphasizes the
need to understand the experience of the person we
are trying to reach in order to help them. To promote
change, interventions must be provided that are
appropriate for the stage in the process that people
are in."
"Meet people where they are:
The guiding principle of “meeting people where
they are” means more than showing compassion
or tolerance to people in crisis. This principle also
asks us to acknowledge that all people we meet are
at different stages of behavior change."
Think Human factors doesn't have an impact on clinical outcomes like infection rates? Guess again! According to the World Health Organization (2017), infections acquired in healthcare settings represent the most frequent adverse event occurring in the delivery of healthcare and no institution or country has solved the problem yet.
Full Details: https://goo.gl/Z7Mhuy
Controladores y estrategias para evitar la sobreutilización sanitaria en Aten...Javier González de Dios
Objectives: Identify the sources of overuse from the point of view of the Spanish primary care professionals, and
analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals
face these demands.
Design: A cross-sectional study.
Setting: Primary care in Spain.
Participants: A non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was
recruited during the survey.
Primary and secondary outcome measures: The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.
Results: In all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments
that patients could find on printed and digital media, contributed to the professional’s inability to adequately
counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x2 =88.8, P<0.001,
percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x2 =175.7,
P<0.001, PD=12.3).
Conclusion: Satisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.
The Transtheoretical Model also called the Stages
of Change model,7 describes how such behavior
change often occurs. The model emphasizes the
need to understand the experience of the person we
are trying to reach in order to help them. To promote
change, interventions must be provided that are
appropriate for the stage in the process that people
are in."
"Meet people where they are:
The guiding principle of “meeting people where
they are” means more than showing compassion
or tolerance to people in crisis. This principle also
asks us to acknowledge that all people we meet are
at different stages of behavior change."
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
Comparisonof Clinical Diagnoses versus Computerized Test Diagnoses Using the ...Nelson Hendler
The Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com was able to help the former Dean of Los Angeles Chiropractic College detect medical diagnoses which he had overlooked, and he later confirmed.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
A study on drug utilisation evaluation of Bronchodilators using defined daily...Dr. Afreen Nasir
Conference proceeding: Nasir A. A study on drug utilisation evaluation of Bronchodilators using a defined daily dose method. Pharmacy Education Journal [Internet]. 2023 Aug;23(5):23–24. Available from: https://doi.org/10.46542/pe.2023.235.138
V O L U M E 3 4 - N U M B E R 4 - F A L L 2 0 1 6 187FEATURE ART.docxkdennis3
V O L U M E 3 4 , N U M B E R 4 , F A L L 2 0 1 6 187
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Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting Kristen L. Marjama, JoAnn S. Oliver, and Jennifer Hayes
Diabetes is the seventh leading cause of death in the United States, burdening society with
high costs for treatment and placing increased demand on the health care system (1). According to the 2014 National Diabetes Statistics Report, an estimated 29.1 million people in the United States have diabetes, and 8.1 million of them are undiagnosed (2). The lack of screening for early identification of patients at risk for type 2 diabetes is a significant clin- ical problem. Health care providers (HCPs) need to be aware of the in- creasing diabetes burden and to pri- oritize the screening of patients who may be at risk. Screening for risk can aid in both efforts to prevent the development of diabetes and early management of the disease to reduce complications. Clinical trials have demonstrated that type 2 diabetes can be delayed or prevented through life- style modification or pharmacother- apy for people at increased risk (3).
In order to reduce risk for those at risk of developing diabetes, screen- ing is a priority that will raise patient
awareness. Many patients are not aware of their risk for type 2 dia- betes until they receive a confirmed diagnosis from their HCP. There are numerous health care settings in which screenings can be imple- mented, including but not limited to primary care practices, urgent care centers, hospital emergency depart- ments, and retail health clinics.
Retail clinics are located in retail supermarket and pharmacy chains to provide high-quality, affordable, and easily accessible health care services for communities. A true measure of quality in retail clinics is their degree of adherence to several measures iden- tified in the Healthcare Effectiveness Data and Information Set (4). Services in this type of setting may include treatment of acute episodic conditions, physical examinations, vaccinations, health screenings, and prevention and management of chronic conditions (5). Retail clinics provide services to patients with or without insurance or a primary care “home.†Patients’ visits to a retail clinic afford the opportunity to assess
■IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association’s Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail cli.
Delirium Care Pathway MoDelirium Care Pathway Model Design: STOP DELIRIUMdel ...komalicarol
We present a delirium care pathway model that we have dubbed
STOP DELIRIUM. Due to delirium's magnitude and effect in elderly hospitalized patients, we recommend hospitals must have
a delirium care pathway for early identification, prevention, and
delirium management. The protocol STOP DELIRIUM is driven
from evidence-based guidelines to help establish the aim "STOP"
for Spot, Think, Optimize and Prevent delirium. The clinical
pathway model needs to incorporate a clinical information management system and educational materials to increase delirium
awareness. The implementation should be scalable and adaptable
to incorporate other departments.
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
Comparisonof Clinical Diagnoses versus Computerized Test Diagnoses Using the ...Nelson Hendler
The Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com was able to help the former Dean of Los Angeles Chiropractic College detect medical diagnoses which he had overlooked, and he later confirmed.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
A study on drug utilisation evaluation of Bronchodilators using defined daily...Dr. Afreen Nasir
Conference proceeding: Nasir A. A study on drug utilisation evaluation of Bronchodilators using a defined daily dose method. Pharmacy Education Journal [Internet]. 2023 Aug;23(5):23–24. Available from: https://doi.org/10.46542/pe.2023.235.138
V O L U M E 3 4 - N U M B E R 4 - F A L L 2 0 1 6 187FEATURE ART.docxkdennis3
V O L U M E 3 4 , N U M B E R 4 , F A L L 2 0 1 6 187
F E
A T
U R
E A
R T
IC L
E
Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting Kristen L. Marjama, JoAnn S. Oliver, and Jennifer Hayes
Diabetes is the seventh leading cause of death in the United States, burdening society with
high costs for treatment and placing increased demand on the health care system (1). According to the 2014 National Diabetes Statistics Report, an estimated 29.1 million people in the United States have diabetes, and 8.1 million of them are undiagnosed (2). The lack of screening for early identification of patients at risk for type 2 diabetes is a significant clin- ical problem. Health care providers (HCPs) need to be aware of the in- creasing diabetes burden and to pri- oritize the screening of patients who may be at risk. Screening for risk can aid in both efforts to prevent the development of diabetes and early management of the disease to reduce complications. Clinical trials have demonstrated that type 2 diabetes can be delayed or prevented through life- style modification or pharmacother- apy for people at increased risk (3).
In order to reduce risk for those at risk of developing diabetes, screen- ing is a priority that will raise patient
awareness. Many patients are not aware of their risk for type 2 dia- betes until they receive a confirmed diagnosis from their HCP. There are numerous health care settings in which screenings can be imple- mented, including but not limited to primary care practices, urgent care centers, hospital emergency depart- ments, and retail health clinics.
Retail clinics are located in retail supermarket and pharmacy chains to provide high-quality, affordable, and easily accessible health care services for communities. A true measure of quality in retail clinics is their degree of adherence to several measures iden- tified in the Healthcare Effectiveness Data and Information Set (4). Services in this type of setting may include treatment of acute episodic conditions, physical examinations, vaccinations, health screenings, and prevention and management of chronic conditions (5). Retail clinics provide services to patients with or without insurance or a primary care “home.†Patients’ visits to a retail clinic afford the opportunity to assess
■IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association’s Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail cli.
Delirium Care Pathway MoDelirium Care Pathway Model Design: STOP DELIRIUMdel ...komalicarol
We present a delirium care pathway model that we have dubbed
STOP DELIRIUM. Due to delirium's magnitude and effect in elderly hospitalized patients, we recommend hospitals must have
a delirium care pathway for early identification, prevention, and
delirium management. The protocol STOP DELIRIUM is driven
from evidence-based guidelines to help establish the aim "STOP"
for Spot, Think, Optimize and Prevent delirium. The clinical
pathway model needs to incorporate a clinical information management system and educational materials to increase delirium
awareness. The implementation should be scalable and adaptable
to incorporate other departments.
Paediatricians provide higher quality care to children and adolescents in pri...Javier González de Dios
Hay una pregunta que plantea un debate mantenido: ¿qué profesional médico es el más adecuado para impartir cuidados de salud a niños en Atención Primaria en países desarrollados?. Adecuación medida como mayor calidad en términos de salud de la población infantil, entendiendo la calidad en sus tres dimensiones: científico-técnica, relacional-percibida y organizativo-económica.
No es fácil definir qué indicadores de calidad en salud infantil debemos tener en cuenta, pero desde el Grupo de Trabajo de Pediatría Basada en la Evidencia se ha intentado responder a esa pregunta bajo el formato de una revisión sistemática. Y se ha hecho en dos momentos: en aquel año 2010 con la publicación “¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática”, publicada en español en la revista de Pediatría de Atención Primaria y este mismo año 2020 con la publicación “Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review” publicado en inglés en la revista Acta Paediatrica, y que se adjunta debajo par su revisión.
Sus conclusiones tienden a reforzar la postura de la Asociación Española de Pediatría, en general, y de sus dos sociedades de Primaria (AEPap y SEPEAP), en particular, de defensa de la Atención Primaria de niños y adolescentes por pediatras en España. Porque en vista de los resultados expuestos, parece recomendable mantener la figura del pediatra en los equipos de Atención Primaria y reforzar su función específica como primer punto de contacto del niño con el sistema sanitario.
Effectiveness of the nursing educational program upon nurse's knowledge and p...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
2
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
1
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented (Alp & Damani, 2015). Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it (Berríos-Torres, et al., 2017). Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital (Khan, Baig & Mehboob, 2017; Suleyman, & Alangaden, 2016).
Rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determi.
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
18
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
2
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented. 3 Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it. 4 Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. 6 While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital. 5, 7
The rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determine how best an administration has taken care of their needs. Establishing an infection contro.
Patient-centered pharmacovigilance represents a pivotal shift in the landscape of healthcare, emphasizing the active involvement of patients in the monitoring and reporting of adverse drug reactions. Unlike traditional pharmacovigilance, which primarily relies on healthcare professionals to identify and document adverse events, this approach recognizes patients as critical stakeholders in ensuring medication safety. By empowering patients to share their experiences, concerns, and observations regarding medication effects, whether positive or negative, healthcare systems can gain a comprehensive understanding of drug safety and efficacy in real-world settings. Patient-centered pharmacovigilance fosters a collaborative partnership between patients, healthcare providers, and regulatory agencies, promoting transparency, accountability, and ultimately, better patient outcomes. Through increased patient engagement and the utilization of patient-reported data, this approach enables healthcare systems to identify potential safety issues earlier, tailor treatment strategies to individual needs, and enhance overall drug safety surveillance efforts.
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RESUMO
Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde
apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir
estratégias de prevenção e vigilância em saúde ocupacional.
Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores
da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo
com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de
Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p.
Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o in-
cidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam
ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema.
Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da
respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado
reflete o efeito prejudicial da exposição a fontes de stress e ameaça.
Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece
uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo.
Palavras-chave: Fatores de Risco Profissionais; Prevenção; Saúde Ocupacional; Trabalhadores da Saúde; Violência no Local de
Trabalho
Workplace Violence in Healthcare: A Single-Center Study
on Causes, Consequences and Prevention Strategies
A Violência no Local de Trabalho em Instituições
de Saúde: Um Estudo Monocêntrico sobre Causas,
Consequências e Estratégias de Prevenção
1. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal.
2. Emergency Department. Hospital Professor Doutor Fernando da Fonseca. Amadora. Portugal.
3. CISP - Centro de Investigação em Saúde Pública. CHRC - Comprehensive Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa.
Portugal.
4. Occupational Health Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal.
Autor correspondente: Helena Sofia Antão. [email protected]
Recebido: 22 de outubro de 2018 - Aceite: 10 de julho de 2019 | Cop.
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Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com 31
RESUMO
Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde
apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir
estratégias de prevenção e vigilância em saúde ocupacional.
Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores
da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo
com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de
Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p.
Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o in-
cidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam
ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema.
Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da
respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado
reflete o efeito prejudicial da exposição a fontes de stress e ameaça.
Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece
uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo.
Palavras-chave: Fatores de Risco Profissionais; Prevenção; Saúde Ocupacional; Trabalhadores da Saúde; Violência no Local de
Trabalho
Workplace Violence in Healthcare: A Single-Center Study
on Causes, Consequences and Prevention Strategies
A Violência no Local de Trabalho em Instituições
de Saúde: Um Estudo Monocêntrico sobre Causas,
Consequências e Estratégias de Prevenção
1. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal.
2. Emergency Department. Hospital Professor Doutor Fernando da Fonseca. Amadora. Portugal.
3. CISP - Centro de Investigação em Saúde Pública. CHRC - Comprehensive Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa.
Portugal.
4. Occupational Health Department. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal.
Autor correspondente: Helena Sofia Antão. [email protected]
Recebido: 22 de outubro de 2018 - Aceite: 10 de julho de 2019 | Cop ...
Similar to Low clinical value practices and harm caused by doing what should not be done in primary care in Spain. Delphi study (20)
Hace poco anunciamos el inicio de una sección en la revista Pediatría Integral, bajo el nombre de “Terapia cinematográfica en la infancia y adolescencia”, un guiño que quiere poner en relación la ciencia (pediátrica) con el arte (cinematográfico), y hacer del séptimo arte un instrumento más para cimentar la arteterapia en nuestro día a día.
Y bajo este concepto hoy damos comienzo a la primera “prescripción”, bajo el título de “Prescribir películas para adentrarnos en la infancia y adolescencia”. Porque nuestra especialidad se denomina como Pediatría y sus Áreas Específicas, lo que da a entender la amplitud, complejidad y complementariedad de nuestra profesión, que comprende todos los campos de la medicina y de la sanidad, y que abarca cronológicamente desde el nacimiento hasta que el niño llegue a la adolescencia, normalmente hasta los 18 años (aunque incluso hay organismos internacionales que extienden la edad hasta los 21 años) y donde se distinguen varios periodos: recién nacido (0-6 días), neonato (7-29 días), lactante (lactante menor; 1-12 meses de vida, lactante mayor; 1-2 años), preescolar (3-5 años), escolar (6-11 años), puberto (12-14 años) y adolescente (15-18 años).
Tras más de 720 películas comentadas hasta la fecha en el proyecto Cine y Pediatría, no resulta fácil seleccionar aquellas películas que destilen la esencia de esta etapa tan especial de la vida que es la infancia y adolescencia. Pero hoy hemos elegido siete películas que tienen dos características en común: son películas documentales (por lo que no son actores ni actrices sus protagonistas, sino niños y niñas reales) y son películas en francés (y queremos destacar el sentido y sensibilidad de la filmografía que llega desde Canadá, Bélgica y, principalmente, de Francia). Y todas ellas nos dan una visión poliédrica real de esta etapa compleja y maravillosa como es la infancia y la adolescencia (aunque a la adolescencia dedicaremos un capítulo monográfico, porque son tantas las películas enfocadas a esta etapa que llevamos tiempo reivindicándola como un género cinematográfico).
Estas películas son, por orden cronológico de estreno:
- Bebés (Bébé, Thomas Balme, 2010) 3, para entender la normalidad de un recién nacido y lactante.
- Solo es el principio (Ce n'est qu'un debut, Jean-Pierre Pozzi, Pierre Barougier, 2010) 4, para reconocer a los niños como nuestros pequeños filósofos.
- Camino a la escuela (Sur le chemin de l'école, Pascal Plisson, 2013) 5, para reflexionar sobre los distintos caminos que nos llevan a la escuela.
- A cielo abierto (À ciel ouvert, Mariana Otero, 2013) 6, para no olvidar que existen infancias con importantes problemas psiquiátricos.
- El gran día (Le grand jour, Pascal Plisson, 2015) 7, para homenajear el esfuerzo y la dedicación desde los primeros años para alcanzar un sueño, un himno a la esperanza y el coraje.
- Ganar al viento (Et les mistrals gagnants, Anne-Dauphine Julliand, 2016) 8, para demostrar que una hermosa vida con una enfermedad rara
Cada año nacen aproximadamente 15 millones de niños prematuros (< 37 semanas de gestación) en el mundo, de los cuales más de un millón muere antes de cumplir los 5 años. Es más, desde el año 2015 se ha establecido que los nacimientos prematuros son la principal causa de muerte infantil del mundo y, en muchos casos, aquellos bebés que logran sobrevivir pueden desarrollar patologías como retraso cognitivo, trastornos del neurodesarrollo, pérdida de visión o audición y hasta parálisis cerebral.
Unos pacientes donde es esencial que los cuidados sean de la mejor calidad científica y con el mayor nivel de humanización.
Foro de la Profesión Médica-La profesión médica defiende la equidad y cohesió...Javier González de Dios
En estos complicados momentos de la política española, con una sociedad dividida por las concesiones políticas, económicas y sociales que el PSOE ha prometido a determinadas Comunidades Autónomas que buscan la segregación de España, acaban de aparecer noticias preocupantes al respecto del sistema MIR que ha sido ya anunciado en prensa: “El PSOE abre la puerta a transferir el MIR a Cataluña, País Vasco y Galicia”. Una noticia frente a la que la comunidad médica muestra su más firme rechazo, por lo que supodría dinamitar un modelo de éxito.
Y en este sentido, el Foro de la Profesión Médica (conformado por el Consejo General de Colegios Oficiales de Médicos –CGCOM, la Federación de Asociaciones Científico Médicas de España – FACME, la Confederación Estatal de Sindicatos Médicos - CESM, la Conferencia Nacional de Decanos de Facultades de Medicina - CNDFM y el Consejo Estatal de Estudiantes de Medicina – CEEM) acaba de publicar este documento, consensuado este fin de semana, y en el que se defendiede la equidad y la cohesión nacional del sistema MIR actual y la necesidad de cumplir con las directivas europeas para homologación de títulos.
Una reflexión sobre la prevenciíon cuaternaria, con varias preguntas a responder y sobre las que reflexionar:
¿Dónde situamos los distintos tipos de actividades preventivas en la historia natural de la enfermedad?
¿Qué valor tiene el “punto crítico de irreversibilidad” de una enfermedad, así como el “tiempo de adelanto diagnóstico”?
¿Cuáles son los sesgos de las pruebas diagnósticas y de las pruebas de cribado?
¿Qué peso damos a los falsos positivos y al fenómeno de etiquetado en la evaluación de un programa de cribado?
¿Qué papel juega el efecto cascada en el entorno de la detección precoz de enfermedades?
La revista Pediatría Integral es el órgano de expresión de la Sociedad Española de Pediatría Extrahospitalaria y de Atención Primaria (SEPEAP), revista que ha superado ya sus bodas de plata desde que se inició su camino, una revista que ha mantenido su revisión y renovación a lo largo de los años. Es Pediatría Integral una revista con vocación en la formación pediátrica continuada, una puesta al día para mejorar nuestras competencias en las tres grandes dimensiones: saber (conocimientos), saber hacer (habilidades) y saber ser (actitudes). Y Pediatría Integral es un buen foro común que hoy renueva su camino con el inicio de una nueva sección que hemos titulado como “Terapia cinematográfica en la infancia y adolescencia”, un guiño que quiere poner en relación la ciencia (pediátrica) con el arte (cinematográfico), y hacer del séptimo arte un instrumento más para cimentar la arteterapia en nuestro día a día.
Una sección que se nutre del proyecto “Cine y Pediatría”, el cual nació casi sin querer en enero del año 2010 en el blog Pediatría basada en pruebas. Y como que no quiere la cosa, y gracias a la publicación semanal (todos los sábados, sin fallar uno) de un post dedicada a películas que tengan a la infancia y adolescencia como protagonistas (en sus aspectos de la pediatría clínica, social o preventiva), ya hemos publicado más de 720 post. Y desde el blog, “Cine y Pediatría” se ha convertido en realidad en la publicación de 12 libros (con el 13 en edición), uno por año, y con el título de “Cine y Pediatría. Una oportunidad para la docencia y la humanización en nuestra práctica clínica”. Y el proyecto continúa vivo, más vivo si cabe. Y con un objetivo: que los pediatras nos atrevamos a “prescribir” películas, al igual que prescribimos medicamentos, pruebas complementarias o, incluso, direcciones electrónicas de páginas de interés para nuestros pacientes y sus familias. Y para ello nos fundamentamos en estos cinco fundamentos: 1) que la Pediatría es una especialidad “de cine”; 2) que la infancia y adolescencia son los actores de nuestra vida y profesión; 3) que el arte de “prescribir” películas implica arte, ciencia y conciencia; 4) que es preciso aprender a mirar las películas bajo la observación narrativa (prefiguración, configuración y refiguración); y 5) que abogamos por prescribir películas relevantes en su relación con la Pediatría, tanto en su ámbito médico como social.
Y con la experiencia adquirida en el libro electrónico Trilogías del séptimo arte para pediatras “de cine”, estos son algunos de los temas que vamos a ir tratando en sucesivas entregas en Pediatría Integral:
- Películas para entender la infancia
- Películas para entender la importancia de ser pediatra
- Películas para entender las enfermedades raras
- Películas para entender las enfermedades oncológicas
- Películas para entender el trastorno del espectro autista
- Películas para entender otros trastornos del neurodesarrollo
- Películas para entender el síndrome de Down
-
El Día Nacional de la Pediatría en España se celebra el 8 de octubre (o en sus fechas próximas si cayera en fin de semana). Y ello porque la Asociación Española de Pediatría consideró oportuno que esta primera jornada fuera el inicio de un evento que se celebrará anualmente con el objetivo de hacer presente la importante figura de la Pediatría y de los pediatras en nuestra sociedad, como valedores de la salud infanto-juvenil de nuestra población, reivindicando un modelo de asistencia pediátrica modélico y que no pocas veces se cuestiona.
a prevención cuaternaria: herramienta clave para el pediatra del siglo XXIJavier González de Dios
Compartimos la conferencia extraordinaria en el XX Congreso Internacional de Pediatría que se ha celebrado hace dos semanas en Mérida (Yucatán, México) y con el título de “La prevención cuaternaria: herramienta clave para el pediatra del siglo XXI”. Y que se ha desarrollado en estos apartados:
I. Aproximación a la CALIDAD EN SALUD II.
II. GESTIONAR en busca de la (H)EXCELENCIA
III. De la MEDICINA BASADA EN LA EVIDENCIA a la MEDICINA APROPIADA
IV. Profundizando en la PREVENCIÓN CUATERNARIA:
• Prevención cuaternaria y factores de riesgo
• Prevención cuaternaria y pruebas de diagnóstico/cribado
• Prevención cuaternaria y tratamiento
V. REFLEXIONES FINALES, que se pueden resumir así:
- Respecto a los factores de riesgo.
Evitar el EFECTO CASCADA de intervenciones médicas excesivas e innecesarias ante la actual “cultura del riesgo”: la simple asociación estadística entre un factor y una enfermedad (ej. dilatación piélica y anomalías nefrourológicas) se convierte en casi una enfermedad, o en causa necesaria y suficiente de la misma.
- Respecto a las pruebas diagnósticas/cribado.
Considerar en los cribados universales el PUNTO CRÍTICO DE IRREVERSIBILIDAD, el TIEMPO DE ADELANTO DIAGNÓSTICO y el valor de los FALSOS POSITIVOS y el FENÓMENO DE ETIQUETADO Porque no siempre más es mejor. Y hay que evitar la “arrogancia” de la medicina preventiva.
-Respecto al tratamiento.
La EVIDENCE-BIASED MEDICINE limita los resultados de la Evidence-Based Medicine. La “evidencia” es mucho más evidente cuando favorece a los intereses comerciales que a los intereses de los pacientes (ej. anticuerpos monoclonales frente al virus respiratorio sincitial).
Perceptions and attitudes of pediatricians and families with regard to pediat...Javier González de Dios
“Purpose This study aimed to identify the perceptions and attitudes of pediatricians and parents/caregivers regarding medication errors at home, and to compare the fndings from the two populations.
Methods This was a cross-sectional survey study. We designed a survey for working pediatricians and another one for parents or caregivers of children aged 14 years and younger. The survey’s questions were designed to assess provider and parental opinions about the difculty faced by parents providing medical treatment, specifc questions on medication errors, and on a possible intervention program aimed at preventing pediatric medication errors. Pediatrician and parent responses to matching questions in both surveys were compared.
Results The surveys were administered in Spain from 2019 to 2021. In total, 182 pediatricians and 194 families took part. Most pediatricians (62.6%) and families (79.3%) considered that managing medical treatment was not among the main difculties faced by parents in caring for their children. While 79.1% of pediatricians thought that parents consulted the internet to resolve doubts regarding the health of their children, most families (81.1%) said they con sulted healthcare professionals. Lack of knowledge among parents and caregivers was one of the causes of medication errors most frequently mentioned by both pediatricians and parents. Most pediatricians (95.1%) said they would recommend a program designed to prevent errors at home.
Conclusions Pediatricians and families think that medical treatment is not among the main difculties faced by parents in caring for their children. Most pediatricians said they would recommend a medication error reporting and learning system designed for families of their patients to prevent medication errors that might occur in the home environment.”
La ciencia abierta contribuye a aumentar la transparencia y fomentan la participación, la cooperación, la rendición de cuentas, la capacidad de reutilización del trabajo investigador, el impacto y la reproducibilidad de resultados. Así mismo, favorece la democratización y sostenibilidad de los sistemas de I+D+i y promueve la diversificación de perfiles en los grupos de investigación y la incorporación de actores no académicos en todo el ciclo del proceso investigador, desde el diseño del proyecto hasta su evaluación.
Por ello es importante poder conocer este documento del Ministerio de Ciencia y Educación, por título "Estrategia Nacional de Ciencia Abierta (ENCA) 2023 – 2027", y en el que se hace un buen análisis, a través de estos apartados:
- Contexto
- Misión y valor
- Análisis DAFO
- Objetivos estratégicos
- Ejes estratégicos y medidas de actuación por eje:
a) Infraestructuras digitales para la ciencia abierta.
b) Gestión de datos de investigación siguiendo los principios FAIR (Findable, Accesible, Interoperable, Reusable).
c) Acceso abierto a publicaciones científicas.
d) Incentivos, reconocimientos y formación.
- Gobernanza, plan de seguimiento y evaluación.
Nirsevimab y prevención de bronquiolitis en lacatantes nacidos a términoJavier González de Dios
Con motivo del último calendario de vacunaciones (ahora denominado de inmunizaciones) publicado por el Comité Asesor de Vacunas (CAV-AEP), en el que se expresa que “el CAV-AEP recomienda nirsevimab en todos los recién nacidos y lactantes menores de seis meses y su administración anual a niños menores de dos años con enfermedades subyacentes que aumenten el riesgo de infección grave por VRS”, el Comité de Pediatría Basada en la Evidencia acaba de publicar una Evidentia Praxis (que viene a ser una revisión sistemática y valoración crítica de todas las pruebas científicas alrededor de una pregunta clínica estructurada, que aquí corresponde a “En lactantes nacidos a término sanos, ¿es nirsevimab eficaz y seguro para prevenir bronquiolitis por virus respiratorio sincitial?”.
La reflexión final desde el Comité de Pediatría Basada en la Evidencia es: “Pero, ¿tenemos ya suficiente información para hacer una recomendación? ¿es ya el momento para extender su uso universal? Si tenemos en cuenta la carga de enfermedad y la potencial gravedad de las bronquiolitis encontramos argumentos a favor. Pero si consideramos las limitaciones de la evidencia disponible y la conveniencia de conocer los resultados de otros estudios en marcha, la urgencia de la decisión queda cuestionada, por lo que parece prudente esperar para hacer recomendaciones”
El CT-PBE es un comité compartido entre dos sociedades científicas (AEPap y AEP), constituido por pediatras de Atención Primaria y Hospitalaria de España y Latinoamérica, cuyos objetivos han sido y son: 1) asesorar metodológicamente en los protocolos y documentos de la AEP y AEPap; 2) fomentar la implicación de a AEP y AEPap en el desarrollo de GPC; 3( difundir la metodología de la MBE (talleres de búsqueda bibliográfica, lectura crítica, etc.); 4) publicar trimestralmente la revista Evidencias en Pediatría (EVP); 5) impulsar la formación continuada; 6) colaborar de forma habitual con otras revistas científicas (como Revista de Pediatría de Atención Primaria, RPAP, y Formación activa en pediatría de atención primaria, FAPap).
En la presentación se hablan de los cuatro proyectos desarrollados en el último año, alguno de los cuales ya han sido comentados en este blog:
- Guía de práctica clínica COVID 19 en Pediatría (con su versión del año 2021 y actualización del año 2022)
- Revista Evidencias en Pediatría, una revista viva y en continua evolución desde su fundación en el año 2005.
- Calcupedev, la herramienta de cálculo epidemiológico en Pediatría creada desde el propio CT-PBE
- Libro Medicina Basada en la Evidencia, en fase de elaboración y que recogerá el material creado por el CT-PBE durante estas casi dos décadas de existencia. Es el gran reto de este año 2023 y contará con 7 apartados: I. Introducción a la Medicina basada en la evidencia (8 capítulos); II. Diseños metodológicos (15 capítulos); III. Medidas epidemiológicas (7 capítulos); IV. Herramientas para la elaboración de documentos científicos (11 capítulos); V. Lectura crítica de documentos científicos (10 capítulos); VI. Estadística básica (18 capítulos); y VII. Herramientas y calculadoras epidemiológicas (4 capítulos).
En esta presentación, hemos querido responder a tres preguntas:
1. ¿Por qué nace PMRP?
Esta nueva sección de la plataforma Continuum, desarrollada por las diferentes sociedades de especialidad pediátricas de la AEP, se presenta como un complemento virtual de la formación MIR y tiene como propósitos
2. ¿Qué objetivos persigue PMRP?
Se podrían sintetizar en estos tres objetivos: disminuir la variabilidad en la formación de los especialistas en formación, asistir a los tutores en su función docente y facilitar el aprendizaje colaborativo y basado en competencias, el entrenamiento reflexivo y la resolución de problemas propios del perfil profesional de cada especialidad pediátrica por la que roten.
3. ¿Qué ventajas ofrece PMRP para residentes y tutores?
a) Ventaja para los residentes de Pediatría:
- Aprendizaje basado en escenarios clínicos
- Aprendizaje reflexivo
- Aprendizaje colaborativo y comunicación asíncrona
b) Ventajas para los tutores:
- Ayudar en su función docente
- Proporcionar herramientas para lograr evaluar los logros alcanzados
The value of music therapy in the expression of emotions in children with cancerJavier González de Dios
Con respecto al proyecto de tesis que llevamos desarrollando en los últimos años en nuestro Servicio de Pediatría en relación con el valor de la musicoterapia en los pacientes pediátricos oncológicos, en sus familias y en los propios profesionales sanitarios que los atienden, hoy compartimos este artículo “The value of music therapy in the expression of emotions in children with cáncer” publicado en European Jounal of Cancer Care.
Os dejamos el artículo completo para su lectura, pero incluimos el resumen del mismo:
“Background. Children with cancer are subjected to aggressive tests and treatments that can affect their emotional states. Studies available in the academic literature analyse the effect of music therapy on the emotions of these patients are scarce.
Objectives. The objective of this study was to explore and transform the emotional responses that may arise with the application of music therapy (MT) in children with oncological pathology.
Methods. The methodology of this study was based on the participatory action research approach. Semistructured interviews were conducted with 27 children with cancer who participated in 65MT sessions. Interviews were also conducted with their families.
Results. We conducted a thematic analysis using MAXQDA software. Three main categories emerged from this process as follows: (1) expression: children with cancer stated that MT made it easier for them to express their emotions, with indirect benefits to families; (2) participation: patients showed interest in the sessions; and (3) experiences: MT was valued and created a positive environment. The results of this research demonstrate the positive transformative power MT had on children with cancer in terms of their emotions.
Conclusions. Positive results were achieved through MT that encouraged the expression of emotions by children with cancer and favoured and improved their moods. In addition, it also encouraged social interactions in the hospital and helped the children to better cope with their illness through self-awareness. Their families also benefited. Therefore, we encourage healthcare professionals to support the use of MT in paediatric oncology settings”.
La conferencia se desarrolló en seis apartados:
I. El DÍA DEL LIBRO y los días de la Literatura
Donde se recuerda el 23 de abril como el Día Internacional del Libro y algunos pensamientos de literatos de habla española en relación con la importancia de los libros y la lectura.
II. Los 23 LIBROS MÁS VENDIDOS de la Historia
La literatura es indispensable en la Historia, que sin duda sería muy diferente si no tuviéramos libros para conocerla. El tiempo ha conservado aquellos libros que han pasado de generación en generación, siempre con éxito por uno u otro motivo. Y el éxito de ventas ser un buen marcador. Y un reciente estudio realizado sobre los libros impresos que más se vendieron en los últimos 50 años – sin tener en cuenta las ventas digitales - , nos da esta cifra de los 23 libros más vendidos de la historia. Elegimos el 23 en honor a ese 23 de abril, Día del Libro en nuestro país. Y en el top tres se encuentran “Don Quijote de la Mancha”, “Citas del presidentes Mao Tse-Tung” y “La Biblia”, esta última en un destacado e inalcanzable primer lugar.
III. Los 23 ESCRITORES más adaptados al Cine
La fusión entre cine y literatura comienza en los guiones adaptados a partir de obras literarias. Guión adaptado que se fundamenta en tres claves a aplicar a su novela de origen: adecuación lingüística, adecuación de personajes y adecuación al formato de cine. De nuevo elegimos la cifra de los 23 escritores más adaptados al cine y la televisión, listado que está encabezado por un podio (Dickens, Chéjov y Shakespeare, éste muy destacado), pero bien acompañado por otros autores (donde la única mujer es Agatha Christie y el único autor vivo es Stephen King).
IV. Novelas adaptadas en CINE Y PEDIATRÍA
En la parte nuclear de la exposición elegimos 40 películas ya publicadas en Cine y Pediatría y donde la relación con su libro de origen de la historia guarda una especial relación. Una relación cronológica que comienza con “El mago de Oz” (Victor Fleming, 1939) y el libro de cabecera de Lyman Frank Baum publicado en 1900, “The Wonderful Wizard of Oz”, hasta la última versión de “Mujercitas” (Greta Gerwing, 2019) en base a la legendaria obra de Louisa May Alcott publicada en 1868, “Little Women”. Un listado que incluye obras paradigmáticas versionadas a la gran pantalla como “Le avventure de Pinocchio” de Carlo Collodi, “Alicia en el País de las Maravillas” de Lewis Carroll, “The Lord of the Flies” de William Golding o “Le Petit Prince” de Antoine de Saint-Exupèry; pero también novelas menos conocidas como “El juego de los niños” de Juan José Plans, “¿Qué me quieres, amor?” de Manuel Rivas o “Los Pelones” de Albert Espinosa.
V. Un THE END con final feliz
Y cómo toda historia, esta exposición mejor que tenga un final feliz. Y es así que se presentó en primicia el libro Cine y Pediatría 12, adelantándose en tres semanas al acto que tendrá lugar en el XX Festival Internacional de Cine de Alicante. Y también dejamos la lectura de tres ideas finales:
En esta docente presentación en nuestro Servicio de Pediatría se destacan los cuatro momentos clave en la prescripción de antimicrobianos y que sirven para desarrollar las preguntas esenciales que aplican los principios de PROA:
1. ¿Está indicado el tratamiento antibiótico en este paciente?
2. ¿Cuál es el síndrome sospechado?
3. ¿Qué muestras microbiológicas debo extraer para el diagnóstico?
4. ¿Cuál es el antibiótico más apropiado?
5. ¿He aplicado las medidas para el control del foco de la infección?
Era el año 1987 cuando comencé mi Residencia de Pediatría en el Hospital Universitario La Paz (Madrid). Y mi primera rotación fue en Neonatología, en la conocida como Unidad de Transición Neonatal. Y ese fue mi primer contacto con “la 5ª” (como se le conocía entonces) durante seis meses, un servicio liderado en su jefatura por el Prof. José Quero, y con dos jefes de sección de la altura de los Dres. Félix Omeñaca y Jesús Pérez. Y fue allí mi primer contacto con el Dr. Quero, Pepe, como todos le conocíamos.
Y ese contactó se prolongó durante 15 meses al final de mi formación, cuando elegí formarme específicamente como neonatólogo con este equipo. Y allí se fraguó una relación profesional con Pepe, un doctor amante del estudio, afectuoso en la relación, ponderado en las decisiones y amable en las palabras. Cualidades tan apreciables (y poco comunes) para un jefe de servicio y catedrático de Pediatría de aquellos tiempos, lo que convirtió nuestra relación en afecto y amistad. De hecho, mi traslado a la provincia de Alicante hace más de tres décadas se lo debo a él, cuando él me informó y recomendó sobre aquella nueva Unidad Neonatal que se abría en el recién estrenado Hospital Universitario de San Juan.
Continuaron nuestros esporádicos contactos en los congresos científicos y siempre intentábamos vernos, comer juntos, preguntarnos por nuestra vida y nuestra familia. Y siempre iba aderezado por su permanente sonrisa. Lo que se dice, cultivar las relaciones personales que nos regala la vida.
Se jubiló Pepe en el año 2013, tras tres décadas al frente de la Jefatura de Servicio de Neonatología en el Hospital Infantil La Paz (la primera UCIN de España por aquellos inicios), con un amplio bagaje clínico, docente (como Catedrático de Pediatría de la UAM) e investigador, un maestro de muchos de los neonatólogos que hoy lideran esta especialidad en nuestro país. En el mes de enero de este año recibimos la triste noticia de su fallecimiento, y con su partida recuerdo como válido ese pensamiento de que “no es más grande quien más ocupa, sino quien más vacío deja cuando se va”. Y durante este tiempo se han compartido distintos homenajes (In Memoriam) en diferentes revistas y por diferentes amigos que dejó, que fueron muchos, homenaje que merecen las personas que son importantes en nuestra vida.
Quiero destacar el emotivo obituario de un amigo común, el Dr. Félix Omeñaca en Anales de Pediatría, el In Memoriam en la web de Fundación NeNe y en la revista Pediatric Research que os adjunto debajo, estas dos últimas lideradas por el Dr. Alfredo García-Alix.
Un texto de 67 páginas que, en palabras de su autor, el Prof. Manuel Cruz Hernández, "es un resumen de los 30 años de sobreviviente, más de un cuarto de siglo vivido, totalmente inesperado, cuando me llegó la impuesta y no deseada jubilación el 30 de septiembre de 1992, cubriendo la pesadumbre propia con el manto alegre de los Juegos olímpicos de Barcelona". Y es así, como si una bitácora personal y profesional fuera, describe tres décadas fructíferas (desde 1992 a 2022) en esa etapa de "júbilo" que le hace un ejemplo de aprovechar la vida y dar frutos (el texto se ha publicado a sus 97 años de edad).
Creo que una obra así no puede por menos que ser compartida, como ejemplo. Y con su permiso, así lo hago. Gracias, estimado maestro y amigo, Prof. Cruz Hernández. Su magisterio y ejemplo nos hace mejor a todos y usted es un paradigma de que las personas no son grandes por lo que tienen, sino por lo que son.
Una sesión que os invito a revisar, pues abordar aspectos muy prácticos como la habitación de despedida, cómo manejar la comunicación verbal y no verbal en estas situaciones, las frases a usar y las frases que evitar, qué hacer y qué no hacer, los cuidados del bebé y la caja de recuerdos, la posibilidad de donación de leche materna, los grupos de apoyo a los padres y también el cuidado emocional del profesional.
Enumeramos las conclusiones de esta interesante sesión clínica:
- En los últimos años se está adquiriendo una mayor sensibilización, han aumentado los estudios y las medidas y planes con el objetivo de mejorar la humanización en la atención del duelo perinatal y neonatal.
- Los profesionales sanitarios jugamos un papel fundamental durante este proceso proporcionando disponibilidad, apoyo emocional y respondiendo a las necesidades físicas, emocionales, psicosociales y espirituales del recién nacido y su familia mediante la creación de un entorno confortable y la humanización de los cuidados.
- Es necesario la formación de los profesionales sanitarios en el acompañamiento a familiares durante la muerte perinatal o neonatal y apoyo al personal sanitario tras este tipo de situaciones.
La adolescencia en el cine, un viaje a los coming of age. Congreso Virtual CO...Javier González de Dios
En el IV Congreso Virtual CONAPEME (Confederación Nacional de Pediatría de México) tuve la oportunidad de realizar la conferencia de clausura con el tema solicitado por la organización titulado "La adolescencia en el cine, un viaje a los coming of age".
Se conoce con el anglicismo coming of age a un género literario y cinematográfico que se centra en el crecimiento psicológico y moral del protagonista, a menudo desde la juventud hasta la vida adulta, y con epicentro en la adolescencia. Y con dos recursos habituales: la voz en off y el flashbacks (dos anglicismos más). Y se conoce con el germanismo bildungsroman (o novela de aprendizaje) a un subgénero específico del coming-of-age, presente en la literatura y centrado en el desarrollo psicológico y moral del protagonista. En ocasiones van de la mano.
Porque la adolescencia es una maravillosa etapa de transición y viaje desde la infancia previa al horizonte de una joven vida adulta (de ahí el anglicismo coming of age), con algunas señas de identidad: 1) búsqueda de la propia identidad, 2) rebelión frente a las figuras de autoridad, y e) probar nuevas cosas (sin miedo al exceso).
La calidad de la salud como consecuencia de la Medicina basada en la evidenci...Javier González de Dios
La presentación se desarrolla en cuatro apartados.
I. Aproximación a la CALIDAD EN SALUD
Se parte de la definición de la OMS (asegurar que cada paciente reciba el conjunto de servicios diagnósticos y terapéuticos más adecuado para conseguir una atención sanitaria óptima, teniendo en cuenta todos los factores y los conocimientos del paciente y del servicio médico, y lograr el mejor resultado con el mínimo riesgo de efectos iatrogénicos y la máxima satisfacción del paciente con el proceso) y se continúa profundizando en los tres niveles y nueve componentes de la calidad asistencial, influido por una importante variabilidad en la práctica clínica:
a) Gestión científico-técnica (la que más importa a los profesionales sanitarios): eficacia, seguridad y efectividad.
b) Gestión relacional-percibida (la que más importa a los pacientes o usuarios): información, aceptabilidad y satisfacción.
c) Gestión organizativo-económica (la que más importa a los gestores): equidad, accesibilidad y eficiencia.
II. Gestionar en busca de la (H)EXCELENCIA.
Con seis claves para ir en búsqueda del hospital "líquido" con profesionales "sólidos":
- Gestionar hacia la Medicina apropiada
- Gestionar en tiempo KISS
- Gestionar con (H)alma en busca de la (H)excelencia
- Gestionar con las 5C + 4 H
- Gestionar con método deliberativo
- Gestionar entre redes 2.0, 3.0 … y 4.0
III. Claves para sobrevivir a la MEDICINA BASADA EN LA EVIDENCIA… y no morir en el intento
Analizamos los cinco pasos de la MBE con el objetivo de aportar más ciencia al arte de la medicina:
- Primer paso: Pregunta clínica estructurada
- Segundo paso: Búsqueda bibliográfica sistematizada
- Tercer paso: Valoración crítica de documentos científicos
- Cuarto paso: Aplicabilidad en la práctica clínica
- Quinto paso: Adecuación de la evidencia científica a la práctica clínica
Y también revisamos los cinco malos usos y abusos que evitar en la MBE:
- No usar el nombre de la evidencia en vano
- No caer en el fundamentalismo metodológico
- Saber que hay vida más allá de PubMed… y Google
- Estar alerta a la evidence-biased medicine
- No minusvalorar la experiencia, lo que la medicina tiene de “arte y oficio”
IV. De la MEDICINA BASADA EN LA EVIDENCIA a la MEDICINA APROPIADA
Destacamos que el pasado reciente y el presente se ha vinculado a la MBE como herramienta para una práctica clínica que intenta resolver de la mejor forma posible la ecuación entre “lo deseable, lo posible y lo apropiado”, teniendo presente que la medicina es una ciencia sembrada de incertidumbre, variabilidad en la práctica clínica, sobrecarga de información, aumento de demanda y limitación de recursos.
Y que el presente y el futuro camina hacia la Medicina Apropiada, que es la conjunción de lo mejor de la Medicina basada en la evidencia (investigación) con los mejor de la Evidencia basada en la medicina (experiencia clínica).
Y este es el largo y sinuoso camino que cabe recoger para trabajar en ciencia y a conciencia por la calidad de la salu
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. GPs, 25% (2/8) for PEDs, 33% (3/9) for RNs and 25% (1/4) for PNs were considered as potential
causes of harm. Only 26% (7/27) of the DNDs for GPs showed scores equal to or higher than 36
points. The impact measure was higher for ordering benzodiazepines to treat insomnia, agitation or
delirium in elderly patients (mean = 57.8, SD = 25.3).
Conclusions: Low-value and potentially dangerous practices were identified; avoiding these could
improve care quality.
Key words: overuse, patient safety, quality assurance, primary care, Delphi technique
Introduction
At the beginning of this decade, we witnessed a change in the man-
ner of dealing with medical overuse, and sought to eliminate clin-
ical diagnoses and treatment practices of low value and for which
overwhelming evidence shows that they should not continue [1].
Since then, a large number of institutions, scientific societies and
health foundations have highlighted clinical practices that should
be discontinued.
In Europe, the UK’s National Institute for Health and Care
Excellence [2] (NICE) compiled a number of practices that either
did not provide value or whose benefits outweigh their risks; they
were called ‘do not do’ recommendations (DNDs). Today, the
NICE webpage contains some 900 DNDs. In the USA and
Canada, the American Board of Internal Medicine Foundation
(ABIM) led the initiative through interest, the Choosing Wisely
campaign [3–6], which is present in 19 countries and has compiled
a set of 535 DNDs.
In Spain, the Spanish Society of Internal Medicine was a pioneer
in creating a set of DNDs and, along with the Ministry of Health,
Social Services and Equality, launched the Commitment to Quality
of Scientific Societies initiative in 2013. Its purpose was to reduce
those interventions for which there was broad consensus about their
null, scarce or doubtful effectiveness.
Do not dos in primary care
Primary care, particularly in countries where it constitutes the gate-
way to the health system, plays a key role in reducing practices of
low value [7]. This is due both to its capacity to determine whether
ordering tests, procedures or referrals is actually necessary, and its
inclusion of dialogs with patients, which reduce overuse [8].
In 2011, The National Physicians Alliance identified five prac-
tices [9] that should be avoided in primary care. For its part, the
Choosing Wisely campaign incorporated a set of 15 recommenda-
tions seeking to reduce overuse. In 2014, the Swiss Society of
General Internal Medicine launched Smarter Medicine, which identi-
fied five diagnostic and therapeutic procedures of low value. In Italy,
the Slow Medicine campaign had similar objectives [10].
In 2014 in Spain, the Spanish Society of Family and Community
Medicine (semFYC) agreed on an initial list of 15 recommendations
on what should not be done in primary care [11]. This list currently
includes 30 DNDs [12], and it recently prioritized 15 DNDs adapted
to urgent care in primary care [13]. The Spanish Society of
Pediatrics (AEP), also in 2014, produced five DNDs [14], of which
four were applicable to primary care pediatricians. The Essential
Project included an evaluation of 30 DNDs aimed at primary care
physicians [15, 16].
Do not dos’ impact
The frequency of overuse has been systematically studied by the
Less is More Medicine [17] movement. In studies carried out in
America and Europe, it has been shown that institutional cam-
paigns to reduce overuse are known to less than half of profes-
sionals [18, 19]. In Spain, only 56% of general practitioners and
34% of pediatricians claim to be aware of the Commitment to
Quality initiative [20].
Some of these DNDs are more easily accepted than others by
patients [21, 22] and professionals [3, 23], and even though signifi-
cant progress has been made, overuse persists in clinical practice
[17, 24–27]. Professionals tend to overestimate the benefits and
underestimate the harm of unnecessary practices [28].
Do not dos and patient safety
In addition to the unnecessary financial burden that overuse puts on
health organizations [29], doing things that should not be done can
cause harm (adverse event) [30]. However, this aspect has barely
been studied [31, 32].
Aim
This study’s objective was to determine, through consensus
among professionals, the frequency of certain do-not-dos occur-
ring in primary care in Spain and their likelihood of causing and
an adverse event.
Method
This study used the Delphi technique [33], carried out between
September and December 2017. The study protocol was approved
by the Ethics Committee of Research on Primary Care in the
Valencian Community.
Definitions
An adverse event was defined as unintentional harm caused to the
patient as an unexpected clinical result of medical care provided and
that may or may not be associated with a clinical error [34].
A DND was defined as a diagnostic or therapeutic practice for
which extensive evidence exists that it does not provide any benefit
to patients, or whose benefits do not outweigh the risks it entails
[35]. These DNDs had to be included in the proposals about what
should not be done prepared by either national or regional agencies
or scientific societies [36, 37].
2 Mira et al.
Downloadedfromhttps://academic.oup.com/intqhc/advance-article-abstract/doi/10.1093/intqhc/mzy203/5106598bySuUBBremenuseron25September2018
3. Scope of the study
Four care contexts were considered: general practice (GP), pediatrics
(PED) (in Spain, pediatricians provide care for patients from birth
up to 14 years of age), pediatric nursing (PN) and nursing for adult
patients (RN).
Subjects
Using snowball sampling, 128 primary care professionals were
recruited from the Spanish National Health System. These included
50 GPs, 28 PEDs, 31 RNs and 19 PNs. All of the participants ful-
filled the specified inclusion criteria of at least 10 years’ experience
in primary care and experience carrying out teaching activities
aimed at health professionals. Participation was voluntary; they
were informed of the objectives of the study and the methodology
that was going to be applied.
Delphi questionnaire
For each context, a Questionnaire 0 was designed, following the
same procedure, to apply the Delphi technique. The elements in this
questionnaire were chosen from the DNDs of the semFYC [12], the
AEP [14], the health services of Aragón, Castilla La Mancha,
Catalonia, the Valencian Region and the Madrid region; and from a
nursing group with training and experience in patient safety [8].
In all, 45 DNDs were selected. This set of recommendations was
initially analyzed by 10 primary care professionals (4 GPs, 2 PEDs,
2 RNs and 2 PNs), each with more than 15 years of clinical experi-
ence, to ensure its legibility and suitability. From this review, similar
DNDs related to requests for diagnostic tests that primary care phy-
sicians could no longer order were eliminated. This group recom-
mended more specificity in the drafting of seven DNDs, and to
exclude one, and add four. The definitive Questionnaire 0 contained
27 DNDs directed at GPs, 8 at PEDs, 9 at RNs and 4 at PNs. All
DNDs considered in this study are included in Appendix I.
Response scale
The participants assessed the frequency that each selected practice
was still present in clinical practice. Here, a scale from 0 to 10 (with
0 = ‘hardly occurs’ and 10 = ‘occurs very frequently’) was
employed. They also assessed the likelihood of these selected prac-
tices being the cause of an adverse event (regardless of whether the
harm caused was serious or minor). This used a similar scale, where
0 meant there was no likelihood and 10 meant that the selected
practice was highly likely to cause the patient harm.
Procedure
The subjects who agreed to participate in the study received instruc-
tions by email as well as a link to the online questionnaire. They
had four weeks to respond to version 0 of the questionnaire (first
wave). As many as three reminders were given to improve the
response rate. The second wave began in late November 2017.
Wave 2 only included the elements that had not shown an accept-
able degree of agreement in the preceding wave, and the very same
response scale was used. Wave 2 was only sent to the participants
who responded to the first wave. In wave 2, the participants were
informed about their scores in wave 1 along with the mean from
their group in order to be able to score the second time. Once again,
three reminders were given.
Consensus
It was thought that there was an acceptable degree of consensus
among the participants for scores between the percentile ≥25 and
the profile ≥65 of the coefficient of variation (CV).
Expected impact of DND
To determine which DND kept occurring in practice and whether
they caused harm, a measurement of the impact was calculated by
multiplying the scores of the frequency that they kept occurring and
the possibility of causing harm. This measure of impact was calcu-
lated when the DND had a frequency or a possibility to cause harm
equal to or higher than 6 points. This new measure had a maximum
of 100 points.
Results
In the first wave, 100 professionals responded: 38 GPs (76%
response rate), 22 PEDs (78.6% response rate), 26 RNs (83.9%
response rate) and 14 PNs (73.7% response rate).
Table 1 Results from the first and second waves of the Delphi study
General practitioners (N = 38) Pediatricians (N = 22)
Do not do frequency Likelihood of causing
an AE
Do not do frequency Likelihood of causing
an AE
Wave 1 Wave 2 Wave 1 Wave 2 Wave 1 Wave 2 Wave 1 Wave 2
Mean 4.2 4.1 5.6 5.5 3.1 2.9 5.9 5.9
Median 3.8 3.7 5.8 5.8 2.6 2.4 5.6 5.6
Standard deviation 1.7 1.8 1.3 1.4 1.9 2.0 1.6 1.7
Coefficient of variation (median) 68.1 56.5 38.2 35.5 108.9 90.9 45.0 41.5
Percentile 65 75.1 59.5 40.6 36.5 127.3 97.5 47.5 45.1
Nurses caring for adult patients (N = 26) Pediatric nurses (N = 14)
Mean 4.3 4.3 4.6 4.6 3.1 3.1 3.9 3.9
Median 3.7 3.7 3.2 3.2 2.7 2.7 2.5 2.5
Standard deviation 2.0 2.0 2.3 2.3 1.0 1.0 2.7 2.7
Coefficient of variation (median) 78.5 65.0 86.0 65.6 73.8 73.8 59.4 59.4
Percentile 65 82.5 70.0 87.6 67.8 74.8 74.8 62.1 62.1
Scale from 1 to 10.
3Low-value practices causing harm
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4. In the first wave, a consensus was reached on 12 out 27 (44.4%)
practices in the case of GPs, in 5 out 8 (62.5%) in the case of PEDs,
in 4 out 9 (44.4%) for RNs and none of the PNs. The scores for the
set of DNDs on the scales of frequency and likelihood of causing an
adverse event in the first wave are shown in Table 1. These scores
showed great diversity in the assessments of the frequency with
which they were thought to still occur in clinical practice and in the
likelihood that they would result in harming a patient, especially
among PEDs.
In the second wave, 97 professionals responded: 38 GPs (100%
response rate), 22 PEDs (100% response rate), 24 RNs (92.3%
response rate) and 12 PNs (85.7% response rate). The mean scores
for the set of DNDs hardly changed (Table 1). The coefficients of
variation among the scores of the four groups of participants in the
second wave were reduced significantly, both for that related to the
frequency of occurrence in clinical practice (89.9 versus 67.5; 95%
confidence interval for the difference, 17.5–27.2, T-test 9.4; P-value
<0.0001) and for that related to their potential to cause harm (58.4
versus 42.6; 95% confidence interval for the difference; 11.9–19.4,
T-test 8.4; P-value <0.0001).
Most frequent DNDs
In all, 22% (6/27) of the practices of GPs, 12% (1/8) of those directed
at PEDs, 33% (3/9) of those directed at RNs, and none of those direc-
ted at PNs were cataloged as occurring frequently in daily practice of
primary care (score ≥6). Table 2 shows the scores when the frequency
or potential harm was assessed as equal to or higher than 6.
Among GPs, prescribing benzodiazepines to treat insomnia, agi-
tation, or delirium in elderly patients (mean = 7.1, SD = 2.5) was
the DND assigned the greatest frequency; for PEDs, it was combin-
ing or alternating treatment between ibuprofen and paracetamol
(mean = 6.2, SD = 3.2). RNs indicated overuse of monitoring blood
pressure, heart rate, weight or blood sugar monitoring at the
patients’ request (mean = 7.1, SD = 2.8); and among PNs, no fre-
quency scores were equal to or higher than 6.
DNDs’ harm
The DND that could cause the most harm and occurred more fre-
quently in daily clinical practice for GPs was ordering benzodiaze-
pines to treat insomnia, agitation, or delirium in elderly patients
(mean = 7.9, SD = 1.3) (Table 2). For PEDs, it was delaying empiric
antibiotherapy when invasive meningococcal disease was suspected
(mean = 9.2, SD = 1.5); for PNs and RNs, it was administering
injections without consultation for possible allergies (mean = 8.5,
SD = 0.8; mean = 8.7, SD = 1.9, respectively).
DNDs’ impact
Table 2 shows a measure of the impact of each of these DNDs.
Only 7/27 (25.9%) of the DNDs for GPs showed scores equal to or
higher than 36 points. These were related to inadequate use of ben-
zodiazepines, proton pump inhibitors antimicrobials, non-steroidal
anti-inflammatory drugs, acetylcholinesterase inhibitors, and para-
cetamol, or inadequate performance of prostate cancer screenings.
Discussion
Prescribing benzodiazepines to elderly persons, prescribing antimi-
crobials or drugs to interrupt the production of stomach acid in the
absence a definite indication, and indicating screening for prostate
cancer in asymptomatic patients are, according to this study, the
overuse practices with the greatest negative impact on patient safety.
In the case of PEDs, ensuring the correct use of antimicrobials and
eradicating the combination of ibuprofen and paracetamol are prior-
ity objectives for achieving better practice. Total immobilization of
first-degree sprained ankles, the custom of inserting urinary cathe-
ters routinely, and administering injections at the request of patients
who do not show signs of possible allergies are relatively frequent
practices that are also highly likely to cause harm that nursing pro-
fessionals should stop doing.
The appropriate use of antimicrobial guidelines [17, 26], and
proton pump inhibitors [26], and ordering screenings for prostate
cancer [26, 38], constitute three of the practices that receive the
most attention in overuse studies. This and other studies [39] high-
lighting them as priority objectives in attempts to prevent inappro-
priate use of resources and to increase patient safety in primary
care. Furthermore, this study also addresses overuse by other pri-
mary care professionals (PEDs, RNs and PNs), an aspect that has
been studied less.
Primary care physicians occupy a strategic position in health
care systems, and their actions are decisive when it comes to overuse
[7]. Most studies have shown their greater willingness toward
informative campaigns about what should not be done [40, 41], and
their greater response to interventions intended to ensure that the
number of inappropriate antimicrobial prescriptions is reduced [42].
However, one must also consider that pressure from patients who
demand these types of treatment, along with defensive medical prac-
tices, also play a part in accounting for the overuse figures [8]. Thus,
interventions intended to eradicate low-value practices must not be
directed at the professionals only [26, 43]. Health authorities and
those responsible for campaigns to reduce overuse could consider
the results of this study and focus their attention on those DNDs
that can cause greater harm. The number of DNDs and the institu-
tions that determine their own DNDs have grown exponentially
since 2011 [39, 44]. although there is only clear evidence to support
two-thirds of these DNDs. This study fixed its target on those rela-
tively frequent practices for which there is sufficient evidence about
their risks or lack of effectiveness and, it thus seeks to attract atten-
tion from professionals for the sake achieving changes in clinical
practice routines.
The results suggest that there is significant variability between
GPs and PNs in their assessment of the frequency with which these
practices persist in clinics (a variability in the estimation of the fre-
quency was 37%) and in the likelihood that adverse events asso-
ciated with them occur (as much as 17 percentage points). The
differences in the acceptability of the DNDs observed in other stud-
ies [28] could explain these results.
This approach permits the establishment of priorities in attempts
to reduce practices that should not be done, as has been suggested
by other investigators [7, 45]. In this case, the focus is placed on
those practices that persist in daily primary care activities, as they
have a greater potential to cause an adverse event.
This is the first study conducted on the national level in Spain
that analyzes the frequency and potential adverse events related to
low-value practices in primary care related to general practitioners,
pediatricians and nurses. This approach to identifying what should
not be done addresses part of the overuse issue, which represents
one of the problems in all health systems due to its impact on safety
and sustainability [2–4].
4 Mira et al.
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5. Table 2 Harm, frequency and impact of the do not dos analyzed in this study (only harm or frequency scores equal to or higher than 6
have been included)
HARM FREQUENCY IMPACT**
General practitioners N Range Mean* SD CV Range Mean* SD CV Range Mean$
SD CV
21. Prescribe benzodiazepines to treat insomnia, agitation or
delirium in elderly persons.
38 5 7.9 1.3 17 9 7.1 2.5 35 94 57.8 25.3 43.8
25. Maintain treatment with proton pump inhibitors
without proven indication.
38 9 6.2 2.2 36 10 6.3 2.7 43 100 39.8 25.8 64.7
8. Order antibiotic treatment for acute bronchitis without
comorbidity.
38 7 5.9 2.2 37 9 6.2 2.4 39 90 38.5 23.7 61.5
16. Prescribe non-steroidal anti-inflammatory drugs
(NSAIDs) for patients with cardiovascular disease,
chronic kidney disease, hypertension, heart failure or liver
cirrhosis.
36 6 7.8 1.6 21 10 4.9 2.6 53 100 38.3 22.8 59.6
24. Maintain treatment with acetylcholinesterase inhibitors
(donepezil, galantamine and rivastigmine) in Alzheimer’s
patients over 85 years of age.
38 9 5.8 2.3 39 10 6.3 2.8 45 100 38.1 24.9 65.0
4. Perform prostate cancer screening in asymptomatic
patient through PSA or a rectal examination.
37 8 5.5 2.0 35 7 6.6 1.8 28 58 37.6 18.3 49.0
9. Systematically recommend taking 1 g doses of
paracetamol.
38 9 5.9 2.0 34 10 6.4 2.7 42 90 37.3 22.1 59.1
14. Prescribe antibiotics in asymptomatic bacteriuria cases
for the following population groups: non-pregnant
premenopausal women, diabetics, the elderly,
institutionalized elderly, patients with spinal cord injuries
and patients with urinary catheters.
38 8 6.2 1.9 30 9 5.2 2.5 48 80 32.3 19.6 60.8
11. Recommend oral corticosteroids for more than 7–10
days to patients with exacerbation from chronic
obstructive pulmonary disease.
38 8 6.1 2.1 34 10 4.4 2.7 62 70 28.7 21.6 75.5
10. Prescribe drugs with potential extrapyramidal side
effects (antiemetic, antivertiginous, prokinetic) to patients
with Parkinson’s disease.
37 9 7.1 1.9 27 8 3.4 2.3 70 80 23.6 19.4 82.4
19. Prescribe bisphosphonates to patients with low fracture
risk.
38 7 6.0 1.4 24 8 3.7 2.1 58 64 23.1 16.3 71
23. Prescribe glitazones to diabetics with heart failure. 37 5 6.6 1.3 20 7 1.9 1.6 83 49 13.3 11.8 89
22. Routinely establish the association of a direct renin
inhibitor and an angiotensin-converting-enzyme inhibitor
(ACE inhibitor) or antagonist of angiotensin II receptors
(AGTR2).
37 4 6.6 1.0 16 6 1.4 1.3 95 48 9.6 9.7 101
15. Utilize hormone therapy (estrogen or estrogen with
progestogen) with the objective of preventing
cardiovascular disease, dementia or impairment of
cognitive function in postmenopausal women.
37 8 6.4 1.8 28 6 1.2 1.3 106 42 8.0 9.1 114
Pediatricians N Range Mean* SD CV Range Mean* SD CV Range Mean$
SD CV
6. Combine or alternate treatment between ibuprofen and
paracetamol.
22 7 4.4 2.0 46 10 6.2 3.2 52 70 27.0 20.1 74
3. Delay empiric antibiotherapy when invasive
meningococcal disease is suspected by having cultures
(blood and/or spinal fluid) obtained.
22 7 9.2 1.5 16 7 1.3 1.6 119 70 11.9 15.2 128
4. Routinely prescribe antibiotics for boys and girls with
stomach flu.
21 8 7.2 2.0 28 4 0.8 1.0 126 28 5.4 7.1 131
Nurses caring for adult patients N Range Mean* SD CV Range Mean* SD CV Range Mean$
SD CV
3. Apply total immobilization to first-degree sprained
ankles.
25 9 6.6 2.2 34 10 4.8 3.1 65 90 33.0 24.9 75
5. Administer medical injections without consultation for
possible allergies.
26 8 8.7 1.9 22 8 3.4 2.7 79 72 29.4 24.7 84
1. Routinely insert urinary catheters in cases of acute
ischemic stroke or urinary incontinence.
23 5 6.5 1.4 22 8 3.6 2.0 57 56 23.5 14.3 61
2. Provide glucometers and test strips to diabetics with
hypoglycemic agents.
24 8 2.8 2.1 74 10 6.3 2.5 40 64 18.0 16.4 91
Table continued
5Low-value practices causing harm
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6. Limitations
In interpreting data, we must consider the tendency of professionals
to underestimate the frequency of DNDs [28]. Also, the dissemin-
ation of DNDs is fundamentally accomplished through the websites
of professional organizations and national agencies concerned with
patient safety, whose access and consultation can determine the suc-
cess of their dissemination [47], and this aspect was not controlled
in this study. The methodology employed does not permit us to
establish the magnitude of the impact of continuing to do what
should not be done. The number of experts in the PN group was
under 20, which limits the strength of the conclusions in their case.
Most of the DNDs included in this study were related to prescrip-
tion, because scientific societies and institutions are focused on
them. Among the analyzed DNDs, referrals to other specialists were
nor included, even though they may be the origin of the unnecessary
tests or over-treatments mentioned in other overuse studies [48].
Conclusion
This study allowed us to identify low-value practices in primary care
in Spain that are potentially dangerous to patients, these should be
the focus of efforts to improve quality. Future studies could consider
making a quantitative estimation of the magnitude of their impact in
clinical and economic terms. If, generally speaking, doing what
should not be done is unnecessary and inefficient, in the case of
health interventions it must be considered that it can also comprom-
ise the health and well-being of people.
Supplementary material
Supplementary material is available at International Journal for Quality in
Health Care online.
Acknowledgements
We must recognize the anonymous and selfless work by the 10 professionals
who reviewed Questionnaire 0, in addition to the efforts by the 100 people
who participated in the Delphi study. All contributed knowledge and experi-
ence, making this study possible.
Funding
This study was supported by the Spanish Health Research Fund (FIS), and the
European Regional Development Fund (ERDF) call for Health Research
[Grant numbers PI16/00816 and PI16/00971].
References
1. Brody H. Medicine’s ethical responsibility for health reform—the Top
Five List. N Engl J Med 2010;362:283–5.
2. National Institute for Health and Care Excellence (NICE). Do not do
Recommendations. http://www.nice.org.uk/savingsandproductivity/
collection (24 March 2018, date last accessed).
3. Martin S, Miñarro R, Cano P et al. Resultados de la aplicabilidad de las
«do not do recommendations» del National Institute for Health and Care
Excellence en un hospital de alta complejidad. Rev Calid Asist 2015;30:
117–28.
4. Crema M, Verbano Ch. Lean Management to support Choosing Wisely
in healthcare: the first evidence from a systematic literature review. Int J
Qual Health Care 2017;29:889–95.
5. The ABIM Foundation. Choosing Wisely. http://www.choosingwisely.
org/ (24 March 2018, date last accessed).
6. Wolfson D, Sant J, Slass L. Engaging physicians and consumers in conver-
sations about treatment overuse and waste: a short history of the
Choosing Wisely Campaign. Acad Med 2014;89:990–5.
7. Alber K, Kuehlein T, Schedlbauer A et al. Medical overuse and quater-
nary prevention in primary care—a qualitative study with general practi-
tioners. BMC Fam Pract 2017;18:99.
8. Mira JJ, Carillo I, Silvestre C et al. Drivers and strategies for avoiding
overuse. A cross-sectional study to explore the experience of Spanish pri-
mary care providers handling uncertainty and patients’ requests. BMJ
Open 2018;8:e021339.
9. Good Stewardship Working Group. The ‘top 5’ lists in primary care:
meeting the responsibility of professionalism. Arch Intern Med 2011;171:
1385–90.
10. Bonaldi A, Vernero S. Italy’s slow medicine: a new paradigm in medicine.
Recenti Prog Med 2015;106:85–91.
11. Grupo de Trabajo de la semFYC para el proyecto Recomendaciones «No
hacer». Recomendaciones «NO HACER. Barcelona: semFYC ediciones,
2014.
12. Grupo de Trabajo de la semFYC para el proyecto Recomendaciones «No
hacer». Recomendaciones «NO HACER» 2.ª Parte. Barcelona: semFYC
ediciones, 2015.
13. Grupo de Trabajo de la semFYC para el proyecto Recomendaciones «No
hacer». 15 Recomendaciones «No hacer» en urgencias. Barcelona:
semFYC ediciones, 2016.
14. Asociación Española de Pediatría (AEP). Recomendaciones de ‘no hacer’
en Pediatría 2014. http://www.aeped.es/documentos/recomendaciones-no-
hacer-en-pediatria [26 March 2018, date last accessed].
15. Caro-Mendivelso J, Almazán C, Parada-Martínez I et al. Identificación y
priorización de prácticas clínicas de poco valor: los profesionales de atención
primaria deciden. Aten Primaria 2017. doi:10.1016/j.aprim.2017.08.006.
16. Essencial. http://essencialsalut.gencat.cat/ca/inici [28 March 2018, date
last accessed].
Table 2 Continued
Nurses caring for adult patients N Range Mean* SD CV Range Mean* SD CV Range Mean$
SD CV
4. Measure BP/HR/weight/blood sugar routinely in patients
who request it.
26 6 2.2 1.8 86 9 7.1 2.8 40 48 15.4 14.0 91
9. Monitor blood pressure, blood sugar and weight every 3
months for chronic patients who are in a stable condition.
24 7 3.1 2.0 66 8 6.5 2.2 34 25 6.3 6.7 106
Pediatric nurses N Range Mean* SD CV Range Mean* SD CV Range Mean$
SD CV
11. Administer medical injections without consultation for
possible allergies.
11 3 8.5 0.8 10 5 2.4 1.4 60 35 19.2 11.0 57
*Scale from 1 to 10.
$
Scale from 1 to 100.
**IMPACT score in frequency multiplied by the score of the likelihood to cause harm.
CV, coefficient of variation; BP, blood pressure; HR, heart rate.
6 Mira et al.
Downloadedfromhttps://academic.oup.com/intqhc/advance-article-abstract/doi/10.1093/intqhc/mzy203/5106598bySuUBBremenuseron25September2018
7. 17. Rosenberg A, Agiro A, Gottlieb M et al. Early trends among seven recom-
mendations from the Choosing Wisely Campaign. JAMA Intern Med
2015;175:1913–20.
18. PerryUndem Research/Communication. Unnecessary Tests and
Procedures In the Health Care System: What Physicians Say About The
Problem, the Causes, and the Solutions: Results from a National Survey
of Physicians. ABIM Foundation, 2014 May.
19. Zambrana-García JL, Lozano Rodríguez-Mancheño A. Actitudes de los
médicos hacia el problema de las pruebas y los procedimientos innecesar-
ios. Gac Sanit 2016;30:485–6.
20. Mira JJ, Carillo I, Silvestre C et al. Grado de conocimiento entre médicos
de familia, pediatras y enfermería de la campaña Compromiso por la
Calidad y de recomendaciones No hacer para Atención Primaria. An Sist
Sanit Navar 2018. doi:10.23938/ASSN.0228.
21. Silverstein W, Lass E, Born K et al. A survey of primary care patients’
readiness to engage in the de-adoption practices recommended by
Choosing Wisely. BMC Res Notes 2016;9:301.
22. Kevin S, Cornuza J, Cohidon C et al. How do Swiss general practi-
tioners agree with and report adhering to a top-five list of unnecessary
tests and treatments? Results of a cross-sectional survey. Eur J Gen
Pract 2018;24:32–8.
23. Zikmund-Fisher BJ, Kullgren JT, Fagerlin A et al. Perceived barriers to
implementing individual Choosing Wisely
®
Recommendations in two
national surveys of primary care providers. J Gen Intern Med 2016;32:
210–7.
24. Sabbatini AK, Tilburt JC, Campbell EG et al. Controlling health costs:
physician responses to patient expectations for medical care. J Gen Intern
Med 2014;29:1234–41.
25. Hong AS, Ross-Degnan D, Zhang F et al. Small decline in low-value back
imaging associated with the ‘Choosing Wisely’ Campaign, 2012–14.
Health Aff (Millwood) 2017;36:671–9.
26. Selby K, Cornuz J, Cohidon C et al. How do Swiss general practitioners
agree with and report adhering to a top-five list of unnecessary tests and
treatments? Results of a cross-sectional survey. Eur J Gen Pract 2018;
24:32–8.
27. Zalts R, Buchrits S, Khateeb J et al. Diagnostic process-how to do it right?
The SMART medicine initiative. Eur J Intern Med 2017;46:e11–2.
28. Hoffmann TC, Del Mar C. Clinicians’ expectations of the benefits
and harms of treatments, screening, and tests. JAMA Intern Med 2017;
177:407–19.
29. Nassery N, Segal JB, Chang E et al. Systematic overuse of healthcare ser-
vices: a conceptual model. Appl Health Econ Health Policy 2015;13:1–6.
30. Gibson R. The human cost of overuse. Br Med J 2014;348:g2975.
31. Zapata JA, Lai AR, Moriates C. Is excessive resource utilization an
adverse event? J Am Med Assoc 2017;317:849–50.
32. Mira JJ, Carrillo I, Gea MT et al. Protocol for a retrospective cohort
study. When doing what should not be done goes wrong in primary care.
The SOBRINA Spanish Study. (In evaluation).
33. Mira JJ, Pérez-Jover V, Lorenzo S et al. Investigación cualitativa: una
alternativa también válida. Aten Primaria 2004;34:161–9.
34. World Health Organization. Conceptual framework for the International
Classification for Patient Safety. Final technical report. Geneva: World
Health Organization, 2009.
35. Chassin MR, Galvin RW. The urgent need to improve health care quality.
Institute of Medicine National Roundtable on Health Care Quality. J Am
Med Assoc 1998;280:1000–05.
36. Grady D, Redberg RF. Less is more: how less health care can result in bet-
ter health. Arch Intern Med 2010;170:749–50.
37. Otte J. Less is More. http://www.lessismoremedicine.com/ (24 March
2018, date last accessed).
38. Jessen K, Søndergaard J, Larsen PV et al. Danish general practitioners’
use of prostate-specific antigen in opportunistic screening for prostate
cancer: a survey comprising 174 GPs. Inter J Family Med 2013;2013:
540707.
39. García-Mochón L, Olry de Labry A, Bermúdez-Tamayo L. Priorización
de actividades clínicas no recomendadas en Atención Primaria. An Sist
Sanit Navar 2017;40:401–12.
40. Colla CH, Kinsella EA, Morden NE et al. Physician perceptions of
Choosing Wisely and drivers of overuse. Am J Manag Care 2016;22:
337–43.
41. Sirovich BE, Woloshin S, Schwartz LM. Too little? Too much? Primary
care physicians’ views on US Health Care. Arch Intern Med 2011;171:
1582–5.
42. Légaré F, Labrecque L, Cauchon M et al. Training family physicians
in shared decision-making to reduce the overuse of antibiotics in acute
respiratory infections: a cluster randomized trial. CMAJ 2012;184:
e726–34.
43. Moro ML, Marchi M, Gagliotti C et al. Why do paediatricians pre-
scribe antibiotics? Results of an Italian regional Project. BMC Pediatr
2009;9:69.
44. Steel N, Abdelhamid A, Stokes T et al. A review of clinical practice
guidelines found that they were often based on evidence of uncertain rele-
vance to primary care patients. J Clin Epidemiol 2014;67:1251–7.
45. Morgan DJ, Leppin AL, Smith CD et al. A practical framework for under-
standing and reducing medical overuse: conceptualizing overuse through
the patient-clinician interaction. J Hosp Med 2017;12:346–51.
46. Morgan D, Dhruva S, Coon E et al. 2017 Update on medial overuse. a
systematic review. JAMA Intern Med 2018;178:110–5.
47. Lorenzo S, Mira JJ. Are Spanish physicians ready to take advantage of
the Internet? World Hosp Health Serv 2004;40:31–5.
48. de Prado-Prieto L, García-Olmos L, Rodríguez-Salvanés F et al.
Evaluación de la demanda derivada en atención primaria. Aten Primaria
2005;35:146–51.
Appendix I Do not do recommendations for
primary care included in this study
General practitioners
• Do not perform imaging tests on non-specific low back pain without
warning signs within 6 weeks.
• Do not routinely order densitometry in postmenopausal women to assess
the risk of osteoporotic fracture without first performing a risk factor
assessment.
• Do not order imaging tests for headache without complications.
• Do not perform prostate cancer screening in asymptomatic patient
through PSA or a rectal examination.
• Do not perform sinus x-rays to diagnose probable acute bacterial
rhinosinusitis.
• Do not perform thyroid ultrasound in subclinical hypothyroidism.
• Do not treat bronchial asthma with half-life/long-life bronchodilators
without inhaled corticosteroids (long-acting beta-agonists (LABAs) on a
regular basis as sole treatment for asthma in adults).
• Do not order antibiotic treatment for acute bronchitis without
comorbidity.
• Do not systematically recommend taking 1 g doses of paracetamol.
• Do not prescribe drugs with potential extrapyramidal side effects (antie-
metic, antivertiginous, prokinetic) in patients with Parkinson’s disease.
• Do not recommend oral corticosteroids for more than 7–10 days to
patients with exacerbation from chronic obstructive pulmonary disease.
• Do not systematically prescribe bronchodilator treatment with b2-
adrenergic agonists for acute bronchiolitis.
• Do not prescribe antibiotics in tonsillopharyngitis cases without suspicion
of streptococcal etiology.
• Do not prescribe antibiotics in asymptomatic bacteriuria cases for the fol-
lowing population groups: non-pregnant premenopausal women, dia-
betics, the elderly, institutionalized elderly, patients with spinal cord
injuries and patients with urinary catheters.
• Do not utilize hormone therapy (estrogen or estrogen with progestogen)
with the objective of preventing cardiovascular disease, dementia or
impairment of cognitive function in postmenopausal women.
• Do not prescribe non-steroidal anti-inflammatory drugs (NSAIDs) for
patients with cardiovascular disease, chronic kidney disease, hypertension,
heart failure or liver cirrhosis.
7Low-value practices causing harm
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8. • Do not systematically prescribe lipid lowering agents for the primary pre-
vention of cardiovascular events in people over 75 years of age.
• Do not use rifampicin together with pyrazinamide in primary chemo-
prophylaxis of tuberculosis in immunocompetent adults.
• Do not prescribe bisphosphonates to patients with low fracture risk.
• Do not routinely use calcium channel antagonists to reduce cardiovascu-
lar risk after a myocardial infarction.
• Do not prescribe benzodiazepines to treat insomnia, agitation or delirium
in elderly persons.
• Do not routinely establish the association of a direct renin inhibitor and
an angiotensin-converting-enzyme inhibitor (ACE inhibitor) or antagonist
of angiotensin II receptors (AGTR2).
• Do not prescribe glitazones to diabetics with heart failure.
• Do not maintain treatment with acetylcholinesterase inhibitors (donepezil,
galantamine and rivastigmine) for Alzheimer’s patients over 85 years of age.
• Do not maintain treatment with proton pump inhibitors without proven
indication.
• Do not indicate self-monitoring of capillary glycaemia for type 2 diabetic
patients without hypoglycemic treatment.
• Do not perform more than two Hba1c controls per year in diabetics with
good control.
Nurses caring for adult patients
• Do not routinely insert urinary catheters in cases of acute ischemic stroke
or urinary incontinence.
• Do not provide glucometers and test strips to diabetics with hypoglycemic
agents.
• Do not apply total immobilization to first-degree sprained ankles.
• Do not measure BP/HR/weight/blood sugar routinely in patients who
request it.
• Do not administer medical injections without consultation for possible
allergies.
• Do not replace wet wound dressings daily as in the case of dry wound
dressings.
• Do not repeat the test of basal blood sugar rate with different glucometers
to compare results.
• Do not repeat INR if the value is in the range (2–3, 2.5, 3.5).
• Do not monitor blood pressure, blood sugar and weight every 3 months
for chronic patients who are in a stable condition.
Pediatricians
• Do not routinely perform chest x-rays in cases of acute bronchiolitis.
• Do not order complementary tests at the request of the parents: blood
tests for non-specific symptoms or signs, x-rays for respiratory tract infec-
tions or ultrasound for intestinal symptoms.
• Do not delay empiric antibiotherapy when invasive meningococcal disease
is suspected by having cultures (blood and/or spinal fluid) obtained.
• Do not routinely prescribe antibiotics for boys and girls with stomach flu.
• Do not prescribe antibiotics for pharyngitis even if the patient does not
test positive for strep.
• Do not combine or alternate treatment between ibuprofen and paracetamol.
• Do not prescribe mucolytic, antitussive or antibiotic drugs for upper
respiratory tract infections.
• Do not schedule face-to-face consultations of complacency with no spe-
cific care objective.
Pediatric nurses
• Do not revaccinate for tetanus with each wound.
• Do not perform weekly weight measurement on normally developing
infants.
• Do not administer vaccinations prescribed by doctors or pediatricians in
their private practice.
• Do not administer injections without consultation for possible allergies.
8 Mira et al.
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