ABSTRACT
RESUMO Introdução A medicina é uma atividade laborativa conhecida por elevados padrões de exigência. O período de formação do profissional médico inclui a residência médica, etapa em que fatores estressores podem ser magnificados. Assim, essa população poderia estar mais suscetível a síndrome de exaustão emocional, despersonalização e reduzida realização profissional, conhecida como burnout. Objetivo Determinar a prevalência de burnout e de cada uma de suas dimensões na população de médicos residentes do Hospital de Clínicas de Porto Alegre (HCPA) e investigar características sócio-ocupacionais associadas. Métodos Estudo transversal com médicos residentes do Hospital de Clínicas de Porto Alegre (HCPA), realizado no período de dezembro de 2015 a janeiro de 2016, mediante aplicação de um instrumento informatizado que contém dois questionários: um com variáveis sociodemográficas e o questionário Maslach Burnout Inventory (MBI). Análise estatística foi realizada pelo software SPSS versão 18, sendo utilizado o teste exato de Fisher e o teste do Qui-Quadrado de Pearson para as correlações. Resultados Dos 506 médicos residentes do HCPA, 151 participaram voluntariamente do estudo. Burnout esteve presente em 123 participantes (81,5%). "Exaustão emocional" foi a mais frequente dimensão (53%), seguida por "despersonalização" (47,7%) e "falta de realização profissional" (45%). Gênero masculino e residentes do segundo ano apresentaram maior possibilidade estatística de desenvolver burnout, sendo que os últimos também apresentaram menor realização profissional e maior despersonalização. Residentes do quarto ano estiveram menos associados à despersonalização e ao burnout de maneira global. Residentes de especialidades cirúrgicas estiveram menos associados à exaustão emocional. Cursar Psiquiatria mostrou-se um fator protetor para despersonalização, enquanto Radiologia apresentou ser um risco para essa dimensão. Conclusão A alta prevalência de burnout entre médicos residentes, especialmente entre aqueles que cursam o segundo ano, suscita preocupação, uma vez que pode levar ao risco de desenvolver depressão, ao abandono profissional e à diminuição na qualidade assistencial prestada aos pacientes. Assim, medidas preventivas contra seu desenvolvimento, associadas ao diagnóstico precoce e manejo clínico adequado, são fundamentais para a redução de sua prevalência.
ABSTRACT Introduction Medicine is a labor activity known for high standards of demand. The medical professional's training period includes medical residency, a step in which stressors factors can be magnified. Thus, this population could be more susceptible to the syndrome of emotional exhaustion, depersonalization and reduced professional accomplishment, known by burnout. Objective To determine the prevalence of burnout and of each of its dimensions in the population of medical residents of the Hospital de Clínicas de Porto Alegre (HCPA) and to investigate associated socio-occupational characteristics. Methods A cross-sectional study was carried out with medical residents of the Hospital de Clínicas de Porto Alegre (HCPA) conducted from December 2015 to January 2016, using a computerized instrument containing two questionnaires: one with sociodemographic variables and the Maslach Burnout Inventory (MBI).Statistical analysis was performed by SPSS Software version 18, using Fisher's exact test and Pearson's chi-square test. for correlations. Results Of the 506 HCPA medical residents', 151 participated voluntarily in the study. Burnout was present in 123 participants (81.5%). "Emotional exhaustion" was the most frequent dimension (53%), followed by "depersonalization" (47.7%) and "lack of professional achievement" (45%). Male gender and residents of the second year had a higher statistical possibility of developing Burnout, and the latter, also presented lower professional achievement and greater depersonalization. Fourth-year residents were less associated with depersonalization and burnout overall. Residents of surgical specialties were less associated with emotional exhaustion. Studying psychiatry was shown to be a protective factor for depersonalization, while radiology presented a risk to this dimension. Conclusion The high prevalence of burnout among medical residents especially among those attending the second year, raises concern, since it can lead to the risk of developing depression, to professional abandonment, to a decrease in the quality of care provided to patients. Thus, preventive measures against its development associated to the early diagnosis and adequate clinical management are fundamental for the reduction of its prevalence.
ABSTRACT
Background: The SAMe-TT2R2 score was introduced to identify atrial fibrillation patients with a high risk of not achieving a good time in therapeutic range (TTR) during vitamin K antagonists (VKA) therapy. Objective: The aim of this study was to evaluate this score in venous thromboembolism (VTE) patients. Patients and methods: A retrospective cohort study of patients receiving care at the outpatient anticoagulation clinic of a tertiary care teaching hospital. Patients were classified as having low (score 0-1) or high risk (score ≥2) of not achieving a good TTR. The area under the ROC curve was calculated to assess the ability of the score to predict a TTR ≥ 65%. Adverse event-free survival curves according to the SAMe-TT2 R2 score were calculated by the Kaplan-Meier method and compared by the log-rank test. A p-value < 0.05 was considered statistically significant. Results: We investigated 111 patients during a median follow-up of 2.3 (0.7-6.4) years. Mean age was 54.1 ± 15.7 years and 71 (64.0%) were women. Low- and high-risk groups had similar mean TTR (51.9 vs. 49.6%; p = 0.593). The two groups did not differ significantly in the percentage of patients achieving a TTR ≥ 65% (35.6 vs. 25.8%; p =0.370). The c-statistic was 0.595 (p = 0.113) for TTR ≥ 65%. Adverse event-free survival during anticoagulation was also similar in both groups (p = 0.136).Conclusions: The SAMe-TT2R2 score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting