Cuidado ao Paciente Oncológico na Perspectiva da Oncologia Integrativa / Care for Cancer Patients from the Perspective of Integrative Oncology / Atención al Paciente Oncológico desde la Perspectiva de la Oncología Integrativa

Introdução: A oncologia integrativa é um campo recente e promissor que visa ao cuidado integral centrado no paciente, com uma abordagem baseada em evidências. Objetivo: Verificar o conhecimento científico produzido sobre a oncologia integrativa na atenção hospitalar. Método: Revisão integrativa com buscas nas bases de dados PubMed, LILACS, SciELO e MOSAICO, realizadas de fevereiro a março de 2022. A partir dos critérios de elegibilidade (estudos referentes ao tema publicados de 2000 a 2022, disponíveis na íntegra no acesso público, nos idiomas inglês, português e espanhol), foram selecionados sete artigos, analisados de acordo com a modalidade temática. Resultados: Os artigos elegíveis foram publicados entre 2018 e 2021, com destaque para a produção europeia, que corresponde a quatro (57,14%) artigos. O conteúdo dos estudos foi organizado em dois temas: a implementação de cuidados de oncologia integrativa e o acesso equitativo à oncologia integrativa e outros desafios. Foi observado que a oncologia integrativa tem sido praticada em diferentes cenários, com variadas ações realizadas, e tem como desafio central a ampliação do acesso ao usuário, por meio do desenvolvimento de diretrizes baseadas em evidências e da implementação de políticas de financiamento e qualificação profissional. Conclusão: O conhecimento científico produzido aponta que a implementação de cuidados de oncologia integrativa na atenção hospitalar ainda é limitada, com desafios relacionados ao acesso equitativo, ao financiamento, à gestão e à qualificação dos profissionais de saúde

Introduction: Integrative oncology is a recent and promising field, which aims a patient-centered comprehensive care, within an evidence-based approach. Objective: To investigate the scientific knowledge produced on integrative oncology in hospital care. Method: Integrative review with searches in PubMed, LILACS, SciELO and MOSAICO databases carried out from February to March 2022. Based in the eligibility criteria (studies related to the subject published from 2000 to 2022, available in full by public access, in English, Portuguese and Spanish) seven articles were selected and analyzed according to the thematic modality. Results: The eligible articles were published between 2018 and 2021, with emphasis on European production, which corresponds to four (57.14%) articles. The content of the studies was organized in two themes, namely: the implementation of integrative oncology care and the equitable access to integrative oncology and other challenges. It has been observed that integrative oncology has been practiced in different scenarios, with variable actions taken, and its central challenge is to expand the user access, through the development of evidence-based guidelines and the implementation of funding and professional qualification policies. Conclusion: The scientific knowledge produced indicates that the implementation of integrative oncology care in hospital attention is still limited, with challenges related to equitable access, funding, management and qualification of health professionals

Introducción: La oncología integrativa es un campo reciente y prometedor, que apunta a la atención integral centrada en el paciente, en un enfoque basado en la evidencia. Objetivo: Verificar el conocimiento científico producido sobre oncología integrativa en la atención hospitalaria. Método: Revisión integrativa con búsquedas en las bases de datos PubMed, LILACS, SciELO y MOSAICO, realizada de febrero a marzo de 2022. A partir de los criterios de elegibilidad (estudios relacionados con el tema publicados entre 2000 y 2022, disponibles en su totalidad para acceso público, en inglés, portugués y español) fueron seleccionados siete artículos, analizados según la modalidad temática. Resultados: Los artículos elegidos fueron publicados entre 2018 y 2021, con énfasis en la producción europea, lo que corresponde a cuatro (57,14%) artículos. El contenido de los estudios se organizó en dos temas, a saber: la implementación de la atención oncológica integradora y el acceso equitativo a la oncología integradora y otros desafíos. Se ha observado que la oncología integrativa se ha practicado en diferentes escenarios, con acciones variables, y su desafío central es ampliar el acceso de los usuarios, a través del desarrollo de pautas basadas en evidencia y la implementación de políticas de financiamiento y calificación profesional. Conclusión: El conocimiento científico producido apunta que la implementación de la atención oncológica integrativa en la atención hospitalaria aún es limitada, con desafíos relacionados con el acceso equitativo, el financiamiento, la gestión y la calificación de los profesionales de la salud

Profile of primary caesarean section at Musienene Hospitalin North Kivu, Eastern DRC

Introduction. The rate of cesarean section has increased in recent decades and primary caesarean section (PCS) seems to be prominent. The objective of this study was to determine the rate and factors associated with PCS at Musienene Hospital.Methods. It was a retrospective cross-sectional study. It involved 466 singleton pregnancies with no previous Caesarean Section (CS) scar, in 2016. Data were analyzed with Epiinfo software version 7. Chi-square was used to test the independent variables that can influence the mode of delivery, the relative risk to evaluate the degree of influence of each of the variables to the mode of delivery of the laboring women. Results. The rate of PCS was 23.2%. Mothers aged less than 20 years were 3.9 times as likely to deliver by cesarean section. Nulliparous women were 2.54 times more likely to undergo cesarean than multiparous. Mothers admitted during the night-shift were 2.74 times more likely to undergo caesarean section than those who were monitored during daytime care.Conclusion. The general CS rate as well as the primary cesarean section rate is very high at Musienene HGR. Most frequent during night shift in adolescent and nulliparous. Staff level, especially at night needs to be improved. The staff needs to be introduced to current maternity guidelines, and introduction of CS Audit will help in reducing the high rate. Raising community awareness of the risks associated with early pregnancy

Empatia de médicos avaliada por meio da Jefferson Scale of Empathy (JSE) - Physician como marcador do cuidado centrado no paciente / Physician empathy evaluated by the Jefferson Scale of Empathy (JSE) - Physician as a marker of patient-centered care

A empatia é considerada um pilar do cuidado centrado na pessoa, de qualidade e seguro, que permite a consolidação de parcerias e melhores desfechos. O objetivo deste estudo foi a adaptação transcultural da Jefferson Scale of Empathy ­ Physician - JSE (versão para médicos) para a língua portuguesa e o contexto brasileiro. É o instrumento mais pesquisado e utilizado no mundo, com validações em outras culturas, no qual a empatia é um atributo predominantemente cognitivo e divide-se em três dimensões: assumir perspectivas diferentes; cuidado com compaixão e vivenciar o lugar do paciente (calçar os sapatos do paciente). Foram realizadas as etapas de equivalências conceitual, semântica (tradução, retradução, equivalência entre retraduções e o instrumento, revisão pelo grupo de especialistas), pré-teste (20 entrevistados), operacional e de mensuração - Análise Fatorial Exploratória (AFE) e Confirmatória (AFC) e, consequentemente, a funcional. A JSE foi aplicada de outubro de 2017 a março de 2018 no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), hospital com longo caminho voltado à qualidade. Responderam 101 médicos, 75% do sexo masculino, com idades entre 24 a 66 anos (média: 39,3). Os valores dos escores variaram de 75 a 140, com média de 117,8 (Desvio padrão - DP:13,5); escores médios dos itens variaram de 6,7 (DP:0,77) a 4,3 (DP:1,82). A estimativa de confiabilidade da escala (Alpha de Cronbach) foi 0,794 (também foram satisfatórios os Alfa de Cronbach padronizado, Alpha ordinal, Theta de Armor e Theta ordinal). Para validade do construto, foi realizada AFE com três dimensões, com rotação ortogonal varimax, oito itens carregaram na primeira dimensão; quatro na segunda e três na terceira. Três itens (1, 8 e 19) apresentaram cargas fatoriais com valores próximos (<0,2) nos fatores 2 e 3, e o item 2 carregou nos fatores 1 e 3. Três fatores com eigenvalues ≥ 1,5 foram extraídos com ACP, que explicam 41,4% da variância total. A análise de Kaiser-Meyer-Olkin apresentou um índice de 0,67, o teste de esfericidade de Bartlett mostrou um valor igual a 1027,04 (p < 0,01), o teste Steiger igual a 1879,70 (p < 0,01) e o teste de Jennrich igual a 276,70 (p < 0,01), que indicam a adequação dos dados para a análise fatorial. As subescalas cuidado com compaixão e assumir perspectivas estavam fortemente correlacionadas (r: 0,627), bem como as escalas vivenciar o lugar do paciente e cuidado com compaixão (r: 0,494). Na análise fatorial confirmatória, o modelo com 20 variáveis dependentes e 3 variáveis latentes apresentou bons índices de ajuste: RMSEA = 0,050 (IC 90%: 0,023-0,070), CFI = 0,952, TLI = 0,945 e SRMR = 0,071. Em nenhum dos estudos que validaram a escala, com variações metodológicas, a mesma se comportou exatamente como no trabalho original. O peso do fator cultural entre os diversos povos ainda não está bem esclarecido. Este é o primeiro estudo brasileiro de validação da JSE (médicos), possui diversas limitações, com clara correlação com o construto. São necessários mais estudos com a mesma, para permitir sua utilização de forma sistemática no nosso meio e elaborar planos de melhorias em prol do cuidado centrado na pessoa

Empathy is considered a pillar of quality, safe, person-centered care, allowing partnerships, leading to better outcomes. The objective of this study was the cross - cultural adaptation of the Jefferson Scale of Empathy - Physician - JSE (version for physicians) to the Portuguese language and the Brazilian context. It is the most researched and used instrument in the world, with validations in other cultures, in which empathy is a predominantly cognitive attribute and is divided into three dimensions: assume different perspectives; care with compassion and experience the patient's place (put on the patient's shoes). The pre-test (20 interviewed), operational and measuring equivalents - Exploratory Factor Analysis (AFE) and Confirmatory (Analysis, Retranslation, Equivalence between retranslations and the instrument, review by the group of experts) were performed. AFC) and, consequently, functional. The JSE was applied from October 2017 to March 2018 at the National Institute of Traumatology and Orthopedics Jamil Haddad (INTO), a hospital with a long road to quality. A total of 101 doctors were male (75%) aged 24 to 66 years (mean: 39.3). The values of the scores ranged from 75 to 140, with a mean of 117.8 (Standard deviation - SD: 13.5); mean scores of items ranged from 6.7 (SD: 0.77) to 4.3 (SD: 1.82). The reliability estimate of the scale (Cronbach's Alpha) was 0.794 (the standard Cronbach's alpha, Alpha ordinal, Armor's Theta and Theta ordinal were also satisfactory). For the validity of the construct, three-dimensional AFE was performed, with orthogonal varimax rotation, eight items loaded in the first dimension; four in the second and three in the third. Three items (1, 8 and 19) presented factorial loads with close values (<0.2) in factors 2 and 3, and item 2 loaded on factors 1 and 3. Three factors with eigenvalues ≥ 1.5 were extracted with ACP , which explain 41.4% of the total variance. The Kaiser-Meyer-Olkin analysis presented an index of 0.67, the Bartlett sphericity test showed a value equal to 1027.04 (p <0.01), the Steiger test equal to 1879.70 (p <0) , 01), and the Jennrich test was 276.70 (p <0.01), which indicates the adequacy of the data for the factorial analysis. The compassionate and compassionate subscales were strongly correlated (r: 0.627), as well as the scales experiencing the patient's place and compassionate care (r: .494). In the confirmatory factor analysis, the model with 20 dependent variables and 3 latent variables had good adjustment indexes: RMSEA = 0.050 (IC 90%: 0.023-0.070), CFI = 0.952, TLI = 0.945 and SRMR = 0.071. In none of the studies that validated the scale, with methodological variations, it behaved exactly as in the original work. The weight of the cultural factor among the various peoples is still not clear. This is the first Brazilian validation study of JSE (physicians), and it has several limitations, but a clear correlation with the construct. Further studies are needed to enable it to be used systematically in our setting and to develop improvement plans for person-centered care

Evaluation de la satisfaction des patients hospitalisés dans les services du département de Médecine du Centre hospitalier universitaire Souro Sanou (CHUSS) de Bobo-Dioulasso, Burkina Faso

La satisfaction des usagers des établissements sanitaires fait partie de l'appréciation de la qualité des soins. L'objectif était d'étudier la satisfaction des patients hospitalisés dans les services du département de médecine du Centre hospitalier universitaire Souro Sanou (CHUSS) de Bobo-Dioulasso, Burkina Faso. Il s'est agi d'une étude transversale à visée analytique conduite en 8 mois. Les domaines de satisfaction ont été calculés selon le modèle SAPHORA (version 7). Des 294 patients éligibles, 250 (85,0 %) patients ont été retenus dont 42,0 % de femmes. L'âge moyen des patients était de 47,1 (± 17,9) ans. Les domaines à score faible étaient : niveau global de satisfaction, accueil, communication avec le personnel, restauration et organisation de la sortie. Les patients plus âgés et ceux à durée d'hospitalisation plus longue étaient plus satisfaits. Les 94,0 % des patients sans assurance maladie étaient moins satisfaits.Les scores des domaines de satisfaction par service et le score global de satisfaction étaient inférieurs à 50,0 %. Les différences entre les services étaient en lien avec : accueil, qualité humaine du personnel, soins médicaux, hôtellerie, restauration, coûts, et niveau global de satisfaction. L'amélioration de la satisfaction des patients hospitalisés requiert le respect des besoins fondamentaux des patients et une réorganisation des services avec un personnel engagé, pour l'offre de soins et services de santé de qualité

Current status and directions of resident education

A resident is a preliminary specialist with a medical license. It is also the status of an employee at a training hospital who is trained by clinical faculty. This duality makes the role of a resident unique, because its interpretation differs dramatically depending on whether one focuses on a resident's status as a trainee or as an employee. Issues regarding patient safety have emerged as residents have come to emphasize their role as employees in discussions of how to balance their work duties with their learning responsibilities. The workload that was taken for granted is no longer considered natural. Two years have elapsed since the enactment of the resident law, which was passed to improve the training environment and working conditions of residents, and limits them to 80 hours of work per week. However, confusion persists in the field. In order to solve problems regarding resident education, new education program with hospitalists and the financial and administrative support from hospitals and the government are important.

Current status and future of internal medicine hospitalist in Korea

A hospitalist system was introduced in Korea in September in 2016 to improve the quality of in-patient care and to cope with the shortage of medical residents. This study aimed to outline the current situation of internal medicine hospitalist and to suggest a development strategy. By May 2019, the number of hospitalists in Korea had increased to 124. Patient safety issues, resident law, and the shortage of medical residents has led to an increase in the demand for hospitalists in Korea. Internal medicine hospitalist care in Korea has been associated with patient satisfaction, length of stay, and waiting time in emergency departments. There are three different hospitalist ward models in the Korean health care system, and each hospital needs the model that fits its specific situation. In the general ward model, the role of the hospitalist is similar to that of the chief residents because the wards are categorized into nine subspecialty areas, such as internal medicine (including gastroenterology, pulmonology, and cardiology). In the short-term admission ward model, patients are usually turned around within 72 hours; therefore, the hospitalist is able to care for patients independently. After that, patients are discharged or admitted to a specialty ward. In integrated care model, patients from all specialty areas are admitted to the same ward; therefore, hospitalists care for patients independently. In this model, consultation with specialists is required. There were strengths and weaknesses in each model. Therefore, the models should be considered based on the hospital's function. This study found some problems in the present hospitalist system, including undefined roles and responsibilities, unclear future employment prospects, burnout due to patient' severity of illness, and inadequate payment systems for weekend and night work. To further develop the hospitalists system in Korea, the Korean government, the Korean associated of internal medicine, hospitals, and hospitalists must work together to solve the present problems.

Development of the role of teaching hospitalists in the education of residents

Resident law was enacted to improve the training environment and working conditions. However, the law caused confusion in the field and resulted in a medical vacuum in inpatient care. It also resulted in a lack of training time. A hospitalist system was introduced to improve the quality of patient care and to cover the shortage of residents. This study aimed to outline a development strategy for hospitalists participation in resident education in Korea. The result of pilot study of the hospitalists in Korea showed that patients, nurses, and residents were satisfied with hospitalists. Eighty-five percent of surgical residents were helped in postoperative patient care and 70.7% of residents were willing to work with a hospitalist. The competency of surgical hospitalists includes understanding surgery and the appropriate management of postoperative complications. In order to shift the paradigm of resident education, the Korean government must pay the expenses for resident training. Through hospitalists' participation in the resident training, it may be possible to provide residents with more comprehensive and continuous education for inpatient care.

The Current Status of Hospital Medicine in Korea, 2019 / 대한내과학회지

No abstract available.

An Acute Medical Unit in a Korean Tertiary Care Hospital Reduces the Length of Stay and Waiting Time in the Emergency Department

A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5–16.7) to 9.1 days (IQR, 5.1–15.0) (P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% (P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.

Trends of US Hospitalist and Suggestions for Introduction of Korean Hospitalist / 대한내과학회지

A gap in the number of physicians caring for inpatients is expected in 2014 based on the restricted working hours for Korean medical residents. One potential solution is the use of hospitalists. The US hospitalist movement has proliferated due to high-quality care and economics. This movement has brought positive changes including a shorter length of hospital stay, increased quality of care, and greater patient satisfaction. Because the Korean government controls all suppliers and maintains a low financial compensation level for universal coverage, hospitals do not have the financial resources to introduce hospitalists. Therefore, in contrast to the US, the use of hospitalists must be developed as a cost-compensated system in Korea. Institutional strategies must be introduced to develop a hospitalist system in Korea. A hospitalist system in Korea would be distinct from that in the US. Further studies and specific strategies are needed that consider Korea's circumstances to effectively introduce a hospitalist system.

Medicina hospitalaria a 15 años de su implementación: ¿Cuáles son los potenciales beneficios en nuestro medio? / Hospital medicine in Chile

After 15 years of development of Hospital Medicine in Chile, there are several benefits of this discipline. Among others, a reduction in the length of hospital stay, readmissions, costs, and improved medical teaching of students, residents and fellows have been observed. However, in South América there are only isolated groups dedicated to Hospital Medicine in Chile, Argentina and Brazil, with a rather slow growth. The unjustifiedfear of competitionfrom sub specialists, and the fee for service system ofpayment in our environment may be importantfactors to understand this phenomenon. The aging of the population makes imperative to improve the safety of our patients and to optimize processes and resources within the hospital, to avoid squandering healthcare resources. The following is a detailed and evidence-based article, on how hospital medicine might benefit both thepublic and prívate healthcare systems in Chile.