Exploration on Optimizing "Five-sphere" Medical Humanistic Care Service in Medical and Nursing Institutions / 中国医学伦理学

The combination of medical care and nursing is an important measure of health care for the aged, and it is also an important part of aging work. Under the background of increasing aging, and under the background of changing from disease-centered and patient-centered medical model to health-centered "big medicine" model, medical humanities are particularly important for how to make the elderly spend their old age in peace and make the road of combining medical care with nursing care wider. Based on the practice of combination of medical care and nursing, under the guidance of the concept of great health, this paper discussed the establishment of a "Five-sphere" all-round humanistic care concept integrating medical care, nutrition care, sports care, mental care and other convalescent health care factors, and provided a series of comprehensive multi-angle humanistic care service measures from physiology to psychology for elderly patients with chronic diseases, which has achieved good results.

Improving the Waiting Time in Outpatient Clinics Using Lean Approach in Hospital: A Systematic Review

@#Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.

Repercusión de la pandemia COVID-19 en el diagnóstico y tratamiento del cáncer de mama en pacientes asistidas en la Unidad de Mastología del Hospital de Clínicas

Introducción: la crisis sanitaria por COVID-19 impactó en la atención de diversas patologías, entre ellas, el cáncer. Con el fin de disminuir el riesgo de contraer SARS-CoV-2 se redujo el número de consultas, lo que determinó un aumento en la tasa de morbilidad y mortalidad para otras patologías, lo que se ha denominado la "segunda pandemia". Objetivo: describir la actividad asistencial de la Unidad de Mastología (UM) en el período marzo 2020 - marzo 2022 y compararla con la del período marzo 2019 - marzo 2021. Objetivo: describir la actividad asistencial de la Unidad de Mastología (UM) en el período marzo 2020 - marzo 2022 y compararla con la del período marzo 2019 - marzo 2021. Material y método: estudio observacional retrospectivo que incluyó a pacientes asistidas por cáncer de mama (CM) en el período marzo 2019 - marzo 2022. Resultados: durante el año previo a la pandemia se asistieron 30 nuevas pacientes. En cuanto al tiempo entre el diagnóstico anatomopatológico y el primer tratamiento, en 73,3% fue ≤ 2 meses, 16,6% > 2 meses y ≤ 4 meses y en 10% fue > 4 meses. Durante la pandemia se asistieron 50 pacientes nuevas, lo que se traduce en un descenso de 16,6%. En cuanto al tiempo entre el diagnóstico anatomopatológico y el primer tratamiento: en 41% fue ≤ 2 meses, 33% > 2 meses y ≤ 4 meses y en 25% fue > 4 meses. Conclusiones: si bien se logró mantener la actividad asistencial y dar continuidad a la mayoría de los tratamientos, durante la pandemia COVID-19 se redujo el número de pacientes derivadas al servicio en aproximadamente 16,6% y se produjo un aumento en el tiempo transcurrido entre el diagnóstico y el primer tratamiento.

Introduction: the COVID-19 health crisis had a significant impact on the management of various pathologies, including cancer. To reduce the risk of contracting SARS-CoV-2, the number of consultations was reduced, leading to increased morbidity and mortality rates for other pathologies, which has been referred to as the "second pandemic." Objective: The aim of this study is to describe the clinical activity of the Breast Unit (BU) during the period March 2020-2022 and compare it with the activity during the period March 2019-2021. Objective: the aim of this study is to describe the clinical activity of the Breast Unit (BU) during the period March 2020-2022 and compare it with the activity during the period March 2019-2021. Method: retrospective observational study including patients attending the BU during the period March 2019-2022. Results: in the year before the pandemic, 30 new patients were assisted. Regarding the time between anatomopathological diagnosis and the initiation of the first treatment: in 73.3% of cases, it was ≤ 2 months, 16.6% > 2 months and ≤ 4 months, and in 10%, it was > 4 months. During the pandemic, 50 new patients were assisted, representing a decrease of approximately 16.6% in the number of new patients attended. Regarding the time between anatomopathological diagnosis and the initiation of the first treatment: in 41% of cases, it was ≤ 2 months, 33% > 2 months and ≤ 4 months, and in 25%, it was > 4 months. Conclusion: although the BU managed to maintain its clinical activity and continuity of most treatments during the COVID pandemic, there was a reduction in the number of patients referred to the service by approximately 16.6% and an increase in the time elapsed between diagnosis and the initiation of the first treatment.

Introdução: a crise sanitária causada pela COVID-19 impactou o atendimento de diversas patologias, inclusive o câncer. Para diminuir o risco de contrair SARS-CoV-2, reduziu-se o número de consultas, o que determinou um aumento da taxa de morbimortalidade por outras patologias, o que tem sido chamado de "segunda pandemia". Objetivo: descrever a atividade assistencial da Unidade de Mastologia (UM) no período março de 2020 - março de 2022 e compará-la com a do período março de 2019 - março de 2020. Material e método: estudo observacional retrospectivo que incluiu pacientes atendidos pelo CM no período março de 2019 - março de 2022. Resultados: no ano anterior à pandemia foram atendidos 30 novos pacientes. Em relação ao tempo entre o diagnóstico patológico e o primeiro tratamento: em 73,3% foi ≤2 meses, 16,6% >2 meses e ≤4 meses e em 10% foi >4 meses. Durante a pandemia, foram atendidos 50 novos pacientes, o que se traduz em uma queda de 16,6%no número de novos pacientes atendidos. Quanto ao tempo entre o diagnóstico patológico e o primeiro tratamento: em 41% foi ≤2 meses, 33% >2 meses e ≤4 meses e em 25% foi >4 meses. Conclusão: embora tenha conseguido manter a atividade assistencial e dar continuidade à maioria dos tratamentos, durante a pandemia de COVID-19 o número de pacientes encaminhados para o Serviço diminuiu cerca de 16,6% e houve um aumento do tempo decorrido entre o diagnóstico e o primeiro tratamento.

Atención médica en el enfrentamiento a la COVID-19. Hospital Pediátrico Universitario de Cienfuegos, 2021-2022

Fundamento: la pandemia de COVID-19 tensó enormemente los servicios de salud en el mundo entero y Cuba no fue una excepción. Aunque la proporción de casos confirmados en niños fue menor, es necesaria la descripción de la atención médica a este sector de la población. Objetivo: describir la organización de los servicios médicos y morbilidad hospitalaria durante la COVID-19, de enero 2021 a febrero 2022, en el pediátrico de Cienfuegos. Métodos: estudio descriptivo realizado en el Hospital Pediátrico de Cienfuegos sobre la atención médica a niños, durante la pandemia de COVID-19. Se analizaron las variables número de casos, edad, sintomatología, casos ingresados en unidades de cuidados intensivos, egreso. Resultados: fueron ingresados 2758 pacientes confirmados de COVID-19; los meses de junio a septiembre aportaron el mayor número de casos, con agosto como más representativo con 46,4 %. Cienfuegos y Cumanayagua fueron los municipios con más casos; predominaron los menores de cinco años (88,3 %) fundamentalmente los menores de un año (49,2 %). La presentación clínica asintomática fue preponderante y sintomatología leve. Requirieron cuidados intensivos el 1,1 % del total y la letalidad fue de 0,04 %. El enfrentamiento a la enfermedad tuvo un carácter intersectorial; el cumplimiento de los protocolos y guías se dieron en un contexto donde primó la reorganización de los servicios y la gestión del conocimiento. Conclusiones: la atención médica oportuna y encaminada a alcanzar el mayor detalle científico asistencial, acompañado de una continua gestión del conocimiento para su adherencia permitió que la mayoría de los niños con COVID-19 egresaran de manera satisfactoria.

Foundation: the COVID-19 pandemic greatly strained health services throughout the world and Cuba was no exception. Although the proportion of confirmed cases in children was lower, it is necessary to describe the medical care provided to this sector of the population. Objective: to describe the medical services organization and hospital morbidity during COVID-19, from January 2021 to February 2022, at the Cienfuegos pediatric hospital. Methods: descriptive study carried out at the Cienfuegos Pediatric Hospital on medical care for children, during the COVID-19 pandemic. The variables number of cases, age, symptomatology, cases admitted to intensive care units, and discharge were analyzed. Results: 2758 confirmed COVID-19 patients were admitted; from June to September contributed to the greatest number of cases, with August as the most representative with 46.4%. Cienfuegos and Cumanayagua were the municipalities with the most cases; there was a predominance of children under five years of age (88.3%), mainly those under one year of age (49.2%). The asymptomatic clinical presentation was preponderant and mild symptoms. 1.1% of the total required intensive care and the lethality was 0.04%. The confrontation with the disease had an intersectoral character; compliance with the protocols and guidelines occurred in a context where the reorganization of services and knowledge management prevailed. Conclusions: timely medical care aimed at achieving the greatest scientific care detail, accompanied by continuous knowledge management, allowed most children with COVID-19 to be discharged satisfactorily.

Algunas consideraciones sobre la atención médica en la "nueva normalidad" poscovid-19

Debido a que los pronósticos favorables en relación con el control de la pandemia de COVID-19 en Cuba, se anunció una etapa de "nueva normalidad", con "desescalamiento" progresivo de medidas que se habían implementado para prevenir la enfermedad. Esto ha sido posible gracias a la labor conjunta de toda la sociedad, con sus máximas autoridades al frente, la capacidad y entrega de los profesionales de la salud organizados en un vigoroso sistema nacional de salud, la obtención y aplicación de fármacos autóctonos eficaces y la inmunización masiva contra el SARS-COV-2, con nuestras vacunas cubanas Abdala y Soberanas. Se comenta acerca de un grupo de lecciones aprendidas durante la pandemia, de la existencia de muchas dudas e interrogantes aún sin respuestas, de los nuevos riesgos -sobre todo para los más vulnerables- incluyendo el denominado síndrome poscovid, cuando se incrementa la celebración de eventos masivos de diferente índole, así como se alerta de la aparición frecuente de variantes del nuevo coronavirus y de recientes "olas" de enfermos en diferentes países. Se aborda de manera abreviada la situación actual de la COVID-19 en Cuba y las recomendaciones aconsejadas para esta etapa.

Due to the favorable prognoses in relation to the control of the COVID-19 pandemic in Cuba, a stage of "new normality" was announced, with a progressive "de-escalation" of measures that had been implemented to prevent the disease. This has been possible thanks to the joint efforts of the whole of society, with its highest authorities ahead, the capacity and dedication of health professionals organized in a vigorous national health system, obtaining and applying effective native drugs and the massive immunization against SARS-COV-2, with our Cuban Abdala and Soberanas vaccines. Comments are made on a group of lessons learned during the pandemic, on the existence of many doubts and questions still unanswered, on the new risks -especially for the most vulnerable- including the so-called post-COVID syndrome, when events are held more massive outbreaks of different kinds, as well as alerting to the frequent appearance of new coronavirus' variants and recent "waves" of patients in different countries. The current situation of COVID-19 in Cuba and the suggested recommendations for this stage are briefly addressed.

Self-assumed Neurologic Related Condition Deviated Metoclopramide-Induced Acute Dystonic of Oculogyric Crisis in a Woman of Childbearing Age: A Case Report

A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.

Research on the driving mechanism of residents′ willingness to participate in tiered medical care based on harmonious management theory / 中华医院管理杂志

Objective:To construct and validate a theoretical model of residents′ willingness to participate in tiered medical care based on harmonious management theory, providing reference for promoting the tiered medical care system and aiding governmental decision-making.Methods:Based on the harmonious management theory and literature review, a model capturing residents′ propensity to engage in tiered medical care was formulated. Using convenience sampling method, a questionnaire survey was conducted on 2 067 residents from 24 communities in Zhejiang province from April to May 2022. Descriptive statistical analysis was conducted on the survey results, and multilevel linear regression and structural equation modeling were used to analyze the driving mechanism of residents′ willingness to participate in tiered medical care.Results:The willingness rate of residents to participate in tiered medical care was 69.7%, which was at an average level. Regression insights highlighted the positive influence of policy support perception ( β=0.170, P<0.01), awareness of management mechanisms ( β=0.093, P<0.01), cognitive attitudes ( β=0.102, P<0.01), and trust levels ( β=0.244, P<0.01) on residents′ participation willingness. In contrast, resource allocation perceptions lacked a significant effect ( β=0.065, P>0.05). The structural equation model revealed that cognitive attitudes played a mediating role in the " policy system perception → participation willingness" and " management mechanism perception → participation willingness" pathways, with effect sizes of 0.030 and 0.039, respectively. Trust levels also mediated these paths, with effect sizes of 0.039 and 0.045, and entirely mediated the " resource allocation perception → participation willingness" path, registering an effect size of 0.053. Conclusions:The harmonious management theory can be used to explain the formation mechanism of residents′ willingness to participate in tiered medical care. The government and medical institutions urgently need to further improve residents′ awareness of tiered medical care, focus on enhancing residents′ trust, and further improve policies and management measures such as financial investment, medical insurance reimbursement, and referral systems.

Virtual reality training can effectively improve the cognitive functioning and functional fitness of persons with subjective cognitive decline / 中华物理医学与康复杂志

Objective:To observe any effect of virtual reality (VR) training on the cognitive functioning and functional fitness of nursing home residents with subjective cognitive decline (SCD).Methods:Fifty-six of such residents were randomly divided into an observation group and a control group, each of 28. Both groups received health education and routine care, but the observation group was additionally provided with 45 minutes of VR training three times a week for 6 months. The training included Baduanjin, magic, flying bird, supermarket shopping, gravity ball and gym episodes. Both groups′ cognition was evaluated using the subjective cognitive decline questionnaire (SCD-Q), the Montreal cognitive assessment (MoCA), the Rivermead Behavioural Memory Test (second edition) (RBMT-Ⅱ), a digit symbol substitution test (DSST), an animal fluency test (AFT) and trail-making test A-B (TMT A-B). Functional fitness was quantified using the 8-foot up-and-go test (8UGT), a 30-second arm curl test (30sACT), a 30-second chair stand test (30sCST), a back scratching test (BST), the sit-and-reach test (CSRT) and a 2-minute step test (2MST) before and after the 6-month intervention.Results:After the intervention, the average SCD-Q, MoCA, RBMT-Ⅱ, DSST, TMT-A, and TMT-B scores of the observation group were significantly better than before the intervention, and significantly better than the control group′s averages. And except for the back scratching their functional results were also significantly better, on average, than those of the control group.Conclusions:VR training can effectively improve the cognition and functional fitness of nur-sing home residents with SCD. Such training is worthy of promotion and wider application in nursing homes.

A wound diagnosis and treatment mode with integrated medical care for repair of chronic infectious wounds plus bone exposure at lower extremities / 中华创伤骨科杂志

Objective:To evaluate a wound diagnosis and treatment mode with integrated medical care in the repair of chronic infectious wounds plus bone exposure at lower extremities.Methods:A retrospective analysis was conducted of the 64 patients with chronic infectious wound plus bone exposure at the lower 1/3 of the leg who had been admitted to Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University from January 2019 to December 2021. The patients were divided into 2 groups according to the wound diagnosis and treatment mode. In the observation group of 31 patients subjected to the wound diagnosis and treatment mode with integrated medical care led by specialist nurses, there were 24 males and 7 females with an age of (53.6±12.4) years, the wound was located at the tibial side in 15 cases and at the fibular side in 16 cases, the wound areas averaged [28.27 (23.56, 37.70) cm 2], and the time from injury to treatment was (27.3±4.1) d. Evaluation of the patient's condition, wound diagnosis and formulation of treatment protocols were performed jointly by a doctor-nurse team after the patients were admitted, and continuous diagnosis and treatment of the wounds were carried out mainly by specialist nurses during the doctors' follow-up. In the control group of 33 patients subjected to the conventional wound diagnosis and treatment mode led by doctors, there were 25 males and 8 females with an age of (51.3±14.3) years, the wound was located at the tibial side in 17 cases and at the fibular side in 16 cases, the wound areas averaged [27.49 (17.84, 40.45) cm 2], and the time from injury to treatment was (27.6±4.0) d. The 2 groups were compared in the wound healing rate, wound recurrence rate, hospitalization time and patients' satisfaction. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The observation group achieved a significantly higher wound healing rate within 1 month after treatment [83.87% (26/31)] than the control group [60.61% (20/33)], a significantly lower wound recurrence rate within 6 months after treatment [0% (0/31)] than the control group [18.18% (6/33)], significantly shorter hospitalization time [18.0 (15.1, 20.9) d] than the control group [26.8 (18.4, 40.1) d], and significantly higher patients' satisfaction [50 (50, 50) points] than the control group [50 (42, 50) points] (all P<0.05). Conclusion:In the repair of chronic infectious wounds plus bone exposure at lower extremities, the wound diagnosis and treatment mode with integrated medical care led by specialist nurses may result in a higher wound healing rate, a lower wound recurrence rate, a shorter hospital stay and higher patients' satisfaction than the conventional wound diagnosis and treatment mode led by doctors.

Feasibility of reducing perioperative radiography -- analysis of risk factors for internal fixation loosening after closed reduction and internal fixation with Kirschner wire for supracondylar fracture of the humerus in children / 中华创伤骨科杂志

Objective:To explore the necessity of perioperative radiography by analyzing the risk factors for internal fixation loosening after closed reduction and internal fixation with Kirschner wire for supra-condylar fracture of the humerus in children.Methods:Retrospectively analyzed were the 502 patients with supracondylar fracture of the humerus who had been treated at Department of Orthopedics, Children's Hospital of Fudan University by closed reduction and internal fixation with Kirschner wire from January 1, 2019 to December 31, 2021. There were 307 boys and 195 girls, with an age of (60.0±27.2) months. There were 224 Gartland type Ⅱ supracondylar fractures and 278 Gartland type Ⅲ supracondylar fractures. Follow-ups revealed internal fixation loosening in 52 cases (set as a loosening group) and no internal fixation loosening in the other 460 cases (set as a non-loosening group). The angles between Kirschner wires (angle 1 and angle 2), the effective fixation ratios of the Kirschner wire (ratio 1, ratio 2, and ratio 3), the metaphyseal shaft angle α, and the distal anteversion angle of the humerus β were measured on the perioperative and postoperative elbow X-ray films and compared. Other data affecting the internal fixation loosening were collected. Multiple logistic regression was used to analyze the risk factors for internal fixation loosening after closed reduction and internal fixation of supracondylar fracture of the humerus. Results:There were no significant differences between the intraoperative and postoperative data in the angle 1 or angle 2 between Kirschner wires (26.58°±14.22° versus 26.75°±10.70°; 41.85°±8.67° versus 41.31°±7.79°), the effective fixation ratio 1, 2 or 3 of Kirschner wire (0.904±0.182 versus 0.887±0.206; 0.897±0.119 versus 0.895±0.142; 0.890±0.035 versus 0.889±0.076), the metaphyseal shaft angle α (86.25°±2.74° versus 85.52°±1.86°), or the distal anteversion angle of the humerus β (31.04°±0.97° versus 29.54°±0.45°) (all P>0.05). Multiple logistic regression analysis showed that fracture site ( P=0.032), fracture classification ( P=0.041) and postoperative infection ( P=0.004) were the risk factors for internal fixation loosening. Conclusions:As supracondylar fractures of the humerus remain stable in the perioperative period with little risk of fracture displacement or internal fixation loosening after closed reduction and internal fixation with Kirschner wire, postoperative radiography is not necessary. The risks for internal fixation loosening are positively correlated with fracture site, fracture type and postoperative infection.

Analysis on the Difficulties and Strategies in Promoting the Red Doctor’s Culture: Taking Western Fujian as an Example / 中国医学伦理学

Red doctor’s culture is a precious spiritual wealth formed in the medical and health practice of the Central Soviet Area during a specific historical period. With the development of society and the changes of the times, the red doctor’s culture has been endowed with new connotation. Western Fujian was the earliest place to provide medical support for the revolutionary army, the birthplace of the Republic’s health service, and made great contributions to the victory of the Chinese revolution. The cultural resources of red doctor’s in western Fujian are abundant, and it is one of the important lineages of the red culture in western Fujian, with its unique historical value. At present, there are many problems in promoting the red doctor’s culture. Actively exploring and researching specific paths and methods to promote the red doctor’s culture is of great significance and value for giving full play to the connotation of the red doctor’s culture in the new era, promoting its value leading role at various levels of society, and passing down the spirit and culture of red doctor’s.

Analysis on the Development Dilemmas of Integrated Eldercare Services with Medical Care in China under the Healthy China Strategy / 中国医学伦理学

With the arrival of aging, various industries in society are facing great pressure, especially higher requirements for the medical and nursing industries. The integrated eldercare services with medical care breaks through the traditional endowment pattern and integrates medical treatment, elderly care, rehabilitation, and nursing. However, many factors hinder the development of this model at present, and it requires the cooperation of the country and various departments to improve. From the perspective of a Healthy China, based on the release and implementation of policies such as the "Healthy China 2030" Plan Outline and the "Healthy China Action (2019-2030)" , this paper briefly summarized the current status and existing problems of the development of integrated eldercare services with medical care in China, and put forward rectification suggestions, aiming to provide reference to build a new endowment pattern of integrated eldercare services with medical care with Chinese characteristics.

Work Progress and Outlook of Rare Skin Diseases Team / 罕见病研究

There are many kinds of rare skin diseases, but the research into the diagnosis and treatment of rare skin diseases is relatively scarce. In recent years, the rare skin diseases team has made a series of accomplishments, including establishing the professional committee of Rare Skin Disease Committee of China Alliance for Rare Diseases, establishing China's first Medical Care Alliance for Rare Skin Diseases, launching two national collaborative projects, promoting the project of improving the diagnosis and treatment of rare diseases supported by the Central Special Lottery public welfare Fund, exploring the multidisciplinary diagnosis and treatment model of skin rare diseases, holding academic conferences, and compiling professional books on rare skin diseases. In the future, we will further improve the remote consultation model of rare skin diseases, develop artificial intelligence assisted diagnosis system of rare skin diseases, carry out high-quality clinical research, and improve the overall diagnosis and treatment level of rare skin diseases in China, for the sake of benefiting more patients.

Developing a “Multidisciplinary Collaboration Ability Scale (MCAS)”: Examining the Reliability and Validity for Medical Professionals Engaged in Cancer Care

Purpose: The purpose of this study is to develop a “Multidisciplinary Collaboration Ability Scale (MCAS)” and examine the reliability and validity for medical professionals engaged in cancer care. Method: The first MCAS draft was created, and the content validity and surface validity of the scale were examined for medical professionals. Next, a cross-sectional questionnaire survey was conducted on medical professionals engaged in cancer care who worked in medical institutions. Exploratory factor analysis and known-groups technique were carried out, coefficient α calculated, and concurrent validity examined. This study was conducted with the approval of the research ethics review. Result: Exploratory factor analysis resulted in 33 items of 4 factors (ability to promote discussion, foundational relationship building, self-control, and problem-solving activities). The MCAS score was significantly higher for those who had participated in a multidisciplinary workshop and those who had more years of experience. Coefficient α for the entire scale and for each factor was .80 and above. Examination of concurrent validity showed a moderate correlation. Conclusion: The reliability and validity of MCAS in its development stage were generally verified.

Treatment delay and influencing factors of tuberculosis patients in Xianning from 2008 to 2021 / 公共卫生与预防医学

Objective To analyze the current situation, change trend and influencing factors of the delay in the treatment of tuberculosis patients in Xianning from 2008 to 2021, and to provide a scientific basis for controlling the tuberculosis epidemic. Methods The current situation and trend of the delay in the treatment of tuberculosis patients in Xianning City from 2008 to 2021 were described, and the multivariate Logistic regression analysis model was used to explore the influencing factors of the treatment delay in tuberculosis patients. Results The delay rate of seeking medical care for tuberculosis patients in Xianning from 2008 to 2021 was 58.53%, and the delay rate in the first six years tended to be stable. From 2014 to 2016, it increased slightly and then decreased year by year to 44.76% in 2021. Different gender and age groups showed the same trends as overall patients. The analysis results of the multivariate Logistic regression analysis model showed that females, household registration address in Jiayu County, occupations including service industries, workers, farmers and herdsmen, retirees, and others, the diagnosis result being positive for etiology, and the direct treatment in the patient source were high-risk factors for patients with delayed treatment. The risk of delay in treatment in ≥ 65-year-old patients was lower than that of < 25-year-old patients. Conclusion From 2008 to 2021, the phenomenon of delay in the treatment of patients with pulmonary tuberculosis in Xianning City is relatively common, and the high-risk factors of the delay in treatment need to be paid more attention to.

Percepción de atención obstétrica inadecuada a pacientes de un hospital público de Ciudad Juárez, Chihuahua / Perception of obstetric violence in patients treated in a public hospital in Ciudad Juárez, Chihuahua

Resumen OBJETIVO: Determinar la sensación de maltrato o de acciones contra el natural modo de proceder durante la atención obstétrica e identificar los factores asociados con esa percepción por parte de las pacientes atendidas en un hospital público de Ciudad Juárez, Chihuahua. MATERIALES Y MÉTODOS: Estudio descriptivo, prospectivo, de serie de casos al que se incluyeron todas las pacientes internadas en el área de Ginecología del Hospital 66 del Instituto Mexicano del Seguro Social de Ciudad Juárez, Chihuahua, con diagnóstico de puerperio de parto, cesárea y aborto atendidas entre los meses de junio a diciembre de 2022. RESULTADOS: De 496 pacientes, 13.9% (n = 67) percibieron algún tipo de procederes incorrectos en las dimensiones de: mal trato y abuso 9.9% (n = 49), atención médica no autorizada 2.4% (n = 12). En percepción de acciones contra el natural modo de proceder: 22% (n = 109) de las mujeres entre 14 y 19 años percibieron que el trato recibido no fue el adecuado. De las pacientes atendidas en el turno nocturno 18% percibieron tratos inadecuados. El 17% de las mujeres atendidas por aborto percibieron que el trato recibido no fue adecuado. Riesgo de atención alejada del natural modo de proceder: grupo de edad de 14 a 19 años (RR 1.96; 1.30-3.72), las mujeres que han tenido 1 embarazo tuvieron un RR 1.92 (1.15-3.21) y con escolaridad secundaria RR 1.35 (0.81-2.24). CONCLUSIONES: Las pacientes en mayor riesgo de no recibir una atención obstétrica apegada a las normas de buen trato fueron las adolescentes de entre 14 a 19 años, las mujeres con escolaridad secundaria, las atendidas en el turno nocturno y las primíparas. Esto evidencia que la atención obstétrica no estrictamente apegada al natural modo de proceder sigue siendo una problemática importante en nuestra población de estudio.

Abstract OBJECTIVE: To determine the feeling of mistreatment or actions against the natural way of proceeding during obstetric care and to identify the factors associated with this perception on the part of patients attended in a public hospital in Ciudad Juárez, Chihuahua. MATERIALS AND METHODS: Descriptive, prospective, case series study including all patients admitted to the Gynaecology Department of Hospital 66 of the Instituto Mexicano del Seguro Social in Ciudad Juárez, Chihuahua, with a diagnosis of postpartum labour, caesarean section and abortion attended between June and December 2022. RESULTS: Of 496 patients, 13.9% (n = 67) perceived some type of incorrect procedures in the following dimensions: mistreatment and abuse 9.9% (n = 49), unauthorised medical care 2.4% (n = 12). In perception of actions against the natural way of proceeding: 22% (n = 109) of the women between 14 and 19 years of age perceived that the treatment received was not adequate. Of the patients seen during the night shift, 18% perceived obstetric violence. 17% of the women attended for abortion perceived that the treatment received was inadequate. Risk of care away from the natural way of proceeding: age group 14-19 years (RR 1.96; 1.30-3.72), women who have had 1 pregnancy had a RR 1.92 (1.15-3.21) and with secondary schooling RR 1.35 (0.81-2.24). CONCLUSIONS: Patients at highest risk of not receiving obstetric care adhering to standards of good treatment were adolescents aged 14-19 years, women with secondary schooling, those seen on the night shift and primiparas. This shows that obstetric care that is not strictly adherent to the natural way of proceeding continues to be a major problem in our study population.

Historia clínica electrónica: miradas críticas de médicos del área metropolitana de Buenos Aires, Argentina / Electronic medical records: critical views of doctors in the metropolitan region of Buenos Aires, Argentina / Registro médico eletrônico: pontos de vista críticos dos médicos da área metropolitana de Buenos Aires, Argentina

Resumen Los procesos de digitalización del siglo XX extendieron el uso de Tecnologías de Información y Comunicación al campo de la salud. El artículo aborda la Historia Clínica Electrónica a partir de las críticas y debilidades señaladas por especialistas en Clínica Médica, Medicina General y/o de Familia del Área Metropolitana de Buenos Aires, Argentina. El diseño metodológico cualitativo incluyó 43 entrevistas realizadas entre junio de 2019 y marzo de 2020. El andamiaje teórico interpretativo articula tres campos: Comunicación y Salud; Biomedicina, Biopolítica y Tecnologías de Información y Comunicación; Subjetividad, Derechos y Género. Los principales resultados conciernen a cambios en las relaciones médico-paciente, registro y uso de datos, implicancias sobre los derechos y las subjetividades, potencialidades y problemáticas de la informatización en salud en un contexto de precaria infraestructura, desafíos en la regulación y desigualdades estructurales.(AU)

Abstract Digitalization has extended the use of information and communications technologies in the field of health. This article addresses electronic medical records drawing on the criticisms and weaknesses highlighted by clinical specialists, general practitioners, and family doctors working in the metropolitan region of Buenos Aires, Argentina. The qualitative research design included 43 interviews conducted between June 2019 and March 2020. We developed an interpretive framework structured around three categories: communications and health; biomedicine, biopolitics and information and communication technologies; subjectivity, rights and gender. The main results refer to: changes in doctor-patient relations; data recording and usage; implications for rights and subjectivities; potential and challenges of health informatization in a context of precarious infrastructure; and regulatory challenges and structural inequalities.(AU)

Resumo Os processos de digitalização do século XX estenderam o uso das Tecnologias da Informação e Comunicação ao campo da saúde. O artigo aborda o Registro Médico Eletrônico a partir das críticas e fragilidades apontadas por especialistas em Clínica Médica, Medicina Geral e / ou Família da Área Metropolitana de Buenos Aires, Argentina. O desenho metodológico qualitativo incluiu 43 entrevistas realizadas entre junho de 2019 e março de 2020. O referencial teórico interpretativo articula três campos: Comunicação e Saúde; Biomedicina, Biopolítica e Tecnologias de Informação e Comunicação; Subjetividade, Direitos e Gênero. Os principais resultados referem-se a mudanças nas relações médico-paciente, registro e uso de dados, implicações em direitos e subjetividades, potencialidades e problemas de informatização em saúde em um contexto de infraestrutura precária, desafios na regulação e desigualdades estruturais.(AU)

Percepção dos internos de Medicina acerca do atendimento destinado às pessoas com deficiência: modelo curricular insuficiente? / Perception of Medical interns about assisting people with disabilities: insufficient curriculum model?

Resumo Introdução: O conceito de deficiência relaciona-se às limitações socialmente impostas aos deficientes por seus corpos não corresponderem ao modelo aceito como normal. Em geral, o acesso à saúde dessa população é precário, em parte, pela falta de preparação voltada ao cuidado dos pacientes deficientes durante a formação médica, demonstrando que os currículos das faculdades necessitam de revisão. Objetivo: Este estudo teve como objetivo analisar a percepção do aluno interno do curso de Medicina da Universidade Federal do Ceará (UFC) acerca do modelo curricular atual no contexto da formação médica, especificamente voltado ao atendimento destinado às pessoas com deficiência. Método: Foi disponibilizado um formulário elaborado no Google Formulários, para coletar informações de internos da Faculdade de Medicina (Famed). Depois, realizaram-se entrevistas semiestruturadas via Google Meet mediante questões que objetivaram entender a relação entre futuros médicos e pessoas com deficiências, além da confiança do preparo para o atendimento a tais pacientes. Para exame do material empírico adquirido, utilizou-se a análise de discurso de Rueda. Resultado: Foram entrevistados 13 internos que relataram limitação no aprendizado do estabelecimento da relação médico-paciente em relação a pessoas com deficiência, durante o ciclo básico (do primeiro ao quarto semestre), evoluindo, principalmente, para o internato. Consideraram-se a educação, o entendimento das condições socioeconômicas e culturais do paciente, e a construção de um plano terapêutico executável as qualidades a serem desenvolvidas pelo interno. Quanto aos principais problemas relatados, destacou-se a dificuldade na realização do exame físico e na comunicação. Por sua vez, a ajuda de acompanhantes e o auxílio da equipe profissional foram apontados como aspectos positivos. Percepções referentes ao preparo para atender deficientes foram contrastantes: alguns relataram segurança por capacitações e conhecimentos empíricos, enquanto outros se sentiram inseguros ou incapazes. Percebe-se, também, importante consideração para haver adaptação curricular acerca desse tema, com intervenções nas disciplinas obrigatórias e optativas. Conclusão: Evidenciou-se que os entrevistados sentem dificuldades no atendimento destinado a deficientes, o que sugere alterações no currículo da Famed-UFC.

Abstract Introduction: The concept of disability is related to the socially-imposed limitations on the disabled because their bodies do not correspond to the model accepted as normal. Access to health care for this population is generally precarious, partly due to the lack of preparation for the care of disabled patients during medical school. This suggests that the school curricula need to be revised. Objective: To analyse the perception of the senior medical students at the Federal University of Ceará (UFC) about the current curriculum, specifically, in relation to the care of people with disabilities. Method: A form previously prepared on the Google Forms platform was made available to collect information from senior medical students at the School of Medicine (FAMED). Afterwards, semi-structured interviews were carried out via Google Meet using questions that aimed to understand the relations between future doctors and people with disabilities, as well as the confidence of the students in their preparation for caring for such patients. For analysis of the empirical material acquired, we used Rueda's speech analysis. Result: Thirteen interns were interviewed, who reported limitations in learning how to establish a doctor-patient relationship with patients with disabilities during the first two years of medical school, having effects on the future clinical rotations. Politeness, knowledge of the patient's socioeconomic and cultural conditions, and building an executable therapeutic plan were considered qualities to be developed by the student. The main problems reported was difficulty in performing the physical examination and communication with disabled patients. However, help from the patients' carers and from the professional team was considered positive by the students. Perceptions regarding the preparation to care for the disabled were contrasting: some reported confidence, due to training and empirical knowledge, while others felt insecure or incapable. It is also important to consider adapting the curriculum on this subject, with interventions in compulsory and elective subjects. Conclusion: Considering the responses and analyses, it was evident that the interviewees experience difficulties in caring for the disabled, suggesting changes to the FAMED-UFC curriculum.

Estudios de ecología de la atención médica: análisis comparado en dimensión histórica, 1928-2018 / Studies on the ecology of medical care: a comparative analysis in historical perspective, 1928-2018

RESUMEN En la definición de las políticas de salud y en la toma de decisiones por parte de la gestión suele primar una separación entre clínica, epidemiología y salud pública, situación naturalizada desde la mirada de los hospitales y ministerios, pero artificial en los territorios, donde los problemas no se estructuran siguiendo la fragmentación de saberes, sino que se expresan en la complejidad de los problemas de las personas y los conjuntos poblacionales. Desde esa concepción, este trabajo recopila y analiza los estudios de ecología de la atención médica, realizados entre 1928 y 2018, que retoman el estudio precursor "The ecology of medical care", de White, Williams y Greenberg, para centrar la discusión en tres ejes: 1) las regularidades presentes en los estudios de ecología de la atención médica, independientemente del año y el país; 2) los sistemas de información en salud y las encuestas de salud; y 3) la hegemonía institucional del hospital en el campo de la salud.

ABSTRACT In the definition of health policies and decision-making on the part of health officials, there is often a prevailing separation between clinical practice, epidemiology, and public health. Although this division is naturalized from the viewpoint of hospitals and public agencies, it is artificial in the context of concrete territories and communities, where problems are not structured according to the fragmentation of knowledge, but rather express the complexities of the problems faced by individuals and population groups. In this context, this article compiles and analyzes studies on the ecology of medical care carried out between 1928 and 2018 that have revisited the pioneering study "The ecology of medical care" by White, Williams and Greenberg. The discussion is structured around three central issues: 1) recurrent themes in studies on the ecology of medical care; 2) health information systems and health surveys; and 3) the institutional hegemony of hospitals in the health field.