Postmortem qualitative analysis of psychological, occupational, and environmental factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists: case series.

BACKGROUND: Anesthetic and/or opioid abuse is more prevalent among anesthesiologists than in other medical specialties and it has been associated with high mortality. The aim of this study was to evaluate factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists. METHODS: We evaluated psychological factors, and occupational history and circumstances of death of anesthesiologists who died from anesthetic abuse. Data were obtained post-mortem from colleagues, and relatives. After finding eligible cases, we identified the key informants, who were interviewed personally or via email, through the qualitative method known as "Psychological Autopsy". RESULTS: Eighteen cases of death were identified, but we were able to interview 44% of them (n = 8), most of whom were young males. They died at home or at the hospital and were found "at the scene". Being an introspective person who did not share personal issues at workplace was the most prevalent personal characteristic. At work, they seemed to perform very well their functions, but some presented subtle changes such as to staying more than usual at the workplace and/or neglecting some of their responsibilities. The main reported factors to explain their substance abuse were emotional problems including psychiatric, excessive hours of work, and other health factors. CONCLUSION: This study identified that emotional disturbances, compulsive work, and general health problems were the more prominent factors involved with those deaths. Further, larger studies are needed to better understand how these factors could be early identified in order to timely prevent anesthetic and/or opioid abuse and several deaths among anesthesiologists.

Rumo aos 40 anos de entrevista motivacional: evolução da abordagem / Towards 40 years of motivational interviewing: evolvement of the approach

A Entrevista Motivacional (EM) é uma abordagem pautada na empatia, na escuta reflexiva e na resolução da ambivalência para auxiliar no processo de mudança. Desde sua criação, foram realizadas revisões teóricas importantes com o objetivo de aprimorar o método e melhor adequá-lo às diferentes demandas, porém a literatura no Brasil ainda encontra-se desatualizada. Método: Foi realizada uma revisão não-sistemática da literatura sobre a EM buscando sintetizar e apresentar as principais mudanças teóricas realizadas. Resultados e Discussão: Os princípios centrais e as fases da mudança foram algumas das reformulações propostas, que agora melhor refletem a complexidade do processo e oferecem diretrizes mais estruturadas para direcionar o trabalho do terapeuta, esclarecendo também alguns dos conceitos originais. Conclusões: Considerando o aumento da utilidade da EM nos diversos contextos e as mudanças realizadas ao longo dessas últimas décadas, acredita-se que esta atualização favorecerá o ensino, pesquisa e a prática da EM no país.

Motivational Interviewing (MI) is an approach that relies on empathy, reflexive listening and ambivalence resolution to assist people in the process of changing. Since its creation, important theoretical revisions have been made with the aim of improving the method according to different demands, but literature in Brazil is found to be out of date. Method: A non-systematic review of literature on MI was carried out, seeking to synthesize and present the main theoretical changes made. Results and Discussion: The main principals and phases of change were among some of the changes proposed, which now reflect the complexity of the process and provide more structured guidelines for the therapist, also clarifying some of the original concepts. Conclusions: Considering the increase of the MI utility in various contexts and changes made over the last decades, it is believed that this update will favor the teaching, research and practice of MI in the country.