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Zittoun C, Garbous W, Raffin H, Gusso G. Le shiatsu : une médecine complémentaire au service de l’apaisement et de la verbalisation des traumatismes. Encephale 2022; 48 Suppl 1:S56-S60. [DOI: 10.1016/j.encep.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
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Li E, Tsopra R, Jimenez G, Serafini A, Gusso G, Lingner H, Fernandez MJ, Irving G, Petek D, Hoffman R, Lazic V, Memarian E, Koskela T, Collins C, Espitia SM, Clavería A, Nessler K, O’Neill BG, Hoedebecke K, Ungan M, Laranjo L, Ghafur S, Fontana G, Majeed A, Car J, Darzi A, Neves AL. General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study. PLOS Digit Health 2022; 1:e0000029. [PMID: 36812543 PMCID: PMC9931239 DOI: 10.1371/journal.pdig.0000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
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Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France
- Inria Paris, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Geronimo Jimenez
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Heidrun Lingner
- Hannover Medical School, Center for Public, Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Germany
| | - Maria Jose Fernandez
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine- Epidemiology Research Group, Skane University Hospital, Malmö, Sweden
| | - Tuomas Koskela
- General Practice, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Finland
| | | | | | - Ana Clavería
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
- Primary Care Research Unit. Vigo Health Area, Vigo, Spain
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Braden Gregory O’Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Kyle Hoedebecke
- Department of Utilization Management, Oscar Health, Dallas, United States of America
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Saira Ghafur
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gianluca Fontana
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Center for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Leiro Health Center, Leiro, Spain
- Galicia South Health Research Institute, Vigo, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Spain
| | - Ara Darzi
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (EL); (ALN)
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Silva B, Hens N, Gusso G, Lagaert S, Macinko J, Willems S. Dual Use of Public and Private Health Care Services in Brazil. IJERPH 2022; 19:ijerph19031829. [PMID: 35162852 PMCID: PMC8835064 DOI: 10.3390/ijerph19031829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 (n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users (n = 6484; 14.7%). Dual use happened both in the direction of public to private (n = 4628; 67.3%), and of private to public (n = 1855; 32.7%). Higher income had a significant effect on dual use (p < 0.0001), suggesting a dose–response relationship, even after controlling for confounders. Significant effects were also found for region (p < 0.0001) and usual source of care (USC) (p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.
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Affiliation(s)
- Bianca Silva
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
- Correspondence:
| | - Niel Hens
- Data Science Institute (DSI), I-BioStat, Hasselt University, BE-3500 Hasselt, Belgium;
| | - Gustavo Gusso
- Faculty of Medicine, University of São Paulo, São Paulo 05403-000, Brazil;
| | - Susan Lagaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
| | - James Macinko
- Department of Health Policy and Management, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90095, USA;
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
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Neves AL, Li E, Serafini A, Jimenez G, Lingner H, Koskela TH, Hoffman RD, Collins C, Petek D, Claveria A, Tsopra R, Irving G, Gusso G, O'Neill BG, Hoedebecke K, Espitia SM, Ungan M, Nessler K, Lazic V, Laranjo L, Memarian E, Fernandez MJ, Ghafur S, Fontana G, Majeed A, Car J, Darzi A. Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study. JMIR Res Protoc 2021; 10:e30099. [PMID: 34292867 PMCID: PMC8396553 DOI: 10.2196/30099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. OBJECTIVE This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. METHODS This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers' personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants' characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. RESULTS Data collection took place from June 2020 to September 2020. As of this manuscript's submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. CONCLUSIONS The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30099.
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Affiliation(s)
- Ana Luísa Neves
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Geronimo Jimenez
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Heidrun Lingner
- Center for Public Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Hannover Medical School, Hannover, Germany
| | - Tuomas H Koskela
- Department of General Practice, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Robert D Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Claveria
- Primary Care Research Unit, Vigo Health Area, Vigo, Spain
- Galicia South Health Research Institute, Vigo, Spain
| | - Rosy Tsopra
- Information Sciences to Support Personalized Medicine, Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Gustavo Gusso
- Department of Internal Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Braden Gregory O'Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Kyle Hoedebecke
- Department of Utilization Management, Oscar Health, Dallas, TX, United States
| | | | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Internal Medicine and Epidemiology Research Group, Skane University Hospital, Malmö, Sweden
| | - Maria Jose Fernandez
- Galicia South Health Research Institute, Vigo, Spain
- Leiro Health Center, Leiro, Spain
| | - Saira Ghafur
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gianluca Fontana
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Vieira Targa L, Floss M, Gusso G, Almeida M, Massakazu Ando N, Lima M, Luiz da Silva A. História do Grupo de Trabalho em Medicina Rural da SBMFC. Rev Bras Med Fam Comunidade 2020. [DOI: 10.5712/rbmfc15(42)2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Este artigo apresenta a História do Grupo de Trabalho em Medicina Rural da SBMFC, um dos mais ativos grupos de trabalho da SBMFC. São revisados os primeiros passos desde a sua criação e posteriores desenvolvimentos. Um dos principais resultados identificados foi o de ajudar a consolidar a identidade do “MFC rural” e trazer a discussão da saúde das populações rurais para a agenda da saúde, da atenção primária e da medicina de família. Este relato tem também como objetivo auxiliar outros grupos em criação ou já estabelecidos a criar estratégias de fortalecimento de seus trabalhos.
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Gusso G. The International Classification of Primary Care: capturing and sorting clinical information. Cien Saude Colet 2019; 25:1241-1250. [PMID: 32267427 DOI: 10.1590/1413-81232020254.30922019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022] Open
Abstract
The International Classification of Primary Care-2 (ICPC-2) is the result of forty years of continuous development. It originates in the second half of the twentieth century after the concern of general practitioners about the need to record and encode data specifically related to primary care, both in the reasons for encounter and procedures and conditions or diagnoses. The World Health Organization endorsed the classification, as did the developer committee after the Alma Ata meeting, since it also identified specific needs. Two forms of use are employed now in gathering information: by encounter or by an episode of care. The latter is more complex and controversial. Recently, an eleventh version of the International Classification of Diseases has been released, and the third edition of ICPC is being developed. One cannot predict how new technologies, classifications, and international organizations will interact. The role of front line health professionals and patients will define the course.
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Affiliation(s)
- Gustavo Gusso
- Faculdade de Medicina, Universidade de São Paulo. Av. Enéas Carvalho de Aguiar 155, Pinheiros. 05403-000 São Paulo SP Brasil.
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Olagundoye OA, Malan Z, Mash B, van Boven K, Gusso G, Ogunnaike A. Reliability measurement and ICD-10 validation of ICPC-2 for coding/classification of diagnoses/health problems in an African primary care setting. Fam Pract 2018; 35:406-411. [PMID: 30060181 DOI: 10.1093/fampra/cmx132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The routine application of a primary care classification system to patients' medical records in general practice/primary care is rare in the African region. Reliable data are crucial to understanding the domain of primary care in Nigeria, and this may be actualized through the use of a locally validated primary care classification system such as the International Classification of Primary Care, 2nd edition (ICPC-2). Although a few studies from Europe and Australia have reported that ICPC is a reliable and feasible tool for classifying data in primary care, the reliability and validity of the revised version (ICPC-2) is yet to be objectively determined particularly in Africa. OBJECTIVES (i) To determine the convergent validity of ICPC-2 diagnoses codes when correlated with International Statistical Classification of Diseases (ICD)-10 codes, (ii) to determine the inter-coder reliability among local and foreign ICPC-2 experts and (iii) to ascertain the level of accuracy when ICPC-2 is engaged by coders without previous training. METHODS Psychometric analysis was carried out on ICPC-2 and ICD-10 coded data that were generated from physicians' diagnoses, which were randomly selected from general outpatients' clinic attendance registers, using a systematic sampling technique. Participants comprised two groups of coders (ICPC-2 coders and ICD-10 coders) who coded independently a total of 220 diagnoses/health problems with ICPC-2 and/or ICD-10, respectively. RESULTS Two hundred and twenty diagnoses/health problems were considered and were found to cut across all 17 chapters of the ICPC-2. The dataset revealed a strong positive correlation between selected ICPC-2 codes and ICD-10 codes (r ≈ 0.7) at a sensitivity of 86.8%. Mean percentage agreement among the ICPC-2 coders was 97.9% at the chapter level and 95.6% at the rubric level. Similarly, Cohen's kappa coefficients were very good (κ > 0.81) and were higher at chapter level (0.94-0.97) than rubric level (0.90-0.93) between sets of pairs of ICPC-2 coders. An accuracy of 74.5% was achieved by ICD-10 coders who had no previous experience or prior training on ICPC-2 usage. CONCLUSION Findings support the utility of ICPC-2 as a valid and reliable coding tool that may be adopted for routine data collection in the African primary care context. The level of accuracy achieved without training lends credence to the proposition that it is a simple-to-use classification and may be a useful starting point in a setting devoid of any primary care classification system for morbidity and mortality registration at such a critical level of public health importance.
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Affiliation(s)
| | - Zelra Malan
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Bob Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gustavo Gusso
- Department of General Practice, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Afolasade Ogunnaike
- Department of Family Medicine, General Hospital Lagos, Lagos Island, Nigeria
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Garcia AP, Cadioli LM, Lopes Júnior A, Gusso G, Valladão Júnior JBR. Preceptoria na Residência de Medicina de Família e Comunidade da Universidade de São Paulo: políticas e experiências. Rev Bras Med Fam Comunidade 2018. [DOI: 10.5712/rbmfc13(40)1610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A atividade de preceptoria dentro da formação médica tem sido globalmente estabelecida como modelo para o processo docente na área e existem diversas formas e experiências de organização. O Programa de Residência Médica (PRM) em Medicina de Família e Comunidade (MFC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP) apresenta um modelo de preceptoria incomum, composto por preceptores do programa de residência médica e por preceptores dos residentes (tutores), cada um com especificidades próprias e complementares. Objetivo: Nosso objetivo neste relato de experiência foi compartilhar as políticas institucionais e experiências de preceptoria em nosso programa de residência médica, bem como apontar as múltiplas adversidades existentes e possíveis formas de enfrentamento. Resultados: Atingir o nível de excelência no desenvolvimento das competências necessárias para a formação do especialista em MFC, em situações adversas de valorização da especialidade e do corpo docente, é uma tarefa árdua. Neste difícil desafio de conduzir o PRM e garantir o desenvolvimento das competências almejadas com qualidade, o papel do preceptor do programa de residência médica e do preceptor do residente (tutor) são fundamentais. Conclusão: Frente aos desafios apontados, observa-se grande desgaste dos tutores, que voluntariamente desempenham as atividades de ensino mesmo atuando em sobrecarga assistencial. A falta de reconhecimento, escasso apoio institucional e da gestão administrativa são fatores que oferecem obstáculos ao melhor desenvolvimento e ampliação do programa de residência.
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Jamoulle M, Roland M, Bae JM, Heleno B, Visentin G, Gusso G, Godycki-Cwirko M, Pizzanelli M, Ouvrard P, La Vallev R, Gomes F, Widmer D, Bernstein J, Marino M, Lima Wagner H, Rossi I. [Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention]. Rev Med Brux 2018; 39:383-393. [PMID: 30321004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the ageold ethical requirement: first, a doctor must not harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 12 countries and 3 continents. This collective text deals more specifically with the ethics of prevention, the importance of teaching Quaternary prevention and Evidence Based Medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.
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Affiliation(s)
- M Jamoulle
- Université de Liège (ULg), Belgique
- Université Isalud, Buenos Aires, Argentine
| | - M Roland
- Université libre de Bruxelles (ULB)
- Président de Médecins du Monde
| | - J M Bae
- Département de médecine préventive. Université nationale de Jeju, Corée du Sud
| | - B Heleno
- Université Nouvelle de Lisbonne, USF das Conchas, Portugal
| | - G Visentin
- Centro Studi e Ricerche in Medicina generale, Milan, Italie
| | - G Gusso
- Département de Soins primaires, Université de São Paulo, Brésil
| | - M Godycki-Cwirko
- Faculté des Sciences Médicales, Université médicale de Lodz, Pologne
| | - M Pizzanelli
- Département de Médecine familiale, Université de la République (UDELAR), Florida, Uruguay
- Président du Groupe d'Intérêt spécial de la WONCA sur la Prévention quaternaire et la Surmédicalisation
| | - P Ouvrard
- Direction de la Recherche. Société de Formation et de Thérapeutique généraliste (SFTG), Paris, France
- Vice-Président de l'Union européenne des Médecins généralistes (UEMO)
| | - R La Vallev
- Département de Médecine familiale, Université de Buenos Aires
- Université nationale de Hurlingham, Argentine
| | - F Gomes
- Faculté de Médecine, Université d'Algarve, Faro, Portugal
| | - D Widmer
- Département de Médecine familiale, Université de Lausanne, Suisse
- Vice-Président de l'Union européenne des Médecins généralistes (UEMO)
| | - J Bernstein
- Président de la Commission de Prévention quaternaire de la Fédération argentine de Médecine générale et familiale (FAMFyG)
- Président du Chapitre Prévention quaternaire de l'Association des Psychiatres d'Argentine, Buenos Aires, Argentine
| | - M Marino
- Société argentine de Médecine Interne (SAMIG), Buenos Aires, Argentine
| | - H Lima Wagner
- Précepteur du Programme de Résidence en Médecine familiale et communautaire au Secrétariat de la Santé de Curitiba, Brésil
| | - I Rossi
- Institut des Sciences sociales, Faculté des Sciences sociales et politiques, Université de Lausanne (UNIL), Suisse
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Abstract
Assumimos como editores da Revista Brasileira de Medicina de Família e Comunidade (RBMFC) há quase um ano. Nesse período tentamos implementar uma reforma na gestão para que a Revista ganhasse em eficiência. Ao mesmo tempo, modificamos alguns fluxos, fornecedores, secretaria e escopo.
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Abstract
This article presents an overview of different techniques and skills necessary for teaching and learning quaternary prevention (P4). It adopts the Expertise Model that defines the competences required in P4 for each level: novice, competent, proficient, and expert. This framework should be used as a step-wise roadmap for teachers in order to achieve high levels of performance. This proposal is complemented by a list of methods applied in teaching and assessment of learners’ performance and competence. By covering a range of learning and teaching issues, those who aim to teach quaternary prevention can explore the proposed framework. Quaternary prevention is a research and teaching fertile medical field that entails the integration of different areas such as health service organisation, epidemiology, communication skills, and andragogy either at the macro or the micro levels of health related activities.
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Abstract
This paper reviews the development of the specialty of family medicine with attention to strategies that may be used to strengthen Brazilian health care with appropriately trained family doctors. These strategies include establishing academic departments of family and community medicine in all Brazilian medical schools, ensuring a common core curriculum in training programs, and defining standards for the evaluation and certification of family doctors. These strategies could enhance the quality, scope and effectiveness of the Brazilian Family Healthcare Program.
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Cimitan M, Volpe R, Candiani E, Gusso G, Ruffo R, Borsatti E, Massarut S, Rossi C, Morassut S, Carbone A. The use of thallium-201 in the preoperative detection of breast cancer: an adjunct to mammography and ultrasonography. Eur J Nucl Med 1995; 22:1110-7. [PMID: 8542893 DOI: 10.1007/bf00800591] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thallium-201 breast scans were performed preoperatively in 72 female patients with breast abnormalities detected by mammography and/or ultrasonography (7.5-13 MHz), in order to differentiate benign from malignant breast disease. Informed consent was obtained from each patient. Scintigraphy consisted of anterior and oblique planar images of the affected breast and axilla at 10 min and 3 h following the injection of 201Tl chloride (110 MBq). All 201Tl scans were interpreted without prior knowledge of surgery data. Pathological features of breast malignancies, such as tumour size, axillary lymph node metastases, tumour grading, lymphatic vascular channel invasion and receptor status, were analysed for their association with 201Tl uptake by tumour cells. A total of 76 breast lesions were assessed in the study. On final histological diagnosis, there were 56 malignant tumours, 14 benign nodules (9 fibroadenomas, two cases of adenosis, two cases of focal fibrosis and one case of epitheliosis) and six atypical lesions (atypical ductal or lobular hyperplasia). Thallium scintigraphy was shown to have high accuracy (92%) in detecting breast cancer, better than mammography (74%) and ultrasonography (84%). Almost all (51/56) breast cancers showed greater 201Tl activity than surrounding normal breast tissue while there was no significant increase in 201Tl activity above background in all but one (19/20) case of non-malignant disease. 201Tl activity within breast tumours, calculated as tumour/background (T/B) ratio, ranged between 1.2 and 2.5 with a mean value of 1.45. In our experience the concentration of thallium in the breast cancer seems to be primarily dependent on vascularity and tumour size rather than tumour grading, lymphatic/vascular invasion or receptor status. 201Tl scan sensitivity was 97% for malignant lesions larger than 1.5 cm (n = 35) and 80% for lesions of 1.5 cm or less (n = 21); however, five of the eight breast cancers smaller than 1.0 cm were also detectable by 201Tl scintigraphy, compared with five out of seven by mammography. Thallium scintigraphy would not be useful in evaluating the axilla for lymph node metastases (sensitivity 27%, specificity 77%).
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Affiliation(s)
- M Cimitan
- Department of Nuclear Medicine and Diagnostic Ultrasound, Centro di Riferimento Oncologico-IRCCS, Aviano, Italy
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