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Moreno M, Arrieta O, Celis MA, Domínguez J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Verástegui E, Rocha-Arrieta LL, Toussaint S, Vilar-Compte D, Sotelo J. Who judges medical practice? GAC MED MEX 2022; 158:332-334. [PMID: 36572021 DOI: 10.24875/gmm.m22000704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.
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Affiliation(s)
- Mucio Moreno
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Oscar Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Miguel A Celis
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Judith Domínguez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Sergio Islas-Andrade
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alberto Lifshitz
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Iris Martínez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alejandro Reyes-Sánchez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Guillermo J Ruiz-Argüelles
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Antonio Soda-Merhy
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Emma Verástegui
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Sonia Toussaint
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Diana Vilar-Compte
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Julio Sotelo
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
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Roshdy A, Elsayed AS, Saleh AS. Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey. Med Intensiva 2022; 46:549-558. [PMID: 36155678 DOI: 10.1016/j.medine.2021.06.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. DESIGN Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. SETTING International study conducted in 78 countries. PARTICIPANTS Physicians working in ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. RESULTS 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. CONCLUSION ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.
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Affiliation(s)
- A Roshdy
- Intensive Care Unit, North Middlesex University Hospital, London, UK; Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - A S Elsayed
- Intensive Care Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - A S Saleh
- Alhayat Clinic, Edku, el-Beheira, Egypt
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3
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Roshdy A, Elsayed AS, Saleh AS. Intensivists' perceptions and attitudes towards infectious diseases management in the ICU: An international survey. Med Intensiva 2021; 46:S0210-5691(21)00174-1. [PMID: 34417082 DOI: 10.1016/j.medin.2021.06.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Exploring infectious diseases (ID) practice in Intensive Care Unit (ICU) to identify gaps and opportunities. DESIGN Online international survey (PRACT-INF-ICU) endorsed by the ESICM and open from July 30, 2019 to October 19, 2019. SETTING International study conducted in 78 countries. PARTICIPANTS Physicians working in ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Practice variations were assessed according to respondents' countries income class, training, and years of practice. Univariate and multivariate ordinal logistic regression were used to estimate associations between respondents' characteristics and their perceptions regarding adequacy of training. RESULTS 466 intensivists with a median practice of 10 years (interquartile range, 5-19) completed the survey. A third reported no antimicrobial stewardship program and 40% had no regular microbiological rounds in their ICUs. Intensivists were mostly the decision makers for the initial antimicrobial therapy which in 70% of cases were based on guidelines or protocols. Non-ICU expertise were sought more frequently on reviewing (48/72h, culture adjustment and discontinuation in 32%, 39% and 21% respectively) rather than antimicrobial therapy initiation (16%). Only 42% described ID training as adequate. Multivariate ordinal logistic regression showed that low- to middle-income countries (OR: 0.41, 95% CI: 0.28-0.61), ICU practice ≤10 years (OR: 0.55, 95% CI: 0.39-0.79), and dual training with anaesthesia (OR: 0.52, 95% CI: 0.34-0.79) or medicine (OR: 0.49, 95% CI: 0.32-0.76) were associated with less training satisfaction. CONCLUSION ID practice is heterogeneous across ICUs while antimicrobial stewardship program is not universally implemented. From intensivists' perspective, ID training and knowledge need improvement.
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Affiliation(s)
- A Roshdy
- Intensive Care Unit, North Middlesex University Hospital, London, UK; Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - A S Elsayed
- Intensive Care Unit, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - A S Saleh
- Alhayat Clinic, Edku, el-Beheira, Egypt
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Martín-Delgado J, Carrillo I, Mira JJ. [Outcome of complaints by patients due to the refusal of Primary Care Physicians to agree to a treatment request]. J Healthc Qual Res 2020; 35:113-116. [PMID: 32273106 DOI: 10.1016/j.jhqr.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyse the frequency of complaints due to the refusal of Primary Care Physicians to indicate a diagnostic test, treatment, or referral requested by a patient. METHODS Observational, retrospective study was conducted by analysing the complaints filed in a Primary Care Area during the years 2016, 2017, and 2018. RESULTS A total of 378 complaints were included. Of these, 30 (8%) were justified in the refusal by the doctors to a request of the patient (28 addressed to general practitioners and 2 to paediatricians). The most frequent related to the request was for a treatment (18 [60%]) followed by the request for diagnostic tests (9 [30%]). While the total number of claims increased by 151%, the relative weight of the claims for not responding to a patient's request was reduced (2016, 8/70, 11.4%; 2017, 11/132, 8.3%; and 2018, 11/176, 6.3%). No professional liability claims were filed. CONCLUSIONS Complaints for rejecting patient requests increased slightly, but tends to decrease their relative weight when considering the volume of complaints.
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Affiliation(s)
- J Martín-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)-Sant Joan d'Alacant, Alicante, España.
| | - I Carrillo
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)-Sant Joan d'Alacant, Alicante, España; Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España
| | - J J Mira
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)-Sant Joan d'Alacant, Alicante, España; Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España; Departamento de Salud Alicante-Sant Joan d'Alacant, Alicante, España
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Rinaldi C, D'Alleva A, Leigheb F, Vanhaecht K, Knesse S, Di Stanislao F, Panella M. Defensive practices among non-medical health professionals: An overview of the scientific literature. J Healthc Qual Res 2019; 34:97-108. [PMID: 30928325 DOI: 10.1016/j.jhqr.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Defensive medicine (DM) is used when a doctor deviates from good practices to prevent complaints from patients or caregivers. This is a structured phenomenon that may not only affect the physician, but all healthcare personnel. The aim of this review was to determine whether DM is also performed by Non-Medical Health Professionals (NMHP), and the reasons, features, and effects of NMHP-DM. MATERIALS AND METHODS The review was conducted according to PRISMA guidelines, and specific inclusion criteria were used to search for relevant documents published up to 12 April 2018 in the main biomedical databases. RESULTS A total of 91 potentially relevant studies were identified. After the removal of duplicates, 72 studies were screened for eligibility, separately by two of the authors. Finally, 14 qualitative and quantitative studies were considered relevant for the purpose of the present review. These last studies were assessed for their methodological quality. CONCLUSIONS NMHP-DM is quite similar to DM practiced by doctors, and is mainly caused by fear of litigation. Midwives and nursing personnel practiced both active and passive DM, such as over-investigation, over-treatment, and avoidance of high-risk patients. NMHP-DM could increase risks for patient health, costs, risk of burnout for healthcare employees. Further studies are needed to better understand prevalence and features of NMHP-DM in all health professional fields, in order to apply appropriate preventive strategies to contrast DM among health care personnel.
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Affiliation(s)
- C Rinaldi
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy; A.O.U. Maggiore della Carità, Novara, Italy
| | - A D'Alleva
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of Marche, Ancona, Italy.
| | - F Leigheb
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy; A.O.U. Maggiore della Carità, Novara, Italy
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - S Knesse
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - F Di Stanislao
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - M Panella
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
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Celis MÁ, Halabe J, Arrieta O, Burgos R, Campillo C, Llata MDL, Domínguez J, Islas S, Jasso-Gutiérrez L, Lifshitz A, Moreno M, Plancarte-Sánchez R, Reyes-Sánchez A, Ruiz-Argüelles G, Soda A, Verástegui E, Sotelo J. [El consentimiento informado: recomendaciones para su documentación]. GAC MED MEX 2018; 154:716-718. [PMID: 30532120 DOI: 10.24875/gmm.18004339] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Informed consent is an indispensable element to obtain adequate patient participation either in research protocols or in therapeutic design. The Committee of Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine developed several recommendations for informed consent to be documented.
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Affiliation(s)
- Miguel Ángel Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - José Halabe
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Rubén Burgos
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Carlos Campillo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Manuel De la Llata
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Judith Domínguez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Sergio Islas
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Luis Jasso-Gutiérrez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Ricardo Plancarte-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Alejandro Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Guillermo Ruiz-Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Antonio Soda
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Ciudad de México, México
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Panella M, Rinaldi C, Leigheb F, Donnarumma C, Kul S, Vanhaecht K, Di Stanislao F. The determinants of defensive medicine in Italian hospitals: The impact of being a second victim. ACTA ACUST UNITED AC 2016; 31 Suppl 2:20-5. [PMID: 27373579 DOI: 10.1016/j.cali.2016.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear. OBJECTIVE To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians. DESIGN, SETTING AND PARTICIPANTS A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event. RESULTS A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians' experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty. CONCLUSIONS Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine.
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Affiliation(s)
- M Panella
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - C Rinaldi
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
| | - F Leigheb
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - C Donnarumma
- Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - S Kul
- Center for Applied Medical Statistics. University of Gaziantep, Gaziantep, Turkey
| | - K Vanhaecht
- Center for Health Services and Nursing Research, School of Public Health, University of Leuven, Leuven, Belgium
| | - F Di Stanislao
- Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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