No description available.

O ritmo intenso do envelhecimento populacional no Brasil tem levado a questionamentos sobre o impacto das mudanças demográficas em diferentes âmbitos da Seguridade Social, dentre os quais destacamos a área da saúde e, mais especificamente, as Unidades de Terapia Intensiva. Os avanços representados pelos princípios do Sistema Único de Saúde, a criação do Estatuto do Idoso e a preocupação com os direitos humanos tornam urgentes reflexões sobre o que se coloca como desafio no atendimento médico à população idosa em UTI. Médicos intensivistas têm sua atuação marcada, dentre outros fatores, pelos sentidos que atribuem à fase da vida e a visão que têm de seus pacientes idosos. Esta pesquisa teve por objetivo compreender quais os sentidos que médicos que atuam em UTI atribuem a velho/velhice/envelhecimento e suas relações com as práticas de assistência prestada aos pacientes idosos. Trata-se de pesquisa qualitativa, realizada por meio de observação participante de reuniões de equipes que atuam em UTI de um hospital escola na cidade de São Paulo, e de entrevistas com médicos que compõem estas equipes. Os dados foram analisados sob a ótica Construcionista. Os resultados apontam para a existência de uma polissemia relacionada à velhice, incluindo sentidos que podem produzir práticas idadistas quando não há uma postura reflexiva dos profissionais a respeito do tema, ou quando conflitos decorrentes da complexidade que envolve o atendimento hospitalar em diferentes contextos econômicos se impõem aos profissionais, dificultando o diálogo entre os envolvidos mais diretamente na situação de internação (profissionais da saúde, pacientes, familiares, cuidadores, gestores). Essa nova realidade demográfica deve ser discutida na formação profissional, envolvendo as novas e diferentes demandas da população idosa. Relacioná-las ao respeito ao direito humano à vida e à dignidade, e aos sentidos atribuídos aos profissionais à essa fase da vida, aos velhos e ao processo de envelhecimento, bem como à forma como esses sentidos são produzidos e os seus contextos de produção, pode contribuir para que práticas de exclusão não se (re)produzam. / The intense pace of population aging in Brazil has led to questions about the impact of demographic changes on different aspects of Social Security, among which we highlight the area of health and, more specifically, the Intensive Care Units (ICU). The advances represented by the principles of the Unified Health System (SUS), the creation of the Elderly Statute and the concerns for Human Rights, have sped up reflections on what it is a challenge in the medical care to old people population in the ICU. Intensive care physicians have marked their performance, among other factors, by the meanings they attribute to this stage of life and by the vision they have of their elderly patients. This research aimed to explain which are the meanings attributed by that physicians working in ICUs to old/old people/aging, and their relationship to practical assistance provided to elderly patients. This is a qualitative research, resulting from the participatory observations of teams working at ICU in a university hospital in São Paulo, and from interviews with the physicians who take part in these teams. Data have been analyzed from the constructionist perspective. The results signalize to the existence of an age-related polysemy, including meanings that may produce ageist practices when there is a lack of reflexive posture of professionals about the subject, or when conflicts arising from the complexity that involves inpatient care in different economic contexts are imposed to professionals, impeding the dialogue among those involved more directly in the hospitalization (healthcare professionals, patients, family members, caregivers, managers). This new demographic reality should be discussed during professional training, involving new and different demands of the elderly population. Relate those demands to the respect to the human rights, to life and dignity, and to the meanings attributed by the professionals to this stage of life, to the old people and to the aging process, as well as to the way these meanings are produced and their contexts of production, can contribute to impede the re(production) of exclusionary practices.

O ritmo intenso do envelhecimento populacional no Brasil tem levado a questionamentos sobre o impacto das mudanças demográficas em diferentes âmbitos da Seguridade Social, dentre os quais destacamos a área da saúde e, mais especificamente, as Unidades de Terapia Intensiva. Os avanços representados pelos princípios do Sistema Único de Saúde, a criação do Estatuto do Idoso e a preocupação com os direitos humanos tornam urgentes reflexões sobre o que se coloca como desafio no atendimento médico à população idosa em UTI. Médicos intensivistas têm sua atuação marcada, dentre outros fatores, pelos sentidos que atribuem à fase da vida e a visão que têm de seus pacientes idosos. Esta pesquisa teve por objetivo compreender quais os sentidos que médicos que atuam em UTI atribuem a velho/velhice/envelhecimento e suas relações com as práticas de assistência prestada aos pacientes idosos. Trata-se de pesquisa qualitativa, realizada por meio de observação participante de reuniões de equipes que atuam em UTI de um hospital escola na cidade de São Paulo, e de entrevistas com médicos que compõem estas equipes. Os dados foram analisados sob a ótica Construcionista. Os resultados apontam para a existência de uma polissemia relacionada à velhice, incluindo sentidos que podem produzir práticas idadistas quando não há uma postura reflexiva dos profissionais a respeito do tema, ou quando conflitos decorrentes da complexidade que envolve o atendimento hospitalar em diferentes contextos econômicos se impõem aos profissionais, dificultando o diálogo entre os envolvidos mais diretamente na situação de internação (profissionais da saúde, pacientes, familiares, cuidadores, gestores). Essa nova realidade demográfica deve ser discutida na formação profissional, envolvendo as novas e diferentes demandas da população idosa. Relacioná-las ao respeito ao direito humano à vida e à dignidade, e aos sentidos atribuídos aos profissionais à essa fase da vida, aos velhos e ao processo de envelhecimento, bem como à forma como esses sentidos são produzidos e os seus contextos de produção, pode contribuir para que práticas de exclusão não se (re)produzam. / The intense pace of population aging in Brazil has led to questions about the impact of demographic changes on different aspects of Social Security, among which we highlight the area of health and, more specifically, the Intensive Care Units (ICU). The advances represented by the principles of the Unified Health System (SUS), the creation of the Elderly Statute and the concerns for Human Rights, have sped up reflections on what it is a challenge in the medical care to old people population in the ICU. Intensive care physicians have marked their performance, among other factors, by the meanings they attribute to this stage of life and by the vision they have of their elderly patients. This research aimed to explain which are the meanings attributed by that physicians working in ICUs to old/old people/aging, and their relationship to practical assistance provided to elderly patients. This is a qualitative research, resulting from the participatory observations of teams working at ICU in a university hospital in São Paulo, and from interviews with the physicians who take part in these teams. Data have been analyzed from the constructionist perspective. The results signalize to the existence of an age-related polysemy, including meanings that may produce ageist practices when there is a lack of reflexive posture of professionals about the subject, or when conflicts arising from the complexity that involves inpatient care in different economic contexts are imposed to professionals, impeding the dialogue among those involved more directly in the hospitalization (healthcare professionals, patients, family members, caregivers, managers). This new demographic reality should be discussed during professional training, involving new and different demands of the elderly population. Relate those demands to the respect to the human rights, to life and dignity, and to the meanings attributed by the professionals to this stage of life, to the old people and to the aging process, as well as to the way these meanings are produced and their contexts of production, can contribute to impede the re(production) of exclusionary practices.

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 using the Administrative Claims Data in Chronic Condition Warehouse (CCW). The results for the first research question revealed that an increase in the number of primary care physicians was correlated with a decrease in ED visits; thus, persons living in areas with higher PCPs also had lower ED visits therefore the first null hypothesis was rejected (Ï?2 = 3.85, p=.05) . The results for the second research question revealed that ED visits had no significant relationship with death in a given year; thus, patients may be diverted to less expensive care sites to minimize cost and ED overcrowding, therefore the second null hypothesis was not rejected (Ï?2 = 0, p=.98). In both cases, the confounding variables of gender, age, and race had significant effects upon the relationship. Health Professionals and policy makers may use the findings to develop strategies to increase supply of PCPs, adapt patient centered interventions and modify existing chronic disease care strategies to minimize or prevent lifestyle and environmental factors that affect chronic disease outcomes. Such improvements could contribute to positive social change by eliminating or reducing the overcrowding that occurs in emergency departments in Maryland and other states.

Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005. / Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).

The purpose of this study was to examine the practicing characteristics of graduates of a college of medicine with a rural primary care mission, including influences on graduates' specialty choices and practice locations. Secondary data analyses were conducted on student records and AMA Physician Masterfile data. Fewer graduates were practicing primary care than had entered primary care training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended other primary care programs. Women and rural track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Primary care physicians (PCPs) were practicing in more rural locales than non-PCPs. Family physicians tended to practice in the most rural locales. FMDRL_ID: 4822

Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment.

The prevalence of chronic Lyme disease (CLD) remains relatively unknown in Connecticut because there is not an agreement on what CLD is and how it should be diagnosed in addition to which pathological agent causes CLD. The aim of this quantitative study was to assess whether there were significant differences between two groups of primary care physicians (PCP) working in Connecticut from two different points in time regarding their knowledge in the diagnosis, treatment, and management of CLD. A knowledge, attitude, and practice model was used as the underlying theoretical framework for this study. A random cross-sectional survey was mailed out to the 1,726 PCPs found in the list of certified medical doctors in Connecticut of 2015. One hundred and forty-five PCPs responses (11.9% response rate) were received and compared to responses from previous data (a 2010 study) of 285 PCPs (39.1% response rate) from the list of certified medical doctors in 2006. The PCP estimated mean number of patients diagnosed and treated for CLD was not significantly different between 2006 and 2015. However, a significantly higher number of PCPs in 2015 reported knowing Lyme disease (LD) symptoms but not feeling comfortable diagnosing LD (χ� = 536.83, p < 0.001), and significantly more PCPs in 2015 reported knowing LD symptoms and feeling comfortable diagnosing CLD (χ� = 265.41, p < 0.001). This study can promote social change by encouraging Connecticut PCPs to recognize CLD as a diagnosis to enable the development of registries and case-control assessments. The findings of this study may also inspire future studies.

Nearly 11 million deaths in 2012 can be attributed to ischemic and hypertensive heart disease, stroke, and diabetes. Yet, these diseases are highly preventable and even treatable via improvement in nutritional intake and physical activity. From a public health perspective, primary care providers have promising and population-wide potential for modifying patient behavior to reduce dietary risk factors. However substantial socio-structural barriers prevent physicians from applying nutrition to improve patient outcomes. In my thesis, I first examine the epidemiological context in both the populations of United States and Switzerland. I then elucidate the importance and context of the application of nutrition knowledge in primary care based on the ideologies of holistic, patient-centered health. Then, I identify and analyze the obstacles physicians face in applying nutrition in patient care, as well as the sociological structures in which these barriers arise. Lastly, I set forth models of progress to improve patient outcome via reformed and restructured application of nutrition in primary care, using studies of exemplary strategies for addressing these barriers to nutrition counseling.

Bakgrund: Beslut om att avstå och avbryta livsuppehållande behandling har de senaste åren ökat i antal inom intensivvården i Europa. Intensivvårdspatienter har ofta nedsatt autonomi, och läkare och sjuksköterskor måste därför försöka avgöra vad som är rätt för patienten. Detta kan orsaka moralisk stress eftersom att det inte finns några enhetliga riktlinjer för när den livsuppehållande behandlingen övergår till att vara meningslös. Motiv: Beslut kring att avstå eller avbryta livsuppehållande behandling kan vara ett mångfacetterat etiskt beslut som försvåras av intensivvårdspatientens nedsatta autonomi. Den föreliggande studien syftar till att belysa de etiska utmaningar som uppstår när beslutet ska fattas. Syfte: Att belysa läkares och sjuksköterskors resonemang kring att avstå och avbryta livsuppehållande behandling på en intensivvårdsavdelning. Metod: En vinjettstudie genomfördes med individuella semistrukturerade intervjuer med intensivvårdsläkare (n=5) och intensivvårdssjuksköterskor (n=5). Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Deltagarnas resonemang kring att avstå och avbryta livsuppehållande behandling utmynnade i nio subteman som delades in i tre olika teman; Strävan efter att göra gott, Involvering av närstående och Behov av reflektion i teamet. Konklusion: Teamet ansågs betydelsefullt i beslut kring livsuppehållande behandling. Det fanns ibland olika uppfattningar inom teamet kring vilken behandling som gagnar patienten och vidare forskning behövs kring metoder, exempelvis etiska ronder, för att överbrygga dessa meningsskiljaktigheter. Om de etiska utmaningarna läkare och sjuksköterskor upplever kring beslut att avstå eller avbryta livsuppehållande behandling uppmärksammas och diskuteras, ökar chanserna för att alla involverade känner att rätt beslut fattas för patienten som individ. / Background: There is an increase of decisions to withhold or withdraw life sustaining treatment within intensive care units in Europe. Intensive care patients often have a limited autonomy and physicians and nurses therefore have to decide what is right for the patient. This can cause moral stress due to a lack of unitary guidelines for when life sustaining treatment becomes futile. Motive: Decisions to withhold or withdraw life sustaining treatment can be a multifaceted ethical dilemma that is complicated by the intensive care patients' limited autonomy. This study aims to illustrate the ethical challenges occurring when this decision is to be made. Aim: To illustrate the reasoning of physicians' and nurses' about withholding and withdrawing life sustaining treatment in an intensive care unit. Methods: A vignette study was conducted with individual semi structured interviews with intensive care physicians (n=5) and intensive care nurses (n=5). Collected data was analysed with qualitative content analysis. Result: The participants reasoning to withhold or withdraw life sustaining treatment resulted in nine subthemes that was further divided into three themes; Striving to do good, Involment of relatives and A need to reflect within the team. Conclusion: The team was considered important in decisions regarding life- sustaining treatment. Sometimes there were different views within the team about what treatment would benefit the patient and further research is needed of methods, such as ethical rounds to overcome disagreements regarding decisions to withhold and withdraw life-sustaining treatment within intensive care. If these ethical challenges experienced by physicians and nurses due to these decisions are acknowledged and discussed, chances increase that everyone involved feels that the right decision is made for the patient as an individual.