Articles: professional-practice.
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Annals of family medicine · Apr 2022
ReviewPresence for racial justice: disrupting racism through physician-patient communication.
Context: Anti-Black racism is firmly rooted in US healthcare, but many clinicians do not have the tools and language to question their biases and address racism in clinical practice, eg biased communication practices such as "non-compliance" in medical documentation. Objective: Presence 5 for Racial Justice (P5RJ) leverages the Presence 5 patient-provider communication framework to identify anti-racism communication practices that support trusting relationships between physicians and Black patients and empower Black individuals in clinical care. Study design: For this multi-phased community-based participatory research (CBPR) overseen by an advisory board of clinicians and patients at four community clinics, we conducted a literature review, interviews with Black patients, clinician small-group discussions, and design thinking interviews with non-medical professionals. ⋯ Outcomes: Strategies on how providers, through communication and connection in the clinical visit, can navigate and address structural, institutional, and personally mediated forms of racism faced by Black patients. Results: P5RJ practices included: 1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address emergent bias and social determinants of health; 2) Listen intently and completely by using focused interpersonal listening without interruption and deep listening for racism impacts; give patients time and space to tell their story; 3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort, consent, and referral planning; 4) Connect with the patient's story by acknowledging socio-political factors influencing patient health and focusing on positive efforts/events to encourage patient agency; 5) Explore emotional cues by noticing and naming patient emotions and considering how racial trauma might influence these emotions. Conclusion: P5RJ practices offer strategies to reflect on clinician biases, address racism and known gaps in care for Black patients and promote health equity in their clinical care.
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Annals of family medicine · Apr 2022
Impacts of the COVID-19 pandemic on gamblers in Canada: qualitative analysis of responses to an open-ended question.
draw up a portrait of the experience of gamblers regarding the impacts of the COVID-19 pandemic on their gambling practices. STUDY DESIGN: Qualitative analysis. SETTING: Content analysis of responses to a single open-ended question placed at the end of a cross-sectional survey which was online from February 16 to March 15 2021 in Quebec (Canada). Participants were recruited by a non-randomised online sampling. POPULATION STUDIED: 1529 individuals participated in the study, of whom 724 answered the open-ended question. Inclusion criteria were: (1) 18 years and older (2) living in the province of Quebec, Canada (3) has gambled at least once in the past year. ⋯ The pandemic has created space to fill into many individuals' lives as usual leisure activities, hobbies and spending habits became out of reach. It led to increased gambling for many participants. While many did not report deleterious effects of this increase, others expressed being at great risk and therefore need primary care professionals to be equipped to support them.
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Anesthesia and analgesia · Mar 2022
The Practice of Pediatric Cardiac Anesthesiology in the United States.
With advances in surgical and catheter-based interventions and technologies in patients with congenital heart disease (CHD), the practice of pediatric cardiac anesthesiology has evolved in parallel with pediatric cardiac surgery and pediatric cardiology as a distinct subspecialty over the past 80 years. To date, there has not been an analysis of the distribution of pediatric cardiac anesthesiologists relative to cardiac and noncardiac procedures in the pediatric population. The primary aim is to report the results of a survey and its subsequent analysis to describe the distribution of pediatric cardiac anesthesiologists relative to pediatric cardiac procedures that include surgical interventions, cardiac catheterization procedures, imaging studies (echocardiography, magnetic resonance, computed tomography, positron emission tomography), and noncardiac procedures. ⋯ The majority of currently practicing pediatric cardiac anesthesiologists have not completed a fellowship training in the subspecialty. There is, and will continue to be, a need for subspecialty training to meet increasing demand for services especially with increase survival of this patient population and to replace retiring members of the workforce.
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Annals of family medicine · Mar 2022
Failure of the Problem-Oriented Medical Paradigm and a Person-Centered Alternative.
Our problem-oriented approach to health care, though historically reasonable and undeniably impactful, is no longer well matched to the needs of an increasing number of patients and clinicians. This situation is due, in equal parts, to advances in medical science and technologies, the evolution of the health care system, and the changing health challenges faced by individuals and societies. ⋯ Shifting the focus of care from clinician-identified abnormalities to person-relevant goals would elevate the role of patients; individualize care planning; encourage prioritization, prevention, and end-of-life planning; and facilitate teamwork. Paradigm shifts are difficult, but the time has come for a reconceptualization of health and health care that can guide an overdue transformation of the health care system.
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Annals of family medicine · Jan 2022
Clinicians' Core Needs in a Pandemic: Qualitative Findings From the Chat Box in a Statewide COVID-19 ECHO Program.
Research on primary care's role in a pandemic response has not adequately considered the day-to-day needs of clinicians in the midst of a crisis. We created an Oregon COVID-19 ECHO (Extension for Community Healthcare Outcomes) program, a telementoring education model for clinicians. The program was adapted for a large audience and encouraged interactivity among the hundreds of participants via the chat box. We assessed how chat box communications within the statewide program identified and ameliorated some of clinicians' needs during the pandemic. ⋯ Using a novel data source, we found sharing the experience of practicing in a rapidly changing environment via comments and questions in an ECHO program both defined and supported participants' needs.