Using Partnerships to Create a Medical Specialty Camp for Youth with Diabetes

Complications associated with a complex chronic illness, specifically, type 1 diabetes, negatively impact youth as they struggle to maintain healthy lifestyles. Type 1 diabetes is the second most common chronic illness affecting youth as well as one of the most psychologically and behaviorally demanding illnesses. Fortunately, organized camps have been shown to positively influence long-term outcomes for youth. Family Diabetes Camp, the only family medical program in the state where this study occurred, was created in collaboration with a local university, a diabetes center at a hospital, and a chapter of the Lions Club. This collaborative camp program aimed to test the effect of active participation in a Family Diabetes Camp upon youth outcomes for campers with type 1 diabetes. Specifically, the purpose was to evaluate the impact of a collaborative medical camp on campers’ resilience and youth developmental outcomes (e.g., independence). Family Diabetes Camp was designed using Outcome-Focused Programming (OFP) to promote positive youth development. The Family Diabetes Camp included 50 campers for the pre-test and post-test (n= 19 males and n= 31 females). While there were no statistically significant differences from pretest (M=4.97, SD= .53) to post-test scores (M=5.01, SD= .46), with t(50) = -.56, p= .57) researchers found a slight increase in resilience from pre to post-test. Using a retrospective measure, campers showed gains in the seven critical youth development outcomes identified by the American Camp Association. Finally, campers learned new knowledge about site injection, carbohydrate counting, and the use of exercise to help manage their diabetes. The impact associated with adapting activities and an environment to encourage, analyze, and challenge resilient behaviors is essential in encouraging independence, shared experiences, and effective disease management for youth living with type 1 diabetes. The camp, solely staffed by volunteers, included physicians, diabetes educators, certified therapeutic recreation specialists, dietitians, nurses, pump specialists, recreation professionals and students, and Lions Club Members. The camp program is unique not only in how it fills a void for youth with type 1 diabetes but how three large organizations work in concert to meet the needs of entire families. These types of data can be instrumental in establishing more camps and other out of school time programming that positively impacts quality of life, health care cost, and mortality among youth with type 1 diabetes.

Médicos de Família e Comunidade ou médicos da Estratégia Saúde da Família? / Family and Community doctors, or doctors from the Family Health strategy?

Em resposta à revisão integrativa “Papel do Médico de Família e Comunidade no Manejo da Hipertensão Arterial na Atenção Primaria à Saúde”, cumpre destacar que os médicos de família e comunidade constituem uma especialidade médica, enquanto os médicos da estratégia Saúde da Família constituem uma ocupação. Discute-se a não sobreposição entre as duas categorias no mercado de trabalho, e a distinção no que diz respeito ao escopo da prática, com ênfase na saúde mental.---Abstract: In response to the integrative review “Role of the Family and Community Doctor in theManagement of Hypertension in Primary Health Care”, it should be noted that family and communitydoctors are a medical specialty, while doctors of the Family Health strategy constitute an occupation. Itdiscusses the non-overlapping between the two categories in the labor market, and the distinctionregarding the scope of practice, with an emphasis on mental health.

A Qualitative Exploration of Medical Student Empathy During the COVID-19 Pandemic

BackgroundThere is evidence that medical student self-reported empathy may decline as one progresses through their clinical training. Due to the unprecedented changes to both patient care and medical education caused by COVID-19, it is reasonable to assume that medical student empathy may be impacted. The goal of this July 2020 study was to qualitatively explore how the COVID-19 pandemic might affect medical students’ reported experience of empathy.MethodUsing a semi-structured interview, the authors interviewed 12 medical students, 6 second-year and 6 fourth-year. They selected these groups because of the distinct differences in their clinical experience. ResultsData analysis identified 5 major themes: 1) Expanded Perspective (e.g., a feeling of “we’re in this together”, increased awareness of patient vulnerability) 2) Moral Dilemmas (e.g., difficult decisions faced by students as a result of the pandemic such as weighing educational vs. family responsibilities, students risking their own health to provide the best possible care) 3) Confirmation of Values (e.g., Feeling reaffirmed in decision to enter medicine, feeling the pandemic was “what we signed up for” by entering medical school) 4) Shaping Priorities (e.g., changes in medical specialty or populations of interest) 5) Barriers to Empathy and Adaptive Strategies (e.g., COVID-19 created many physical, psychological, and social barriers to empathy for students, students presented many strategies for ameliorating these barriers). Five students (42%) reported increased empathy with no students reporting a decrease in empathy due to experiences during the pandemic. Conclusions Participants did not report that their personal experience of empathy for patients was negatively influenced by the COVID-19 pandemic. Many reported that their empathy increased. The observed differences in responses by pre-clinical (second-year) and clinical (fourth-year) students suggests a possible shift in how empathy is experienced and practiced as one progresses through their medical education. The overwhelmingly positive responses to the semi-structured interview, emphasizing appreciation of the opportunity to discuss topics not previously openly discussed, underscores the importance of providing explicit opportunities for students to discuss their emotional/interpersonal experiences within medical education, particularly in difficult times such as the COVID-19 pandemic.

Conceptions of homeopathy teaching in the faculties of pharmacy in the State of Rio de Janeiro

Introduction: Homeopathy is a pharmaceutical and medical specialty practiced in Brazil since 1840 and known by the Federal Council of Medicine since 1980. The homeopathic pharmacy is a recognized part of the pharmaceutical profession regulated and supervised by the Federal Council of Pharmacy (CFF) and the Regional Councils of Pharmacy throughout Brazil (CFF 319/97 and CFF 440/05). Despite the existence of a Federal Law (number 1552, published in 1952) which implemented the teaching of “Notions of Homeopathic Pharmaceutical Techniques” in all colleges of pharmacy, these lectures are still not present in the majority of Brazilian Pharmacy curricula. This reluctance in the implementation of the teaching of homeopathy consists in an obstacle to the formation of new pharmaceutical homeopaths in Rio de Janeiro. Aim: To evaluate how the teaching of homeopathy is being taught in undergraduate courses in pharmacy in Rio de Janeiro and register through a specific questionnaire, the students' interest, as well as the availability of internships in the field of homeopathy. Methodology: The survey was started in May 2011 with a sample of ten pharmacy colleges in the state of Rio de Janeiro (UNIG, UNIGRANRIO, UNIABEU, UNIPLI, Universo Niterói, Universo São Gonçalo, UFRJ, UNISUAM, Estácio de Sá and UFF). A specific previously developed questionnaire was applied to undergraduate students to register their interest and availability for internships in the field of homeopathy. Moreover, the students were interviewed for relevant information about their interests in the area of homeopathy. Results: Preliminary results showed that 57% of the respondents presented interest so far in qualifying in homeopathy pharmacy, 32% of them did not show any interest in the area and 11% reported not having a definite position. Regarding working with homeopathy, 51% expressed interest in working in this area, 36% showed no interest and 13% were indecisive. As far as conducting a refresher course in homeopathy, 57% showed interest, 35% showed no interest and 8% expressed no definite opinion. The traineeship of at least 240 hours, required by the Federal Council of Pharmacy to all pharmacists who wish to assume responsibility for technical laboratory or industrial homeopathic pharmacy, has not been offered by the majority of Pharmacy Faculties, considering that 89% of the respondents have not done this traineeship. Data collection will be finished by the second half of June. Conclusion: The spread of homeopathy should be done from the beginning of the undergraduate course in pharmacy to evoke the interest in the discipline, especially in colleges where it is not compulsory. Most of interviewed students were not informed about the legal obligation of the training in the laboratory or pharmacy of homeopathy. Almost all colleges used in this study do not provide the internship for the students who show an interest in homeopathy. This scenario draws our attention to the necessity of new projects that enable a comprehensive and systematic teaching of homeopathy, providing new possibilities for homeopathic professional activities.

The evaluation of the relevance of teaching of homeopathy at the medical school

Background: In 1912 the Hahnemann Medical Faculty to graduate homeopathic physicians was created. This was one of the courses that originated the present Federal University of the State of Rio de Janeiro – UNIRIO. Homeopathy in UNIRIO was consolidated during the 80s and 90s through the relationship with other specialties. In 1999, the interface of Homeopathy and the curriculum guidelines of the Brazilian Ministry of Education justified the inclusion of Homeopathy as a compulsory subject in the medical course at UNIRIO. In 2001 a University program to improve the development of research called “Homeopathy - Health and Quality of Life”, was created to integrate the activities of Teaching, Research and Extension. Aim: To evaluate the relevance of the compulsory teaching of Homeopathy in the medical area at the Federal University of the State of Rio de Janeiro – UNIRIO, Brazil. Methods: A prospective longitudinal qualitative and quantitative research was used with semi-structured questionnaires with open and closed questions at the beginning and end of each semester. Undergraduate students from the third year of the UNIRIO Medical Faculty (2008/March till 2009/September) who accepted the “Consent Form”, were included. Students who didn't respond adequately to the questions were excluded. This research was approved and registered at the Brazilian Research Ethics Center. Microsoft Office Excel 2007 used to data collection and analysis. Results: Total number of students attending the course during the four semesters: 304. 70% answered the questionnaires. 60% of the students had heard of homeopathy before attending the homeopathy course (67% as patients, 21% as patients and through media, 6% through media and 6% by other means of contact). 86% consider that homeopathy brought new knowledge to the medical and academic training. 72% consider that this knowledge could be applicable to their future career. Conclusion: Most students aim to learn the guiding principles of homeopathy. Their aim is to know all available treatment, modalities and alternatives to allopathy in medical education. They considered that the learning of Homeopathy is a part of general medical training due to the fact that it has been a recognized medical specialty in Brazil since 1980. The student’s opportunity to learn homeopathy during the undergraduate course in medical schools widens the individuality concept, “the doctor-patient relationship and the holistic vision of the patient”. These results demonstrate the relevance of teaching homeopathy in the medical curriculum and the need to spread the teaching of homeopathy as a compulsory course for all other medical universities.

Homeopathic potencies of Opium in alcohol dependence: exploratory open-label study

Background: The conventional pharmacological options for the treatment of alcoholism are limited, which led to the search for solutions in alternative or complementary medicine (CAM). Homeopathy is a CAM modality recognized as medical specialty in Brazil. According to the clinical experience of the early homeopaths, Opium was used to treat patients with alcohol dependence. Aim: to perform a preliminary assessment of the effectiveness and tolerability of fifty-millesimal potencies of Opium in the treatment of alcohol-dependent patients. Methods: exploratory, prospective, open-label trial, with pre-treatment measures as control. Confidence intervals were used to estimate the magnitude of the clinical differences. Results: a total of 14 patients were included, from which 12 were evaluated (intention to treat analysis - ITT). There was a significant reduction in the average daily alcohol consumption (-29.37 units of alcohol/day; 95% CI=10.63; 48.11) and in the severity of alcohol dependence, measured by the mean score of the Short Alcohol Dependence Data questionnaire (-10.17; 95% CI= 4.12; 16.22). No serious adverse events were reported. Randomized controlled studies with larger samples are needed.

Emergency medicine in Brazil: historical perspective, current status, and future challenges

Background Emergency medicine (EM) in Brazil has achieved critical steps toward its development in the last decades including its official recognition as a specialty in 2016. In this article, we worked in collaboration with the Brazilian Association of Emergency Medicine (ABRAMEDE) to describe three main aspects of EM in Brazil: (1) brief historical perspective; (2) current status; and (3) future challenges. Main text In Brazil, the first EM residency program was created in 1996. Only 20 years later, the specialty was officially recognized by national regulatory bodies. Prior to recognition, there were only 2 residency programs. Since then, 52 new programs were initiated. Brazil has now 54 residency programs in 16 of the 27 federative units. As of December 2020, 192 physicians have been board certified as emergency physicians in Brazil. The shortage of formal EM-trained physicians is still significant and at this point it is not feasible to have all Brazilian emergency care units and EDs staffed only with formally trained emergency physicians. Three future challenges were identified including the recognition of EM specialists in the house of Medicine, the need of creating a reliable training curriculum despite highly heterogeneous emergency care practice across the country, and the importance of fostering the development of academic EM as a way to build a strong research agenda and therefore increase the knowledge about the epidemiology and organization of emergency care. Conclusion Although EM in Brazil has accomplished key steps toward its development, there are several obstacles before it becomes a solid medical specialty. Its continuous development will depend on special attention to key challenges involving recognition, reliability, and research.

A Narrative Literature Review of Bias in Collecting Patient Reported Outcomes Measures (PROMs)

There is a growing interest in the collection and use of patient reported outcomes because they not only provide clinicians with crucial information, but can also be used for economic evaluation and enable public health decisions. During the collection phase of PROMs, there are several factors that can potentially bias the analysis of PROM data. It is crucial that the collected data are reliable and comparable. The aim of this paper was to analyze the type of bias that have already been taken into consideration in the literature. A literature review was conducted by the authors searching on PubMed database, after the selection process, 24 studies were included in this review, mostly regarding orthopedics. Seven types of bias were identified: Non-response bias, collection method related bias, fatigue bias, timing bias, language bias, proxy response bias, and recall bias. Regarding fatigue bias and timing bias, only one study was found; for non-response bias, collection mode related bias, and recall bias, no agreement was found between studies. For these reasons, further research on this subject is needed in order to assess each bias type in relation to each medical specialty, and therefore find correction methods for reliable and comparable data for analysis.

IMPACT OF DISASTERS ON DISASTER MEDICINE EDUCATION

Introduction: Disaster medicine is a novel but rapidly evolving medical specialty. It aims for evidence based practices as they are essential for contemporary medicine. Every calamity provides input for development. Researchers in the field study these events for the purpose of amending theory and practice to reflect new challenges. The better the understanding of the shortfalls reported is, the greater will the worth for disaster medical response to the upcoming events be. Purpose: The objective of the study is to demonstrate the connection between disasters and commencement and evolution in disaster medicine education and to highlight the significance of lessons learned for practice improvement. Materials and methods: By means of the descriptive method, lessons learned from disaster medical support to some of the most significant catastrophic events in recent years are presented. Comparative and deductive analyses are performed in order to assess the influence of disasters on the evolution of disaster medical support education and training. Results: Analysis of the most consequential disasters proves that the affected countries have implemented disaster medical support planning, organization, and management changes. These changes in policy and practice lead to amendments and advances in disaster medical tuition. Conclusion: As a conclusion, disaster medicine education reliance on the best practices approved throughout the disaster relief operations is noted. Every gained experience and lesson learned have to be implemented into the lectures and seminars, thus transforming real life achievements into knowledge and wisdom.

Physicians’ Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study

Background In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far. Objective The aim of this study was to investigate physicians’ and psychotherapists’ current attitudes toward mHealth apps, barriers to adoption, and potential remedies. Methods We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists. Results A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies. Conclusions To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended.