Medical work

"An Analysis of the Dynamics of Multi-Disciplinary Medical Team Meetings and the Use of Communication Technology. Bridget Kane, Department of Computer Science, Trinity College Dublin. This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or mechanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective. MDTMs are collaborative fora where healthcare specialists come together to discuss patient cases. The principle purpose of the MDTM is to establish a definitive diagnosis and determine the best treatment strategy for the patient. Here, the work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion. This longitudinal study followed the development of a multidisciplinary medical team through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM. System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result. Cases discussed in teleconference are less satisfactory from the users' perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions. Case controlled study reveals a ‘doubling effect’ observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (artefacts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted. Visual needs are identified for both sides of the teleconference interface at MDTMs. Providing more control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make communication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment. The internal temporal structure identified in PCDs prompts the investigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of communication within the health service."

An Analysis of the Dynamics of Multi-Disciplinary Medical Team Meetings and the Use of Communication Technology. Bridget Kane, Department of Computer Science, Trinity College Dublin.

This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or mechanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective.

MDTMs are collaborative fora where healthcare specialists come together to discuss patient cases. The principle purpose of the MDTM is to establish a definitive diagnosis and determine the best treatment strategy for the patient. Here, the work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion.

This longitudinal study followed the development of a multidisciplinary medical team through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM.

System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result.

Cases discussed in teleconference are less satisfactory from the users' perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions. Case controlled study reveals a ‘doubling effect’ observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (artefacts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted.

Visual needs are identified for both sides of the teleconference interface at MDTMs. Providing more control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make communication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment.

The internal temporal structure identified in PCDs prompts the investigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of communication within the health service.

RESUMEN Objetivos. Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú. Materiales y métodos. Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta. Resultados. De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganar >S/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganar >S/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganar >S/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos. Conclusiones. Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos. ABSTRACT Objectives. To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. Materials and methods. We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. Results. Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. Conclusions. Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.

Stress, workload, conflicts and responsibility in exercising an activity lead to a number of psychosocial risks, and the consequences have a negative impact on the individual, on perceptions and attitudes of working. The purpose of the study is to define the main risk factors among working midwives.The purpose of the study is to define the main risk factors among working midwives. Workplace risk factors and the causes of their occurrence have a profound impact on the health of individuals, organisations such as institutions and the system.The opinion of 65 working midwives from the SHOGAT "Prof. Dr. D. Stamatov "Varna and HOSPITAL" St. On the risks in the exercise of the obstetric profession in the workplace. The study was conducted in October 2019. Methods used: Documentary, statistical-questionnaire, graphical analysis. Results and discussion: Health professionals experience stress and uncertainty when work sets out requirements that are higher than their ability to deal with them. In addition to mental health problems, they can further develop serious problems with physical health, such as cardiovascular diseases or musculoskeletal problems.It has been researched the opinion of 65 working midwifes from "Prof. Dr. D.Stamatov" Varna and Hospital for active treatment "St,Anna" Varna in relation to the risks in practising the obstetrics at working place. The research was done in September 2019. There have been used different methods: documentary, statistical-questionnaire and graphical analysis. Result and Discussion Health professionals experience stress and uncertainty when work sets out requirements that are higher than their ability to deal with them. In addition to mental health problems, they can further develop serious problems with physical health, such as cardiovascular diseases or musculoskeletal problems.Over half of the respondents identified their work place as very busy. Working midwives define the factors relevant to the workplace-stress, impaired communication, conflict, high responsibility, many and heterogeneous duties.A major risk factor in exercising the obstetric profession for 78.5% is stress, and the causes of stress in the workplace are varied, dependent on the components of the environment and the subjects. These are all working situations, for which the high professional requirements are characteristic in quantitative terms (too much work for 67.7%), workers have limited decision-making capacity (possibility to decide how and what to do 43.1%) and poor professional support from colleagues and executives for 44.6%. ConclusionIt is necessary to care for the workplace, for relationships, for shared responsibility, by applying different techniques to improve the workplace, to improve communication skills and to master mediation techniques, to Overcoming conflicts and resolving them.

This paper examines physicians’ progress notes, an artifact that, in spite of its obvious importance in the coordination of cooperative work in clinical settings, has not been subjected to systematic study under CSCW auspices. While several studies have addressed the role of the medical record in patient care, they have not dealt specifically with the role, structure, and content of the progress notes. As a consequence, CSCW research has not yet taken fully into account the fact that progress notes are coordinative artifacts of a rather special kind, an open-ended chain of prose texts, written sequentially by cooperating physicians for their own use as well as for that of their colleagues. We argue that progress notes are the core of the medical record, in that they marshal and summarize the overwhelming amount of data that is available in the modern hospital environment, and that their narrative format is uniquely adequate for the pivotal epistemic aspect of cooperative clinical wo...

Stress, workload, conflicts and responsibility in exercising an activity lead to a number of psychosocial risks, and the consequences have a negative impact on the individual, on perceptions and attitudes of working. The purpose of the study is to define the main risk factors among working midwives.The purpose of the study is to define the main risk factors among working midwives. Workplace risk factors and the causes of their occurrence have a profound impact on the health of individuals, organisations such as institutions and the system.The opinion of 65 working midwives from the SHOGAT "Prof. Dr. D. Stamatov "Varna and HOSPITAL" St. On the risks in the exercise of the obstetric profession in the workplace. The study was conducted in October 2019. Methods used: Documentary, statistical-questionnaire, graphical analysis.Results and discussion: Health professionals experience stress and uncertainty when work sets out requirements that are higher than their ability to ...

Resumen La glucemia es un indicador importante del estado metabólico del organismo, por lo que la alteración de sus valores normales es una alerta inminente de posibles fallas metabólicas; los profesionales de la salud no están exentos de ello, sin embargo aun con los conocimientos adquiridos en su formación pueden ser afectados en igual proporción que una persona de cualquier otra profesión. Se buscó la frecuencia de alteraciones en los niveles glucémicos de médicos. Realizando 100 encuestas aplicadas por encuestador a médicos de la ENMyH (Escuela Nacional de Medicina y Homeopatía) que desempeñan actividades docentes, administrativa y/o practica medica acompañadas de un testeo rápido usándose dos glucómetros, uno de la marca Accu-Sheck de tipo sensor y el otro marca Optium. Se encontró un índice del 22% de alteraciones glucémicas y 50% de la población presentaron factores determinantes que favorecen la aparición de alteraciones glucémicas, como la asociación entre la cantidad de ingestas y la glucemia (r=0.15), el 78% de la población estudiada presento valores normoglucémicos, siendo hasta el momento el más alto en comparación de otros países donde se ha estudiado; las alteraciones fueron asociadas al estilo de vida laboral y alimentación. Además se hicieron hallazgos que asocian los hábitos de control, estilo de vida y seguimiento con los valores de la glucemia por parte de los médicos. Med Segur Trab (Internet) 2012; 59 (227) 107-116 Palabras clave: Glucemia, hiperglucemia, actividades físicas, factores, determinantes, ocupación, enfermedades inducidas por el estilo de vida.