Quality of life, resilience, empathy, daytime sleepiness and academic performance in internal medicine residents: qualitative and quantitative analysis

INTRODUÇÃO: Na residência médica, inúmeros fatores favorecem o desgaste emocional, colocando em risco atitudes relevantes, como empatia, resiliência e percepção da qualidade de vida, o que pode comprometer o desempenho profissional. OBJETIVO: Avaliar o impacto do treinamento em Clínica Médica na percepção da qualidade de vida, empatia, resiliência e sonolência diurna, e suas correlações com o desempenho médico na avaliação de competências clínicas pelo método OSCE. A influência do gênero nesses construtos também foi investigada. METODOLOGIA: Estudo transversal com médicos residentes do primeiro ano de Clínica Médica, com questionários de autorrelato para avaliar a percepção de qualidade de vida específica para residência médica (Veras-Q), dados sociodemográficos, empatia (escala Jefferson), resiliência (escala Wagnild& Young RS-14) e sonolência diurna (escala de Epwoth). O desempenho acadêmico foi avaliado pelo método OSCE no final do primeiro ano da residência em Clínica Médica. Análise de grupos focais com residentes do sexo feminino foi feita para compreender as diferenças entre os gêneros nos construtos investigados. RESULTADOS: Cento e nove médicos residentes participaram do estudo: 31 (28,4%) do sexo feminino e 78 (71,6%) masculinos. As residentes do sexo feminino apresentaram escores de qualidade de vida significativamente menores do que os residentes masculinos nos domínios de uso do tempo (30,3, feminino vs 41,1, masculino p < 0,001), psicológico (48,1, feminino vs 56,7, masculino p < 0,01) e saúde física (42,8, feminino vs 53,6, masculino p < 0,05). Os escores de sonolência diurna foram significativamente maiores para as residentes do sexo feminino (13,0, feminino vs 9,0, masculino p < 0,001), com valores considerados patológicos (p < 0,001). Houve moderada correlação negativa entre sonolência diurna e o domínio manejo do tempo da qualidade de vida (p < 0,01). Houve forte correlação positiva entre resiliência e os domínios psicológico e saúde física da qualidade de vida (respectivamente, 0,48 e 0,50; p < 0,01). Os escores do desempenho acadêmico pelo método OSCE não diferiram entre os gêneros e não apresentaram correlação com os construtos investigados. A análise dos grupos focais destacou dificuldade de manejo do tempo, insegurança, sensação de perda, autocobrança, dificuldade de estabelecer laços afetivos, dificuldade de concentração e de aquisição do conhecimento como fatores relacionados à pior percepção da qualidade de vida para as residentes do sexo feminino. CONCLUSÃO: Ao final do primeiro ano da residência em Clínica Médica, os residentes apresentaram baixos escores na percepção da qualidade de vida e maior sonolência diurna. Houve diferenças significativas entre os gêneros na percepção da qualidade de vida e na sonolência diurna, com escores menores de qualidade de vida e escores maiores de sonolência diurna nas residentes do sexo feminino. Não foram identificadas correlações entre qualidade de vida, empatia, resiliência, sonolência diurna e o desempenho acadêmico pelo método OSCE em residentes do primeiro ano de Clínica MédicaINTRODUCTION: During medical residency, many factors may lead to emotional distress, putting at risk relevant attitudes such as empathy, resilience and perception of quality of life, which can compromise professional performance. OBJECTIVE: To evaluate the impact of training in internal medicine on quality of life, empathy, resilience, daytime sleepiness and their correlation with academic performance using the OSCE method. The influence of gender in these constructs was also investigated. METHODOLOGY: A cross-sectional study with first-year internal medicine residents was performed to evaluate self-reported quality of life specific for medical residency (Veras-Q), socio demographic data, empathy (Jefferson scale), resilience (Brief Resilience Scale from Wagnild and Young) and daytime sleepiness (Epwoth scale). Academic performance was assessed by the OSCE method at the end of the first year of internal medicine residency. Differencesbetween genders were investigated using focus groups analysis with female residents. RESULTS: One hundred and nine resident physicians participated in the study: 31 (28.4%) were female and 78 (71.6%) were male. Female residents presented significantly lower scores than those of male residents for quality of life in the domains of time management (30.3, females vs 41.1, males p < 0.001), psychological (48.1 females vs 56, 7, males p < 0.01) and physical health (42.8, females vs 53.6, males p < 0.05). They also scored higher in daytime sleepiness (13.0, females vs 9.0, males p < 0.001) with pathological scores for daytime sleepiness. A moderate negative correlation between daytime sleepiness and time management domain of quality of life (p < 0.01) was observed. There was a strong positive correlation among resilience, psychological and physical health domains of quality of life (respectively 0.48 and 0.50, p < 0.01). Academic performance scores by the OSCE method did not differ between genders and did not correlate with empathy, resilience and daytime sleepiness scores. The focus group assessment revealed difficulty in concentration and knowledge acquisition, insecurity, feeling of loss, greater critical perception, self-doubt and difficulty in creating affective bonds to support the training period as the main factors involved in the lower perception of quality of life among the women. CONCLUSION: Female residents had lower scores of quality of life and higher scores on daytime sleepiness. No significant differences between genders were detected for academic performance scores and no relationship among quality of life, empathy, resilience, daytime sleepiness and academic performance by the OSCE method was observed in first-year internal medicine residents. Measures to improve quality of life among female residents during this critical period of medical training might include investing in mentoring to help them better manage their time and encouraging activities that facilitate relationship developmen

Quality of life, resilience, empathy, daytime sleepiness and academic performance in internal medicine residents: qualitative and quantitative analysis

INTRODUÇÃO: Na residência médica, inúmeros fatores favorecem o desgaste emocional, colocando em risco atitudes relevantes, como empatia, resiliência e percepção da qualidade de vida, o que pode comprometer o desempenho profissional. OBJETIVO: Avaliar o impacto do treinamento em Clínica Médica na percepção da qualidade de vida, empatia, resiliência e sonolência diurna, e suas correlações com o desempenho médico na avaliação de competências clínicas pelo método OSCE. A influência do gênero nesses construtos também foi investigada. METODOLOGIA: Estudo transversal com médicos residentes do primeiro ano de Clínica Médica, com questionários de autorrelato para avaliar a percepção de qualidade de vida específica para residência médica (Veras-Q), dados sociodemográficos, empatia (escala Jefferson), resiliência (escala Wagnild& Young RS-14) e sonolência diurna (escala de Epwoth). O desempenho acadêmico foi avaliado pelo método OSCE no final do primeiro ano da residência em Clínica Médica. Análise de grupos focais com residentes do sexo feminino foi feita para compreender as diferenças entre os gêneros nos construtos investigados. RESULTADOS: Cento e nove médicos residentes participaram do estudo: 31 (28,4%) do sexo feminino e 78 (71,6%) masculinos. As residentes do sexo feminino apresentaram escores de qualidade de vida significativamente menores do que os residentes masculinos nos domínios de uso do tempo (30,3, feminino vs 41,1, masculino p < 0,001), psicológico (48,1, feminino vs 56,7, masculino p < 0,01) e saúde física (42,8, feminino vs 53,6, masculino p < 0,05). Os escores de sonolência diurna foram significativamente maiores para as residentes do sexo feminino (13,0, feminino vs 9,0, masculino p < 0,001), com valores considerados patológicos (p < 0,001). Houve moderada correlação negativa entre sonolência diurna e o domínio manejo do tempo da qualidade de vida (p < 0,01). Houve forte correlação positiva entre resiliência e os domínios psicológico e saúde física da qualidade de vida (respectivamente, 0,48 e 0,50; p < 0,01). Os escores do desempenho acadêmico pelo método OSCE não diferiram entre os gêneros e não apresentaram correlação com os construtos investigados. A análise dos grupos focais destacou dificuldade de manejo do tempo, insegurança, sensação de perda, autocobrança, dificuldade de estabelecer laços afetivos, dificuldade de concentração e de aquisição do conhecimento como fatores relacionados à pior percepção da qualidade de vida para as residentes do sexo feminino. CONCLUSÃO: Ao final do primeiro ano da residência em Clínica Médica, os residentes apresentaram baixos escores na percepção da qualidade de vida e maior sonolência diurna. Houve diferenças significativas entre os gêneros na percepção da qualidade de vida e na sonolência diurna, com escores menores de qualidade de vida e escores maiores de sonolência diurna nas residentes do sexo feminino. Não foram identificadas correlações entre qualidade de vida, empatia, resiliência, sonolência diurna e o desempenho acadêmico pelo método OSCE em residentes do primeiro ano de Clínica MédicaINTRODUCTION: During medical residency, many factors may lead to emotional distress, putting at risk relevant attitudes such as empathy, resilience and perception of quality of life, which can compromise professional performance. OBJECTIVE: To evaluate the impact of training in internal medicine on quality of life, empathy, resilience, daytime sleepiness and their correlation with academic performance using the OSCE method. The influence of gender in these constructs was also investigated. METHODOLOGY: A cross-sectional study with first-year internal medicine residents was performed to evaluate self-reported quality of life specific for medical residency (Veras-Q), socio demographic data, empathy (Jefferson scale), resilience (Brief Resilience Scale from Wagnild and Young) and daytime sleepiness (Epwoth scale). Academic performance was assessed by the OSCE method at the end of the first year of internal medicine residency. Differencesbetween genders were investigated using focus groups analysis with female residents. RESULTS: One hundred and nine resident physicians participated in the study: 31 (28.4%) were female and 78 (71.6%) were male. Female residents presented significantly lower scores than those of male residents for quality of life in the domains of time management (30.3, females vs 41.1, males p < 0.001), psychological (48.1 females vs 56, 7, males p < 0.01) and physical health (42.8, females vs 53.6, males p < 0.05). They also scored higher in daytime sleepiness (13.0, females vs 9.0, males p < 0.001) with pathological scores for daytime sleepiness. A moderate negative correlation between daytime sleepiness and time management domain of quality of life (p < 0.01) was observed. There was a strong positive correlation among resilience, psychological and physical health domains of quality of life (respectively 0.48 and 0.50, p < 0.01). Academic performance scores by the OSCE method did not differ between genders and did not correlate with empathy, resilience and daytime sleepiness scores. The focus group assessment revealed difficulty in concentration and knowledge acquisition, insecurity, feeling of loss, greater critical perception, self-doubt and difficulty in creating affective bonds to support the training period as the main factors involved in the lower perception of quality of life among the women. CONCLUSION: Female residents had lower scores of quality of life and higher scores on daytime sleepiness. No significant differences between genders were detected for academic performance scores and no relationship among quality of life, empathy, resilience, daytime sleepiness and academic performance by the OSCE method was observed in first-year internal medicine residents. Measures to improve quality of life among female residents during this critical period of medical training might include investing in mentoring to help them better manage their time and encouraging activities that facilitate relationship developmen

Gender differences in the perception of quality of life during internal medicine training: a qualitative and quantitative analysis

Abstract Background The higher level of participation by women in medicine may impact this profession’s evolution due to gender differences perceived during medical school, after graduation and during residency. Gender differences regarding quality of life are associated with higher states of anxiety and depression among female physicians. We aimed to assess gender differences in the perception of quality of life with quantitative methods and to understand further, from the female residents´ point of view, the reasons that may influence the perception of quality of life using qualitative method. Resilience, empathy and daytime sleepiness were also scored. Methods We performed a cross-sectional study with first-year internal medicine residents to evaluate self-reported quality of life factors specific to medical residents (VERAS-Q), including empathy (Jefferson Scale of Empathy), resilience (Wagnild and Young Brief Resilience Scale) and daytime sleepiness (Epworth Scale). We explored, from the female residents´ view which factors may influence the perception of quality of life using a focus group method. Results In our study, one hundred and nine residents completed the survey: 31 (28.4%) were female and 78 (71.6%) were male. Female residents exhibited significantly lower scores than those of male residents for quality of life in the domains of time management (30.3, females vs 41.1, males; p < 0.001), psychology (48.1, females vs 56.7, males; p < 0.01) and physical health (42.8, females vs 53.6, males; p < 0.05). Female residents also scored higher for daytime sleepiness (13.0, females vs 9.0, males; p < 0.001), with pathological scores for daytime sleepiness. No significant gender differences were found in the resilience or empathy scores. The focus group assessment revealed difficulty in concentration and knowledge acquisition, insecurity, feelings of loss, greater critical perception, self-doubt and difficulty in creating effective bonds to support the training period as the main factors involved in the lower perception of quality of life among the women. Conclusions In conclusion, female residents had lower scores for quality of life and higher scores for daytime sleepiness. Measures to improve quality of life among female residents during this critical period of medical training might include investing in mentoring to help them better manage their time and encouraging activities that facilitate relationship development

Oxidative stress and inflammatory mediators contribute to endothelial dysfunction in high-fat diet-induced obesity in mice

Objective We investigated the effects of high-fat diet-induced obesity on vascular proinflammatory factors and oxidative stress on endothelium-dependent relaxation of the aorta. Methods Female Swiss mice were submitted to a high-fat diet for 16 weeks. At the end of the experimental period, we evaluated blood pressure, relaxation in response to acetylcholine in aortic rings in the absence and the presence of the superoxide anion scavenger, superoxide dismutase (SOD, 150 U/ml), and the nuclear factor (NF)-kappa B inhibitor, sodium salicylate (5 mmol/l). Aortic protein expression of endothelial nitric oxide synthase, Cu/Zn-SOD, NF-kappa B, I kappa B-alpha, and proinflammatory cytokines were also evaluated. Results Obese mice presented higher systolic and diastolic blood pressure than control mice (P<0.05). The relaxation of aortas to acetylcholine, but not to sodium nitroprusside, was significantly decreased in obese mice and was corrected by both SOD and sodium salicylate (P<0.05). The protein expression of endothelial nitric oxide synthase and Cu/Zn-SOD was significantly decreased in aorta from obese mice (P<0.05). Total p65 NF-kappa B subunit protein expression was not affected by obesity, but the protein expression of NF-kappa B inhibitor I kappa B-alpha was lower in aorta from obese mice (P<0.05). There were no significant differences in the interleukin (IL)-1 beta and IL-6 protein expression between groups. In contrast, the expression of TNF-alpha was significantly increased in aortas from obese mice. Conclusion Our resultssuggest that the reducedantioxidant defense and the local NF-kappa B pathway play an important role in the impairment of endothelium-dependent relaxation in aorta from obese mice. J Hypertens 28: 2111-2119 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), BrazilConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

NURSING CARE FOR PATIENTS UNDERGOING PALLIATIVE CARE IN THE CONTEXT OF DIGITAL HEALTH

The aim is to identify the evidence available in the literature on nursing care for patients undergoing PC in the context of digital health. The methodology proposed is an Integrative Literature Review, based on the following steps: defining the review question, determining the search strategy, critical evaluation of the research results, summarizing the research results, data extraction and reduction, analysis, conclusions and implications. The guiding question adopted the PICo strategy, being: (P) population - “patients undergoing palliative care”, (I) interest – “nursing care”, (Co) context - “digital health”, generating: “What evidence is available in the literature about nursing care for patients undergoing PC in the context of digital health?”. The sources of information will be studies indexed in the databases: National Library of Medicine National Institutes of Health (PUBMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American Caribbean Literature in Health Sciences (LILACS), EMBASE and Web of Science (WOS)