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Breaking bad news (BBN) is necessary in medical practice and requires training. The purpose of this study is to evaluate the efficacy and mainly explore the components involved in medical students' and residents' performance after a flipped educational intervention to train them to break bad news. A randomized controlled before-after study was conducted with 43 medical students and residents in the intervention group and 41 in the control group. The intervention combined an online multimedia program (DocCom) with a two-hour workshop. BBN performance was assessed at two clinical stations using Objective Structured Clinical Examination and analyzed using a mixed between-within subject analysis of variance. A factor analysis was conducted to analyze the performance by checklist components. The intervention group improved its overall performance in BBN over time (p = 0.000; Eta[superscript 2] = 0.38) and when compared to the control group (p = 0.01; Eta[superscript 2] = 0.12). The factor analysis revealed two main components: Factor 1--"giving bad news and responding with empathy"--and Factor 2--"using general communication skills". Performance analysis by these components revealed that the improvement occurred mainly in Factor 1 (over time, p = 0.000; Eta[superscript 2] = 0.48, group x time, p = 0.000; Eta[superscript 2] = 0.38). The intervention combining DocCom Module 33 and a workshop had a moderate effect on the improvement of medical students' and medical residents' BBN overall performance in standardized encounters. This improvement was mainly related to communication skills for giving bad news and responding with empathy, in which the intervention effect was large over time and between groups.

Objectives: This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV) insufficiency. Methods: Sixty patients were randomly allocated to EVLA or EVLA–UGFS groups which focused on GSV occlusion rates, complications, additional treatments, and quality of life (QoL) changes. Results: Among 55 participants, the EVLA group had higher 12-month occlusion rates (92.3% vs. 75.8%, p = 0.11). Nervous injury (NI) was rarer in EVLA–UGFS (3.4% vs. 23.1%, p = 0.04). No significant difference in other complication rates (p > 0.05). QoL improved in both groups (p < 0.001). EVLA–UGFS required more subsequent procedures (24.1% vs. 7.7%, p = 0.03). Conclusions: EVLA and EVLA–UGFS effectively treat GSV insufficiency, enhancing QoL. The combined method reduces NI risk but may require more follow-up procedures. [ABSTRACT FROM AUTHOR]

Effective doctor-patient-family communication is an integral and sensitive part of health care, assessing its quality is essential to identify aspects needing disclosure and, if necessary, improvement. Cross-sectional study aimed to analyze the sources of evidence of validity and the number of participants needed to reliably apply the Quality of Communication Questionnaire (QoC) through Generalizability Theory (GT). The mean age of the 150 patients hospitalized at the end of life was 50.5 (SD = 13.8) years, the mean hospital length of stay was 7.5 (SD = 10.2) days, 56.9% were male. Regarding the 105 patients' family members of patients whose mean length of hospital stay was 9.5 (SD = 9.1) days, their mean age was 42.2 (SD = 14.7) years, 69.5% were female. GT was used to quantify the minimum number of questionnaires needed, with the aim of reaching a reliable estimate of QoC with G-coefficients. To reach a reliability of.90, there is a need for 25 for the Eρ2 questionnaires and 35 for the Φ. The exact estimation identified the minimum number of questionnaires required for the evaluation of physicians by patients. To obtain a reliability of.90, there is a need for 30 and 40 questionnaires for the G-coefficients. A practical and fast application makes it possible to use QoC in its entirety or alone to evaluate general communication or communication about palliative care. Furthermore, based on these results, it was possible to identify which aspects were effective or ineffective in these contexts. [ABSTRACT FROM AUTHOR]

Assessment of communication between physicians and patients' family members is essential to improving healthcare quality. To adapt the Quality of Communication Questionnaire (QoC) for family members and to analyze its validity evidence for use in Brazil. Data were collected between 2017 and 2019, with family members of patients in intensive care (IC) and palliative care (PC) from five public hospitals in the South Brazil. The QoC was adapted for family members for use in Brazil, and its cross-cultural adaptation was carried out. The clarity and cultural appropriateness of the pre-final version were evaluated by 30 family members of patients in IC. The final version was responded by 198 family members of patients. All items were considered clear, and appropriate to Brazilian culture. The goodness of fit index for proposed model had CFI 0.96 (CI95%: 0.94 – 0.98), TLI 0.95 (CI95%: 0.92 – 0.97), RMSEA 0.07 (CI90%: 0.06 – 0.08), and χ2/df 2.18. Cronbach's alpha coefficient (α) among family members of patients in PC was 0.88 for the general communication (first subscale) and 0.80 for the end-of-life communication (second subscale). However, among family members of patients in IC, α was 0.86 for the first subscale and only 0.53 for the second subscale. The QoC for family members and its cross-cultural adaptation were carried out successfully. It has strong validity evidence among those with loved ones in PC, but only the QoC general communication subscale has strong validity evidence among those with loved ones in IC. [ABSTRACT FROM AUTHOR]

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was.75, and.84 in the general communication subscale and.51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was.83, and.88 in the general communication subscale, and.71 in the end-of-life communication subscale. The root mean square error of approximation was.07 (90% CI:.04 –.08); Tucker-Lewis index was.97 (95% CI:.95 –.98); comparative fit index was.98 (95% CI:.97 –.99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p =.05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC. [ABSTRACT FROM AUTHOR]

To analyze the presence of gastroesophageal reflux disease (GERD) and dysphagia in patients with chronic obstructive pulmonary disease (COPD) and evaluate associated factors. Cross-sectional study part of a large cohort study. The Dysphagia Handicap Index (DHI), Gastroesophageal Reflux Disease Symptoms Questionnaire (QS-GERD) and The Eating Assessment Tool (EAT-10) were applied. A medical consultation, spirometry examination, and health status assessments (by modified Medical Research Council scale - mMRC, COPD Assessment Test - CAT, Saint George Respiratory Questionnaire - SGRQ) were performed on the same day as the DHI, QS-GERD and EAT-10. Thirty-four individuals participated in the study, with a mean age of 65.2 (SD=7.9) complete years with COPD, 52.9% being female, and a body mass index of 26.6 (SD=6.3) kg/m². Eleven individuals were classified as having risk for dysphagia. The evaluation of gastroesophageal reflux symptoms through the QS-DRGE showed moderate correlation with EAT-10. The GERD-SQ instrument showed moderate correlation with the SGRQ, as well as in the three domains, finding that the presence of GERD symptoms is a factor that is associated with worsening quality of life. It is concluded that patients with COPD present symptoms of dysphagia and gastroesophageal reflux. In this study, it was found that the presence of GERD symptoms and swallowing disorders are factors associated with worsening quality of life. [ABSTRACT FROM AUTHOR]