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1.
Saudi Med J ; 45(9): 919-928, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39218469

RESUMO

OBJECTIVES: To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. METHODS: This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. RESULTS: For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. CONCLUSION: Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.


Assuntos
Artrite Reumatoide , Articulações Carpometacarpais , Padrões de Prática Médica , Encaminhamento e Consulta , Polegar , Humanos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Transversais , Articulações Carpometacarpais/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Polegar/cirurgia , Arábia Saudita , Artrite Reumatoide/cirurgia , Cirurgiões Ortopédicos/estatística & dados numéricos , Inquéritos e Questionários , Masculino , Feminino , Cirurgiões/estatística & dados numéricos
2.
Artigo em Inglês | MEDLINE | ID: mdl-39269912

RESUMO

INTRODUCTION: Social media offers physicians marketing opportunities previously unavailable. We sought to evaluate social media use and its correlation with public rankings among Association of Hip and Knee Surgeons members. METHODS: A list of members and demographics was collected. Social media sites were reviewed for each surgeon, and a score was calculated based on active use. The US News and World Report (NWR) was used to determine rating and number of reviews. The Spearman correlation coefficient and independent samples t-test were used to measure correlation and compare means between the groups, respectively. RESULTS: A total of 2436 members were analyzed. The average social media score was 4.14. The average US NWR score was 4.25. A strong correlation was observed between social media and US NWR scores (r = 0.74, P < 0.01) but not with the number of reviews (r = 0.40, P = 0.17). A strong association with US NWR rating (r = 0.74, P = 0.04) and a weak correlation with the total number of reviews (r = 0.61, P = 0.06) were found. CONCLUSIONS: Social media use is correlated with US NWR scores. Association of Hip and Knee Surgeons members may be underutilizing social media for the promotion of their practices. Future studies are needed to evaluate whether it affects patient volume and outcomes.


Assuntos
Cirurgiões Ortopédicos , Mídias Sociais , Sociedades Médicas , Humanos , Estados Unidos , Masculino , Feminino , Ortopedia
6.
Eur J Med Res ; 29(1): 422, 2024 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-39152486

RESUMO

Regarding medico-legal malpractice suits, lawyers and insurers focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for platelet-rich plasma (PRP) injections. The objective of the present study was to create a pre-designed, evidence-based informed consent form specifically for PRP injections. The current evidence on the medico-legal implications of PRP injections was accessed, as well as informed consent in general and specifically informed consent in PRP injections. Additionally, we interviewed orthopaedic surgeons and patients who had undergone PRP injections in the past year using a semi-structured approach. A legally valid and evidence-based informed consent form for PRP injections ensures rights, encouraging open communication and transparency between the patient and surgeon. Moreover, if a lawsuit arose, informed consent would be a critical document in surgeons' defence and would withstand scrutiny from lawyers and the judiciary. An evidence-based informed consent form for PRP injections was elaborated and reviewed by a legal expert to ensure adherence to legal proprieties. The final form of the informed consent for PRP injection was administered for one year and validated at our institution.


Assuntos
Consentimento Livre e Esclarecido , Cirurgiões Ortopédicos , Plasma Rico em Plaquetas , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Cirurgiões Ortopédicos/legislação & jurisprudência , Termos de Consentimento/legislação & jurisprudência , Termos de Consentimento/normas , Medicina Baseada em Evidências/legislação & jurisprudência , Medicina Baseada em Evidências/normas , Injeções
7.
Injury ; 55(10): 111800, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39121806

RESUMO

Intimate partner violence is an overlooked, underestimated, and under reported cause of musculoskeletal injury. This literature review aims to provide an updated overview of the prevalence of IPV, along with the identification and screening tools available to orthopaedic surgeons for early detection and intervention. Additionally, the review discusses the importance of training in medical education for orthopaedic surgeons to effectively recognize and address IPV. Through an analysis of current research and best practices, this review highlights the need for increased awareness, education, and collaboration among healthcare professionals to effectively address IPV as a public health issue.


Assuntos
Violência por Parceiro Íntimo , Programas de Rastreamento , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/estatística & dados numéricos , Prevalência , Cirurgiões Ortopédicos/educação , Ortopedia/educação , Educação Médica/métodos
8.
Bone Joint J ; 106-B(9): 942-948, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39216866

RESUMO

Aims: This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures. Methods: This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64). Results: Overall, 281 patients (57.7%) were treated by orthopaedic surgeons, and 206 patients (42.3%) by podiatrists. When controlling for age, sex, and time between symptom onset and presentation, the likelihood of undergoing operative treatment was significantly greater when treated by a podiatrist (odds ratio (OR) 2.9 (95% CI 1.2 to 8.2); p = 0.029). A greater proportion of patients treated by orthopaedic surgeons were allowed to immediately bear weight on the injured foot (70.9% (178/251) vs 47.3% (71/150); p < 0.001). Patients treated by podiatrists were immobilized for significantly longer (mean 8.4 weeks (SD 5.7) vs 6.8 weeks (SD 4.3); p = 0.002) and experienced a significantly longer mean time to clinical healing (12.1 (SD 10.6) vs 9.0 weeks (SD 7.3), p = 0.003). Conclusion: Although there was considerable heterogeneity among zone 2 fracture management, orthopaedic surgeons were less likely to treat patients operatively and more likely to allow early full weightbearing compared to podiatrists.


Assuntos
Fraturas Ósseas , Ossos do Metatarso , Podiatria , Humanos , Ossos do Metatarso/lesões , Ossos do Metatarso/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Fraturas Ósseas/diagnóstico por imagem , Adulto , Podiatria/métodos , Suporte de Carga , Idoso , Consolidação da Fratura , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões Ortopédicos
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(8): 942-946, 2024 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-39175315

RESUMO

Clavicle fracture is a common orthopedic injury, accounting for approximately 2.6%-4% of all adult skeletal fractures. In 2023, the American Academy of Orthopaedic Surgeons (AAOS) developed evidence-based treatment guidelines for clavicle fractures, which include 4 recommendations and 10 options. This article, based on a thorough review of the guidelines, discusses the clinical treatment of clavicle fractures, aiming to share advancements and the latest diagnostic and therapeutic considerations with orthopedic colleagues to enhance treatment outcomes.


Assuntos
Clavícula , Fraturas Ósseas , Clavícula/lesões , Humanos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Fixação Interna de Fraturas/métodos , Guias de Prática Clínica como Assunto , Cirurgiões Ortopédicos , Estados Unidos , Ortopedia/normas
11.
Bull Hosp Jt Dis (2013) ; 82(3): 186-193, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39150872

RESUMO

PURPOSE: Rheumatologists and orthopedic surgeons frequently collaborate on difficult decisions regarding perioperative management of immunosuppression in rheumatic disease patients, balancing risk of postoperative infection with risk of disease flares. Current evidence-based guidelines pertain specifically to arthroplasty, thus we sought to understand the trends and common practices regarding peri-arthroscopic use of immunosuppression. METHODS: Rheumatologists and sports medicine surgeons, from a variety of New York hospitals and serving a broad range of demographics, were surveyed on immunosuppressive medication management in rheumatic disease patients undergoing arthroscopic surgeries. Physicians' preferences were elicited regarding the use of common anti-rheumatic medications with the lower risk meniscectomies and the higher risk anterior cruciate ligament (ACL) reconstructions and allografts. Physicians were asked specifically about peri-arthroscopic use of conventional synthetic diseasemodifying antirheumatic drugs (csDMARDs), biologics, and Janus kinase (JAK) inhibitors. RESULTS: During the survey period, 25 rheumatologists and 19 sports medicine fellowship-trained orthopedic surgeons completed the questionnaire. For lower-risk arthroscopies, rheumatologists favored continuing various csDMARDs (72% to 100%), biologics (50% to 64%) and JAK inhibitors (57%), while a majority of surgeons concurred for all three drug classes (csDMARDs 63%; biologics 53%; and JAK inhibitors 58%). For higher-risk arthroscopies, most rheumatologists preferred that patients continue csDMARDs (63% to 100%) but fewer supported the use of biologics (28% to 39%) or JAK inhibitors (22%). Surgeons were more hesitant to endorse any class of immunosuppressive antirheumatic medications (22% to 27%) around these higher risk surgeries. The rheumatologists were most concerned about surgeries taking place too soon after the last dose of rituximab, recommending these higher risk surgeries not take place for 7.7 ± 8.8 weeks following the last infusion. CONCLUSION: For lower-risk arthroscopies, most rheumatologists but only about half of orthopedic surgeons preferred patients continuing csDMARDs. Approximately half of both groups preferred patients hold biologics and JAK inhibitors. In more involved arthroscopies, most rheumatologists but few orthopedists supported the continued use of csDMARDs, and the consensus was to hold all other immunosuppression when possible. While the duration medications were held perioperatively were somewhat reflective of the current guidelines for arthroplasty, there is a need for evidencebased guidelines specifically regarding peri-arthroscopy immunosuppression in rheumatic disease patients.


Assuntos
Artroscopia , Imunossupressores , Cirurgiões Ortopédicos , Padrões de Prática Médica , Doenças Reumáticas , Reumatologistas , Humanos , Padrões de Prática Médica/tendências , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões Ortopédicos/tendências , Cirurgiões Ortopédicos/estatística & dados numéricos , Reumatologistas/tendências , Imunossupressores/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/cirurgia , Artroscopia/tendências , Antirreumáticos/uso terapêutico , Antirreumáticos/efeitos adversos , Inquéritos e Questionários , Produtos Biológicos/uso terapêutico , Produtos Biológicos/efeitos adversos , Inibidores de Janus Quinases/uso terapêutico , Medicina Esportiva/tendências , Medicina Esportiva/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde
13.
Musculoskelet Surg ; 108(3): 339-345, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38967771

RESUMO

BACKGROUND: We created a multicenter survey for Italian orthopedic surgeons on how they approach leg length discrepancy (LLD) when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow the literature recommendations during clinical practice. METHODS: The survey was composed of 25 questions divided into four sections: 1-surgeon's profile, 2-preoperative and 3-intraoperative evaluation, and 4-postoperative management. In this paper, we report results to answer Sects. 1 and 2. Absolute and relative frequencies of answers to Sects. 2 and 3 are reported. We divided the participants in subgroups based on the "surgeon's profile" and evaluated difference in the answers given. RESULTS: Absolute and relative frequencies demonstrate low agreement among participants in all phases of LLD management. We demonstrated a statistically significant difference based on the surgeon's profile regarding these questions: radiographic measure of LLD depending on working experience, p = 0.008; digital planning based on surgeons' age, p < 0.001, and workplace, p = 0.026; intraoperative anatomical landmarks based on numbers of procedures per year, p = 0.020; and use of intraoperative X-rays based on working experience, p = 0.002. CONCLUSIONS: LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition and surgeons' preference.


Assuntos
Artroplastia de Quadril , Desigualdade de Membros Inferiores , Humanos , Desigualdade de Membros Inferiores/etiologia , Artroplastia de Quadril/métodos , Itália , Cuidados Pré-Operatórios , Cuidados Intraoperatórios , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões Ortopédicos , Feminino , Inquéritos e Questionários , Masculino
14.
J Pediatr Orthop ; 44(9): e858-e862, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39021094

RESUMO

BACKGROUND: Orthopaedic surgeons routinely face exposure to ionizing radiation during intraoperative use of fluoroscopy. Lead personal protective equipment reduces occupational radiation exposure. Female-specific lead aprons are designed with expanded lateral coverage to improve protection of breast tissue against radiation beams. The purpose of this study was to identify current trends in knowledge and utilization of female-specific lead aprons as well as any barriers to utilization. METHODS: An anonymous electronic survey including 20 multiple choice and multiple selection responses was distributed to all members of the Pediatric Orthopaedic Society of North America (POSNA). Respondents who reported the use of intraoperative fluoroscopy in their practice were included in the study. RESULTS: Most respondents were attending surgeons (91%) and practiced in an academic setting (85%) in an urban environment (75%). Most respondents reported using a lead apron for every case (76%) and a thyroid shield for every case (75%), while most respondents reported they do not wear lead glasses (73%). Fifty-one percent of respondents were aware of female-specific lead aprons. The majority of respondents reported female-specific lead is unavailable (45%) or available in insufficient quantities (5.5%) at their institution. Ninety percent of females reported they do not wear female-specific lead with the common reasons being lack of availability and discomfort. CONCLUSIONS: Knowledge of female-specific lead is low with lack of availability as a common barrier to utilization. As female presence in the field of orthopaedic surgery expands, efforts should be made to improve education and availability of sex-specific lead aprons.


Assuntos
Exposição Ocupacional , Cirurgiões Ortopédicos , Roupa de Proteção , Proteção Radiológica , Humanos , Feminino , Masculino , Roupa de Proteção/estatística & dados numéricos , Proteção Radiológica/métodos , Exposição Ocupacional/prevenção & controle , Inquéritos e Questionários , Chumbo , Fluoroscopia , Conhecimentos, Atitudes e Prática em Saúde , Exposição à Radiação , Fatores Sexuais
15.
Orthopedics ; 47(4): e214-e216, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39038107

RESUMO

Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into "preop," "intraop," and "postop" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [Orthopedics. 2024;47(4):e214-e216.].


Assuntos
Dor Musculoesquelética , Cirurgiões Ortopédicos , Humanos , Dor Musculoesquelética/prevenção & controle , Dor Musculoesquelética/etiologia , Terapia por Exercício/métodos , Doenças Profissionais/prevenção & controle , Doenças Profissionais/etiologia , Postura
16.
Injury ; 55(8): 111695, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38959676

RESUMO

INTRODUCTION: There is a lack of research on the state of racial, ethnic, and gender diversity in the emerging orthopedic trauma workforce. The purpose of this study was to analyze the training pathway for diverse candidates in orthopedic trauma as it relates to race, ethnicity, and sex. METHODS: Self-reported demographic data were compared among allopathic medical students, orthopedic surgery residents, orthopedic trauma fellows, and the general population in the United States (2013-2022). Race categories consisted of White, Asian, Black, and Native American/Alaskan Native (NA/AN), and Native Hawaiian/Pacific Islander (NH/PI). Ethnicity categories were Hispanic/Latino or non-Hispanic/Latino. Sex categories were male and female. Representation was calculated at each stage of accredited training. Participation-to-prevalence ratios (PPRs) quantified the equitable representation of demographic groups in the emerging orthopedic trauma workforce relative to the US population. PPR thresholds were used to classify representation as overrepresented (PPR > 1.2), equitable (PPR = 0.8-1.2), and underrepresented (PPR < 0.8). RESULTS: Relative to medical school and orthopedic surgery residency, fewer female (48.5 % vs 16.7 % vs 18.7 %, P < 0.001), Hispanic (6.1 % vs 4.5 % vs 2.6 %, P < 0.001), Black (6.9 % vs 5.0 % vs 3.1 %, P < 0.001), and Asian (24.0 % vs 14.3 % vs 12.2 %, P < 0.001) trainees existed in orthopedic trauma fellowship training. In contrast, more male (51.5 % vs 83.3 % vs 81.3 %, P < 0.001) and White (62.8 % vs 79.1 % vs 84.0 %, P < 0.001) trainees existed in orthopedic trauma fellowship relative to earlier training stages. There were zero NA/AN or NH/PI trainees in orthopedic trauma (PPR = 0). Relative to the US population, Hispanic (PPR = 0.14), Black (PPR = 0.25), and female (PPR = 0.37) trainees were underrepresented in orthopedic trauma. In contrast, Asian (PPR = 2.04), male (PPR = 1.64), and White (PPR = 1.36) trainees were overrepresented in orthopedic trauma. CONCLUSION: Women, racial, and ethnic minorities are underrepresented in the emerging orthopedic trauma workforce relative to the US population, and earlier stages of training. Targeted recruitment and guided mentorship of these groups may lead to greater interest, engagement, and diversity in orthopedic trauma.


Assuntos
Diversidade Cultural , Internato e Residência , Cirurgiões Ortopédicos , Ortopedia , Adulto , Feminino , Humanos , Masculino , Educação de Pós-Graduação em Medicina , Etnicidade/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Cirurgiões Ortopédicos/estatística & dados numéricos , Ortopedia/educação , Traumatologia/educação , Estados Unidos/epidemiologia , Grupos Raciais
20.
Clin Orthop Relat Res ; 482(8): 1351-1357, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39031037

RESUMO

BACKGROUND: Women remain underrepresented in leadership roles, faculty roles, and among residents in orthopaedic surgery. It has been suggested that having women in leadership positions in orthopaedic surgery may help to increase the gender diversity of residency programs. However, to our knowledge, no study has explored the relationship, if any, between the gender of the residency program director and the percentage of women in the residency program. QUESTIONS/PURPOSES: (1) Is the program director's gender associated with differences in the percentage of women orthopaedic surgery residents? (2) Do women and men differ in the time to appointment of program director? METHODS: A list of 207 orthopaedic surgery residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) website for the academic year 2021 to 2022. The study excluded 6% (13) of programs; 4% (8) were those without ACGME accreditation and those with initial accreditation, and 2% (5) did not have updated 2021 to 2022 resident lists. Descriptive information on 194 programs was obtained from publicly accessible resources from July 2021 through July 2022. The institution's website and the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was used to collect residency program characteristics and resident demographics [ 2 ]. Doximity, Healthgrades, and LinkedIn were used to further collect current orthopaedic surgery residency program director demographics, including gender, age, and education/training history. To determine gender, photographs and pronouns (she/her/hers or he/him/hers) used in their biographies were used first. To confirm this, secondary sources were used including their NPI profile, which lists gender; Doximity; and their LinkedIn profile. Scopus was used to analyze research output by the program directors-using the Hirsch index (h-index) as the primary bibliometric metric. A total of 194 program directors were identified, of whom of 12% (23) were women and 88% (171) were men. Of the 4421 total residents among these programs, 20% (887) were women and 80% (3534) were men. A univariate analysis comparing program directors was conducted, with continuous variables analyzed using an independent-sample t-test and categorical variables analyzed using a Pearson chi-square test. With the numbers available, a post hoc statistical power calculation indicated that we could detect an 32% difference in the percentage of women in a program as significant with 80% power at the p < 0.05 level, whereas we might have been underpowered to discern smaller differences than that. RESULTS: With the numbers available, we found no difference in the percentage of women in residency programs run by women program directors than in programs in which the program director was a man (22% [125 of 558] versus 20% [762 of 3863], mean difference 2% [95% CI -1.24% to 7.58%]; p = 0.08). Comparing women to men program directors, women had fewer years between residency completion and appointment to the position of program director (8 ± 2 years versus 12 ± 7 years, mean difference 4 years [95% CI 2.01 to 7.93 years]; p = 0.02) and had a lower mean h-index (7 ± 4 versus 11 ± 11, mean difference 4 [95% CI 1.70 to 6.56]; p = 0.03) and number of publications (24 ± 23 versus 41 ± 62, mean difference 17 [95% CI 3.98 to 31.05]; p = 0.01), although they did not differ in terms of their advanced degrees, duration of training, or likelihood of having taken a fellowship. CONCLUSION: Orthopaedic residency programs that were run by women did not contain a higher percentage of women residents, suggesting that the gender of the individual in that role may not be as important as has been speculated by others. Future studies should investigate the intersectionality of gender, race, and ethnicity of residents, program directors, and current faculty. CLINICAL RELEVANCE: The fact that women were placed in program director roles earlier in career may also carry special jeopardy for them. Those roles are difficult and can impair a faculty member's ability to conduct individual research, which often is key to further academic promotions. Given that and the fact that the gender of the program director was not associated with differences in gender composition of residency programs, we believe that increasing mentorship and access to pipeline programs will help promote diversity in residency programs.


Assuntos
Internato e Residência , Liderança , Ortopedia , Médicas , Humanos , Internato e Residência/estatística & dados numéricos , Feminino , Masculino , Médicas/estatística & dados numéricos , Ortopedia/educação , Educação de Pós-Graduação em Medicina , Estados Unidos , Cirurgiões Ortopédicos/educação , Fatores Sexuais , Diretores Médicos/estatística & dados numéricos , Equidade de Gênero , Acreditação , Sexismo , Procedimentos Ortopédicos/educação
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