RESUMO
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.
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COVID-19 , Internato e Residência , Médicos , Humanos , Estados Unidos , Pandemias , COVID-19/epidemiologia , Educação de Pós-Graduação em Medicina , Hospitais de EnsinoRESUMO
Medical education in Texas is moving in the right direction. The Texas Medical Association has been a major partner in advancing medical education initiatives. This special symposium issue on medical education examines residency training costs, the Next Accreditation System, graduate medical education in rural Texas, Texas' physician workforce needs, the current state of education reform, and efforts to retain medical graduates in Texas.
Assuntos
Acreditação , Educação de Pós-Graduação em Medicina , Internato e Residência/economia , Médicos/provisão & distribuição , Humanos , TexasAssuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Adolescente , Criança , Hipotireoidismo Congênito/sangue , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/epidemiologia , Hipotireoidismo Congênito/fisiopatologia , Hipotireoidismo Congênito/terapia , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/epidemiologia , Hipotireoidismo/fisiopatologia , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Prognóstico , Valores de Referência , Tireotropina/sangue , Tiroxina/sangue , Tiroxina/uso terapêutico , Estados Unidos/epidemiologiaRESUMO
Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children. Early diagnosis and treatment prevent the devastating outcome of mental retardation. Clinical features of CH are subtle and are not evident early in the neonatal period. Therefore, universal newborn screening (NS) is effective in detecting CH and implementing early treatment. This article reviews the current literature regarding the epidemiology, etiology, classification, clinical features, diagnosis of primary CH, and the management of abnormal newborn screen as well as treatment and prognosis of primary CH and outlines the importance of universal newborn screening in preventing mental retardation.
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Hipotireoidismo Congênito/diagnóstico , Triagem Neonatal , Algoritmos , Hipotireoidismo Congênito/terapia , Humanos , Recém-NascidoRESUMO
PURPOSE: Consensus recommendations to help ensure safe insulin use in hospitalized patients are presented. SUMMARY: Insulin products are frequently involved in medication errors in hospitals, and insulin is classified as a high-alert medication when used in inpatient settings. In an initiative to promote safer insulin use, the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation convened a 21-member panel representing the fields of pharmacy, medicine, and nursing and consumer advocacy groups for a three-stage consensus-building initiative. The panel's consensus recommendations include the following: development of protocol-driven insulin order sets, elimination of the routine use of correction/sliding-scale insulin doses for management of hyperglycemia, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses and i.v. infusions to the pharmacy department. In addition, the panelists recommended that hospitals better coordinate insulin use with meal intake and glucose testing, prospectively monitor the coordination of insulin delivery and rates of hypoglycemia and hyperglycemia, and provide standardized education and competency assessment for all hospital-based health care professionals responsible for insulin use. CONCLUSION: A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medication-use process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations.
Assuntos
Insulina/uso terapêutico , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/normas , Sociedades Farmacêuticas , Consenso , HumanosAssuntos
Fention/intoxicação , Inseticidas/intoxicação , Linfangioleiomiomatose/diagnóstico , Hipersecreção Hipofisária de ACTH/diagnóstico , Adenoma/complicações , Adenoma/cirurgia , Hormônio Adrenocorticotrópico/sangue , Criança , Dexametasona , Diagnóstico Diferencial , Feminino , Fention/farmacologia , Preparações para Cabelo/efeitos adversos , Preparações para Cabelo/química , Humanos , Hidrocortisona/sangue , Inseticidas/farmacologia , Linfangioleiomiomatose/terapia , Masculino , Hipersecreção Hipofisária de ACTH/etiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Intoxicação/diagnósticoAssuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/terapia , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/terapia , Criança , Comorbidade , Síndrome de Cushing/epidemiologia , Diabetes Mellitus/epidemiologia , Doenças do Sistema Endócrino/epidemiologia , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade/epidemiologiaRESUMO
The treatment of children with short stature was revolutionized by the creation of recombinant growth hormone therapy. While it cannot be denied that therapy adds significant height to children who are growth hormone deficient, such treatment is both painful, requiring many injections for years, as well as extremely expensive, both for the children's parents as well as for medical health care for society. With the indications for growth hormone treatment expanding over the years to include children with short stature who are not growth hormone deficient, it is important to determine all potential benefits beyond the obvious physical effects in order to make efficient cost-benefit determinations on appropriate usage of growth hormone therapy. One aspect of possible benefits for these children with short stature may be psychological features, such as increased overall happiness and self-esteem that is gained with increased height. A review and analysis of literature was undertaken in order to determine what effect, if any, growth hormone therapy has on short children's psychosocial well-being.
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Transtornos do Crescimento/tratamento farmacológico , Transtornos do Crescimento/psicologia , Hormônio do Crescimento/uso terapêutico , Adolescente , Adulto , Estatura/efeitos dos fármacos , Criança , HumanosRESUMO
Unrecognized congenital hypothyroidism leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. The primary thyroid-stimulating hormone screening has become standard in many parts of the world. However, newborn thyroid screening is not yet universal in some countries. Initial dosage of 10 to 15 microg/kg levothyroxine is recommended. The goals of thyroid hormone therapy should be to maintain frequent evaluations of total thyroxine or free thyroxine in the upper half of the reference range during the first 3 years of life and to normalize the serum thyroid-stimulating hormone concentration to ensure optimal thyroid hormone dosage and compliance. Improvements in screening and therapy have led to improved developmental outcomes in adults with congenital hypothyroidism who are now in their 20s and 30s. Thyroid hormone regimens used today are more aggressive in targeting early correction of thyroid-stimulating hormone than were those used 20 or even 10 years ago. Thus, newborn infants with congenital hypothyroidism today may have an even better intellectual and neurologic prognosis. Efforts are ongoing to establish the optimal therapy that leads to maximum potential for normal development for infants with congenital hypothyroidism. Remaining controversy centers on infants whose abnormality in neonatal thyroid function is transient or mild and on optimal care of very low birth weight or preterm infants. Of note, thyroid-stimulating hormone is not elevated in central hypothyroidism. An algorithm is proposed for diagnosis and management. Physicians must not relinquish their clinical judgment and experience in the face of normal newborn thyroid test results. Hypothyroidism can be acquired after the newborn screening. When clinical symptoms and signs suggest hypothyroidism, regardless of newborn screening results, serum free thyroxine and thyroid-stimulating hormone determinations should be performed.