Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review.

INTRODUCTION: Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. METHODS: We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. RESULTS: We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. CONCLUSIONS: Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.

[The first 25 years of oncopsychology at the National Institute of Oncology: antecedents and events (1988-2013)]. / Az onkopszichológia elso 25 éve az Országos Onkológiai Intézetben: elozmények és események (1988-2013).

The first oncopsychological department was established in National Institute of Oncology by Sándor Eckhardt in 1988. At an early stage the specialists who were interested in mental hygiene made a united effort with Katalin Muszbek's oncopsychologic group. Ágnes Riskó was the first specialist who seceded from this group, and she became a permanent member of the onco-hematology group in 1992. Due to the universalized approach, the psyhcologist would become a permanent member of onco-team. The overhand and increasing multidisciplinary cooperation enable to use this accepted method in the daily medical treatment. When necessary, patients' relatives may come in for treatment and this method can help for medical stuff to avoid burnout. As a result of oncopsychology techniques and cooperation of oncologic teamwork the integration of psychosocial intervention into a complex oncologic treatment has already begun. The attendance of supervised onco-psychological specialists is being increased. Our activity contributes to improve our patients' psychosocial standard of living, their cooperation with the medical staff and the atmosphere of oncologic departments. The integration of the approach and methods of psychosocial rehabilitation into the new oncologic professional guideline has also begun.

Erving Goffman's asylums and institutional culture in the mid-twentieth-century United States.

Sociologist Erving Goffman based his seminal work Asylums (1961) on a year of field research at St. Elizabeths Hospital in Washington, DC. Goffman described the mental hospital as a "total institution," in which regimentation dominated every aspect of daily life and patients were denied even the most basic means of self-expression; rather than promote recovery, such conditions produced the sorts of disordered behavior for which men and women were ostensibly admitted. A closer look at the changes transforming St. Elizabeths around the time of Goffman's research reveals a far richer portrait of institutional culture. Group therapy, psychodrama, art and dance therapy, patient newspapers, and patient self-government-each of which debuted at the hospital in the 1940s and 1950s-provided novel opportunities for men and women to make themselves heard and to take their fate into their own hands. While these initiatives did not reach all of the patients at St. Elizabeths, surviving documentation suggests that those who participated found their involvement rewarding and empowering. Goffman explicitly set out to describe "the social world of the hospital inmate." His failure to appreciate fully the capacities of his subjects, however, appears to have led him to underestimate the importance of these developments.

Circuloterapia: uma metáfora para o enfrentamento da dor crônica em duas clínicas de dor / Circle therapy: a metaphor for coping with chronic pains in two pain clinics

Este artigo descreve e analisa a dinâmica da clínica de dor enquanto um "artefato complexo" do sistema terapêutico biomédico, explorando as múltiplas vozes e as relações dialógicas sobre dor e a interdisciplinaridade no cotidiano clínico de duas clínicas de dor situadas em hospitais-escola nas cidades de Salvador e São Paulo. Foi realizado estudo etnográfico orientado pela antropologia interpretativa, na qual se buscou a descrição de situações singulares e expressivas da dinâmica da clínica de dor (considerada enquanto um serviço, constituído no interior da Biomedicina, destinado ao cuidado da dor crônica). Tais situações expressam tensões e soluções construídas a partir do enfrentamento da dor crônica enquanto objeto complexo que impõe, a todos, flexibilidade. Essa experiência etnográfica focalizou quatro espaços terapêuticos: a sala de espera, o corredor, a consulta médica e as discussões de caso clínico. A descrição produzida ilumina as múltiplas vozes sobre dor e interdisciplinaridade no cotidiano da clínica. Os sentidos da circulação nos espaços terapêuticos, representado no texto a partir da metáfora "circuloterapia", orientam essa discussão em torno dos limites e possibilidades da constituição e funcionamento deste serviço.

This paper describes and analyzes the pain clinic's dynamics as a "complex product" of the biomedical therapy system, exploring the many discussions about the meaning of pain and the interdisciplinary collaboration in the therapeutic daily routines of two pain clinics, located in university hospitals in the cities Salvador and São Paulo. An ethnographic approach guided by interpretative anthropology was used to search for the description of singular and expressive situations of the pain clinic's dynamics (considered as a service, established within Biomedicine, intended for care of chronic pain). Such situations express tensions and solutions created from the confrontation of the chronic pain as a complex object that imposes flexibility to all. This ethnography focuses on four therapeutic spaces: the waiting-room, the hall, the medical consultation and the clinical case discussion. The resulting description enlightens the multiple voices on pain and interdisciplinary collaboration in the clinic's daily routines. The directions of circulation within therapeutic spaces guided this reflection around the limits and possibilities of the establishment and operation of this service.

The midwives ordinance of Palestine, 1929: historical perspectives and current lessons.

Until 1929, midwifery in Palestine was relatively open to anyone and only partially regulated by the 1918 Public Health Ordinance, legislated shortly after the beginning of British rule. This article describes the factors that guided the shaping of midwifery and suggests possible sources of inspiration for the British legislator in crafting the Midwives Ordinance in 1929, including American, local (Jews and Arabs), and British ones. The Midwives Ordinance reflects the adjustment of midwifery to changes in the society that evolved under the British Mandate. The ordinance shows how the modern midwife's role contracted relative to the traditional one, in the context of social processes in other countries, east and west. This historical research project is based on interviews, archive documents and research literature. It analyzes the British interests in regulating midwifery, including the rationale of preserving public health and reducing infant mortality, against a background of political power struggles as well as cultural, social and professional diversity in Palestine (the tensions between the powers of doctors, nurses, and pharmacists).

Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes.

ST-segment elevation myocardial infarction (STEMI) is one of the greatest medical emergencies, for which organization of care has a determinant impact on patient outcomes. The purpose of this paper is to review systems of care for STEMI patients. Although primary percutaneous coronary intervention (PCI) is the preferred option for patients with STEMI, offering easy and emergent access to this procedure often remains difficult because of geographic and diverse structural difficulties. intravenous fibrinolysis, especially when administered early after symptom onset and as part of a pharmacoinvasive strategy (i.e., followed by rapid coronary angiography with PCI when necessary), offers a reasonable therapeutic option in selected cases and has yielded satisfactory clinical results. Network organization is central for optimizing patient care at the acute stage of myocardial infarction. This review describes different clinical experiences with network implementation both in Europe and in North America. In all instances, early recognition of STEMI and, particularly in the pre-hospital setting, shortening time delays is central for the achievement of optimal clinical results. Overall, the encouraging results described in the models presented here, as diverse as they might be, should be an encouragement to promote and implement regional protocols according to the specific local constraints and to monitor their effectiveness by recording simple quality indicators in ongoing registries.

Estratégias terapêuticas no tratamento da dor crônica: uma genealogia da clínica da dor / Therapeutic strategies in the treatment of chronic pain: a genealogy of the pain clinic

O objetivo desse trabalho é analisar a singularidade das estratégias terapêuticas introduzidas pelo modelo das Clínicas da Dor, através de um estudo genealógico desse projetoterapêutico e sua contextualização no âmbito da racionalidade científica moderna. Mais especificamente, pretende-se analisar as transformações na racionalidade médica que permitiram, sucessivamente, a apreensão da dor pelo discurso médico, a concepção da dorcomo uma doença e a construção e a consolidação do modelo terapêutico das Clínicas da Dor. Para tal, inicialmente, analisamos o modelo terapêutico desenvolvido pelo médico anestesista John Bonica, idealizador do modelo das Clínicas da Dor, destacando as ferramentas conceituais que possibilitaram a compreensão da dor crônica como doença e como fenômenobiopsicossocial. Num segundo momento, realizamos uma descrição e análise dos principais eventos que permitiram a consolidação da medicina da dor como uma prática específica e multidisciplinar, dando destaque à inserção deste modelo no contexto do Sistema Único de Saúde Brasileiro. Finalmente, a partir de uma experiência clínico-institucional buscamos refletir sobre os limites e possibilidades da aplicação prática deste modelo, lançando luz sobre os impasses da clínica e tensões oriundas da problematização do dualismo mente e corpo e das práticas terapêuticas interdisciplinares.

La interdisciplinariedad como camino para la superación de la especialización / Interdisciplinary work as a way for overcoming specialization

En este trabajo nos acercamos al área de nuestro interés, el de la salud, para tratar de instalar la reflexión en torno a la problemática de la interdisciplinariedad. Pretendemos lograr que, sobre esta base, se dé un proceso de concientización para el abordaje de cuestiones complejas en este campo. Entendiendo que la súper especialización constituye una traba, tanto para la adquisición de nuevos conocimientos como para una mejor atención a los pacientes, apuntamos a encontrar los medios para su superación, vislumbrando que la misma podría ser posible mediante el trabajo interdisciplinario. Entendemos que es preciso desarrollar capacidades nuevas para realizar este trabajo. Proponemos algunas de estas capacidades como respuesta a la pregunta de ¿cuál es el camino? (AU)

La interdisciplinariedad como camino para la superación de la especialización / Interdisciplinary work as a way for overcoming specialization

En este trabajo nos acercamos al área de nuestro interés, el de la salud, para tratar de instalar la reflexión en torno a la problemática de la interdisciplinariedad. Pretendemos lograr que, sobre esta base, se dé un proceso de concientización para el abordaje de cuestiones complejas en este campo. Entendiendo que la súper especialización constituye una traba, tanto para la adquisición de nuevos conocimientos como para una mejor atención a los pacientes, apuntamos a encontrar los medios para su superación, vislumbrando que la misma podría ser posible mediante el trabajo interdisciplinario. Entendemos que es preciso desarrollar capacidades nuevas para realizar este trabajo. Proponemos algunas de estas capacidades como respuesta a la pregunta de ¿cuál es el camino?

[Development of psychosomatic medicine and psychotherapeutic medicine in Germany]. / Zur Entwicklung der Psychosomatik und Psychotherapeutischen Medizin in Deutschland.

The following article comes from a historical description of the concept of psychosomatics and the psychotherapeutic system of supply. With reference to the memorandum of the situation of the psychosomatic medicine at German universities the developments of the psychotherapeutic system of supply, the guidelines, the psychotherapeutic procedures, settings and concepts of treatment are lined out. The criterions of the description of those specialists are explained as like as outpatient and inpatient treatment models. In the meantime there are many investigations available also to the need of treatment and the demands of this special field. Period of treatment, number of personal included and quality management are also part of the short survey.

Early years of the out-patient services, Singapore (1880-1946).

This article traces the history of the Out-patient Services from its humble beginnings in the late 19th Century to just after World War II. The class of patients catered for, the disease pattern, the work done and benefits accrued are recorded.