Medical students' attitudes towards participating in a palliative medicine course: A new specialty in Israel.

BACKGROUND: Palliative medicine is a growing field in Israel, and its training program is still in process. The current study aimed to evaluate students' attitudes regarding a course in palliative care established in a division of oncology. METHOD: Some 45 medical students in their 5th to 6th years participated in a one-week course on palliative care. At the end of each training week, students were asked to complete a questionnaire, evaluating their attitudes regarding different aspects of the program content, such as its importance and relevance to their training as physicians, as well as the contribution of specific parts of the program to their knowledge regarding palliative care. RESULTS: The overall satisfaction of the 45 students was high. The most contributory parts of the course were the multidisciplinary team and the complementary and alternative medicine. Participating in the staff meetings and accompanying physicians in their daily work were scored as the least contributory parts.Significance of resultsThis preliminary study demonstrated students' overall high satisfaction with the newly established palliative care course and their need for more practical skills. Future studies should investigate and evaluate educational programs in palliative care in order to establish suitable training for medical students.

El experto y la ley de Agrest / The expert and the Agrest law

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[Geriatrics or geriatricization of medicine : Quo vadis geriatrics?] / Geriatrie oder Geriatrisierung der Medizin : Quo vadis Geriatrie?

This article examines the question whether and how geriatrics will change in the future and whether in view of the demographic changes the trend will go more in the direction of a further expansion of geriatrics or more towards a geriatricization of individual specialist medical fields. The different development of geriatrics in the individual Federal States can only be understood historically and is absolutely problematic against the background of the new hospital remuneration system. Geriatrics is a typical cross-sectional faculty and still has demarcation problems with other faculties but has also not yet clearly defined the core competence. This certainly includes the increasing acquisition of decentralized joint treatment concepts and geriatric counselling services in the future, in addition to the classical assessment instruments. Keywords in association with this are: traumatology and othopedics of the elderly, geriatric neurology and geriatric oncology. Interdisciplinary geriatric expertise is increasingly being requested. Outpatient structures have so far not been prioritized in geriatrics. An independent research is under construction and it is gratifying that academic interest in geriatrics seems to be increasing and new professorial chairs have been established. It is not possible to imagine our hospital without geriatrics; however, there is still a certain imbalance between the clearly increased number of geriatric hospital beds, the representation of geriatrics in large hospitals (e.g. specialized and maximum care hospitals and university clinics), the secure establishment in further education regulations and the lack of a uniform nationwide concept of geriatrics.

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality.

BACKGROUND & AIMS: Little is known about provider and health system factors that affect receipt of active therapy and outcomes of patients with hepatocellular carcinoma (HCC). We investigated patient, provider, and health system factors associated with receipt of active HCC therapy and overall survival. METHODS: We performed a national, retrospective cohort study of all patients diagnosed with HCC from January 1, 2008 through December 31, 2010 (n = 3988) and followed through December 31 2014 who received care through the Veterans Administration (128 centers). Outcomes were receipt of active HCC therapy (liver transplantation, resection, local ablation, transarterial therapy, or sorafenib) and overall survival. RESULTS: In adjusted analyses, receiving care at an academically affiliated Veterans Administration hospital (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.60-2.41) or a multi-specialist evaluation (OR, 1.60; 95% CI, 1.15-2.21), but not review by a multidisciplinary tumor board (OR, 1.19; 95% CI, 0.98-1.46), was associated with a higher likelihood of receiving active HCC therapy. In time-varying Cox proportional hazards models, liver transplantation (hazard ratio [HR], 0.22; 95% CI, 0.16-0.31), liver resection (HR, 0.38; 95% CI, 0.28-0.52), ablative therapy (HR, 0.63; 95% CI, 0.52-0.76), and transarterial therapy (HR, 0.83; 95% CI, 0.74-0.92) were associated with reduced mortality. Subspecialist care by hepatologists (HR, 0.70; 95% CI, 0.63-0.78), medical oncologists (HR, 0.82; 95% CI, 0.74-0.91), or surgeons (HR, 0.79; 95% CI, 0.71-0.89) within 30 days of HCC diagnosis, and review by a multidisciplinary tumor board (HR, 0.83; 95% CI, 0.77-0.90), were associated with reduced mortality. CONCLUSIONS: In a retrospective cohort study of almost 4000 patients with HCC cared for at VA centers, geographic, provider, and system differences in receipt of active HCC therapy are associated with patient survival. Multidisciplinary methods of care delivery for HCC should be prospectively evaluated and standardized to improve access to HCC therapy and optimize outcomes.

Atención especializada en el manejo de la enfermedad inflamatoria intestinal / Specialist care in the management of inflammatory bowel disease

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Medicina de Familia como asignatura obligatoria en el grado de Medicina de la Universitat de Lleida: análisis de la percepción de los estudiantes / Family Medicine as a compulsory course in the Medicine degree at the University of Lleida: analysis of students' perceptions

Objetivo. Evaluar la percepción y la satisfacción respecto a la adquisición de competencias sobre la especialidad de Medicina de Familia y Comunitaria (MFyC) por parte de los estudiantes de pregrado matriculados en el primer año de instauración de la asignatura obligatoria de nuestra especialidad en la Facultad de Medicina de la Universitat de Lleida. Materiales y métodos. Estudio descriptivo transversal mediante encuesta anónima sobre la satisfacción respecto a la adquisición de competencias de la especialidad de MFyC y el cumplimiento de algunas de las competencias que forman parte de la asignatura. Se incluyó a los 107 alumnos matriculados que cumplimentaron la encuesta de satisfacción. Resultados. Los alumnos consideraron que la asignatura transmitía bien los conocimientos de MFyC, con una media de 7,96 ± 1,38 puntos, y que conseguía transmitir una visión integral del individuo respecto a la enfermedad, con 7,51 ± 1,75 puntos. La práctica asistencial obtuvo 9,0 ± 1,3 puntos y la valoración global de la asignatura, 7,03 ± 1,51. Las ocho competencias específicas obtuvieron 7,94 puntos de cumplimiento y las cuatro competencias transversales, una media de 7,95 puntos. Conclusiones. La enseñanza en el pregrado de MFyC ha cumplido las expectativas de los alumnos y ha logrado transmitir los conocimientos de las competencias asignadas (AU)

Aim. To evaluate undergraduate students' opinions of the compulsory course in Family and Community Medicine (FCM) in the bachelor's degree at the Faculty of Medicine, Lleida, and their satisfaction with the skills and knowledge acquired. Materials and methods. A descriptive, cross-sectional, anonymous survey of undergraduates' satisfaction with the skills and knowledge acquired in the FCM speciality. Results. The survey was completed by 107 students. Mean scores awarded were 7.96 ± 1.38 for the subject matter, 7.51 ± 1.75 for the holistic view provided of the individual with respect to disease, and 9.0 ± 1.3 for the practicals in patient care. The mean score for the overall assessment of the course was 7.03 ± 1.51. The eight specific skills were awarded a mean score of 7.94 and the four cross-sectional skills a mean score of 7.95. Conclusions. The course in FCM in the bachelor's degree in Medicine has met the expectations of students and provides a satisfactory overview of the skills required (AU)

Current trends in hand surgery.

Hand surgery became an established subspecialty between World Wars I and II. Prior to this time, hand injuries were cared for by various specialists-neurosurgeons, plastic surgeons, orthopedic surgeons, and general surgeons-each of whom would focus on their particular tissue within the hand. With the nearly 90,000 hand injuries sustained during World War II, military hospitals were created to deal solely with hand injuries, and hand specialists began to treat the hand as a single functional organ. This article briefly reviews the origin of the field and discusses current trends in hand surgery.

[20 years of professional specialist for psychosomatic medicine and psychotherapy in Germany]. / Zwanzig Jahre Facharzt fur Psychosomatische Medizin und Psychotherpie in Deutschland.

OBJECTIVE: This contribution provides an overview of the development of the professional specialty area of psychosomatic medicine and psychotherapy since its establishment by the German Parliament in 1992. RESULTS: First, the reasons behind the decision to create this professional specialty are elucidated. Then, the three revisions of the official training regimen, the subsequent development of the number of specialists in both outpatient and inpatient sectors, and the development of hospital wards for psychosomatic disorders and rehabilitation clinics for this purpose are discussed. The creation of this specialty may be judged to have been a successful venture that has led to a better treatment of the concerned patients. The recent development of specific psychosomatic research points to the increasing emphasis on special studies of bio-psycho-social interactions, which in turn have shaped and will continue to shape the contours of this specialty. DISCUSSION: The necessary further developments in continuing education as well as increasing cooperation with other disciplines and other pending decisions concerning treatment alternatives are discussed.

[The future of uro-oncology: what needs to be done to secure its place in the field of urology?]. / Die Zukunft der Uroonkologie : Was muss geschehen, um den Bereich für die Urologie zu sichern?

The specialty of urology has changed considerably with regard to the subspecialty of uro-oncology and requires more than just knowledge of hormone therapy for metastatic prostate cancer and standard treatment of testicular tumors. Many oncology centers offer specialized and interdisciplinary treatment, but often the process of navigating through the jungle of diagnostic workup and treatment is inadequate. Thus, clinical centers for uro-oncology must include specialists in pharmacological therapy for cancer and drug development who will work closely with the department of urology.

Specialisation within vascular surgery.

Despite its short existence, vascular surgery has already grown out of the scope of a mono-specialty. Meanwhile emerging interests of other competing specialties push into the field of vascular care. Continuous technological innovation drives the need for sub-specialisation to provide disease-centred expertise; however, treatment success equally depends on balanced patient-centred care. Vascular surgeons are amidst this controversy and are currently challenged by their own demand to offer all aspects of vascular care - as "the vascular specialist". This article discusses the natural driving forces towards sub-specialisation and appraises advantages and limitations with respect to the future of integrated vascular care.