Jonas Friedenwald, Eugene Wolff, and the Two Books That Helped Bridge the Specialty Gap.

Background: Eugene Wolff (1896-1954) and Jonas S. Friedenwald (1897-1955) were life-long students and educators of anatomic pathology and ophthalmology. Both contributed toward narrowing the gap between the two rapidly diverging specialties of pathology and ophthalmology. Friedenwald in 1929 and Wolff in 1934 each published textbooks of ophthalmic pathology that influenced medical education for decades to come. Summary: Friedenwald's The Pathology of the Eye and Wolff's A Pathology of the Eye introduced ophthalmologists in training and practice to anatomic pathology, while familiarizing pathologists with the nature of ocular disease. Both books appeared at the time when anatomic pathology was departing from its mostly academic roles in education and research to assume more active participation in clinical care by establishing diagnoses through biopsy. Key Messages: Wolff and Friedenwald dedicated their careers to teaching the art and science of anatomic pathology to clinical ophthalmologists. Their efforts helped anchor ophthalmology to the traditions of mainstream medicine.

Factors affecting the choice of medical specialties in Turkiye: an analysis based on cross-sectional survey of medical graduates.

BACKGROUND: Modern healthcare systems require the right mix of medical specialties for effective provision of high-quality services. Despite increased availability of general physicians and specialists, Türkiye lags behind high-income countries in terms of availability of specialists. The purpose of the study is to identify several specific factors that affect the choice of medical specialization. METHODS: All 350 medical school graduates in a specialty examination preparation bootcamp were requested to participate in the survey and 333 completed the self-administered questionnaire. The survey asked questions about factors affecting choice of medical specialty by medical graduates. RESULTS: The empirical results indicate that surgical specialties, compared to other broad medical specializations, are selected because of its higher income-earning potential and social prestige. The likelihood of selecting surgical specialties is negatively affected by rigorousness of the training program, high work-load, risk of malpractice lawsuits and risk of workplace violence. Male participants were 2.8 times more likely to select surgery specialty compared to basic medical science. Basic medical science areas were selected at a higher rate by female graduates and graduates with high level of academic performance in medical schools. CONCLUSIONS: It is critically important to improve trust and inter-personal communications between the patients and physicians in all specialties to lower the likelihood of malpractice lawsuits and workplace violence. Policy-makers may adopt policies to affect income earning potential and social prestige of targeted specializations to improve their supply.

Personality Traits and Potential Career Choices Among Medical Students at Sultan Qaboos University: A Cross-Sectional Study.

Background Personality plays a vital role in choosing a medical specialty. Despite this, research is scarce on this subject, especially in Oman. This study aimed to investigate the correlation between the personality traits of medical students at Sultan Qaboos University (SQU), Muscat, Oman, and the specialty they wished to undertake after graduation. Methods This was a cross-sectional study. Two hundred and thirty-four medical students completed the Big Five personality questionnaire and were asked what specialty they would like to choose. The specialties were divided into three namely, surgical-oriented, medicine-oriented, and basic medicine. An ANOVA test was used to find any statistically significant correlation between personality traits and the desired specialty. Results The students who chose surgery-oriented specialties had significantly higher scores in the extraversion and openness means (P<0.05) than the students who opted for medicine-oriented specialties and basic medicine. The students who chose basic medicine had significantly higher scores in the neuroticism means (P<0.05) than the other groups. Conclusion The students who chose surgery-oriented specialties were more likely to be highly extraverted and open, while the medical students who chose basic medicine were more likely to have higher neuroticism levels when compared with the other groups. This study indicates that there is a correlation between personality traits and desired specialty. Further studies should be done to investigate if these personality traits remained similar after graduation.

Perceptions and Attitudes Toward Community Medicine Among Medical Students: A Systematic Review.

Community medicine is yet to become a popular discipline as a choice for postgraduation and career among medical students in India. Our objective is to find the proportion of students opting for community medicine as a choice for a career. We also aim to find out the perceptions and attitudes of medical students about the subject of community medicine. Our inclusion criteria encompassed studies of any design, written or translated into the English language, and published from their inception up to the last date of our search, which was 15th August 2023. Our comprehensive search covered prominent databases, including PubMed, Scopus, and Embase, as well as an extensive screening of the first 10 pages of Google Scholar and Google. The risk of bias in the studies was evaluated by using the quality assessment tools recommended by the Joanna Briggs Institute critical appraisal tool for prevalence studies. In the initial search, 2069 articles were identified, with 1109 duplicates removed. The remaining 960 articles underwent title and abstract screening, leading to the exclusion of 931 articles. After applying eligibility criteria and reviewing the full text of 29 articles, seven studies were excluded. Ultimately, 22 studies were deemed eligible for inclusion in the systematic review. Among the total of 5106 students, 1032 students expressed a willingness to choose community medicine as their career. The pooled estimate, derived through a random effects model, was 0.21, with a 95% CI of 0.14 to 0.27. Studies conducted in India revealed a willingness of 0.23 (95% CI: 0.13- 0.33), whereas studies conducted outside India reported a lower proportion of 0.17 (0.14-0.24). When considering the year of study, a combined willingness of 0.02 (95% CI: 0.00-0.03) was observed among first and second-year students, contrasting with a higher proportion of 0.18 (95% CI: 0.04-0.32) among third-year students. Fourth-year students and interns demonstrated a willingness of 0.03 (95% CI: 0.00-0.06). The factors for disliking the subject included the perceived absence of clinical engagements, concerns about financial rewards, limited prospects for recognition and fame, etc. By actively engaging in the solution of these challenges, medical educators and policymakers can contribute to the vitalization of community medicine as a coveted and attractive specialty.

Knowledge, attitude, and practice regarding COVID-19 skin manifestations among doctors working at Khartoum dermatology and venereology teaching Hospital, 2021

Background: COVID-19 is a global pandemic caused by SARS_COV2. The symptoms of covid-19 include: fever, dyspnea, fatigue, a recent loss of smell and taste, sore throat, cough, and cutaneous lesions. In addition, some skin manifestations were reported to be associated with COVID-19. Methods: The study design is a descriptive cross-sectional hospital-based study. The study aimed to evaluate the level of knowledge and practice about skin manifestations of COVID-19 among doctors working at Khartoum dermatology and venereology teaching hospital. A self-administrated questionnaire was used for data collection after an informed consent was taken. Results: Among 140 doctors working in the dermatology and venereology teaching hospital, 75.7% of the doctors had knowledge that COVID-19 can present with skin manifestations. The study results showed that about half of the participants have poor knowledge about COVID-19 skin manifestations while 25% have no knowledge, and that 35 (25%) doctors have good knowledge. From a total of 140 doctors; 46.4% reported that when patients present with COVID-19 skin lesions, they will isolate them in separate rooms and call the epidemiology center, whereas, 61 doctors (43.6%) did not know if they have a protocol for COVID-19 suspected cases. This study reported a significant association between job category and level of knowledge toward COVID-19 skin manifestations measured by Chi-square test, the P-value was 0.003 (significant at 0.05), and the same significant association was found between the year of rotation and knowledge. Conclusion: Half of the doctors covered by this study had poor knowledge about COVID-19 skin manifestations, and therefore, educating doctors in dermatology hospitals about skin manifestations of COVID-19 is recommended, besides clear and precise guidelines and protocols for diagnosis and management.

Factors Influencing the Choice of Radiology Subspecialty Among Radiology Trainees in Sudan.

Background and objective There are numerous reasons why radiologists would be interested in seeking additional fellowship training, some of which are personal, such as the possibility of bettering their career prospects, while others are work-related. This study aimed to identify whether the Sudanese radiology trainees wanted to pursue fellowship and what were the motivating and restricting factors affecting their career choices. Methods This was a re-do research of a study from Saudi Arabia previously published in the Cureus journal in 2019. This was a descriptive cross-sectional study conducted among the radiology registrars training under Sudan Medical Specialization Board (SMSB) in 2022 (n=90). By using convenient sampling, 74 of the 90 registrars were contacted, and a response rate of 81% (n=60) was achieved. Data were collected using a pre-tested self-administered online questionnaire. Data were analyzed using IBM SPSS® Statistics version 25.0 (IBM Corp., Armonk, NY). A p-value ≤0.05 was considered statistically significant. Results The majority of the trainees in our study were females (61.7%, 37/60). More than 93% (n=56) of our participants were training in Khartoum, the capital of Sudan. The most commonly chosen subspecialties in our study were as follows: neuroradiology (33.3%, n=20) body imaging (26.7%, n=16), and interventional radiology (25%, n=15). In contrast, nuclear medicine (1.7%, n=1) and emergency radiology (3.3%, n=2) were among the least popular subspecialties. The top influencing factors among our trainees in choosing a subspecialty included "strong personal interest," "lifestyle," and "area of strong personal knowledge." The most common factors preventing trainees from opting for a fellowship were "financial restriction" (55%, n=33) and "family obligation" (28.3%, n=17). Of those with no plans to subspecialize, 75% (six out of eight) stated that the lack of a fellowship program in Sudan is a possible deterrent. A statistically significant association was found between gender and the choice of subspecialty in interventional radiology and women's/mammogram imaging. Our findings revealed that there are currently no trainees in the first year of radiology residency because the last selection exam had been conducted in 2019. Despite the current unavailability of subspecialty training in Sudan, 75% (n=45) of trainees in our study were interested in joining a local program for fellowship training in the future. Conclusion Radiology trainees in Sudan share similar interests and influencing and restricting factors when pursuing subspecialty training, as reported in the literature. Unlike other countries, females predominate in the field of radiology training in Sudan at the moment. Radiologists from Sudan who are interested in subspecializing usually travel abroad for training; and once they find better prospects, many of them may not return. Programs offering subspecialization locally could mitigate the attrition of radiologists in Sudan. When designing subspecialty training programs in Sudan, stakeholders should use knowledge of influential factors and understanding of subspecialty decision trends among radiology trainees as a reference point. To the best of our knowledge, this study is the first of its kind to be conducted in this field in Sudan.

Toward a comparative history of medical genetics as a medical specialty in North America.

Much of what has been written about the history of medical genetics in North America has focused on physician involvement in eugenics and the transition from heredity counseling to genetic counseling in the United States. What are typically missing in these accounts are details concerning the formation of a new medical specialty, i.e., medical genetics, and Canada's involvement in specialty formation. Accordingly, this paper begins to fill in gaps by investigating, on the one hand, the history of American and Canadian geneticists working together to support the creation of examining and teaching positions in human genetics in North American medical schools and, on the other, working independently of one another to monitor the rate and direction of workloads and patient access to local genetic counseling and laboratory services and, subsequently, achieve recognition for medical genetics as a medical specialty at the national level.

[History of neurology in the GDR: a systematic review]. / Neurologie in der DDR: eine systematische Literaturübersicht zur historischen Aufarbeitung.

BACKGROUND: Neurology as a discipline developed differently in the two German states after 1945 and little is known about neurology in the GDR. OBJECTIVE: This article examines the present state of historical research on neurology in the GDR. MATERIALS AND METHODS: We systematically screened the existing literature from the period 1991-2021 and assigned the studies to different categories. RESULTS: We found significant regional differences in the way specific topics are addressed. We also identified a lack of a general overview on the subject and a lack of studies dealing with neurology within the specific socio-political context of the GDR. Comparative studies between the GDR and the BRD and between the GDR and other countries are also scarce. CONCLUSION: Further systematic research (in the form of a separate research project) into the history of neurology in the GDR and its role within the socialist healthcare system of the GDR is needed, taking comparative aspects into account.

Demographics and distribution of australia's medical immigrant workforce.

Background: International medical graduates (IMGs) have made important contributions to Australian healthcare since colonization. Recent published data have documented source countries and characteristics of IMGs undertaking the examinations of the Australian Medical Council. However, information about those currently practicing in Australia is limited. Objective: To analyze a cross section of IMGs currently practicing in Australia to determine patterns of change in donor countries, other demographic characteristics, geographical locations, and their areas of specialization. Methods: A random sample of all practitioners on a national database was interrogated for their country of first medical qualification. Those who qualified outside Australia were then analyzed for demographic variables such as age, gender, country of origin, and years of graduation and immigration. Their practice locations were matched to the Australian Bureau of Statistics geographical framework, and their specialties compared with those of a random sample of graduates from Australian medical schools. Results: Over the approximately 60 years since those surveyed arrived in Australia, IMGs' countries/regions of origin have changed from mainly the UK and Ireland to Southern Asia, in line with demographic changes in Australia as a whole. Most arrived soon after graduation, and IMGs are twice IMGs as likely as local graduates to be working in a rural area of workforce shortage. Compared with local graduates, significantly more IMGs are working in general practice. Conclusions: IMGs currently practicing in Australia make up a substantial proportion of the workforce and are more likely than local graduates to provide health services in regional and remote areas.

Personality Traits, Strategies of Coping with Stress and Psychophysical Wellbeing of Surgical and Non-Surgical Doctors in Poland.

The aim of the study was to determine the personality traits, strategies of coping with stress and psychophysical wellbeing of surgical and non-surgical Polish doctors. The study used the following questionnaires and scales: the Resiliency Assessment Scale, the Type D Personality Scale, the Framingham Type A Scale, the Mini COPE-Coping Inventory and the Wellbeing Scale. Doctors performing surgical specialties were characterized by a significantly higher level of resilience components, a more frequent occurrence of the type B behaviour pattern and less frequent type D personality than doctors performing non-surgical specializations. The Mini COPE point values were comparable between surgical and non-surgical physicians. The sense of psychological wellbeing was higher in surgical specialists. The higher the values of the Optimistic approach to life and the ability to mobilize oneself in difficult situations, the lower the values of the Turning to religion domain and the higher the values of the Denial domain correlated with the performance of surgical specialization. Men performing surgical specializations were more often optimistic and inclined to consume alcohol, while women with non-surgical specialization more often coped with stress by turning to religion. We conclude that the personality traits of Polish doctors vary depending on their specialization. Physicians' coping strategies do not differ depending on their specialization. The sense of mental wellbeing is higher in surgical specialists compared to non-surgical specialists. An optimistic approach to life and the ability to mobilize oneself in difficult situations, as well as coping with stress by denial are associated with the surgical specialization. Men performing surgical specialties more often declare optimism and a tendency to cope with stress by consuming alcohol or psychoactive substances, while women who perform non-surgical specializations more often cope with stress by turning to religion. Psychological screening tests and appropriate training, taking into account medical specialization, could be one way of improving resilience and coping with stress among doctors.

Trends in Medical Specialization and Employability in Mexico According to Gender.

BACKGROUND: Feminization of medicine is a worldwide phenomenon. Countries must consider feminization of medical specializations in the planning of health public politics. OBJECTIVE: To analyze trends in medical specialization and employability in México according to gender. METHOD: We analyzed the electronic repositories of students and hired physicians at IMSS from 2006-2020. RESULTS: 42,647 specialists graduated in the period. The percentage of women increased 3% in medical specializations and 9% in surgical ones. Women significatively predominate in first entry and controllable lifestyle specialization. The percentage of hired women physicians increased 14 and 17% in leadership positions. CONCLUSIONS: There is a steady increase in feminization of medical specialization. To date, 52% of residents, 48% of hired physicians and 42% of leaders are women.

Evolución y desafíos en la formación médica de posgrado en Brasil / Evolution and challenges in postgraduate medical training in Brazil

La especialización médica es un gran desafío porque necesita preparar un profesional recién egresado en el especialista que la po-blación quiere y necesita para asegurar mejores condiciones de atención a la salud. La construcción de un sistema para la capacitación de estos profesionales es un gran desafío dada la característica de la formación en servicio, es decir, los profesionales en formación trabajan directamente en la asistencia, dependiendo de instalaciones adecuadas, aparatos, tutores médicos y un programa teórico que garantice el desarrollo del aprendizaje según los parámetros técnicos más actuales. Un desafío adicional es la cantidad y diversidad de instituciones involucradas, desde hospitales universitarios con tradición docente hasta hospitales privados donde el desempeño se limita a la prestación de servicios. En este artículo, buscamos mostrar la trayectoria de la construcción de este sistema en Brasil, que desde hace cerca de 40 años se ha mejorado y ampliado ante la creciente demanda de atención de calidad por parte de la población.

Medical specialization is a challenge because it needs to prepare a newly graduated professional as the specialist that the population wants to ensure better conditions in health care. The construction of a system for training these professionals is a challenging given the characteristic of in-service training where professionals work directly with patients, depending on adequate facilities, equipment, medical tutors, and theoretical programs that guarantee the development of learning within the most current technical parameters. An additional challenge is the number and diversity of institutions involved, including university hospitals that have a tradition of teaching and private hospitals where the performance is based on practice. We seek to show in this article the trajectory of the construction of this system in Brazil, which for about 40 years has been improving and expanding to fulfill the population ́s growing demand for quality care.

Development of a specialty intensity score to estimate a patient's need for care coordination across physician specialties.

BACKGROUNDS AND AIMS: This article develops a Specialty Intensity Score, which uses patient diagnosis codes to estimate the number of specialist physicians a patient will need to access. Conceptually, the score can serve as a proxy for a patient's need for care coordination across doctors. Such a measure may be valuable to researchers studying care coordination practices for complex patients. In contrast with previous comorbidity scores, which focus primarily on mortality and utilization, this comorbidity score approximates the complexity of a patient's the interaction with the health care system. METHODS: We use 2015 inpatient claims data from the Centers for Medicare and Medicaid Services to model the relationship between a patient's diagnoses and physician specialty usage. We estimate usage of specialist doctors by using a least absolute shrinkage and selection operator Poisson model. The Specialty Intensity Score is then constructed using this predicted specialty usage. To validate our score, we test its power to predict the occurrence of patient safety incidents and compare that with the predictive power of the Charlson comorbidity index. RESULTS: Our model uses 127 of the 279 International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis subchapters to predict specialty usage, thus creating the Specialty Intensity Score. This score has significantly greater power in predicting patient safety complications than the widely used Charlson comorbidity index. CONCLUSION: The Specialty Intensity Score developed in this article can be used by health services researchers and administrators to approximate a patient's need for care coordination across multiple specialist doctors. It, therefore, can help with evaluation of care coordination practices by allowing researchers to restrict their analysis of outcomes to the patients most impacted by those practices.

6th year medical students' future specialty preferences: A cross-sectional study.

BACKGROUND: Studying career preferences can help in designing and improving health service systems. Determining the preferred specialty and understanding the compulsion affecting specialty choice will provide clues to influence such choice in the future to shift the balance of specialties among practitioners. The current study aimed to determine medical students' preferable specialty choices and the factors influencing their choices and their attitude towards postgraduate medical education in Jordan and abroad. MATERIALS AND METHODS: The descriptive cross-sectional study design included 6th-year medical students in medical faculties in Jordan. An online questionnaire was created on Google Forms and posted on platforms accessible by medical students at level six. Numbers and percentages were presented for all variables. Frequency distributions were also presented. Chi-square distribution was used to measure the association between categorical data. Alpha level of 0.05 was used. RESULTS: Most students 188 (74.3%) preferred to continue their post-graduate training abroad, while only 65 (25.7%) favored Jordan. 150 (59.3%) of the respondents are interested in the medical - non-surgical - specialties. The most important factor that encouraged the students to choose a specialty was Job opportunity (32.5%) followed by the number of years required to complete the training and the expected income (27.7%) each. CONCLUSION: Supportive steps should be undertaken to motivate medical graduates toward the needed specialties. Moreover, local Specialty training programs need to be -reevaluated to ensure proper post graduate medical learning.

Avaliação psicométrica da prova de título de especialista em cardiologia da Sociedade Brasileira de Cardiologia / Psychometric Evaluation of the Test for the Title of Specialist in Cardiology of the Brazilian Society of Cardiology

Introdução: A certificação profissional está cada vez mais presente no currículo médico, seja por exigências do mercado, seja por demandas jurídicas. Após longa jornada inicial para a formação, o médico pode escolher entre dois caminhos para obter o título de especialista, uma residência ou uma especialização médica, desde que chanceladas por entidades oficiais. Nesse último modelo, o médico precisa, após a conclusão da especialização, realizar uma prova para a obtenção do título de especialista. A Sociedade Brasileira de Cardiologia, com o auxílio da Comissão Julgadora do Título de Especialista em Cardiologia, promove, anualmente, uma prova com essa finalidade. Em relação à elaboração de itens, até o presente estudo, não havia sido feita nenhuma avaliação psicométrica da prova do Título de Especialista em Cardiologia (TEC), tendo em vista a Teoria Clássica dos Testes (TCT) e a Teoria de Resposta ao Item (TRI). Essas teorias buscam, de forma técnica, avaliar a qualidade dos itens envolvidos em um teste e, de forma estatística, mostram um perfil do teste em relação a grau de dificuldade, poder de discriminação e possibilidade de acertos ao acaso ("chute"), o que nos permite uma análise crítica da qualidade da prova realizada. Objetivos: Avaliar as propriedades psicométricas da prova do TEC no ano de 2019, em relação aos parâmetros da TCT e da TRI . Materiais e métodos: Estudo observacional, com a análise psicométrica das 120 questões da prova realizada por 1120 (mil cento e vinte) candidatos para a obtenção do título de especialista em Cardiologia, no ano de 2019. Resultados: A análise pela TCT demonstrou que a prova apresenta boa distribuição dos itens em relação ao grau de dificuldade, com uma tendência para maior facilidade. Pela TRI, foi possível verificar que, das 118 questões avaliadas, apenas 49 (41,5%) possuem um fator satisfatório de discriminação. Conclusão: Os resultados deste estudo apresentam uma visão inédita da prova do TEC e, para as entidades oficiais que organizam a prova, poderão desencadear uma série de discussões e propostas para as futuras construções de provas no âmbito da cardiologia e das demais especialidades médicas

Introduction: Professional certification is increasingly present in the medical curriculum, ei-ther due to market demands or due to legal demands. After a long initial journey to training, doctors can choose between two paths to obtain the title of specialist, a residency program or a medical specialization, provided they are certified by official entities. In the latter, upon completing the specialization, the doctor must perform a test to obtain the title of specialist. The Brazilian Society of Cardiology, with the assistance of the Judging Panel on Cardiology Specialist Titles, promotes annually a test for this purpose. Regarding the elaboration of items, until the present study, there had been no psychometric evaluation of the test for the Title of Specialist in Cardiology (TSC), considering the Classical Test Theory (CTT) and the Item Re-sponse Theory (IRT). These theories seek, in a technical way, to evaluate the quality of the items involved in a test and, statistically, yield a profile of the test regarding the degree of difficulty, power of discrimination, and possibility of scoring due to guessing, which allows us to critically analyze the quality of the test performed. Objectives: To evaluate the psycho-metric properties of the TEC test in 2019, considering the CTT and IRT parameters. Materials and methods: Observational study, with the psychometric analysis of the 120 questions of the test performed by 1,120 (one thousand and one hundred and twenty) candidates to obtain the Title of Specialist in Cardiology, in the year 2019. Results: The analysis using CTT demonstrated that the test presents a good distribution of the items regarding the degree of difficulty, with a tendency towards ease. Through the IRT, it was possible to verify that, of the 118 questions evaluated, only 49 (41.5%) have a satisfactory discrimination parameter. Conclusion: The results of this study present an unprecedented view of the TEC test and, for the official entities that organize the test, they may trigger a series of discussions and pro-posals for the future elaboration of tests in the scope of Cardiology and other medical special-ties

Innovation, professional identity, and generational divides in medicine: The case of gynecologic laparoscopy in the USA.

Studies have linked the diffusion of medical innovations to a distinctive professional project. In this project, physician specialists embrace an innovation, work to advance its successes, link these successes to their core-skill definitions, and use this linkage in boundary work to promote their professional identities and expand their jurisdictions, largely by distinguishing themselves from others within their profession. Drawing from a case study examining the diffusion of laparoscopic sterilization procedures in American ob/gyn, this article suggests that a specific type of revitalization movement may serve as an unwitting catalyst for these innovation/professional projects. To promote a"new"specialist identity, this revitalization movement employs foil labeling in its boundary work that dishonors, not outsiders, but established clinicians within the specialty. This dishonoring motivates these clinicians, as a generational cohort, to embrace radical innovations and break established work patterns. Radical innovations may spread across medical fields, not so much through projects bonding professionals to a unified collective, but through reactive projects within highly specialized fields prone to fragment along generational lines.

["Rohleder was one of the first to fully realize the importance of sexology." : Life and work of the venereologist, urologist, and sexologist Hermann Rohleder (1866-1934)]. / "Rohleder gehört zu den ersten, welche die Bedeutung der Sexualwissenschaft in ihrem vollen Umfange erkannt haben." : Leben und Werk des Venerologen, Urologen und Sexualmediziners Hermann Rohleder (1866­1934).

His contemporaries described Hermann Rohleder, a physician from Leipzig, as a pioneer of sexual medicine. His career led him from treating patients with venereal diseases to urology and sexology. Rohleder worked for the institutionalization of sexology in Germany, but his attempts to establish a professorship at the University of Leipzig remained unsuccessful. Rohleder's life and work illustrate how closely the disciplines of urology and sexology were connected in the early 20th century.

The Role of Medical Specialization on Posttraumatic Symptoms in Pediatric Nurses.

PURPOSE: Comparison of medical specialization of repeated exposure to secondary trauma and Post-Traumatic Stress Disorder (PTSD) symptoms in pediatric nurses was examined. DESIGN AND METHODS: The PTSD Checklist-Civilian Version (PCL-C) was administered to 182 nurses over their first year on the job at a pediatric hospital (three time-points: baseline, 3 month follow-up, and 1 year follow-up). Demographic characteristics (age groups, gender, education, and race) and previous healthcare experience on whether nurses met criteria for no, partial, or full PTSD across all three time-points was examined. Differences in unit assignment on total PTSD symptoms and symptoms of each criterion of PTSD (re-experiencing, avoidance, and arousal) were also examined. RESULTS: No significant differences of both demographic characteristics and previous healthcare experience were found on these PTSD categories. However, both ICU and Hematology/Oncology units were more at risk for developing partial and full PTSD, respectively compared to other units. Nurses in the rehabilitation units had significantly higher re-experiencing, avoidance, and arousal symptoms than those assigned to medical/surgical and intensive care units. CONCLUSIONS: Results demonstrate a need for hospitals to assess why nurses from certain units are reporting more PTSD symptoms and screen for PTSD symptoms and other mental health concerns throughout their career. PRACTICE IMPLICATIONS: Being aware of which units may be more at-risk should inform unit-specific prevention and intervention programs to decrease negative outcomes, including burnout, compassion fatigue, and job dissatisfaction.

Reforma da Atenção Hospitalar para modelo de saúde baseada em valor e especialidades multifocais / Remodeling hospital care - an account of experiences in the Federal District of Brazil

Resumo A saúde pública em Brasília sofreu diversas melhorias desde sua implementação devido à mudança do perfil econômico, social e de escolaridade da população. Foi realizada uma reforma na Atenção Hospitalar por gestão baseada em evidências, através de um conjunto normativo que estabeleceu o ordenamento dos Serviços Hospitalares de Emergência, Atenção Ambulatorial Secundária, Regulação de Serviços de Saúde e modelagem organizacional da Secretária de Saúde do Distrito Federal. Tais mudanças permitiram que os profissionais nos seus diferentes níveis de atenção estejam interligados. Ou seja, os profissionais passam a prestar um serviço de saúde de forma contínua para a população, proporcionando um cuidado de saúde integral ao paciente. Essa abordagem garante ganho de eficiência no tratamento do paciente, pois os profissionais multifocais e focais trabalham de maneira integrada. Com a implementação da gestão da organização por processos de trabalho e o planejamento adequado, foi possível redesenhar o modelo assistencial utilizado nos dias atuais, permitindo através da gestão do conhecimento a ampliação do acesso e da interatividade, proporcionado ao cidadão através do modelo de gestão em saúde que agregue valor.

Abstract Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.

Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan.

OBJECTIVES: One feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes. SETTING: Data from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009. PARTICIPANTS AND METHODS: Postoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts. RESULTS: We examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not. CONCLUSIONS: The discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.