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2.
J Surg Oncol ; 121(5): 707-717, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31970764

RESUMEN

The Brazilian Society of Surgical Oncology was established over 30 years ago. Despite that, surgical oncology was finally recognized as a Board-Certified medical specialty in 2017 and has strengthened its role in the standardization of surgical and multimodal approaches in our country. This article aims to describe the process and the main challenges of the specialists training who are qualified for job opportunities and who meet the expectations of the recently created competence matrix for surgical oncologists in Brazil. Thus, we hope to expose the challenges of teaching surgical oncology, describe its history and experiences in important country services, and outline the minimum requirements for creating a more humanistic surgical oncologist who is updated and fully committed with multidisciplinary treatment for cancer patients. We conclude that the main characteristic that the surgical oncologist must have is the ability to offer holistic treatments to the patient, based on the highest level of evidence, love, and compassion, to direct the treatment and understand all of the afflictions that arise with a cancer diagnosis. Moreover, the surgical oncologist in training and in the field must be continuously updating himself to offer the best options of treatment to patients.


Asunto(s)
Curriculum , Educación de Postgrado en Medicina/organización & administración , Oncología Quirúrgica/educación , Brasil , Certificación , Competencia Clínica/normas , Humanos , Internado y Residencia/organización & administración , Sociedades Médicas , Especialización , Consejos de Especialidades
4.
Br Dent J ; 228(1): 39-43, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31925372

RESUMEN

Objectives To establish current implant practice among university and hospital restorative dental specialists in the United Kingdom (UK) and Ireland and their opinions relating to criteria for implant treatment.Materials and methods An online questionnaire was distributed to 150 university and hospital restorative dental specialists in the UK and Ireland.Results The response rate was 27%. Twenty-nine (70%) respondents provided implant treatment, of which 76% and 100% placed and restored implants respectively. In addition, 79% worked with oral surgeons or oral and maxillofacial surgeons as part of the implant team. Hypodontia and malignancy were cited as the main groups that qualified for NHS dental implant treatment. Irradiation, smoking and bisphosphonates were considered the most important medical factors in patient selection for implant placement, while untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important dental factors.Conclusions The majority of responding university and hospital restorative dental specialists within the UK and Ireland provide dental implant treatment and undertake a multidisciplinary approach where necessary. There is variation in the number of patients treated with implants by each respondent annually. The main patient groups that receive priority for NHS dental implant treatment are malignancy and hypodontia. Otherwise, there is general agreement about the factors considered important when selecting patients for implant treatment on the NHS and this aligns to the Royal College of Surgeons guidelines on selecting patients for the provision of dental implants.


Asunto(s)
Implantes Dentales , Humanos , Irlanda , Especialización , Reino Unido , Universidades
5.
Sports Health ; 12(1): 36-42, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31724908

RESUMEN

BACKGROUND: Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport. HYPOTHESES: Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year. RESULTS: A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; P < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; P = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; P < 0.05) were associated with overuse injury only among volleyball athletes. CONCLUSION: Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization. CLINICAL RELEVANCE: Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.


Asunto(s)
Trastornos de Traumas Acumulados/etiología , Especialización , Deportes Juveniles/lesiones , Adolescente , Baloncesto/lesiones , Niño , Estudios Transversales , Trastornos de Traumas Acumulados/prevención & control , Femenino , Humanos , Masculino , Factores de Riesgo , Factores Sexuales , Fútbol/lesiones , Encuestas y Cuestionarios , Voleibol/lesiones
6.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31769352

RESUMEN

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Asunto(s)
Cateterismo Periférico , Fibrinolíticos/administración & dosificación , Hospitales Comunitarios , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrasonido , Enfermedad Aguda , Adulto , Anciano , Cardiólogos , Cateterismo Periférico/efectos adversos , Femenino , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intraarteriales , Masculino , Michigan , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/fisiopatología , Radiólogos , Estudios Retrospectivos , Especialización , Cirujanos , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Terapia por Ultrasonido/efectos adversos
8.
Sports Health ; 12(1): 10-11, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31865889
10.
Rev. enferm. UERJ ; 27: e39165, jan.-dez. 2019. tab
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1024387

RESUMEN

Objetivos: verificar a suspeição de transtornos mentais comuns (TMC) em residentes de enfermagem e analisar os fatores preditores. Método: estudo transversal com uma amostra de 130 residentes de um hospital universitário, situado no município do Rio de Janeiro, que responderam ao Self Reporting Questionnaire (SRQ-20) e questões sociodemográficas, em 2018. Os dados foram analisados por meio da estatística descritiva. Estudo aprovado por Comitê de Ética em Pesquisa. Resultados: a amostra foi composta, em sua maioria, por jovens, solteiros e do sexo feminino, cuja suspeição de transtornos mentais comuns atingiu 52%. Dos fatores preditores mais frequentes, 87,53% afirmaram sentirem-se nervosos, tensos e preocupados, 60,7%, cansados o tempo todo e 57,7% dormem mal. Conclusão: a suspeição de TMC na amostra encontra-se bem acima de estudos realizados com profissionais da saúde e áreas afins, cujos fatores preditores evidenciam sofrimento psíquico e risco de evolução para quadros psiquiátricos severos.


Objective: to detect suspected common mental disorders (CMDs) in nursing residents, and identify related predictive factors. Method: this cross-sectional study examined a sample of 130 residents at a Rio de Janeiro city university hospital who answered the Self Reporting Questionnaire (SRQ-20) and sociodemographic questions, in 2018. The resulting data were analyzed using descriptive statistics. The study was approved by the research ethics committee. Results: the results revealed suspected CMDs in 52% of the sample, which was mainly young, single and female. Of the frequent predictors, 87.53% said they felt nervous, tense and worried, 60.7% felt tired all the time, and 57.7% slept poorly. Conclusion: the level of suspected CMDs in the sample was well above those found in studies of professionals of the health and related fields, and the predictors revealed psychological distress and risk of evolution to severe psychiatric conditions.


Objetivo: verificar la sospecha de trastornos mentales comunes (TMC) en residentes de enfermería y analizar los factores predictores. Método: estudio transversal con una muestra de 130 residentes de un hospital universitario, situado en el municipio de Río de Janeiro, que contestaron al Self Reporting Questionnaire (SRQ-20) y cuestiones sociodemográficas, en 2018. Los datos fueron analizados por medio de la estadística descriptiva. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: la muestra estaba compuesta, en su mayoría, por jóvenes, solteros y del sexo femenino, siendo que del 52% se sospechaba trastornos mentales comunes. En cuanto a los factores predictores más frecuentes, un 87,53% afirmó sentirse nervioso, tenso y preocupado, el 60,7% sentirse cansado todo el tiempo y el 57,7% dormir mal. Conclusión: la sospecha de TMC en la muestra está muy por encima de los estudios realizados junto a profesionales de la salud y áreas relacionadas cuyos predictores evidencian sufrimiento psicológico y riesgo de evolución hacia cuadros psiquiátricos severos.


Asunto(s)
Humanos , Masculino , Femenino , Especialización , Salud Laboral , Enfermería , Internado no Médico , Trastornos Mentales , Estudios Transversales , Hospitales Universitarios
11.
Med Lav ; 110(S1): 7-12, 2019 Dec 06.
Artículo en Italiano | MEDLINE | ID: mdl-31846442

RESUMEN

The author deals with the medical-surgical panorama in Milan at the turn of the 19th century and at the beginning of the 20th century. The advances in knowledge acquired from the mid-nineteenth century on led to the emergence of medical and surgical specializations, as well as of new tools for the prevention and treatment of diseases, and the creation of a health and care network, on which it was possible to graft highly developed training opportunities. The example of an institution set up in Milan at the beginning of the twentieth century to treat the results of traumatic events is emblematic, not only because it is related to occupational accidents, but also because it explains the need to have specialists from various medical and surgical disciplines at the service of the entire population.


Asunto(s)
Instituciones de Salud , Especialización , Accidentes de Trabajo , Historia del Siglo XIX , Historia del Siglo XX , Especialización/historia
12.
Community Dent Health ; 36(4): 240-243, 2019 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-31680491

RESUMEN

OBJECTIVE: The purpose of this study was to determine the geographic distribution of dental specialists permitted to advertise dental practices in Japan. METHOD: We identified the populations of 349 secondary medical zones nationwide from the 2015 population census, as well as the number of dentists in five specialties, namely oral surgeons, pedodontists, periodontists, dental anesthesiologists, and dental radiologists, who had been permitted to advertise dental practices, from a 2016 survey of physicians, dentists, and pharmacists. We determined the placement rate, Lorenz curve, and Gini coefficient for dentists in each specialty in order to describe their geographic distributions. RESULTS: The placement rates of at least one of these types of dentist in each secondary medical zone were 73.9% for oral surgeons, 66.2% for pedodontists, 60.5% for periodontists, 31.8% for dental anesthesiologists, and 18.3% for dental radiologists. The Gini coefficients were 0.397, 0.400, 0.491, 0.650, and 0.761, respectively. CONCLUSION: The dentists in each specialty were few in number and were unequally distributed among the zones, but less so for oral surgeons and pedodontists. Dental anesthesiologists and radiologists were located primarily at university hospitals in urban areas and, therefore, were more unequally distributed.


Asunto(s)
Médicos , Especialización , Odontólogos , Humanos , Japón
13.
Orthopade ; 48(12): 1061-1072, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31720705

RESUMEN

The treatment of patients with acute back pain is becoming increasingly more important due to the high incidence; however, acute clinical pictures from other disciplines can also primarily be symptomatic with back pain and falsely lead to a consultation with an orthopedist. In order to assure an adequate treatment of potentially critical patients, it is absolutely necessary to exclude life-threatening differential diagnoses by a structured study of the patient history, investigations and diagnostics. Depending on the suspected diagnosis, necessary first aid measures and emergency referral to the appropriate specialist department should be initiated. This article gives an overview of selected clinical pictures and tries to look beyond the field of orthopedics.


Asunto(s)
Dolor de Espalda/diagnóstico , Dolor de Espalda/etiología , Ortopedia , Enfermedad Aguda , Diagnóstico Diferencial , Humanos , Relaciones Interprofesionales , Derivación y Consulta , Especialización
14.
Nursing ; 49(12): 53-56, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31764875

RESUMEN

Health science librarianship may interest nurses inclined toward research, technology, and education. This article discusses the role of health science librarians as part of the clinical team.


Asunto(s)
Investigación Biomédica , Bibliotecología , Enfermeras y Enfermeros/psicología , Rol Profesional , Selección de Profesión , Humanos , Perfil Laboral , Satisfacción en el Trabajo , Grupo de Atención al Paciente/organización & administración , Especialización
16.
Lakartidningen ; 1162019 Oct 15.
Artículo en Sueco | MEDLINE | ID: mdl-31638710

RESUMEN

Emergency Medicine became a supraspeciality in Sweden in 2008. The Swedish Specialist Examination in Emergency Medicine is a formative examination that seeks to guide local training in Emergency Medicine, provide feedback to physicians during their residency, and establish national standards for various processes in Emergency Medicine. It consists of six partial examinations and 118 cases. Documents and checklists accessible on the internet specify the degree of competence expected during the examination. Program directors are tasked with offering the examination locally to their residents. During the past 10 years, the examination has been offered during 53 days to 180 residents belonging to 27 training programs. The total number of passed partial examinations is 201. Six physicians have so far passed all six partial examinations.


Asunto(s)
Educación de Postgrado en Medicina , Evaluación Educacional , Medicina de Emergencia/educación , Humanos , Especialización , Suecia
18.
Artículo en Inglés | MEDLINE | ID: mdl-31590364

RESUMEN

Background: There are well-known methodological and analytical challenges in planning regional healthcare services (HCS). Increasingly, the need for data-derived planning, including user-perspectives, is discussed. This study aims to better understand the possible contribution of citizen experience in the assessment of regional HCS needs in two regions of Germany. Methods: We conducted a written survey in two regions of differing size-a community (3653 inhabitants) and a county (165,211 inhabitants). Multinomial logistic regression was used to assess the impact of sociodemographic and regional factors on the assessment of HCS provided by general practitioners (GPs) and specialists. Results: Except for age and financial resources available for one's own health, populations did not differ significantly between the regions. However, citizens' perception of HCS (measured by satisfaction with 1 = very good to 5 = very poor) differed clearly between different services (e.g., specialists: 3.8-4.3 and pharmacies: 1.7-2.5) as well as between regions (GPs: 1.7-3.1; therapists: 2.9-4). In the multivariate model, region (next to income and age) was a consistent predictor of the perception of GP- and specialist-provided care. Discussion: Citizens' perceptions of HCS correspond to regional provider density (the greater the density, the better the perception) and add insights into citizens' needs. Therefore, they can provide valuable information on regional HCS strengths and weaknesses and are a valid resource to support decision makers in shaping regional care structures.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Participación del Paciente , Regionalización/organización & administración , Adolescente , Adulto , Factores de Edad , Anciano , Estudios Transversales , Toma de Decisiones , Femenino , Médicos Generales/provisión & distribución , Alemania , Humanos , Renta , Masculino , Persona de Mediana Edad , Especialización , Encuestas y Cuestionarios , Adulto Joven
20.
Z Evid Fortbild Qual Gesundhwes ; 146: 28-34, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31570212

RESUMEN

INTRODUCTION AND AIM: The ambulatory specialized care (ASV) act (Sect. 116b of the Social Code Fifth Book [SGB V]) is intended to enable patients with a rare disease or a special course of disease or patients needing a highly specialized treatment to get access to outpatient care by office-based as well as hospital doctors. Data concerning care, service performance and fees - in comparison to the usual contract with the statutory insurance or the former Sect. 116b SGB V - are lacking. We explored the question whether differences in reimbursement between ASV and the previous system exist and which factors are influencing them. METHODS: We analyzed ICD-10 diagnoses, performance parameters as well as budgets and service fees in the former care system of medical oncologists in the institutions of three ASV participants of two federal countries treating gastrointestinal malignancies. We compared the results (fees, remuneration) to those from the statutory contract system and the former ambulatory care of hospitals and calculated the differences. Data were analyzed descriptively and analytically using SPSS. RESULTS: The analyses showed significant differences in the reimbursement rates between both office-based teams due to different budgets in the statutory contract system of the different federal countries. This led to additional remuneration of 12.5 to 49 % in ASV. The increase in fees of the hospital-guided team was exclusively due to the ASV-only fees of chapter 51 of EBM since there were no limitations of budgets even in the former system. DISCUSSION AND CONCLUSION: Exemplified with the ASV subgroup GIT, our study shows for the analyzed medical specialty that the difference in reimbursement in ASV is mostly due to the federal country-specific budgets and that the increase in honoraria can be substantial. Due to differences in budgets and quota systems, there may be different results in other ASV indications and specialist groups as well as in other federal states. Irrespective of these arguments, further aspects need to be taken into account when participation in ASV is considered.


Asunto(s)
Instituciones de Atención Ambulatoria/economía , Neoplasias Gastrointestinales , Costos de la Atención en Salud , Reembolso de Seguro de Salud , Atención Ambulatoria/economía , Costos y Análisis de Costo , Neoplasias Gastrointestinales/economía , Alemania , Humanos , Oncología Médica , Mecanismo de Reembolso , Especialización
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