Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 157
Filtrar
1.
Am J Surg ; 220(5): 1208-1212, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32771217

RESUMO

BACKGROUND: Sub-Saharan Africa (SSA) has a shortage of surgeon specialists. Many SSA countries lack specialty training programs but South Africa, an upper middle-income country, has several post-graduate surgical training programs. The primary objective of this study was to describe the retention rates of non-South African SSA surgical trainees from the University of Cape Town (UCT) on the African sub-continent. The secondary objective was to describe advantages and disadvantages of foreign surgical trainees on the UCT surgical training programs. METHODS: This was a two-part cross-sectional survey administered via email between June 1, 2018 and March 1, 2019 to UCT 1) surgical residents and fellows who graduated between 2007 and 2017 and whose country of origin was in SSA but outside South Africa, and 2) UCT surgical division heads. RESULTS: Thirty out of 78 (38%) trainees responded; 83% (n = 25) were male. There was a 96% retention rate of surgical trainees in SSA, 80% (n = 24) returned to their country of origin after training, 83% (n = 25) worked in the public sector, and 90% (n = 27) in teaching hospitals. Seven out of ten surgical division heads responded. Reported advantages of SSA trainees included more junior staff (n = 5, 71%) and the establishment of SSA networks (n = 4, 57%). Disadvantages included increased training responsibilities for educators (n = 2, 29%) and fewer cases for South African trainees (n = 2, 29%). DISCUSSION: Retention on the African sub-continent of surgeons who trained at UCT was high. SSA doctors can utilize South African post-graduate surgical training programs until their own countries increase their training capacity. The majority of trainees returned to their countries of origin, utilizing their skills in the public and academic sectors, and contributing to the teaching of more trainees. These training partnerships also contribute to knowledge-sharing and facilitate a regional network of African surgeons. Active recruitment of more female trainees is needed to ensure gender equity.


Assuntos
Bolsas de Estudo , Médicos Graduados Estrangeiros/estatística & dados numéricos , Internato e Residência , Cirurgiões/provisão & distribução , Universidades , África ao Sul do Saara , Estudos Transversais , Feminino , Mão de Obra em Saúde , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários
4.
Ann Surg ; 272(1): 24-29, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32209893

RESUMO

OBJECTIVE: To determine the representation of Black/AA women surgeons in academic medicine among U.S. medical school faculty and to assess the number of NIH grants awarded to Black/AA women surgeon-scientists over the past 2 decades. SUMMARY OF BACKGROUND DATA: Despite increasing ethnic/racial and sex diversity in U.S. medical schools and residencies, Black/AA women have historically been underrepresented in academic surgery. METHODS: A retrospective review of the Association of American Medical Colleges 2017 Faculty Roster was performed and the number of grants awarded to surgeons from the NIH (1998-2017) was obtained. Data from the Association of American Medical Colleges included the total number of medical school surgery faculty, academic rank, tenure status, and department Chair roles. Descriptive statistics were performed. RESULTS: Of the 15,671 U.S. medical school surgical faculty, 123 (0.79%) were Black/AA women surgeons with only 11 (0.54%) being tenured faculty. When stratified by academic rank, 15 (12%) Black/AA women surgeons were instructors, 73 (59%) were assistant professors, 19 (15%) were associate professors, and 10 (8%) were full professors of surgery. Of the 372 U.S. department Chairs of surgery, none were Black/AA women. Of the 9139 NIH grants awarded to academic surgeons from 1998 and 2017, 31 (0.34%) grants were awarded to fewer than 12 Black/AA women surgeons. CONCLUSION: A significant disparity in the number of Black/AA women in academic surgery exists with few attaining promotion to the rank of professor with tenure and none ascending to the role of department Chair of surgery. Identifying and removing structural barriers to promotion, NIH grant funding, and academic advancement of Black/AA women as leaders and surgeon-scientists is needed.


Assuntos
Afro-Americanos , Docentes de Medicina/provisão & distribução , Médicas/provisão & distribução , Apoio à Pesquisa como Assunto , Cirurgiões/provisão & distribução , Adulto , Feminino , Humanos , Estudos Retrospectivos , Faculdades de Medicina , Estados Unidos
5.
Am Surg ; 86(2): 152-157, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106909

RESUMO

The professional use of social media is increasingly prevalent today, particularly in medicine and surgery. Several recent movements have highlighted the strengths of this forum for networking and mentorship for females in surgery who otherwise may lack mentors locally. We sought to describe modern uses for and strengths of social media for women in surgery globally via a systematic review of the literature. Multiple efforts and avenues have promoted gender equality in surgery, while also uniting female surgeons in a collaborative virtual network of colleagues. In particular, movements on Twitter, such as #ILookLikeASurgeon and #NYerORCoverChallenge, as well as other collaborative virtual fora have brought visibility to female surgeons, while drawing the young population of students and trainees toward surgical careers. Social media provides a unique opportunity for female trainees and established surgeons alike to network and establish mentorship relationships, which may aid in fostering interest in surgery and closing the gender gap in our field.


Assuntos
Tutoria , Médicas , Mídias Sociais , Cirurgiões , Escolha da Profissão , Feminino , Humanos , Tutoria/métodos , Mentores/estatística & dados numéricos , Médicas/organização & administração , Médicas/provisão & distribução , Salários e Benefícios/estatística & dados numéricos , Sexismo , Mídias Sociais/organização & administração , Mídias Sociais/estatística & dados numéricos , Mídias Sociais/tendências , Cirurgiões/organização & administração , Cirurgiões/provisão & distribução
7.
Ann Vasc Surg ; 66: 282-288, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32027989

RESUMO

BACKGROUND: Concern regarding the adequacy of the vascular surgery workforce persists. We aimed to predict future vascular surgery workforce size and capacity using contemporary data on the US population and number, productivity, and practice patterns of vascular surgeons. METHODS: The workforce size needed to maintain current levels of access was estimated to be 1.4 vascular surgeons/100,000 population. Updated population estimates were obtained from the US Census Bureau. We calculated future vascular surgery workforce needs based on the estimated population for every 10 years from 2020 to 2050. American Medical Association Physician Masterfile data from 1997 to 2017 were used to establish the existing vascular surgery workforce size and predict future workforce size, accounting for annual rates of new certificates (increased to an average of 133/year since 2013), retirement (17%/year), and the effects of burnout, reduced work hours, transitions to nonclinical jobs, or early retirement. Based on Medical Group Management Association data that estimate median vascular surgeon productivity to be 8,481 work relative value units (wRVUs)/year, excess/deficits in wRVU capacity were calculated based on the number of anticipated practicing vascular surgeons. RESULTS: Our model predicts declining shortages of vascular surgeons through 2040, with workforce size meeting demand by 2050. In 2030, each surgeon would need to increase yearly wRVU production by 22%, and in 2040 by 8%, to accommodate the workload volume. CONCLUSIONS: Our model predicts a shortage of vascular surgeons in the coming decades, with workforce size meeting demand by 2050. Congruence between workforce and demand for services in 2050 may be related to increases in the number of trainees from integrated residencies combined with decreases in population estimates. Until then, vascular surgeons will be required to work harder to accommodate the workload. Burnout, changing practice patterns, geographic maldistribution, and expansion of health care coverage and utilization may adversely affect the ability of the future workforce to accommodate population needs.


Assuntos
Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Determinação de Necessidades de Cuidados de Saúde/tendências , Cirurgiões/provisão & distribução , Cirurgiões/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Censos , Previsões , Humanos , Modelos Teóricos , Fatores de Tempo , Estados Unidos , Carga de Trabalho
8.
Am J Surg ; 219(2): 355-358, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898943

RESUMO

BACKGROUND: A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery. METHODS: An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship. Telephone interviews were conducted on a portion of these surgeons. RESULTS: Fifty-seven students (3.6%) completing the rural-focused longitudinal integrated clerkship became general surgeons. Of those participating in phone interviews, most (90%) decided to become surgeons during their experience while all stated that preclinical years did not influence their specialty decision. CONCLUSIONS: A substantial portion of these surgeons went on to practice in rural communities. Pre-existing rural and primary care-focused education could help to address the future projected shortage of rural general surgeons.


Assuntos
Escolha da Profissão , Estágio Clínico/organização & administração , Educação de Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Avaliação de Resultados em Cuidados de Saúde , Bases de Dados Factuais , Feminino , Hospitais Rurais/organização & administração , Humanos , Entrevistas como Assunto , Masculino , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Serviços de Saúde Rural/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Cirurgiões/provisão & distribução , Estados Unidos , Adulto Jovem
9.
J Pediatr Surg ; 55(4): 583-589, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31351706

RESUMO

INTRODUCTION: The shortage of medical doctors in certain geographies and certain disciplines, resident work hour limitations and the demonstrated positive impact of advanced providers (nurse practitioners, physician assistants and clinical nurse specialists) on the quality and efficiency of care in numerous specialties have led to broader integration of advanced providers in healthcare organizations. With regard to pediatric surgery, some tertiary centers have successfully implemented 24/7 nurse practitioner coverage for their inpatient services. However, pediatric surgery practices vary throughout North America and the broader presence and function of advanced providers among all practice types and settings has not been characterized previously. The purpose of this survey is to conduct a descriptive evaluation of current pediatric surgical practices in North America with regard to advanced provider coverage and their perceived impact on care delivery and patient satisfaction. METHODS: A 14-item online survey, approved by the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee, was distributed to all full APSA members (N = 1189, opening rate of 56%), representing the vast majority of pediatric surgeons in North America. The survey investigated the practice characteristics of the responding surgeon, the presence and role of advanced providers in their practice and their perceived impact on patient care. Descriptive statistics were performed to characterize the function of advanced providers in pediatric surgery practices. Further analysis was performed to assess for geographic differences in staffing practices using United States Census Divisions. RESULTS: A total of 266 pediatric surgeons completed the survey (response rate 22% and 40% considering "email send out" and "email opening" rates respectively), with 47.6% employed at free standing children's hospitals and 41.1% employed at a children's hospital within an adult hospital. Nearly all respondents (N = 244, 91.7%) reported the presence of advanced providers in their practice with nurse practitioners (N = 216) and physician assistants (N = 101) most commonly represented. The majority of advanced providers (N = 189, 77.8%) covered both general surgery and trauma patients. Advanced providers worked nearly equally in the outpatient (N = 219, 89.8%) and inpatient setting (N = 232, 95.1%), though less often in the neonatal (N = 131) or pediatric (N = 126) intensive care unit. Fifteen percent of surgeons (N = 40) reported that advanced providers provided 24/7 coverage within their surgical practice. Surgeons reported that advanced providers had a very positive (75%) or positive (21%) impact on their clinical practice, with none reporting a negative impact. Surgeons also reported that advanced providers had a very positive (74%) or positive (21%) impact on perceived patient satisfaction. The main area in which surgeons reported the most significant impact of associate providers was continuity of care (N = 77), efficiency of service (N = 66) and education of parents and patients (N = 53). CONCLUSION: Pediatric surgical practices of all types are broadly utilizing advanced providers. Surgeons report that the integration of advanced providers across inpatient and outpatient settings has positively impacted care, advancing both continuity of care and efficiency of service. Advanced providers likely represent part of the solution to delivering quality care in current delivery systems. STUDY TYPE: Prospective Study/ Survey LEVEL OF EVIDENCE: IV.


Assuntos
Pediatria/estatística & dados numéricos , Qualidade da Assistência à Saúde , Especialidades Cirúrgicas/estatística & dados numéricos , Cirurgiões/provisão & distribução , Competência Clínica , Eficiência , Hospitais Pediátricos , Humanos , Pacientes Internados , Unidades de Terapia Intensiva Pediátrica , América do Norte , Estudos Prospectivos , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários
10.
Postgrad Med J ; 96(1133): 162-164, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31874909

RESUMO

The shortage of applicants looking to enter surgical specialties is well documented. Indeed, there are a number of reasons for this ranging from potential flaws within the training pathway to a lack of both financial and social support in what is undoubtedly a stressful career pathway. However, it is important that we discuss these shortcomings and exploit such opportunities to make surgery a more attractive prospect. These changes include adapting student's experience while still at medical school through changes to the medical curriculum and surgical rotations. In addition, it is important to assess what factors applicants prioritise when applying for specialty training, and addressing the gender divide within surgery so as to remove barriers for progression in surgical training. Similarly, by encouraging research within surgery, it improves treatment options for patients as well as motivating those more academically inclined to pursue this specialty. This can produce more proficient surgeons and improve the competitiveness of training posts within remote regions in the UK. Ultimately, these changes will likely translate to more satisfied trainees and improved patient care.


Assuntos
Educação de Pós-Graduação em Medicina , Educação/normas , Especialidades Cirúrgicas/educação , Cirurgiões , Escolha da Profissão , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Humanos , Motivação , Determinação de Necessidades de Cuidados de Saúde , Melhoria de Qualidade , Cirurgiões/educação , Cirurgiões/psicologia , Cirurgiões/provisão & distribução , Reino Unido
11.
Health Aff (Millwood) ; 38(12): 2086-2094, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31794309

RESUMO

Rates of rural hospital closures have been increasing over the past decade. Closures will almost certainly restrict rural residents' access to important inpatient services, and they could also be related in important ways to the supply of physicians in the local health care system. We used data from the Area Health Resources Files for the period 1997-2016 to examine the relationship between rural hospital closures and the supply of physicians across different specialties in the years leading up to and after a closure. We observed significant annual reductions of up to 8.3 percent in the supply of general surgeons in the years leading up to a closure. We also found that rural hospital closures were associated with immediate and persistent decreases in the supply of surgical specialists and long-term decreases in the supply of physicians across multiple specialties-including an average annual 8.2 percent decrease in the supply of primary care physicians in the six years after a closure and beyond. This dynamic relationship could lead to reduced access to care for rural residents. Future policy efforts must focus on supporting and maintaining health care delivery models that do not depend on hospitals.


Assuntos
Fechamento de Instituições de Saúde/tendências , Mão de Obra em Saúde , Hospitais Rurais , Médicos de Atenção Primária/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Hospitais Rurais/estatística & dados numéricos , Humanos , Médicos de Atenção Primária/provisão & distribução , Serviços de Saúde Rural/estatística & dados numéricos , Cirurgiões/provisão & distribução , Estados Unidos
12.
Cir. Esp. (Ed. impr.) ; 97(10): 560-567, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187931

RESUMO

Introducción: El acceso de los cirujanos a los equipos de trasplante hepático en España se realiza de manera heterogénea. El objetivo de este estudio ha sido cuantificar los recursos humanos de los equipos de trasplante españoles, la distribución de las diferentes tareas del trasplante entre los miembros del equipo, el mecanismo mediante el cual se adquieren las habilidades, la visión de sus líderes sobre su continuidad, así como las motivaciones de los residentes de cirugía general españoles para elegir el trasplante como su futura carrera profesional. Métodos: Se elaboraron dos encuestas diferentes, para los jefes de equipo y para residentes, sobre número de personas, capacitación, reclutamiento, organización de tareas y motivación para trabajar en trasplantes. Los cuestionarios se enviaron por correo electrónico tanto a los directores de programa de trasplante como a los residentes de cirugía. Resultados: Hay en promedio 8 cirujanos en cada unidad de trasplante. Más de 4 cirujanos realizan la hepatectomía en el 54,2% de los grupos, mientras que el implante lo realiza más de 4 cirujanos en solo el 25% de los centros. El 42% de los jefes de trasplante hepático aboga por un sistema tipo fellowship y el 87,5% cree que el recambio generacional está garantizado. De los 525 residentes, 101 respondieron. Respecto a la formación, un 12,8% no tiene interés en el trasplante. En cuanto a sus preferencias laborales, el 37,6% no está interesado en el trasplante por ser excesivamente exigente, y el 52,5% no desea ser parte de un equipo de trasplante de hígado en el futuro. Conclusiones: El recambio generacional parece estar garantizado según los directores de programa de trasplante de hígado. Las nuevas generaciones de cirujanos generalmente optan por otras áreas de cirugía diferentes al trasplante. Son necesarios estudios con mayor número de respuestas para validar estos resultados


Introduction: The access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders' view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. Methods: Two different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. Results: There are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed. Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. Conclusions: The generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Emprego/normas , Mão de Obra em Saúde/organização & administração , Transplante de Fígado/estatística & dados numéricos , Cirurgiões/provisão & distribução , Atitude do Pessoal de Saúde , Escolha da Profissão , Competência Clínica , Educação/normas , Emprego/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Motivação/fisiologia , Seleção de Pessoal/métodos , Seleção de Pessoal/estatística & dados numéricos , Diretores Médicos/estatística & dados numéricos , Espanha/epidemiologia , Cirurgiões/normas , Inquéritos e Questionários
13.
PLoS One ; 14(10): e0224215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31648234

RESUMO

INTRODUCTION: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. METHODS: A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS: Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. CONCLUSION: As in Uganda's public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.


Assuntos
Assistência à Saúde , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/economia , Setor Privado/estatística & dados numéricos , Cirurgiões/provisão & distribução , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Anestesiologia , Bancos de Sangue , Cesárea/estatística & dados numéricos , Equipamentos e Provisões Hospitalares/provisão & distribução , Feminino , Humanos , Laparotomia/estatística & dados numéricos , Organizações sem Fins Lucrativos , Gravidez , Estudos Retrospectivos , Uganda
16.
World J Surg ; 43(11): 2934-2944, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31297580

RESUMO

BACKGROUND: Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care. METHODS: We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks. RESULTS: Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions. CONCLUSIONS: We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países em Desenvolvimento , Mão de Obra em Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Anestesiologistas/provisão & distribução , Anestesiologia/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Política de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Hospitais Filantrópicos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Somália , Cirurgiões/provisão & distribução
17.
J Orthop Trauma ; 33(11): e416-e421, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356444

RESUMO

OBJECTIVE: To determine whether increased surgeon and hospital volume is associated with lower rates of complications after tarsal fractures. DESIGN: Retrospective cohort study of the State Inpatient Databases. SETTING: Two hundred ninety-nine hospitals in Florida (2005-2012) and New York (2006-2008). PATIENTS/PARTICIPANTS: Four thousand one hundred thirty-two tarsal fractures that underwent fixation by 1223 surgeons. INTERVENTION: Surgical repair of tarsal fractures. MAIN OUTCOME MEASUREMENTS: Composite of readmission for infection requiring operative treatment, wound dehiscence, nonunion, avascular necrosis, or amputation within 2 years of the index procedure. RESULTS: The mean age was 44 (±15) years, a majority were men (70%) and white (69%), and the mean number of Charlson comorbidities was 0.21 (±0.58). Multivariable logistic regression demonstrated a reduction in the likelihood of complications by 9% for each 5 additional surgeries performed by the operating surgeon [odds ratio (OR), 0.91 per 5 surgeries; 95% confidence interval (CI), 0.82-0.99]. Other factors associated with complications included increased age (OR, 1.23 per 10 years; 95% CI, 1.10-1.36), male sex (OR, 1.56; 95% CI, 1.12-2.17), open fractures (OR, 2.84; 95% CI, 1.92-4.19), number of Charlson comorbidities (OR, 1.23; 95% CI, 1.02-1.48), income quartile (OR, 1.48; 95% CI, 1.00-2.17), uninsured (OR, 2.47; 95% CI, 1.39-4.39), and other government program insurance (OR, 1.52; 95% CI, 1.06-2.18). CONCLUSIONS: We observed a significant inverse relationship between surgeon volume and complication rates when controlling for patient and injury characteristics. In contrast to previous research, a volume-outcome relationship was not observed at the hospital level. These results suggest that such complex injuries should be triaged to the most experienced providers. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Cirurgiões/provisão & distribução , Ossos do Tarso/lesões , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Bases de Dados Factuais , Feminino , Florida , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/diagnóstico por imagem , Hospitais com Alto Volume de Atendimentos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , New York , Papel do Médico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco
18.
Curr Opin Otolaryngol Head Neck Surg ; 27(4): 274-279, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274568

RESUMO

PURPOSE OF REVIEW: Craniomaxillofacial (CMF) trauma is a common cause of global morbidity and mortality. Although in high resource settings the management of CMF trauma has improved substantially over the past several decades with internal rigid fixation technology; these advancements have remained economically unviable and have not yet reached low and middle-income countries (LMICs) en masse. The purpose of this review is to discuss the current management of CMF injuries in low-resource settings. RECENT FINDINGS: Trauma injuries remain a global epidemic with head and neck injuries among the most common. CMF trauma injuries largely occur in LMICs, with motor vehicle trauma being a common cause. Patients present in a delayed fashion which increases complications. Diagnostic methods are often limited to plain radiographs as computed tomography is not always available. In low-resource settings, CMF trauma continues to be treated primarily by closed reduction, maxillomandibular fixation, and transosseous wiring, yielding acceptable results through affordable methods. With the advent of less expensive plating systems, internal fixation with plates and screws are gradually finding their place in the management of facial trauma in low-resource settings. A shortage of CMF surgeons in LMICs is a recognized problem and is being addressed by targeted curricula. SUMMARY: CMF trauma is a major cause of morbidity and mortality globally that remains poorly addressed. Currently, conventional methods of treating CMF trauma in low-resource settings have evolved to meet resource constraints. The education of CMF surgeons remains a key leverage point in improving CMF trauma care globally.


Assuntos
Países em Desenvolvimento , Traumatismos Faciais/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgiões/provisão & distribução , Traumatismos Faciais/diagnóstico por imagem , Humanos
19.
Healthc Q ; 22(1): 6-10, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31244461

RESUMO

Cataract surgery is the most common operation performed in most developed countries, including Canada. Nuanced, evidence-driven policies are needed to ensure appropriate access to this sight-saving operation while maintaining the highest standards in quality of care. The Vision Health Services Research Program at Queen's University, in partnership with members of the Ontario Provincial Vision Task Force, has developed evidence to inform policies aimed at optimizing both access and quality across the eye care spectrum.


Assuntos
Extração de Catarata/normas , Cirurgiões/provisão & distribução , Mobilidade Ocupacional , Extração de Catarata/efeitos adversos , Extração de Catarata/estatística & dados numéricos , Política de Saúde , Humanos , Ontário , Salas Cirúrgicas/provisão & distribução , Oftalmologia/educação , Oftalmologia/normas , Complicações Pós-Operatórias/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA