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1.
J Surg Oncol ; 121(1): 91-99, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650565

RESUMO

BACKGROUND: Lymphedema surgery was not widely known in Austria before the introduction of lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) in 2014. This study shares the experience and process of establishing and institutionalizing lymphedema surgery service in Austria. METHODS: The purpose of introducing reconstructive lymphedema surgery in Austria was to improve lymphedema patients' quality of life and provide them surgical therapy as an adjuvant treatment to complete decongestive therapy. To initialize reconstructive lymphedema surgery in Austria, LVA and VLNT had to be presented and introduced, in the manner of branding and advertizing a new product. Surgeries were performed with quality control by standardized documentation, pre- and postoperatively. RESULTS: Aligned with branding and marketing, presentations were given externally and internally to share knowledge and experience of lymphedema surgery. Lymphedema surgery service was introduced as a new brand in the medical service in Austria. After several communications with the Austrian Health Insurance Fund and with the final application, LVA and VLNT were listed as novel surgical therapies in its 2020 reimbursement catalog. Since 2014, more than 300 lymphedema patients were consulted, and 102 reconstructive lymphedema surgeries were performed. Circumference reduction of extremities after surgery was between 20% and 43%, postoperatively. CONCLUSION: Acceptance of surgery in lymphedema patients varies among continents, hospitals, and surgeons. Evaluation of the requirement of the surgical setup and insurance conditions for lymphedema surgery is essential to establish lymphedema surgery, providing targeted marketing and branding to spread knowledge of the novel technique and grant patients access to therapeutic treatment of their chronic disease.


Assuntos
Cirurgia Geral/organização & administração , Linfedema/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Áustria , Criança , Feminino , Humanos , Linfonodos/transplante , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Centro Cirúrgico Hospitalar , Adulto Jovem
3.
Am Surg ; 85(7): 678-684, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405407
4.
Public Health ; 175: 108-110, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31470236

RESUMO

OBJECTIVES: The aim of the study was to quantify the current shortage of general surgeons in the state of Georgia and to estimate the shortage in 2040. STUDY DESIGN: This is a population-based longitudinal study. METHODS: Data were collected from the US Census Bureau, the Georgia Board for Physician Workforce, and the Accreditation Council for Graduate Medical Education to evaluate changes in the supply of general surgeons from 2000 to 2017 and estimate an expected shortage through 2040. RESULTS: The state of Georgia experienced a net loss of 120 surgeons from 2000 to 2017 and currently faces a shortage of 139 general surgeons. We project a deficit of between 285 and 725 general surgeons in the state of Georgia by 2040. CONCLUSION: Georgia will face a substantial general surgical workforce shortage by 2040. Enhanced efforts at boosting both the output of surgical training programs as well as recruitment and retention of surgeons may help alleviate this deficit.


Assuntos
Previsões , Clínicos Gerais/provisão & distribução , Cirurgia Geral/organização & administração , Mão de Obra em Saúde/tendências , Georgia , Humanos , Estudos Longitudinais , Saúde Pública
5.
Am Surg ; 85(6): 595-600, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267899

RESUMO

Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.


Assuntos
Tratamento de Emergência/métodos , Cirurgia Geral/organização & administração , Transferência de Pacientes/organização & administração , Qualidade da Assistência à Saúde , Estudos de Coortes , Bases de Dados Factuais , Emergências , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Relações Interinstitucionais , Tempo de Internação , Masculino , Maryland , Estudos Retrospectivos , Contrato de Transferência de Pacientes
8.
Rev Epidemiol Sante Publique ; 67(4): 213-221, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31196581

RESUMO

BACKGROUND: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls. METHODS: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half. RESULTS: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10-4); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10-3). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding. CONCLUSION: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays.


Assuntos
Codificação Clínica , Medicina Geral , Cirurgia Geral , Tempo de Internação , Informática Médica , Obstetrícia , Controle de Qualidade , Estudos de Casos e Controles , Codificação Clínica/organização & administração , Codificação Clínica/normas , Grupos Diagnósticos Relacionados/organização & administração , Grupos Diagnósticos Relacionados/normas , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Honorários Médicos , Feminino , França , Medicina Geral/organização & administração , Medicina Geral/normas , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Informática Médica/métodos , Informática Médica/organização & administração , Informática Médica/normas , Obstetrícia/organização & administração , Obstetrícia/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde , Programas Médicos Regionais/organização & administração , Programas Médicos Regionais/normas , Fatores de Tempo , Carga de Trabalho
9.
World J Surg ; 43(9): 2175-2185, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31049605

RESUMO

BACKGROUND: Proper documentation is an essential part of patient safety and quality of care in the surgical field. Surgical procedures are traditionally documented in narrative operative reports which are subjective by nature and often lack essential information. This systematic review will analyze the added value of the newly emerged synoptic reporting technique in the surgical setting. METHODS: A systematic review was conducted to compare the completeness and the user-friendliness of the synoptic operative report to the narrative operative report. A literature search was performed in EMBASE, Ovid MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar for studies published up to April 6, 2018. The Newcastle-Ottawa Scale was utilized for the risk of bias assessment of the included articles. PROSPERO registration number was: CRD42018093770. RESULTS: Overall and subsection completion of the operative report was higher in the synoptic operative report. The time until completion of the operative report and the data extraction time were shorter in the synoptic report. One exception was the specific details section concerning the operative procedure, as this was generally reported more frequently in the narrative report. The use of mandatory fields in the synoptic report resulted in more completely reported operative outcomes with completion percentages close to 100%. CONCLUSIONS: The synoptic operative report generally demonstrated a higher completion rate and a much lower time until completion compared to the traditional narrative operative report. A hybrid approach to the synoptic operative report will potentially yield better completion rates and higher physician satisfaction.


Assuntos
Sistemas Computadorizados de Registros Médicos/normas , Procedimentos Cirúrgicos Operatórios/normas , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Humanos , Registros Médicos , Narração
10.
World J Surg ; 43(9): 2186-2193, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31089767

RESUMO

BACKGROUND: Classical medical teaching has made a clear distinction between signs and symptoms, and diagnosis. However, at the time of ward admission, a diagnosis may remain unclear. We propose administrative pressures during the admission process may have reduced the ability for pathological diagnosis. This may result in increased hospitalisation for investigation of signs and symptoms, rather than for treatment of clear diagnoses. We sought to further clarify this hypothesis and investigate changes in the nature of admissions during the last two decades in an adult emergency general surgery service. METHODS: A retrospective analysis of emergency general surgical admissions during four six-month time periods, between 2000 and 2018, was conducted. The six-month periods were spaced evenly during the 18-year study. Demographic information, emergency department length of stay, incidence of a pathological diagnosis on ward admission and accuracy of admission diagnosis were analysed. RESULTS: 2763 patients were admitted in the four six-month time periods. A significant reduction in number of patients admitted with a pathological diagnosis was noted between the 2012 and 2018 study periods (p < 0.05), with 21.2% of patients admitted in 2018 for investigation of signs and symptoms. The incidence of an accurate admission diagnosis (as assessed by the discharge diagnosis) ranged from 62.3 to 63.6% and did not differ significantly by year. CONCLUSION: Between 2012 and 2018, there was a significant increase in the number of emergency general surgical patients admitted for investigation of signs and symptoms. However, accuracy of admission diagnosis was unchanged during the study period.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Feminino , Cirurgia Geral/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/normas , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Austrália Ocidental , Adulto Jovem
13.
Updates Surg ; 71(1): 97-103, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29770922

RESUMO

The value of minimally invasive pancreatic surgery (MIPS) is still debated. To assess the diffusion of MIPS in Italy and identify the barriers preventing wider implementation, a questionnaire was developed under the auspices of three Scientific Societies (AISP, It-IHPBA, SICE) and was sent to the largest possible number of Italian surgeons also using the mailing list of the two main Italian Surgical Societies (SIC and ACOI). The questionnaire consisted of 25 questions assessing: centre characteristics, facilities and technologies, type of MIPS performed, surgical techniques employed and opinions on the present and future value of MIPS. Only one reply per unit was considered. Fifty-five units answered the questionnaire. While 54 units (98.2%) declared to perform MIPS, the majority of responders were not dedicated to pancreatic surgery. Twenty-five units (45.5%) performed < 20 pancreatic resections/year and 39 (70.9%) < 10 MIPS per year. Forty-nine units (89.1%) performed at least one minimally invasive (MI) distal pancreatectomy (DP), and 10 (18.2%) at least one MI pancreatoduodenectomy (PD). Robotic assistance was used in 18 units (31.7%) (14 DP, 7 PD). The major constraints limiting the diffusion of MIPS were the intrinsic difficulty of the technique and the lack of specific training. The overall value of MIPS was highly rated. Our survey illustrates the current diffusion of MIPS in Italy and underlines the great interest for this approach. Further diffusion of MIPS requires the implementation of standardized protocols of training. Creation of a prospective National Registry should also be considered.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreatectomia/estatística & dados numéricos , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Cirurgiões , Inquéritos e Questionários , Cirurgia Geral/organização & administração , Humanos , Itália/epidemiologia , Laparoscopia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Sociedades Médicas/organização & administração
14.
J Am Coll Surg ; 228(1): 21-28.e7, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30359826

RESUMO

BACKGROUND: Annually, more than 2 million patients are admitted with emergency general surgery (EGS) conditions. Emergency general surgery cases comprise 11% of all general surgery operations, yet account for 47% of mortalities and 28% of complications. Using the statewide general surgery Michigan Surgical Quality Collaborative (MSQC) data, we previously confirmed that wide variations in EGS outcomes were unrelated to case volume/complexity. We assessed whether patient care model (PCM) affected EGS outcomes. STUDY DESIGN: There were 34 hospitals that provided data for PCM, resources, surgeon practice patterns, and comprehensive MSQC patient data from January 1, 2008 to December 31, 2016 (general surgery cases = 126,494; EGS cases = 39,023). Risk and reliability adjusted outcomes were determined using hierarchical multivariable logistic regression analysis with multiple clinical covariates and PCM. RESULTS: The general surgery service (GSS) model was more common (73%) than acute care surgery (ACS, 27%). Emergency general surgery 30-day mortality was 4.1% (intestinal resections 11.6%). The ACS model was associated with a reduction of 31% in mortality (odds ratio [OR] 0.69; 95% CI 0.52-0.92] for EGS cases, related to decreased mortality in the intestinal resection cohort (8.5% ACS vs 12% GSS, p < 0.0001). Morbidity in EGS was 17.4% (9.7% elective); highest (40%) in intestinal resection, and PCM did not affect morbidity. We identified specific variables for an optimal EGS risk adjustment model. CONCLUSIONS: This is the first multi-institutional study to identify that an ACS model is associated with a significant 31% mortality reduction in EGS using prospectively collected, clinically obtained, research-quality collaborative data. We identified that new risk adjustment models are necessary for EGS outcomes evaluations.


Assuntos
Emergências , Cirurgia Geral/organização & administração , Modelos Organizacionais , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Michigan
16.
Ann Surg ; 269(3): 582-588, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29342020

RESUMO

OBJECTIVE: To quantify gender composition of 10 high-impact general surgery journals, delineate how board composition has changed over time, and evaluate qualification metrics by gender. BACKGROUND: Underrepresentation of women on editorial boards may contribute to the gender-based achievement gap in surgery. METHODS: We performed a cross-sectional analysis of the editorial board gender composition among 10 high-impact general surgery journals in 1997, 2007, and 2017. Univariate and multivariate regression analyses were used to assess differences in editors' H-indices, academic rank, and number of advanced degrees. Differences in editor turnover and multiple board positions were evaluated for each time interval. RESULTS: Over 20 years, the proportion of women on editorial boards increased from 5% to 19%. After controlling for time since board certification, no differences between men and women's number of advanced degrees, H-indices, or academic rank remained significant. Women and men were equally likely to hold multiple board positions (1997 P = 0.74; 2007 P = 0.42; 2017 P = 0.69), but men's editorial board tenure was longer across each time interval (1997-2007 P = 0.003; 2007-2017 P < 0.001; 1997-2017 P = 0.01). CONCLUSIONS: Women surgeons have a small but growing presence on surgical editorial boards, and gender-based qualification differences are likely attributable to practice length. Men's longer tenure on editorial boards may drive some of the observed disparity by limiting new appointment opportunities. Strategies such as imposing term limits or instituting merit-based performance reviews may help editorial boards capture the field's changing demographics.


Assuntos
Cirurgia Geral/tendências , Publicações Periódicas como Assunto/tendências , Médicas/tendências , Sexismo/tendências , Mobilidade Ocupacional , Estudos Transversais , Feminino , Cirurgia Geral/organização & administração , Cirurgia Geral/estatística & dados numéricos , Humanos , Fator de Impacto de Revistas , Modelos Logísticos , Masculino , Publicações Periódicas como Assunto/estatística & dados numéricos , Médicas/organização & administração , Médicas/estatística & dados numéricos , Sexismo/estatística & dados numéricos
17.
Ann Surg ; 269(1): 73-78, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29064896

RESUMO

OBJECTIVE: To describe public willingness to participate in regionalized surgical care for cancer. SUMMARY OF BACKGROUND DATA: Improved outcomes at high-volume centers following complex surgery have driven a push to regionalize surgical care. Patient attitudes toward regionalization are not well described. METHODS: As part of the Cornell National Social Survey, a cross-sectional telephone survey was performed. Participants were asked about their willingness to seek regionalized care in a hypothetical scenario requiring surgery. Their responses were compared with demographic characteristics. A geospatial analysis of hospital proximity was performed, as well as a qualitative analysis of barriers to regionalization. RESULTS: Cooperation rate was 48.1% with 1000 total respondents. They were an average of 50 years old (range 18 to 100 years) and 48.9% female. About 49.6% were unwilling to travel 5 hours or more to seek regionalized care for improved survival. Age >70 years [odds ratio (OR) 0.34, 95% confidence interval (95% CI) 0.19-0.60] and perceived distance to a center >30 minutes (OR 0.60, 95% CI 0.41-0.86) were associated with decreased willingness to seek regionalized care, while high income (OR 2.09, 95% CI 1.39-3.16) was associated with increased willingness. Proximity to a major center was not associated with willingness to travel (OR 0.92, 95% CI 0.67-1.22). Major perceived barriers to regionalization were transportation, life disruption, social support, socioeconomic resources, poor health, and remoteness. CONCLUSION: Americans are divided on whether the potential for improved survival with regionalization is worth the additional travel effort. Older age and lower income are associated with reduced willingness to seek regionalized care. Multiple barriers to regionalization exist, including a lack of knowledge of the location major centers.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/organização & administração , Cirurgia Geral/organização & administração , Pesquisas sobre Serviços de Saúde/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Regionalização/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Viagem , Estados Unidos , Adulto Jovem
19.
East Mediterr Health J ; 24(9): 866-876, 2018 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-30570119

RESUMO

Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services. Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons. Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age. Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (ß = 0.427). Female specialists (ß = -0.049) and full-time specialists (ß = -0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P < 0.001) and as the population increases, FTE increases (P < 0.05). Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.


Assuntos
Cirurgia Geral/organização & administração , Adulto , Idoso , Feminino , Cirurgia Geral/estatística & dados numéricos , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Setor Privado/organização & administração , Setor Privado/estatística & dados numéricos , Setor Público/organização & administração , Setor Público/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo
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