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1.
Artigo em Russo | MEDLINE | ID: mdl-33591659

RESUMO

The sociological survey of medical specialists is summoned to identify problematic areas of organization nature in functioning of ultrasound service and to elaborate effective measures to eliminate them. The purpose of research: to study opinions of medical specialists concerning state and priority directions of enhancement of ultrasound diagnostics in children. MATERIALS AND METHODS: The survey of 196 medical specialists in ultrasound diagnostics was carried out using questionnaire that included questions on evaluation of functioning of corresponding medical organizations, ultrasound diagnostics included, satisfaction with their work and means of improving ultrasound service. RESULTS: The majority of respondents were satisfied with their activities, functioning of ultrasound diagnostics their medical organizations in whole and in ultrasound diagnostics in particular. The main cause of dissatisfaction was condition of material and technical base. According to respondents, equipping medical organizations with devices of ultrasound diagnostics within the framework of implementation of program of health care modernization made no due contribution into increasing efficiency of functioning of ultrasound diagnostics service. CONCLUSION: Considering the high level of professional training, the responses of respondents are competent and permit to identify shortcomings, reserves and means of improving their professional activities.


Assuntos
Medicina , Especialização , Criança , Humanos , Satisfação Pessoal , Inquéritos e Questionários
2.
Artigo em Russo | MEDLINE | ID: mdl-33591669

RESUMO

The ultrasound studies are highly informative diagnostic methods. The modern ultrasound devices can be applied as component of mobile telemedicine systems that can significantly increase availability of medical care. However, application of ultrasound scanners requires inclusion of ultrasound diagnostics specialist in the medical team that is not always nor possible or appropriate. In the modern regulatory legal base, transfer of certain functions of ultrasound diagnostics specialist to average medical staff is not provided. The article considers issue of genuine development and testing method of implementation of ultrasound examinations by paramedical personnel under remote control of physician. Two organizational models were tested within the framework of organizational experiment. In the first model, physician monitored progress of examination by telemedicine monitor and, if necessary, directed actions of medical nurse. In the second model, the nurse independently obtained images of patients' organs, and physician according received visual information formulated final conclusion. The organizational experiment included patients with pathology of abdominal cavity, retroperitoneal space and lower limb arteries. Results. On the basis on results of 156 examinations, time-consuming analysis was performed, and effectiveness of developed methods was evaluated. The proposals were proposed to include additions into professional standard of ultrasound diagnostics nurse and to substantiate the need of altering the training programs for paramedical personnel.


Assuntos
Médicos , Telemedicina , Pessoal Técnico de Saúde , Humanos , Especialização
3.
Br Dent J ; 230(1): 14-16, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33420449

RESUMO

For years, the British Society of Paediatric Dentistry has been highlighting the shortage of specialists in paediatric dentistry in the UK and the consequent inadequacy of provision of, and inequality of access to, specialist care. This is a problem which must be addressed nationally. The aim of this article is to understand the obstacles to change and the impact of this continuing shortage, with a particular focus on the decline in the numbers of non-consultant specialists. I will examine the challenges and possible solutions, taking into account the impact of COVID-19 on service delivery.


Assuntos
Criança , Humanos , Odontopediatria , Especialização , Reino Unido
4.
J Am Dent Assoc ; 152(2): 127-135, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33494867

RESUMO

BACKGROUND: Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. METHODS: Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient. RESULTS: Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922). CONCLUSIONS: Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions. PRACTICAL IMPLICATIONS: Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.


Assuntos
Aplicativos Móveis , Consulta Remota , Idoso de 80 Anos ou mais , Odontólogos , Humanos , Smartphone , Especialização
6.
Exp Appl Acarol ; 83(2): 167-182, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33483836

RESUMO

The generalist predator Euseius stipulatus (Athias-Henriot) and the Tetranychidae-specialist predators Neoseiulus californicus (McGregor) and Phytoseiulus persimilis Athias-Henriot play a key role in the regulation of Tetranychus urticae Koch in Spanish citrus orchards. Previous studies have shown that sour orange (Citrus aurantium L.) and Cleopatra mandarin (Citrus reshni hort. ex Tan.) display extreme resistance and susceptibility to T. urticae, respectively. When offered a choice between these two genotypes infested by T. urticae, E. stipulatus preferred Cleopatra mandarin, whereas the specialists did not show any preference. The present study was undertaken to check whether these preferences could be related to the feeding of E. stipulatus on the host plant and/or to differences in prey feeding on the two plants. Our results demonstrate that E. stipulatus is a zoophytophagous mite, which can engage in direct plant feeding in sour orange and Cleopatra mandarin, whereas neither N. californicus nor P. persimilis do so. Whereas Cleopatra mandarin provided a higher-quality prey/feeding substrate for E. stipulatus, which may be related to its phytophagy, no differences were observed for the two specialists. As higher constitutive and faster inducible defense against T. urticae in sour orange relative to Cleopatra mandarin plants result in sour orange supporting lower T. urticae densities and plant damage, our results demonstrate that pest regulation by specialist natural enemies may be more effective when prey feed on better defended plants.


Assuntos
Citrus , Ácaros , Tetranychidae , Animais , Controle Biológico de Vetores , Comportamento Predatório , Especialização
7.
Oecologia ; 195(2): 539-546, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33367959

RESUMO

Strong declines of grassland species diversity in small and isolated grassland patches have been observed at local and landscape scales. Here, we study how plant-herbivore interaction webs and habitat specialisation of leafhopper communities change with the size of calcareous grassland fragments and landscape connectivity. We surveyed leafhoppers and plants on 14 small (0.1-0.6 ha) and 14 large (1.2-8.8 ha) semi-natural calcareous grassland fragments in Central Germany, differing in isolation from other calcareous grasslands and in the percentage of arable land in the surrounding landscape (from simple to complex landscapes). We quantified weighted trophic links between plants and their phytophagous leafhoppers for each grassland fragment. We found that large and well-connected grassland fragments harboured a high portion of specialist leafhopper species, which in turn yielded low interaction diversity and simple plant-leafhopper food webs. In contrast, small and well-connected fragments exhibited high levels of generalism, leading to higher interaction diversity. In conclusion, food web complexity appeared to be a poor indicator for the management of insect diversity, as it is driven by specialist species, which require high connectivity of large fragments in complex landscapes. We conclude that habitat specialists should be prioritized since generalist species associated with small fragments are also widespread in the surrounding landscape matrix.


Assuntos
Conservação dos Recursos Naturais , Cadeia Alimentar , Animais , Biodiversidade , Ecossistema , Alemanha , Pradaria , Insetos , Especialização
8.
Sports Health ; 13(1): 25-30, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32631208

RESUMO

BACKGROUND: The relationships between sport specialization, physical activity, sleep, and illness in younger athletes are unknown. Therefore, the purpose of this study was to evaluate the independent effects of sport specialization, sleep, and physical activity on illness in middle school athletes. HYPOTHESIS: Decreased sleep, decreased physical activity, and higher levels of sport specialization will be associated with an increased risk of illness among middle school athletes. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Parents of middle school-aged children reported baseline sport specialization (low, moderate, or high) as well as sleep duration, physical activity, and illnesses every week throughout the academic year. A mixed-effects logistic regression model was used to assess the association between illness and specialization while accounting for sleep and physical activity for the prior week as fixed effects and each individual as a random effect. RESULTS: A total of 233 children (mean age, 12.1 ± 1.2 years; 61% male) participated, of whom 41%, 25%, and 34% were categorized as low, moderate, and high specialization, respectively. The proportion of individuals who experienced illness did not differ by specialization level (low, 76%; moderate, 70%; high, 59%; P = 0.064). In the multivariable model, the odds of illness compared with the low specialization group was not significantly different for moderate (odds ratio [OR], 0.93; 95% CI, 0.70-1.23; P = 0.61) or high specialization (OR, 0.76; 95% CI, 0.56-1.03; P = 0.073). A decreased risk of illness was associated with greater prior week sleep (OR, 0.79; 95% CI, 0.69-0.91; P < 0.001) and physical activity (OR, 0.94; 95% CI, 0.92-0.96; P < 0.001). CONCLUSION: Sport specialization is not associated with an increased risk of illness among middle school athletes, while increased sleep duration and physical activity appear to reduce the risk of illness. CLINICAL RELEVANCE: Interventions to promote physical activity and improve sleep may reduce the risk of illness in early adolescent athletes.


Assuntos
Exercício Físico , Privação do Sono/fisiopatologia , Especialização , Esportes Juvenis/fisiologia , Adolescente , Criança , Transtornos Traumáticos Cumulativos/fisiopatologia , Feminino , Humanos , Masculino , Condicionamento Físico Humano/fisiologia , Estudos Prospectivos , Fatores de Risco
9.
Eur J Endocrinol ; 184(1): 9-17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112271

RESUMO

Objective: Severe hyponatraemia (plasma sodium concentration, pNa <120 mmol/L) is reported to be associated with mortality rates as high as 50%. Although there are several international guidelines for the management of severe hyponatraemia, there are few data on the impact of treatment. Design and methods: We have longitudinally reviewed rates of specialist input, active management of hyponatraemia, treatment outcomes and mortality rates in patients with severe hyponatraemia (pNa <120 mmol/L) in 2005, 2010 and 2015, and compared the recent mortality rate with that of patients with pNa 120-125 mmol/L. Results: Between 2005 and 2010 there was a doubling in the rate of specialist referral (32 to 68%, P = 0.003) and an increase in the use of active management of hyponatraemia in patients with pNa <120 mmol/L (63 to 88%, P = 0.02), associated with a reduction in mortality from 51 to 15% (P < 0.001). The improved rates of intervention were maintained between 2010 and 2015, but there was no further reduction in mortality. When data from all three reviews were pooled, specialist consultation in patients with pNa <120 mmol/L was associated with a 91% reduction in mortality risk, RR 0.09 (95% CI: 0.03-0.26), P < 0.001. Log-rank testing on in-hospital survival in 2015 found no significant difference between patients with pNa <120 mmol/L and pNa 120-125 mmol/L (P = 0.56). Conclusion: Dedicated specialist input and active management of severe hyponatraemia are associated with a reduction in mortality, to rates comparable with moderate hyponatraemia.


Assuntos
Gerenciamento Clínico , Hiponatremia/mortalidade , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Especialização/estatística & dados numéricos , Idoso , Feminino , Humanos , Hiponatremia/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Sódio/sangue , Resultado do Tratamento
10.
Chirurgia (Bucur) ; 115(6): 756-766, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378634

RESUMO

Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.


Assuntos
Colecistectomia Laparoscópica , Colelitíase , Especialização/normas , Especialidades Cirúrgicas/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/mortalidade , Colecistectomia Laparoscópica/normas , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/cirurgia , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Especialização/estatística & dados numéricos , Especialidades Cirúrgicas/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
11.
Environ Entomol ; 49(6): 1402-1414, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33315074

RESUMO

Recent studies suggest that endosymbionts of herbivore insects can be horizontally transferred to other herbivores feeding on the same host plants, whereby the plant acts as an intermediate stage in the chain of transmission. If this mechanism operates, it is also expected that insect communities sharing the same host plant will have higher chances to share their endosymbionts. In this study, we use a high-throughput 16S rRNA metabarcoding approach to investigate the presence, diversity, and potential sharing of endosymbionts in several species of leaf beetles (Coleoptera: Chrysomelidae) of a local community specialized on an alder diet in North America. Rickettsia and Wolbachia were predominant in the sample, with strong evidence for each species having their own dominant infection, of either or both types of bacteria. However, all species shared a much lower proportion of a particular Wolbachia type, compatible with the same strain dominant in one of the species of leaf beetles. Crucially, the same 16S rRNA haplotype of Wolbachia was found on alder leaf extracts. The combined evidence and the absence of this strain in a syntopic species of leaf beetle feeding on a different host plant support the hypothesis that at least the initial stages of the mechanism that would allow horizontal transmission of endosymbionts across species feeding on the same plant is possible. The accessibility and characteristics of endosymbiont associations of this system make it suitable for deeper analyses of their diversity and transmission in natural conditions.


Assuntos
Alnus , Besouros , Animais , Insetos , América do Norte , Filogenia , RNA Ribossômico 16S/genética , Especialização , Simbiose
12.
Rev. cuba. med ; 59(4): e1398, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144503

RESUMO

Introducción: La evaluación de graduación constituye el examen de culminación de los estudios de la especialización, correspondiente a la enseñanza de posgrado. Objetivo: Proponer y fundamentar la realización de modificaciones en la evaluación de graduación de la especialidad Medicina Interna, en nuestro contexto. Método: Investigación sustentada en el análisis de documentos metodológicos y en una reflexión crítica de la praxis, para la construcción teórica de la propuesta de modificaciones. Resultados: A partir de la identificación de puntos de mejoría y guiados por una serie de principios, se proponen los siguientes cambios: 1) readecuación en la secuencia de los ejercicios teóricos y prácticos que conforman el examen estatal, 2) mayor peso de las actividades prácticas en la evaluación, tanto por aumento del número de actividades como por el tiempo destinado a las ejecuciones, 3) representación más amplia de la diversidad de habilidades y competencias objetivo de aprendizaje en la residencia, y 4) una mirada más exigente y valorizada de las competencias investigativas en general, y del trabajo de terminación de la especialidad en particular. Conclusiones: Mediante los cambios que se proponen se logra una certificación más real y objetiva de las competencias profesionales de los educandos para el cumplimiento del encargo social, y contribuye al mejoramiento de la calidad del profesional egresado, al estimular un proceso formativo dirigido a garantizar la aplicación de los conocimientos(AU)


Introduction: The graduation evaluation constitute the final assessment of the specializing studies, corresponding to postgraduate education. Objective: To propose and to substantiate the conduction of modifications in the graduation evaluation of Internal Medicine specialty, in our context. Method: A research based on the analysis of methodological documents and on praxis critical reflection was carried out for the theoretical construction of the proposed modifications. Results: From the identification of çimprovement points and guided by a series of principles, the following changes are proposed: 1) Readjusting the sequence of theoretical and practical exercises that make up the state exams, 2) Providing greater importance of practical activities in the assessment, both due to the increase in the number of activities and the time allocated to performing, 3) Bringing broader representation of the diversity of skills and competencies which are learning objective in the residence, and 4) Demanding and measuring more the research competences in general, and of the completion paper of the specialty in particular. Conclusions: These proposed changes result in more real and objective certification of the professional competences of the students for achieving the fulfillment of the social mandate. These changes improve the quality of the professional, by stimulating a training process aimed at guaranteeing the application of knowledge(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Especialização/normas , Medicina Interna/educação , Competência Profissional , Avaliação Educacional/métodos
13.
Arq Neuropsiquiatr ; 78(12): 757-761, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33331512

RESUMO

BACKGROUND: The rapid evaluation of non-contrast-enhanced computed tomography (NCCT) brain scans in patients with anterior stroke symptoms saves time and favors optimal and prompt treatment. e-ASPECTS is a tool that automatically calculates the Alberta Stroke Program Early CT Score (ASPECTS) values, leading to a more accurate and timely image evaluation. OBJECTIVE: To determine the ability of e-ASPECTS in differentiating images with and without injury. METHODS: One-hundred sixteen patients admitted to a stroke unit in a Brazilian tertiary hospital underwent a CT scan at admission and at least one control brain imaging (NCCT or magnetic resonance imaging - MRI) 24 hours after admission. ASPECTS evaluation was performed by three neuroradiologists, three neurologists, and three neurology residents, all blinded to the symptoms and the injury side. The scores were compared to the ground truth, and an ASPECTS score was provided by two independent non blinded evaluators. Sensitivity and specificity were analyzed, and receiver operating characteristic curves, Bland-Altman plots with mean error score, and Matthews correlation coefficients (MCCs) were obtained for ASPECTS scores, assuming values equal to 10 for images without injury and values other than 10 for images with ischemic injury. RESULTS: e-ASPECTS demonstrated similar performance to that of neuroradiologists and neurologists, with an area under the curve of 0.78 and an MCC value of 0.48 in the dichotomous analysis. The sensitivity and specificity of e-ASPECTS were 75% and 73%, respectively. CONCLUSION: e-ASPECTS is a validated and reliable tool for determining early signs of ischemia in NCCT.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Alberta , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Brasil , Humanos , Especialização , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
14.
Vnitr Lek ; 66(6): 335-339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380136

RESUMO

Anaphylaxis is a serious, potentially lifethreatening condition, and all healthcare professionals should be aware of it. Prompt recognition of anaphylaxis signs and early initiation of adequate treatment are essential for successful acute management. The firstline treatment is the administration of intramuscular adrenalin, followed by other interventions. Patients should be moni tored after recovery for possible biphasic reaction. Before discharge, the individual risk of further reaction should be assessed and where appropriate an adrenalin autoinjector should be prescribed. Allergy specialist followup is essential for the identification of possible triggers and cofactors. Elimination of these factors reduces the risk of future reactions. Useful preventive measure is allergen immunotherapy, which is definitely indicated in patients with anaphylaxis induced by an insect sting.


Assuntos
Anafilaxia , Anafilaxia/diagnóstico , Anafilaxia/terapia , Conscientização , Epinefrina , Humanos , Especialização
15.
Artigo em Russo | MEDLINE | ID: mdl-33161665

RESUMO

In actual conditions health care priority is in increasing population size and its life expectancy including duration of healthy life, reducing morbidity, mortality and disability of population, observance of rights of citizens related to health protection that can effectively be achieved by adherence of healthy lifestyle. In order to determine possibility of improving motivation of population to lead healthy lifestyle, through formation of leadership qualities in medical specialists, the study applied such methods as expert evaluation, questionnaire survey, interview, monographic and statistical techniques. The sampling consisted of 46 employees of the I. M. Sechenov First Moscow State Medical University as experts, 107 students of this educational organization were involved in questionnaire survey and interviewing, and 68 of them were included in the group with pronounced leadership qualities, and 39 respondents consisted the control group. Involving population into healthy lifestyle is priority task of all medical specialists that is regulated by work functions of their professional standards. The effective direction of this work is to influence internal motivation of citizens. The presence of leadership qualities in future medical specialists increases their ability to motivate the population to lead healthy lifestyle at the level of theoretical training by 33.3% and practical training by 65.5% as compared to control group. The main directions of improving motivational work to involve population into healthy lifestyle by future medical specialists is refusal by students' bad habits, teaching them specialized topics in all related disciplines, formation of students' leadership potential. To develop student's leadership skills, training program can be applied in the laboratory of excellence "Factory of health leaders", implemented at the N. A. Semashko Department of public health and health care.


Assuntos
Motivação , Especialização , Estilo de Vida Saudável , Humanos , Liderança , Moscou
16.
Artigo em Russo | MEDLINE | ID: mdl-33161674

RESUMO

The article considers main issues of implementing the lean polyclinic project in practice of Russian polyclinic institutions. The main problems that can be solved by implementing the principles of economical production, optimizing operations and eliminating losses, including financial ones, are identified. It is concluded that saved funds can be distributed to motivate employees in the form of higher salaries and bonuses, as well as to provide training opportunities, to attend conferences by specialists. This approach results in reasonable use of the Federal funds, the mandatory medical insurance Fund, and regional budgets.


Assuntos
Salários e Benefícios , Especialização , Federação Russa
17.
Artigo em Russo | MEDLINE | ID: mdl-33161675

RESUMO

The personnel policy is one of priority areas of developing national health care. Its effective implementation requires evidence-based development of relevant program documents, the most important of which is the Concept of health care personnel policy that currently exists only in a number of regions of the Russian Federation. In this regard, the purpose of the study was to develop approaches to scientific justification and development of the Concept of health care personnel policy at the level of region of the Russian Federation, as exemplified in the Irkutsk oblast. The article describes progress of this large-scale and lengthy study, its main results included. The developed approaches resulted in comprehensive organizational technology of development corresponding Concept. The results of this experience can be implemented in other regions of the Russian Federation. Therefore, it is of scientific and practical interest for all potential developers of similar program documents and wide range of specialists in health care organization.


Assuntos
Assistência à Saúde , Política de Saúde , Federação Russa , Especialização
18.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 28(Special Issue): 1068-1074, 2020 Oct.
Artigo em Russo | MEDLINE | ID: mdl-33219760

RESUMO

In the health care sector, due to a long cycle of accumulation of human capital, a change of profession often leads to a disruption of this cycle. Therefore, stable employment in the workplace for medical specialists is preferable and should be accompanied by permanent qualification growth within the framework of the profession. Labour mobility to a large extent contradicts this process. One of its most powerful incentives is dissatisfaction with earnings, and this article presents an analysis of the impact of this dissatisfaction on readiness for vocational and labour mobility, based on a questionnaire survey of doctors and nurses of Moscow health care system. A reference group of specialists with proactive attitude towards vocational and professional growth has been singled out. Its assessments of satisfaction with the size of earnings and with correspondence between earnings and labour contribution showed that the dissatisfaction with the inadequacy of earnings is widely spread. This dissatisfaction relates to both base salary and incentive payments against labour contribution. An increase in base salary and in incentive payments together with a simultaneous increase in the share of incentive payments should be the basis for adjusting the wage system. A more accurate accounting of the workload (which has grown as a result of optimization) in earnings is also relevant for paramedical personnel. Should the authorities fail to do this, the undesirable staff turnover, which is already high, may increase even further.


Assuntos
Salários e Benefícios , Especialização , Atitude , Humanos , Moscou , Reorganização de Recursos Humanos
19.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 28(Special Issue): 1131-1136, 2020 Oct.
Artigo em Russo | MEDLINE | ID: mdl-33219770

RESUMO

The aim of the study is to develop a predictive model of the probable contraction of psychosomatic disorders among specialists in the utilization of radioactive substances. The predictive model was developed in order to prevent occupational diseases and preserve the mental health of specialists. The development of the model was carried out on the basis of the results of empirical research focused on identifying biopsychosocial factors that determine or, on the contrary, block the development of vitality in specialists. The vitality is here understood by us as the ability to manage the internal personal resources in the professional situations of personal stress, thereby ensuring one`s professional health. 179 specialists in the utilization of radioactive substances were examined. The study was carried out using a set of specially selected techniques: Scale «Psychosomatic disorders¼ by V. V. Boyko, methods for studying psychophysiological status (data on the brain wave activity (EEG); assessment of the functional state of the nervous system based on a simple and complex visual motor reaction; the color test by M. Luscher), individual psychological characteristics (the method of colour metaphors by I. L. Solomin, diagnostics of latent motivation, the Mini-Mult questionnaire, «The dominant type of interpersonal relations¼ methodology) and social situation of life (the questionnaire by the authors). As a result of the study, there were identified 32 features that have a statistically significant relationship with indicators of psychosomatic disorders (p < 0.001). The identified features were included in multiple logistic regression analysis as independent variables. As a result of further processing of the empirical data, carried out with the help of the method of step-by-step exclusion of variables, a predictive model of the likelihood of psychosomatic disorders in radioactive waste utolozation specialists was constructed, which was based on a subjective assessment of the living standards, the presence of a distrustful-skeptical type in interpersonal relationships and manifestations of paranoia.


Assuntos
Doenças Profissionais , Transtornos Psicofisiológicos , Humanos , Saúde Mental , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/epidemiologia , Especialização , Inquéritos e Questionários
20.
Obstet Gynecol ; 136(5): 981-986, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030879

RESUMO

Shortly after its inception, the Society for Academic Specialists in General Obstetrics and Gynecology recognized that no data described the composition and faculty activities of "academic generalist divisions." Consequently, in 2018, the Society for Academic Specialists in General Obstetrics and Gynecology appointed a presidential task force and conducted the current surveys of chairs and division directors and key informant interviews to understand the composition and faculty activities in divisions of academic specialists in departments of obstetrics and gynecology and propose criteria for excellence in each mission area to guide development of divisions. In 2014, with Society for Academic Specialists in General Obstetrics and Gynecology's guidance, these divisions were referred to as academic specialists divisions and the faculty within as academic specialists to emphasize that they provide specialized women's health care in academic settings. The divisions comprised approximately 30% of departments' full-time faculty (median 12). In 27% of the departments, these divisions contributed more than half of departmental revenue, and 49% contributed 26-50%. Nearly 90% of divisions provided a sizeable proportion of the department's total teaching efforts. Compensation relied more on clinical productivity than on seniority, quality, academic contributions, or academic rank. Subsequently, five performance domains were identified to help divisions define divisional excellence: clinical, education, research, service & advocacy, and academic environment. Furthermore, excellent divisions were characterized as those with outstanding clinicians and educators who emphasize scholarly productivity. Although academic specialists contribute significantly to their departments' financial, clinical, and educational productivity, many have limited opportunities for scholarly activity. Achieving divisional excellence likely will depend on the ability to recruit and retain faculty with career expectations that align with the division's prioritized performance domains.


Assuntos
Docentes de Medicina/tendências , Ginecologia/tendências , Obstetrícia/tendências , Especialização/tendências , Centros Médicos Acadêmicos , Comitês Consultivos , Docentes de Medicina/organização & administração , Feminino , Ginecologia/educação , Ginecologia/organização & administração , Humanos , Obstetrícia/educação , Obstetrícia/organização & administração , Gravidez , Sociedades Médicas
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