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1.
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
2.
J Vasc Interv Radiol ; 31(9): 1449-1452, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32868018

RESUMO

In this article, the updated status of interventional radiology (IR) in China is reported and compared vs that a decade ago based on a poll carried out in 2017 in Jiangsu Province, where the economy and overall health level are among the best of the 31 provinces in China. All 98 polled centers responded, and 56 IR departments (57%) had become independent departments separate from the radiology department; 74 (76%) had inpatient wards. In 2017, there were 538 interventional radiologists performing IR procedures in Jiangsu Province, with a total of 69,277 procedures performed, with interventional oncologic procedures accounting for the largest proportion (58%).


Assuntos
Radiografia Intervencionista/tendências , Radiologistas/tendências , Serviço Hospitalar de Radiologia/tendências , Pesquisa Biomédica/tendências , China , Pesquisas sobre Serviços de Saúde , Humanos , Especialização/tendências , Fatores de Tempo
3.
Orthop Clin North Am ; 51(4): 517-525, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950221

RESUMO

Early sports specialization (ESS) is a relatively new trend that has led to many youth athletes to focus on only 1 sport at an increasingly young age. Although parents and coaches perceive that this will improve their athlete's chances of success at the collegiate and professional levels, studies have shown the opposite. ESS leads to increased injury risk, higher rates of burnout, and lower lifelong sports participation without increasing elite achievement. Throwing athletes are particularly vulnerable to these overuse injuries of the shoulder and elbow, which have been shown to correlate directly to the number of throws and innings played.


Assuntos
Especialização/tendências , Esportes Juvenis/tendências , Humanos , Extremidade Superior , Esportes Juvenis/lesões
6.
Rev. esp. med. legal ; 46(2): 66-70, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193992

RESUMO

INTRODUCCIÓN: El análisis de las tesis doctorales es un indicador de la actividad científica y de investigación. MATERIAL Y MÉTODO: Análisis descriptivo retrospectivo de las tesis en España sobre medicina forense entre 2000-2019 a partir de TESEO, usando el descriptor «medicina forense». RESULTADOS: Se obtuvieron 179 tesis (9,42 tesis/año). El 51,4% de doctorandos fueron mujeres, presentándose tesis en 33 universidades distintas. La Universidad de Murcia aglutina el 24% de las tesis de la muestra. En 41 tesis hubo un solo director/a, en 118 dos y en 20 tres. El 65,28% de directores/as fueron varones. El 38,55% de tesis pertenecían a patología forense, seguidas de toxicología y psiquiatría forense. DISCUSIÓN: La producción de tesis doctorales sobre medicina forense en España es estable, a excepción del año 2016, por aspectos normativos. Destaca una gran diversidad de temáticas acorde con el carácter multidisciplinar de la medicina legal y forense


INTRODUCTION: The analysis of doctoral theses can be a good indicator of scientific and research activity. METHODS: A descriptive and retrospective analysis of theses in Spain on Forensic Medicine, was conducted between 2000-2019, through the TESEO database, using the descriptor "forensic medicine". RESULTS: A total of 179 theses were identified (9.4 theses per year). Fifty one point four percent of the doctoral students were females, presenting theses in 33 different Spanish Universities (24% from Murcia University). In 41 theses there was only one director, two in 118 and three in 20. Sixty-five point twenty-eight percent of the thesis directors were male. Most frequently the theses related to Forensic Pathology (38.55%), Toxicology or Forensic Psychiatry. DISCUSSION: The production of theses in Forensic Medicine could be considered stable, except for in 2016 in relation to regulatory issues. The wide variety of topics for theses should be highlighted, according to multidisciplinary contents of Forensic and Legal Medicine


Assuntos
Humanos , Masculino , Feminino , Medicina Legal/educação , Especialização/tendências , Pesquisa Biomédica/tendências , Dissertações Acadêmicas como Assunto , Espanha , Estudos Retrospectivos , Indicadores Bibliométricos
7.
J Med Vasc ; 45(3): 107-113, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402424

RESUMO

INTRODUCTION: Approximately 15% of patients treated by anticoagulant for a venous thromboembolic event are also treated with antiplatelet therapy; and this association increases the risk of bleeding. The aim of this survey was to evaluate general practitioner's management of antiplatelet therapy at the initiation of anticoagulation, and at six months compared to French vascular physicians' management. METHODS: A questionnaire including 4 clinical situations was established and the physicians were asked to detail antiplatelet and anticoagulant therapy management. From September 2017 to December 2017, an e-mail invitation and a reminder were sent to members of the departmental councils who participated; 218 questionnaires were obtained. RESULTS: Overall, 91.3% of physicians considered that there was an increased risk of bleeding when antiplatelet therapy is associated with anticoagulation. After initiating anticoagulation, 67% of respondents continued antiplatelet therapy, while 30% stopped. Three strategies were used: 49.0% of physicians maintained concomitant antiplatelet therapy with full-dose anticoagulant, both at anticoagulant initiation and at 6 months; 23% of physicians stopped antiplatelet therapy and prescribed full-dose anticoagulant at initiation and at 6 months; 12.4% of physicians prescribed antiplatelet therapy associated with reduced-dose anticoagulation at 6 months regardless of the strategy at anticoagulant initiation. CONCLUSION: One third of general practitioners stopped antiplatelet therapy at the initiation of an anticoagulation for a venous thromboembolic event. Prospective controlled trials are needed to clarify the best way to treat these patients in this situation.


Assuntos
Anticoagulantes/administração & dosagem , Clínicos Gerais/tendências , Inibidores da Agregação de Plaquetas/administração & dosagem , Padrões de Prática Médica/tendências , Tromboembolia Venosa/tratamento farmacológico , Adulto , Idoso , Anticoagulantes/efeitos adversos , Uso de Medicamentos/tendências , Feminino , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Recidiva , Medição de Risco , Fatores de Risco , Especialização/tendências , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia
8.
J Vasc Interv Radiol ; 31(6): 961-966, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32376176

RESUMO

PURPOSE: To evaluate utilization trends in percutaneous embolization among radiologists and nonradiologist providers. MATERIALS AND METHODS: The nationwide Medicare Part B fee-for-service databases for 2005-2016 were used to evaluate percutaneous embolization codes. Six codes describing embolization procedures were reviewed. Physician providers were grouped as radiologists, vascular surgeons, cardiologists, nephrologists, other surgeons, and all others. RESULTS: The total volume of Medicare percutaneous embolization procedures increased from 20,262 in 2005 to 45,478 in 2016 (+125%). Radiologists performed 13,872 procedures in 2005 (68% of total volume) and 33,254 in 2016 (73% of total volume), a 140% increase in volume. While other specialists also increased the number of cases performed from 2005 to 2016, radiologists strongly predominated, performing 87% of arterial and 30% of venous procedures in 2016, more than any other single specialty. In 2014 and 2015, a sharp increase in venous embolization cases performed by nonradiologists preceded a sharp decrease in 2016, likely the result of complicated billing codes for venous procedures. Radiologists maintained a steady upward trend in the number of cases they performed during those years. CONCLUSIONS: The volume of percutaneous embolization procedures performed in the Medicare population increased from 2005 to 2016, reflecting a trend toward minimally invasive intervention. In 2016, radiologists performed nearly 10 times more arterial embolization procedures than the second highest specialty and more venous embolization procedures than any other single specialty.


Assuntos
Embolização Terapêutica/tendências , Neoplasias/terapia , Padrões de Prática Médica/tendências , Radiologistas/tendências , Especialização/tendências , Idoso , Idoso de 80 Anos ou mais , Cardiologistas/tendências , Bases de Dados Factuais , Feminino , Humanos , Masculino , Medicare Part B/tendências , Nefrologistas/tendências , Cirurgiões/tendências , Fatores de Tempo , Estados Unidos
11.
J Vasc Interv Radiol ; 31(4): 614-621.e2, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32127322

RESUMO

PURPOSE: To describe national trends in peripheral endovascular interventions by physician specialty, anatomic segment of disease, and clinical location of service. MATERIALS AND METHODS: Current Procedural Terminology codes were used to identify claims for peripheral vascular interventions (PVIs) in 2011-2017 Physician Supplier Procedure Summary master files, which contain 100% Part B Medicare billing. Market share was defined as enrollment-adjusted proportion of billed PVI services for each specialty. Annual volume of billed services was additionally evaluated by clinical location (inpatient, outpatient, office-based laboratories) and anatomic segment of disease (iliac, femoral/popliteal, infrapopliteal). RESULTS: Aggregate PVI claims increased 31.3%, from 227,091 in 2011 to 298,127 in 2017. Annual market share remained relatively stable for all specialties: surgery, 48.3%-49.6%; cardiology, 37.2%-35.1%; radiology, 12.8%-13.3%. Accounting for Medicare enrollment, the volume of iliac interventions decreased by 18% over the study period, while femoral/popliteal interventions increased modestly (+7.5%) and infrapopliteal interventions increased (+46%). The greatest proportional increase in infrapopliteal claims occurred among radiologists (surgeons +40.4%, cardiologists +32.1%, radiologists +106.6%). Adjusting for enrollment, claims from office-based laboratories increased substantially (+305.7%), while hospital-based billing decreased (inpatient -25.7%, outpatient -12.9%). Office-based laboratory utilization increased dramatically with all specialties (surgery +331.8%, cardiology +256.0%, radiology +475.7%). CONCLUSIONS: Utilization of PVIs continues to increase, while specialty market shares have stabilized since 2011, leaving surgeons and cardiologists as the major providers of endovascular peripheral artery disease care. The greatest relative increases are occurring in infrapopliteal interventions and office-based laboratory procedures, where radiologist involvement has increased dramatically.


Assuntos
Procedimentos Endovasculares/tendências , Extremidade Inferior/irrigação sanguínea , Medicare/tendências , Doença Arterial Periférica/terapia , Padrões de Prática Médica/tendências , Especialização/tendências , Demandas Administrativas em Assistência à Saúde , Assistência Ambulatorial/tendências , Procedimentos Cirúrgicos Ambulatórios/tendências , Cardiologistas/tendências , Bases de Dados Factuais , Hospitalização/tendências , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Radiologistas/tendências , Cirurgiões/tendências , Fatores de Tempo , Estados Unidos
13.
Ann R Coll Surg Engl ; 102(4): 271-276, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31918560

RESUMO

INTRODUCTION: There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in general paediatric surgery performed by adult surgeons. Despite this dialogue, there are no contemporary published data to quantify the issue. This report documents patterns in delivery of general paediatric surgery in England and shows what is being performed where and by whom. MATERIALS AND METHODS: Using the Surgical Workload Outcome Database, we compared hospital-level data between 2009 and 2017. Inclusion criteria were children under 18 years admitted to NHS hospitals in England for elective general paediatric surgery. Data were analysed with an online statistical package performing paired t-tests. RESULTS: There was no real change in the overall number of elective general paediatric surgical marker cases, but the type mix has changed. The number of marker cases performed by adult surgeons fell by 34% (4699 vs 3090 p < 0.05). The number of marker cases performed by specialist paediatric surgeons increased by 21% (8184 vs 9862 p < 0.05). This increase in workload occurred in both tertiary (21% increase) and peripheral (18% increase) centres. When analysing data by operation type it was apparent that 78% of the increased workload was attributable to an increase in orchidopexy rate. CONCLUSION: Best practice is to treat children close to home by staff with the right skills. This study shows significant shifts in the general paediatric surgical workload. It is important to monitor these trends for successful succession planning as well as configuration of services.


Assuntos
Procedimentos Cirúrgicos Eletivos/tendências , Hospitais Gerais/tendências , Hospitais Pediátricos/tendências , Centro Cirúrgico Hospitalar/tendências , Carga de Trabalho/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Inglaterra , Feminino , Planejamento Hospitalar/organização & administração , Hospitais Gerais/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Especialização/estatística & dados numéricos , Especialização/tendências , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Medicina Estatal/tendências , Cirurgiões/estatística & dados numéricos , Cirurgiões/tendências , Centro Cirúrgico Hospitalar/estatística & dados numéricos
15.
J Pediatr Ophthalmol Strabismus ; 57(1): 9-11, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31972034

RESUMO

The fate of pediatric ophthalmology may be in jeopardy. For the past 20 years, there has been declining interest in the field compared to other subspecialties in ophthalmology, as fellowship positions and jobs remain unfilled. Of those fellows who do match in pediatric ophthalmology and strabismus, many are international medical graduates who often return to their native countries to practice, further diminishing the supply of pediatric ophthalmologists in the United States. In previous surveys, resident graduates have expressed disinterest in the field, reluctance to work with children, inadequate reimbursements, and insufficient interactions with faculty as reasons not to pursue this subspecialty. Millions of people throughout the United States do not have access to pediatric ophthalmologists, highlighting the issue of unequal distribution. As more pediatric ophthalmologists retire, there is concern that there will not be enough providers to meet the demands of this subspecialty. Although many of these factors deterring residents from entering this field have been resolved, the major issue of financial reimbursements has not been adequately addressed. [J Pediatr Ophthalmol Strabismus. 2020;57(1):9-11.].


Assuntos
Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Oftalmologia/tendências , Pediatria/tendências , Escolha da Profissão , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Oftalmologia/economia , Pediatria/economia , Especialização/tendências
16.
J Thorac Cardiovasc Surg ; 159(3): 987-996.e6, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31128897

RESUMO

OBJECTIVE: Cardiovascular disease is the leading cause of death worldwide, responsible for 17.5 million deaths every year, of which 80% occur in low- and middle-income countries. Some 75% of the world does not have access to cardiac surgery when needed because of lack of infrastructure, human resources, and financial coverage. This study aims to map access to cardiac surgery around the world. METHODS: A scoping review was done on access to cardiac surgery for an undifferentiated population. Workforce data were collected from the Cardiothoracic Surgery Network database and used to calculate numbers and ratios of adult and pediatric cardiac surgeons to population. RESULTS: A total of 12,180 adult cardiac surgeons and 3858 pediatric cardiac surgeons were listed in the Cardiothoracic Surgery Network in August 2017, equaling 1.64 (0-181.82) adult cardiac surgeons and 0.52 (0-25.97) pediatric cardiac surgeons per million population globally. Large disparities existed between regions, ranging from 0.12 adult cardiac surgeons and 0.08 pediatric cardiac surgeons per million population (sub-Saharan Africa) to 11.12 adult cardiac surgeons and 2.08 pediatric cardiac surgeons (North America). Low-income countries possessed 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries. CONCLUSIONS: This study maps the current global state of access to cardiac surgery. Disparities exist between and within world regions, with a positive correlation between a nation's economic status and access to cardiac surgery. Low early mortality rates in low-resource settings suggest the possibility of high-quality cardiac surgery in low- and middle-income countries. There is the need to increase human and physical resources, while focusing on safety, quality, and efficiency to improve access to cardiac surgery for the 4.5 billion people without.


Assuntos
Procedimentos Cirúrgicos Cardíacos/tendências , Saúde Global/tendências , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/economia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Países em Desenvolvimento , Saúde Global/economia , Custos de Cuidados de Saúde/tendências , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/economia , Humanos , Determinação de Necessidades de Cuidados de Saúde/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Especialização/tendências , Cirurgiões/tendências
17.
Ann Vasc Surg ; 64: 239-245, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31629843

RESUMO

BACKGROUND: The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1, 2018, to enhance cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the federation. METHODS: MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot (DF) diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20, 2019. RESULTS: Response rate was 62%. The survey revealed that vascular surgeons, diabetologists, and wound care nurses made-up the core of the diabetic teams present in 76.9%, 69.3%, and 92.3% of the centers, respectively. Diabetic teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%), but only in 7.9% of cases by nurses. Duplex ultrasonography and computed tomographic angiography were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons, while nonsurgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5% vs 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3% and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4-30%) and a mean reintervention rate of 22.5%, and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor and 30.8% major). The availability of a DF clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental to reduce amputation rates. CONCLUSIONS: Especially since the introduction and spreading of new endovascular techniques for the treatment of DF, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality and it is with this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery.


Assuntos
Amputação/tendências , Pé Diabético/cirurgia , Procedimentos Endovasculares/tendências , Disparidades em Assistência à Saúde/tendências , Isquemia/terapia , Doença Arterial Periférica/terapia , Padrões de Prática em Enfermagem/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Amputação/efeitos adversos , Pé Diabético/diagnóstico por imagem , Pé Diabético/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Pesquisas sobre Serviços de Saúde , Humanos , Isquemia/diagnóstico por imagem , Isquemia/epidemiologia , Região do Mediterrâneo/epidemiologia , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/tendências , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/epidemiologia , Papel do Médico , Reoperação/tendências , Especialização/tendências , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Cicatrização
18.
Am J Surg Pathol ; 44(5): 673-680, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31876580

RESUMO

Intraductal carcinoma of the prostate (IDC-P) has been recently recognized by the World Health Organization classification of prostatic tumors as a distinct entity, most often occurring concurrently with invasive prostatic adenocarcinoma (PCa). Whether documented admixed with PCa or in its rare pure form, numerous studies associate this entity with clinical aggressiveness. Despite increasing clinical experience and requirement of IDC-P documentation in protocols for synoptic reporting, the specifics of its potential contribution to assessment of grade group (GG) and cancer quantitation of PCa in both needle biopsies (NBx) and radical prostatectomy (RP) specimens remain unclear. Moreover, there are no standard guidelines for incorporating basal cell marker immunohistochemistry (IHC) in the diagnosis of IDC-P, either alone or as part of a cocktail with AMACR/racemase. An online survey containing 26 questions regarding diagnosis, reporting practices, and IHC resource utilization, focusing on IDC-P, was undertaken by 42 genitourinary subspecialists from 9 countries. The degree of agreement or disagreement regarding approaches to individual questions was classified as significant majority (>75%), majority (51% to 75%), minority (26% to 50%) and significant minority (≤25%). IDC-P with or without invasive cancer is considered a contraindication for active surveillance by the significant majority (95%) of respondents, although a majority (66%) also agreed that the clinical significance/behavior of IDC-P on NBx or RP with PCa required further study. The majority do not upgrade PCa based on comedonecrosis seen only in the intraductal component in NBx (62%) or RP (69%) specimens. Similarly, recognizable IDC-P with GG1 PCa was not a factor in upgrading in NBx (78%) or RP (71%) specimens. The majority (60%) of respondents include readily recognizable IDC-P in assessment of linear extent of PCa at NBx. A significant majority (78%) would use IHC to confirm or exclude intraductal carcinoma if other biopsies showed no PCa, while 60% would use it to confirm IDC-P with invasive PCa in NBx if it would change the overall GG assignment. Nearly half (48%, a minority) would use IHC to confirm IDC-P for accurate Gleason pattern 4 quantitation. A majority (57%) report the percentage of IDC-P when present, in RP specimens. When obvious Gleason pattern 4 or 5 PCa is present in RP or NBx, IHC is rarely to almost never used to confirm the presence of IDC-P by the significant majority (88% and 90%, respectively). Most genitourinary pathologists consider IDC-P to be an adverse prognostic feature independent of the PCa grade, although recommendations for standardization are needed to guide reporting of IDC-P vis a vis tumor quantitation and final GG assessment. The use of IHC varies widely and is performed for a multitude of indications, although it is used most frequently in scenarios where confirmation of IDC-P would impact the GG assigned. Further study and best practices recommendations are needed to provide guidance with regards to the most appropriate indications for IHC use in scenarios regarding IDC-P.


Assuntos
Carcinoma Ductal/patologia , Recursos em Saúde/tendências , Imuno-Histoquímica/tendências , Padrões de Prática Médica/tendências , Neoplasias da Próstata/patologia , Especialização/tendências , Biomarcadores Tumorais/análise , Biópsia com Agulha de Grande Calibre/tendências , Carcinoma Ductal/química , Carcinoma Ductal/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Gradação de Tumores , Valor Preditivo dos Testes , Neoplasias da Próstata/química , Neoplasias da Próstata/terapia , Reprodutibilidade dos Testes
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