Reflexión estratégica de la Sociedad Española de Endocrinología y Nutrición sobre el futuro de la especialidad en el periodo 2018-2022 / Strategic reflections of the Spanish Society of Endocrinology and Nutrition on the future of the speciality in the period 2018-2022

Las enfermedades endocrinas están experimentando un importante incremento de su prevalencia, debido a causas de diversa índole, entre ellas la epidemia de obesidad y de desnutrición, el envejecimiento de la población, pero también el efecto de los disruptores endocrinos, entre otros. Por otra parte, las nuevas tecnologías, tanto a nivel de analítica molecular y genética, de imagen y de nuevos dispositivos terapéuticos, obligan a que la comunidad profesional endocrina en España tenga que estar en constante formación. La conexión con los pacientes a través de sus asociaciones, cada vez más activas, y con la sociedad civil en general, el compromiso profesional y la demanda de diversos colectivos sociales de una atención moderna y equitativa, y a llevar a cabo investigación que facilite la consecución de avances para los pacientes, obligan al especialista en Endocrinología y Nutrición, y a la Sociedad Española de Endocrinología y Nutrición (SEEN), a posicionarse y dar respuesta a todos estos retos. En el presente documento, la SEEN expone sus propuestas y su estrategia hasta el 2022

Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022

The "Elderly" in Medicine: Ethical Issues Surrounding This Outdated and Discriminatory Term.

The objective of this study was to investigate and describe how the use of the term "elderly" contributes to bias and problems within the medical system. A systematic review of the relevant literature and history was conducted. The term "elderly" does not define age accurately and carries bias and prejudice that lead to harm through discriminatory practices, institutional prejudices, and "ageist" policies in society and medicine. Doctors and healthcare providers seldom intentionally try to harm any patient, but might do so through unconscious anti-elderly bias. Studies indicate that medical students already demonstrate anti-elderly bias; researchers may lump patients aged 65 and over together, confounding specific information needed for individualized treatments; and out of unwarranted concern, medical and surgical treatments may be denied, despite minimal increased risk of mortality. When the cost of healthcare rises, it is the elderly against whom rationing is suggested. The term "elderly" has no place in medicine. Anti-elderly health care rationing is as unethical as rationing targeted against any group. It is reverse paternalism to make rules that limit others' medical care, happiness, and life span without their consent. Medicine is the science and art of individual communication, evaluation and treatment. Once we deny care to any one group, we open the door to denial to others.

Strukturierte Karrierewege in der Universitätsmedizin. / [Structured Career Pathways in the University Medicine - From Promotion to Clinician Scientist Programs].

Scientifically active medical doctors are required for successful translation of novel basic findings into the clinic. However, there is an increasing tendency of young medical doctors to primarily follow a more clinically and not scientifically orientated career pathway. Therefore, the establishment of novel career education structures and career perspectives in university medicine are important to stop this development. Here, we will discuss the current situation and ongoing attempts to design novel structural programs that allow a better combination of clinical and scientific work by highlighting also current developments at the Faculty of Medicine at the University of Freiburg.

Comparison of the h-indices of the editorial board members of seven ophthalmic subspecialty journals.

PURPOSE: To investigate and compare the h-indices of the editorial board members of ophthalmic subspecialty journals. STUDY DESIGN: Descriptive Cross Sectional Research. METHODS: Bibliometric indices were calculated for the editorial board members of seven ophthalmic subspecialty journals. Correlations between the median h-indexes and journal impact factors (JIF), average citations per article and JIF, and publication count and JIF were analyzed. RESULTS: The median h-indices of the board members of Retina, Journal of Glaucoma, Journal of Cataract and Refractive Surgery, Cornea, Ophthalmic Plastic and Reconstructive Surgery, Journal of Neuroophthalmology and Journal of the American Academy of Pediatric Ophthalmology and Strabismus (J AAPOS) were 34, 26, 23, 17, 15, 14 and 13, respectively. H-indices and publication count were correlated with JIF (P<0.05, for each). CONCLUSION: The board members of Retina have the highest h-index and average citations per article, and J AAPOS have the least. These data provide useful benchmarks for comparison of the various subspecialty areas in ophthalmology.

Re-structuring the negotiated order of the hospital.

Researchers continue to lament the lack of organisational focus in the sociology of health and illness. Although studies have increasingly focused on boundaries between organizations, little such research has focused on the formal boundaries within the hospital itself. Given its dramatic compartmentalisation, and continuing prevalence in health systems, the lack of organisational perspective in hospital research limits insights into the effects (as well as the construction) of the order of health work and care. With a greater emphasis on 'ordering' in the concept of negotiated order, the aim of this study is to examine the manifestation and consequences of the formal boundaries of hospital departments. Fieldwork featured 12 months of ethnography, including formal and informal observations, 80 audio-recorded, semi-structured interviews, and 56 field interviews, in the Emergency Departments (EDs) of two tertiary referral hospitals. Compared with in-patient hospital departments, the ED has limited legitimacy claims of organ-specific knowledge to transfer patients out of the ED. The manifestation of specialised knowledge hierarchies in organisational structures disadvantages patients who are older and who have chronic conditions, underpinning the argument that effects as well as the negotiation of stable organisational orders deserve increased attention in the sociology of health and illness.

Organize to serve: An ecclesiastical approach to medicine and dermatology.

Maintenance and promotion of health are worldwide activities, yet those devoted by their profession to these goals are currently hopelessly fractionated and involved in struggling for territory and self-sustenance. The author proposes the creation of a World Medical Congregation, eventually encompassing all physicians. This integrative endeavor would model itself after the governance of the Roman Catholic Church, without the latter's obvious confessional characteristics.

Factors influencing medical specialists' dual practice in the Islamic Republic of Iran.

Background: Dual practice (DP) is performing several different jobs at the same time and has effects on healthcare services delivery. Aims: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran. Methods: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA (version 10.0). Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln. Results: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations. Conclusions: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.

Musculoskeletal Radiology Practice Subspecialization in Canada: A Subject of Substance?

Scientific and technological advances in medical imaging have had a profound impact on health care around the world including Canada. The cost of imaging, however, continues to rise along with innovation. Building a practical subspecialty musculoskeletal imaging service offers the specialty of radiology an opportunity to show how radiologists can consistently add value and improve outcomes without adding a great cost burden to the health care system.

Quality of medicines: Deficiencies found by Brazilian Health Regulatory Agency (ANVISA) on good manufacturing practices international inspections.

The circulation of poor quality medicines, especially in the developing countries, is a public health concern. Compliance with good manufacturing practices (GMP) is essential to ensure the quality, efficacy, and safety of medicines. This study evaluated the outcomes of the Brazilian Health Regulatory Agency's (ANVISA) international inspections of two years (2015 and 2016) and compared these to those of other regulatory authorities. The information from 255 inspection reports was analyzed, and the type and extent of deficiencies were collected. In the period evaluated, 62.75% of ANVISA-inspected companies were classified as GMP "satisfactory," 24.71% were classified as having "on demand" status, and 12.55% of inspections concluded that the company did not comply with Brazilian GMP regulations ("unsatisfactory"). The most common areas of deficiency were documentation (28.63%) and premises (26.27%). The pattern of deficiencies was similar to the findings of other regulatory agencies. However, ANVISA detected a more significant number of non-compliance results than other authorities, which may be caused by differences in classifications adopted by each Agency. Furthermore, manufacturers inspected by ANVISA may follow different standards and practices for products manufactured for the Brazilian market. Disclosure of main GMP deficiencies found can be useful for encouraging the industry to comply with GMP, and additional guidelines in the specific areas where deficiencies are often identified may be useful to industry to improve GMP compliance. Harmonization of GMP guidelines and inspection procedures are the key steps to avoid duplicate work, but regulatory authorities also need to work together to enforce the proper level of GMP compliance by pharmaceutical manufacturers, assuring high quality and safe medicines supply.

Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties.

BACKGROUND: The US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists. METHODS: We used a state-wide data set from Illinois Medicaid specified for Internal Medicine providers and subspecialists. A total of 3191 ICD-9-CM codes were used for 51,078 patient encounters, for a total cost of US $26,022,022 for all internal medicine. We categorized all of the ICD-9-CM codes based on the complexity of mapping to ICD-10-CM as codes with complex mapping could result in billing or administrative errors during the transition. Codes found to have complex mapping and frequently used codes (n = 295) were analyzed for clinical accuracy of mapping to ICD-10-CM. Each subspecialty was analyzed for complexity of codes used and proportion of reimbursement associated with complex codes. RESULTS: Twenty-five percent of internal medicine codes have convoluted mapping to ICD-10-CM, which represent 22% of Illinois Medicaid patients, and 30% of reimbursements. Rheumatology and Endocrinology had the greatest proportion of visits and reimbursement associated with complex codes. We found 14.5% of ICD-9-CM codes used by internists, when mapped to ICD-10-CM, resulted in potential clinical inaccuracies. CONCLUSIONS: We identified that 43% of diagnostic codes evaluated and used by internists and that account for 14% of internal medicine reimbursements are associated with codes which could result in administrative errors.