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Presse Med ; 49(3): 104034, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32650043


Treatment of vasculitides has benefited from the results of several prospective clinical trials focusing on the evaluation of new drugs, therapeutic strategies and adjuvant treatments. In the field of autoimmunity, vasculitides are the group of diseases for which the most important medical progress has been made, combining advances in understanding the pathogenetic mechanisms, classification of the various entities and willingness to evaluate treatments. Several international groups have been actively involved in these tasks. The French Vasculitis Study Group was the first to design and organize prospective trials in the field and to contribute to these medical advances. In this review, we analyze the different treatments and therapeutic strategies evaluated over the last few decades and, more precisely, the last 39 years by the French Vasculitis Study Group.

Cardiologia , Poliarterite Nodosa/terapia , Sociedades Médicas , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Anticorpos Monoclonais/uso terapêutico , Cardiologia/história , Cardiologia/métodos , Cardiologia/organização & administração , Cardiologia/normas , Ensaios Clínicos como Assunto/história , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/organização & administração , Ensaios Clínicos como Assunto/normas , França , História do Século XX , História do Século XXI , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Troca Plasmática , Sociedades Médicas/história , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Sociedades Médicas/tendências
Anesth Analg ; 131(1): 307-316, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32149754


This article summarizes the Gerard W. Ostheimer Lecture given at the 2019 Society for Obstetric Anesthesia and Perinatology annual meeting. The article summarizes key articles published in 2018 that were presented in the 2019 Ostheimer Lecture, with a focus on maternal mortality, maternal complications, analgesic and anesthetic management of vaginal and cesarean deliveries, postpartum care, and the impact of anesthesia on maternal outcomes. The reviewed literature highlights many opportunities for anesthesiologists to impact maternal care and outcomes. The major themes presented in this manuscript are maternal mortality including amniotic fluid and cardiac arrest; postpartum hemorrhage; venous thromboembolism; management of spinal-induced hypotension; postpartum care including opioid use, postcesarean analgesia, and postpartum depression. A proposed list of action items and research topics based on the literature from 2018 is also presented. Specifically, anesthesiologists should use prophylactic vasopressor infusions during elective cesarean delivery; use a structured algorithm to diagnose pulmonary embolus, and reevaluate the use of D-dimer measurements; target postpartum opioid analgesia and prescribing; use multimodal postcesarean delivery analgesia, preferably with neuraxial hydrophilic opioids; and study any association between labor analgesia on postpartum depression.

Anestesia Obstétrica/tendências , Congressos como Assunto/tendências , Parto Obstétrico/tendências , Sociedades Médicas/tendências , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Mortalidade Materna/tendências , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle
Plast Reconstr Surg ; 145(3): 844-852, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097336


BACKGROUND: The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions. METHODS: The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017. RESULTS: The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent). CONCLUSIONS: The authors' study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.

Liderança , Sexismo/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Docentes de Medicina/organização & administração , Docentes de Medicina/estatística & dados numéricos , Docentes de Medicina/tendências , Feminino , Humanos , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Masculino , Faculdades de Medicina/organização & administração , Faculdades de Medicina/estatística & dados numéricos , Faculdades de Medicina/tendências , Sexismo/prevenção & controle , Sexismo/tendências , Sociedades Médicas/organização & administração , Sociedades Médicas/estatística & dados numéricos , Sociedades Médicas/tendências , Cirurgiões/organização & administração , Cirurgiões/tendências , Cirurgia Plástica/organização & administração , Cirurgia Plástica/tendências , Estados Unidos
J. negat. no posit. results ; 5(2): 141-155, feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194005


Se analiza desde el origen de las Reales Academias, sus objetivos y actividades, por qué se crearon y como han evolucionado. Luego se hace un desarrollo especifico de la Real Academia Nacional de Medicina y se pormenoriza una a una las Reales Academias de Medicina de cada autonomía para finalizar con las dos últimas academias creada en el siglo XXI, la de Cantabria (2003) y la de Castilla la Mancha (2019)

It is analyzed from the origin of the Royal Academies, their objectives and activities, because they were created and how they have evolved. Then a specific development of the Royal National Academy of Medicine is made and the Royal Academies of Medicine of each autonomy are detailed one by one to end with the last two academies created in the 21st century, that of Cantabria (2003) and that of Castilla La Mancha (2019)

Humanos , Sociedades Médicas/tendências , Pesquisa Biomédica/tendências , Sociedades Científicas/tendências , Academias e Institutos/história , Espanha , Sociedades Médicas/organização & administração
Spine (Phila Pa 1976) ; 45(5): 333-338, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32032340


STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of this study was to characterize the costs associated with American Society of Anesthesiologists (ASA) class, and to determine the extent to which ASA status is a predictor of increased cost and LOS following lumbar laminectomy and fusion (LLF). SUMMARY OF BACKGROUND DATA: Spinal fusion accounts for the highest hospital costs of any surgical procedure performed in the United States, and ASA (American Society of Anesthesiologists) status is a known risk factor for cost and length of stay (LOS) in the orthopedic literature. There is a paucity of literature that directly addresses the influence of ASA status on cost and LOS following LLF. METHODS: This is a retrospective cohort study of an institutional database of patients undergoing single-level LLF at an academic tertiary care facility from 2006 to 2016. Univariate comparisons were made using χ tests for categorical variables and t tests for continuous variables. Multivariate linear regression was utilized to estimate regression coefficients, and to determine whether ASA status is an independent risk factor for cost and LOS. RESULTS: A total of 1849 patients met inclusion criteria. For every one-point increase in ASA score, intensive care unit (ICU) LOS increased by 0.518 days (P < 0.001), and hospital length of stay increased by 1.93 days (P < 0.001). For every one-point increase in ASA score, direct cost increased by $7474.62 (P < 0.001). CONCLUSION: ASA status is a predictor of hospital LOS, ICU LOS, and direct cost. Consideration of the ways in which ASA status contributes to increased cost and prolonged LOS can allow for more accurate reimbursement adjustment and more precise targeting of efficiency and cost effectiveness initiatives. LEVEL OF EVIDENCE: 3.

Anestesiologistas/economia , Laminectomia/economia , Tempo de Internação/economia , Sociedades Médicas/economia , Doenças da Coluna Vertebral/economia , Fusão Vertebral/economia , Adulto , Idoso , Anestesiologistas/tendências , Bases de Dados Factuais/tendências , Feminino , Humanos , Laminectomia/tendências , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sociedades Médicas/tendências , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/tendências , Estados Unidos
Int J Cardiol ; 299: 37-42, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31253528


BACKGROUND: The evidence base for coronary perforation occurring during percutaneous coronary intervention in patients presenting with an acute coronary syndrome (ACS-PCI) is limited and the specific role of acute pharmacology in its clinical presentation unclear. METHODS AND RESULTS: Using the BCIS PCI database, data were analysed on all ACS-PCI procedures performed in England and Wales between 2007 and 2014. Multiple regressions were used to identify predictors of coronary perforation and its association with outcomes. Propensity score matching was used to evaluate the association between differing P2Y12 inhibitors or glycoprotein inhibitors (GPI) and CP. During 270,329 ACS-PCI procedures, 1013 coronary perforations were recorded (0.37%) with a stable annual incidence. In multiple regression analysis, covariates associated with increased frequency of coronary perforation included age, female gender, CTO intervention, number and length of stents used, and rotational atherectomy use, whilst differing P2Y12 inhibitors were not predictive. Using propensity score matching, use of a GPI was independently associated with tamponade (OR 1.50, [1.08-2.06], p = 0.014). The adjusted odds ratios for all clinical outcomes were adversely affected by coronary perforation. CONCLUSIONS: Coronary perforation is an infrequent event during ACS-PCI but is closely associated with adverse clinical outcomes. GPI use was associated with higher rates of tamponade.

Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/cirurgia , Vasos Coronários/lesões , Traumatismos Cardíacos/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Sociedades Médicas/tendências , Síndrome Coronariana Aguda/diagnóstico , Bases de Dados Factuais/tendências , Inglaterra/epidemiologia , Feminino , Traumatismos Cardíacos/diagnóstico , Humanos , Masculino , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Retrospectivos , País de Gales/epidemiologia
Rinsho Shinkeigaku ; 60(1): 1-19, 2020 Jan 30.
Artigo em Japonês | MEDLINE | ID: mdl-31852875


The Japanese Society of Neurology and Psychiatry was founded in 1902 as a joint society of Neurology and Psychiatry, but was renamed the Japanese Society of Psychiatry and Neurology in 1935 because of the stagnation of activities of Neurology and the rise of those of Psychiatry. After World War II, activities of Neurology were restored and the Japanese Society of Neurology (JSN) independent from the Societies of Internal Medicine and Psychiatry was established in 1960 after overcoming many difficulties. In 1975, neurology was approved by law as one of the specialized fields of medicine. After that, neurology and JSN developed dramatically, both in research and medical practices. As of 2018, JSN had 9,000 members and more than 5,500 board-certified neurology specialists. JSN successfully hosted the World Congress of Neurology twice in 1981 and 2017. In 2002, JSN accepted the offer to join the Japanese Board of Medical Specialties as one of the subspecialties of Internal Medicine. In 2018 JSN enacted a new policy to upgrade the neurology specialist from a subspecialty of Internal Medicine to an independent major medical field. Lessons of the 116 years of history of the Society would teach us a sensible way to achieve the goals.

Neurologia/história , Neurologia/tendências , Sociedades Médicas/história , Sociedades Médicas/tendências , História do Século XX , História do Século XXI , Humanos , Japão
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 654-662, dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184793


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

Endocrinologia/organização & administração , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Estratégias , Endocrinologia/tendências , Sistemas Nacionais de Saúde , Medicina/organização & administração , Promoção da Saúde , Espanha