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1.
Acta Chir Orthop Traumatol Cech ; 86(4): 281-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524590

RESUMO

PURPOSE OF THE STUDY The specialty of orthopedics and traumatology that is completed in the 5 years period in our country is a challenging educational process and our purpose in this study is to demonstrate through a survey training conditions of the orthopedic assistants in our country and the effects of this process on assistants. MATERIAL AND METHODS 524 (70.05%) of 748 assistants who receive specialization training in Turkey were reached. There were 20 multiple choice questions ( 1 mark each) and 3 questions (more than 1 mark each) in the survey consisting of twenty-three questions. Our study group was formed by doctors who have still worked as assistant in our country and have accepted to participate in the study. The doctors who finished assistantship with any reason and did assistantship for time less than 6 months and did not exactly fill the questionnaire form were excluded from the study. RESULTS 524 (71.97%) of 728 assistant who are in 40 (100%) of 40 provinces where assistant training given in Turkey were reached. 474 (90.45%) participants were satisfied to do orthopedic specialization. When considering working hours, it was observed that 337 (64.31%) participants had over 90 hours weekly including night shift and 521 (99.42%) participants had to work after night shift. The majority of participants (361 persons 68.89%) were receiving salaries between TL 4000-6000. When looking at the entire working group, the rate of participants who said that scientific training is weak or there is no scientific training was 427 (81.48%). CONCLUSIONS Our survey study is one of the first statistical study which investigating professional and social problems of orthopedic assistants. Some of important problems as training satisfaction, abuse by patients and/or manager, the average monthly income and psychological status assessment is emphasized. Orthopedics and Traumatology assistantship is a challenging process to cause physical and psychological problems with the hard working conditions in our Turkey. Key words:residency training, orthopedic surgery, life quality, salary.


Assuntos
Internato e Residência/normas , Estresse Ocupacional , Ortopedia/educação , Traumatologia/educação , Humanos , Internato e Residência/organização & administração , Ortopedia/organização & administração , Ortopedia/normas , Admissão e Escalonamento de Pessoal , Jornada de Trabalho em Turnos/psicologia , Jornada de Trabalho em Turnos/normas , Inquéritos e Questionários , Fatores de Tempo , Traumatologia/organização & administração , Traumatologia/normas , Turquia
2.
Chin J Traumatol ; 22(1): 1-11, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30850324

RESUMO

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.


Assuntos
Abdome/cirurgia , Drenagem/métodos , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Sociedades Médicas/organização & administração , Infecção da Ferida Cirúrgica/prevenção & controle , Traumatologia/organização & administração , Vácuo , China , Humanos
3.
Chin J Traumatol ; 22(1): 21-23, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30833162

RESUMO

Trauma is one of the leading causes of death worldwide. It is an urgent task to strengthen the trauma care and prevent the complications. In 2018, Chinese Journal of Traumatology reported a series of trauma-related articles of which the contents include pre-hospital care, in-hospital care and complication prevention, et al, aiming to improve the treatment levels, decrease the trauma incidence, and reduce the trauma mortality and disability.


Assuntos
Publicações Periódicas como Assunto , Sociedades Médicas/organização & administração , Traumatologia/organização & administração , China , Humanos , Fatores de Tempo , Ferimentos e Lesões/prevenção & controle , Ferimentos e Lesões/terapia
5.
Cir. Esp. (Ed. impr.) ; 97(1): 3-10, ene. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181097

RESUMO

El modelo Acute Care Surgery agrupa bajo una misma disciplina el trauma, la cirugía de urgencias y los cuidados intensivos posquirúrgicos. Concebido y extendido durante las 2 últimas décadas por territorio norteamericano, la magnitud e idiosincrasia clínica de la urgencia quirúrgica han hecho que este modelo se haya asumido en muchos otros puntos de la geografía mundial. En nuestro país, el reflejo ha sido la creación e implantación de las denominadas unidades de trauma y cirugía de urgencias, cuyos objetivos son comunes a las publicadas para el modelo original: evitar la nocturnidad en las urgencias quirúrgicas, liberar a los profesionales vinculados a la cirugía electiva en horario laboral y convertirse en el eslabón y referente perfectos de la continuidad asistencial. En el presente artículo se resumen el nacimiento y la expansión del modelo original, la evidencia aportada en cuanto a resultados y la situación actual en nuestro país


The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country


Assuntos
Humanos , Traumatologia/organização & administração , Modelos Organizacionais , Serviço Hospitalar de Emergência , Implementação de Plano de Saúde/organização & administração , Centros de Traumatologia/tendências , Unidades Hospitalares/organização & administração , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Cuidados Pós-Operatórios
6.
Z Orthop Unfall ; 157(4): 434-439, 2019 Aug.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-30481836

RESUMO

BACKGROUND: The German health care system is well accepted, but efficiency, costs and patient satisfaction are sometimes criticised. Opinions and models prevail, and empirical data are rarely presented, although quantitative data are a precondition to assess the acceptance of the health care system. METHOD: To determine the appraisal of the patient-doctor relationship, economic situation and cooperation with clinical institutions, a 37 item was developed where participants indicated their agreement with a statement on a four point Likert scale. This questionnaire was answered by 525 German orthopaedic and/or traumatology surgeons, representing 7.7% of all German specialists working in outpatient care. RESULTS: 75% of all respondents felt challenged by demanding patients and a need for justification; what was less pronounced was the feeling of being exploited as physicians. Restrictions in medical treatment from budgeting expenses were seen by 74%. More than 90% considered that it was impossible to finance their medical practice expenses by conservative medical treatment only. The respondents felt similarly critical about the current cooperation with hospitals - only 19% were not interested in closer cooperation and 96% advocated higher fees for this cooperation. 74% confirmed that hospitals are taking over outpatient tasks, whereas only 35% agreed that more clinical patient care can be provided by outpatient providers, especially due to legal restrictions. DISCUSSION: Practitioning orthopaedic and traumatology surgeons feel exploited by uninformed patients, misallocation of reimbursement funds and legal restrictions, as well as unilateral substitution of outpatient care by hospitals. They do not consider that the current structures are sustainable for long term patient care.


Assuntos
Assistência Ambulatorial/organização & administração , Atitude do Pessoal de Saúde , Ortopedia/organização & administração , Traumatologia/organização & administração , Assistência Ambulatorial/economia , Assistência Ambulatorial/legislação & jurisprudência , Assistência Ambulatorial/psicologia , Alemanha , Pesquisas sobre Serviços de Saúde , Humanos , Relações Interprofissionais , Estresse Ocupacional , Ortopedia/economia , Ortopedia/legislação & jurisprudência , Satisfação Pessoal , Relações Médico-Paciente , Cirurgiões/psicologia , Traumatologia/economia , Traumatologia/legislação & jurisprudência
8.
Orthop Traumatol Surg Res ; 104(8): 1283-1289, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30291032

RESUMO

BACKGROUND: Current trends in patient management include decreasing hospital stay lengths and reductions in available material and human resources. A shortening of hospital stays in university hospitals has been documented over the last decade. However, to our knowledge, no study has assessed possible relationships linking shorter stays to staffing levels or complication rates. The objectives of this study were: 1) to assess changes in case volume in a university orthopaedics and trauma surgery department between 2006 and 2016, 2) and to look for correlations linking these changes to staffing levels and the rates of significant complications, including the number of hip dislocations after total hip arthroplasty (THA) and the number of infections and complications resulting in malpractice litigation after hip, knee, or shoulder arthroplasty. HYPOTHESIS: The case volume increased during the study period, whereas resources remained unchanged or decreased. MATERIAL AND METHODS: A retrospective study was performed using the electronic database of an orthopaedics and trauma surgery department. Data collected between 2006 and 2016 were analysed. Mean hospital stay length, patient age, and surgical volume were recorded, and changes over time in case volume for trauma surgery and scheduled arthroplasties were evaluated. Changes in staffing levels and rates of complications (dislocation after THA and infections and complications resulting in malpractice litigation) between 2006 and 2016 were assessed. Only arthroplasty procedures performed in the department were considered for the study of complications and litigation. RESULTS: Between 2006 and 2016, mean hospital stay decreased from 8.7±10.8 days (range, 0-141 days) in to 7.0±9.4 days (range, 0-150 days). Mean patient age increased from 54.4±21.2 years (range, 11.7-100.9 years) in 2006 to 59.3±20.9 years (range, 13.2-103.1 years) in 2016. The total number of procedures rose from 2158 in 2006 to 3100 in 2016 (+43.6%). The number of THAs increased by 16.2% and the number of total knee arthroplasties by 96.7%. The number of operations for trauma increased from 725 in 2006 to 1135 in 2016 (+56.0%). During the study period, the number of hospital beds declined from 70 to 55. No increase was seen in the frequencies of dislocation after THA (3/284 [1.4%] in 2006 and 4/330 [1.2%] in 2016) or prosthetic joint infection (5/439 [1.1%] in 2006 and 6/657 [0.9%] in 2016). In contrast, malpractice suits filed by patients after arthroplasty increased from 1/439 (0.2%) in 2006 to 8/657 (1.2%) in 2016. CONCLUSION: Over the last decade, trauma and arthroplasty surgical volumes increased substantially, whereas staffing levels remained unchanged and number of beds diminished. The frequency of significant complications such as dislocation after THA did not increase. In contrast, a marked rise was seen in malpractice litigation. However, the increased volume with unchanged resources found in this study should be interpreted in the light of the marked increase in patient dependency and of our role as a referral centre managing patients with complications after surgery performed at other institutions. LEVEL OF EVIDENCE: IV, retrospective observational study.


Assuntos
Luxação do Quadril/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Infecções Relacionadas à Prótese/epidemiologia , Traumatologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia de Quadril/tendências , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Artroplastia do Joelho/tendências , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/estatística & dados numéricos , Criança , França/epidemiologia , Número de Leitos em Hospital/estatística & dados numéricos , Departamentos Hospitalares/organização & administração , Departamentos Hospitalares/estatística & dados numéricos , Hospitais Universitários/organização & administração , Humanos , Tempo de Internação/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Imperícia/tendências , Pessoa de Meia-Idade , Ortopedia/organização & administração , Admissão e Escalonamento de Pessoal , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Traumatologia/organização & administração , Adulto Jovem
9.
Unfallchirurg ; 121(10): 850-854, 2018 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-30178107

RESUMO

On the occasion of the 10th anniversary of the foundation of the German Society for Orthopedics and Trauma Surgery (DGOU), the current General Secretary of the German Society for Trauma Surgery sees the need for a standpoint on trauma surgery in Germany. This manuscript outlines future options and perspectives for the development of trauma surgery in Germany.


Assuntos
Procedimentos Ortopédicos/tendências , Ortopedia/tendências , Traumatologia/tendências , Ferimentos e Lesões/terapia , Competência Clínica/normas , Estado Terminal/terapia , Previsões , Alemanha , Procedimentos Ortopédicos/educação , Procedimentos Ortopédicos/normas , Ortopedia/educação , Ortopedia/organização & administração , Ortopedia/normas , Sociedades Médicas , Traumatologia/educação , Traumatologia/organização & administração , Traumatologia/normas , Ferimentos e Lesões/complicações
11.
J Orthop Trauma ; 32 Suppl 7: S3-S7, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30247390

RESUMO

In March 2016, North American academic leaders with an interest in and commitment to the field of global orthopaedics met in Orlando, Florida, to gauge each institution's clinical, research, and educational programs in developing countries, establish the main limitations to participating in global health efforts, and assess areas of need for both the participating institutions and their international partners. After this inaugural meeting, a needs assessment survey was distributed to the group to better understand how to organize and unify the individual institutional global efforts. The results revealed that surgeons believed there was a vital need for improved communication, mentorship, and infrastructural support between North American universities. To this end, the Consortium of Orthopaedic Academic Traumatologists (COACT) was founded. The COACT seeks to promote a novel framework geared toward improving trauma care capacity by building collaborative partnerships among leading academic centers across the United States and Canada. The consortium represents a comprehensive partnership that promotes communication, collaboration, and advocacy through a central network to facilitate investigative, educational, and clinical services. Academic partners share best practices, resources, and opportunities in their international outreach projects in low- and middle-income countries in the field of orthopaedic trauma. Over the course of the past 2 years, the COACT has grown to more than 80 faculty, fellow, resident, and student members, representing over 20 orthopaedic institutions across North America.


Assuntos
Países em Desenvolvimento , Saúde Global , Sistema Musculoesquelético/lesões , Ortopedia/organização & administração , Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Canadá , Comunicação , Humanos , Cooperação Internacional , Mentores , Sistema Musculoesquelético/cirurgia , Determinação de Necessidades de Cuidados de Saúde , Inquéritos e Questionários , Estados Unidos , Voluntários
12.
J Orthop Trauma ; 32 Suppl 7: S8-S11, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30247391

RESUMO

Trauma continues to be a leading cause of mortality and morbidity in lower to middle-income countries. To meet the ever-growing need of musculoskeletal care in trauma patients, orthopaedic surgeons play an instrumental role in providing care, guided by relevant clinical research studies. Promoting research and publishing results are both crucial to influencing trauma-related skeletal injury treatment in lower to middle-income countries. Currently, few opportunities exist for trauma surgeons in Latin America to participate in clinical research or to contribute to academic publications, thereby limiting their ability to address potentially critical treatment questions faced by their specific patient populations. In response to these obstacles, in 2017, a group of 60 surgeon leaders representing 18 countries throughout Latin America developed the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR; www.actuarla.org). The ACTUAR supports investigative opportunities for Latin American orthopaedic trauma surgeons who want to contribute through collaborative research work. This pioneering initiative aims to improve trauma-related research, clinical care, and health care policies through the development of an international network across the Americas.


Assuntos
Pesquisa Biomédica/organização & administração , Sistema Musculoesquelético/lesões , Ortopedia/organização & administração , Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Países em Desenvolvimento , Saúde Global , Humanos , América Latina , Sistema Musculoesquelético/cirurgia , Desenvolvimento de Programas
13.
J Orthop Trauma ; 32 Suppl 7: S21-S24, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30247395

RESUMO

Uganda, as do many low-middle income countries, has an overwhelming volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia, McMaster University and Makerere University that was initiated in 2007. The goal of the project is to reduce the disabilities that occur secondary to musculoskeletal trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through teaching, innovation, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anesthesia, nursing, rehabilitation, and sterile reprocessing. The project was initiated at the invitation of the Department of Orthopaedics at Makerere University and Mulago Hospital in Kampala. The project is a collaboration between Canadian and Ugandan orthopaedic surgeons and is driven by the needs identified by the Ugandan surgeons. The program has also worked with collaborators to develop several technologies aimed at reducing the cost of providing orthopaedic care without compromising quality. As orthopaedic trauma capacity in Uganda advances, USTOP strives to continually evolve and provide relevant support to colleagues in Uganda to ensure that changes result in sustainable improvements in patient care.


Assuntos
Países em Desenvolvimento , Procedimentos Ortopédicos/normas , Ortopedia/organização & administração , Traumatologia/organização & administração , Pesquisa Biomédica , Assistência à Saúde , Humanos , Cooperação Internacional , Sistema Musculoesquelético/lesões , Sistema Musculoesquelético/cirurgia , Procedimentos Ortopédicos/educação , Ortopedia/educação , Ortopedia/normas , Avaliação de Programas e Projetos de Saúde , Terapias em Estudo , Traumatologia/educação , Traumatologia/normas , Uganda , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle , Ferimentos e Lesões/cirurgia
14.
Can J Surg ; 61(4): 237-243, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30067181

RESUMO

BACKGROUND: Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS: A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected. RESULTS: Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]). CONCLUSION: The characteristics and case mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.


Assuntos
Cirurgia Geral/organização & administração , Traumatologia/organização & administração , Canadá , Estudos Transversais , Grupos Diagnósticos Relacionados , Humanos , Fluxo de Trabalho
15.
Z Orthop Unfall ; 156(5): 579-585, 2018 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-29871006

RESUMO

INTRODUCTION: The development of a new safety culture in orthopaedics and trauma surgery needs to be based on the knowledge of the status quo. The objective of this research was therefore to perform a survey of orthopaedic and trauma surgeons to achieve a subjective assessment of the frequency and causes of "insecurities" or errors in daily practice. METHODS: Based on current literature, an online questionnaire was created by a team of experts (26 questions total) and was sent via e-mail to all active members of a medical society (DGOU) in April 2015. This was followed by two reminder e-mails. The survey was completed in May 2015. The results were transmitted electronically, anonymously and voluntarily into a database and evaluated by univariate analyses. RESULTS: 799 active members took part in the survey. 65% of the interviewed people stated that they noticed mistakes in their own clinical work environment at least once a week. The main reasons for these mistakes were "time pressure", "lack of communication", "lack of staff" and "stress". Technical mistakes or lack of knowledge were not of primary importance. CONCLUSIONS: The survey indicated that errors in orthopaedics and trauma surgery are observed regularly. "Human factors" were regarded as a major cause. In order to develop a new safety culture in orthopaedics and trauma surgery, new approaches must focus on the human factor.


Assuntos
Procedimentos Ortopédicos/normas , Complicações Pós-Operatórias/epidemiologia , Gestão da Segurança/normas , Traumatologia/normas , Ferimentos e Lesões/cirurgia , Estudos Transversais , Alemanha , Humanos , Procedimentos Ortopédicos/tendências , Complicações Pós-Operatórias/prevenção & controle , Gestão da Segurança/organização & administração , Gestão da Segurança/tendências , Traumatologia/organização & administração , Traumatologia/tendências
16.
Am Surg ; 84(2): 244-247, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29580353

RESUMO

A general surgeon shortage exists and fewer surgical residents specialize in trauma and surgical critical care (TSCC). We conducted a survey of trauma directors and administrators to determine what qualities are most desirable when hiring new TSCC fellowship graduates. METHODS: The survey, entitled "A Survey of Directors of Trauma on Hiring New Attending Trauma Surgeons," was submitted to the Eastern Association for the Surgery of Trauma (EAST) and distributed to the association members in January 2016. Categorical data were summarized using frequency counts and percentages. Comparisons of responses were analyzed using the chi-squared or Fisher's exact test. Statistical significance was denoted by P < 0.05. RESULTS: A total of 317 respondents from 1364 submitted surveys presented a response rate of 23.2 per cent. Of these respondents, 85.8 per cent (n = 272) decide whether or not a new trauma surgeon is hired and 33.7 per cent were trauma directors. In all, 82.9 per cent work at academic centers and have an Accreditation Council for Graduate Medical Education-approved general surgery residency and 58.4 per cent have an Accreditation Council for Graduate Medical Education-approved surgical critical care or acute care surgery fellowship. In total, 72.6 per cent work in American College of Surgeons-verified trauma centers and 45.0 per cent hire new trauma surgeons as needed. Of the 272 respondents who decide whether or not a new trauma surgeon is hired, the recommendation of the residency and fellowship program director is important. Word of mouth was the most important manner of finding a new hire and the most important qualities of a new TSCC physician were personality and likeability. CONCLUSION: The survey revealed that well-trained, likeable, enthusiastic, and personable TSCC physicians are the best candidates for hire.


Assuntos
Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Seleção de Pessoal/métodos , Cirurgiões/organização & administração , Traumatologia/organização & administração , Competência Clínica , Cuidados Críticos , Humanos , Personalidade , Cirurgiões/educação , Cirurgiões/psicologia , Inquéritos e Questionários , Traumatologia/educação , Estados Unidos
17.
World J Surg ; 42(9): 2800-2809, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29468262

RESUMO

BACKGROUND: Trauma team activation (TTA) represents a considerable expenditure of trauma centre resources. It is mainly triggered by field triage criteria. The overall quality of the criteria may be evaluated based on the rate of over- and undertriage. However, there is no gold standard that defines which adult patients truly require a trauma team. The objective of this study was to develop consensus-based criteria defining the necessity for a trauma team. METHODS: A consensus group was formed by trauma specialists experienced in emergency and trauma care with a specific interest in field triage and having previously participated in guideline development. A literature search was conducted to identify criteria that have already been used or suggested. The initial list of criteria was discussed in two Delphi round and two consensus conferences. The entire process of discussion and voting was highly standardized and extensively documented, resulting in a final list of criteria. RESULTS: Initially 95 criteria were identified. This was subsequently reduced to 20 final criteria to appropriately indicate the requirement for attendance of a trauma team. The criteria address aspects related to injury severity, admission to an intensive care unit, death within 24 h, need for specified invasive procedures, need for surgical and/or interventional radiological procedures, and abnormal vital signs within a defined time period. CONCLUSIONS: The selected criteria may be applied as a tool for research and quality control concerning TTA. However, future studies are necessary to further evaluate for possible redundancy in criteria that may allow for further reduction in criteria.


Assuntos
Equipe de Assistência ao Paciente/normas , Centros de Traumatologia/organização & administração , Traumatologia/normas , Triagem/métodos , Recursos em Saúde , Hospitalização , Humanos , Radiologia Intervencionista , Traumatologia/organização & administração , Ferimentos e Lesões
18.
Emergencias (St. Vicenç dels Horts) ; 30(1): 41-44, feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-169894

RESUMO

Objetivos. Estudiar si existen diferencias en la asignación de gravedad entre las versiones 98 y 2005 -actualización 2008- de la escala Abbreviated Injury Scale (AIS) y determinar si estas posibles diferencias podrían tener repercusión en la definición de paciente traumatológico grave. Método. Estudio descriptivo de una serie de casos con análisis transversal que incluyó a pacientes ingresados por lesiones debidas a causas externas en dos hospitales españoles, llevado a cabo entre febrero de 2012 y febrero de 2013. Se calculó el Injury Severity Score (ISS) y el New Injury Severity Score (NISS) de cada uno de los casos con ambas versiones de la escala AIS. Resultados. La muestra estuvo compuesta por 699 casos, con una edad media de 52,7 (DE 29,2) años, de los cuales 388 (55,5%) fueron varones. Se obtuvo una mayor clasificación de pacientes graves con la versión AIS 98, tanto para el ISS (2,6%) como el NISS (2,9%). Conclusiones. La versión AIS 2005 -actualización 2008- clasifica un menor número de pacientes como graves en comparación con la versión AIS 98 (AU)


Objectives. To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients. Methods. Descriptive study and cross-sectional analysis of a case series of patients admitted to two Spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005. Results. The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%). Conclusion. The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Traumatologia/organização & administração , Índices de Gravidade do Trauma , Codificação Clínica/organização & administração , Estudos Transversais/métodos , Codificação Clínica/normas , Codificação Clínica
20.
Z Orthop Unfall ; 156(3): 266-271, 2018 06.
Artigo em Alemão | MEDLINE | ID: mdl-29232728

RESUMO

The establishment and implementation of the combined specialisation of orthopaedic and trauma surgery in daily routine was and still is a huge challenge for all stakeholders. In recent years, major efforts have been made by the professional associations, the specialty societies and all parties involved in the implementation of this project. Basically, there is no general recipe for the implementation of such a concept. For each centre or clinic, the local structural, professional and historical circumstances must be meticulously taken into account when considering implementation of this concept. Therefore, the authors would like to report on the strategy of Leipzig University Hospital in combining to the clinics for orthopaedics, traumatology and plastic surgery into a single and interdisciplinary department and the first three years of experience and further development since its implementation.


Assuntos
Modelos Organizacionais , Ortopedia/organização & administração , Especialização/tendências , Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Previsões , Alemanha , Hospitais Universitários/organização & administração , Hospitais Universitários/tendências , Humanos , Ortopedia/tendências , Sociedades Médicas , Traumatologia/tendências
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