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1.
Semin Ophthalmol ; 37(1): 77-82, 2022 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-33975496

RESUMEN

INTRODUCTION: Previous studies have shown patient education material (PEM) in ophthalmology has been written at levels exceeding appropriate reading levels. However, information for readability in the field of oculoplastics remains limited. The aim of this study was to evaluate the readability of patient educational brochures from the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS). METHODS: Patient educational brochures from ASOPRS were analyzed for readability. The body of text from all 18 ASOPRS patient brochures was analyzed by ten validated tests for English readability assessment: Flesch Reading Ease Test (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), New Dale-Chall Readability (NDC), FORCAST, Fry Graph Readability (FG), Raygor Readability Estimate (RRE), and New Fog Count (NFC). RESULTS: The mean (± SD) readability scores from the 18 ASOPRS patient brochures were 48 (4.3), 11.0 (0.8), 13.0 (0.7), 11.7 (0.8), 13.6 (0.9), 11.3 (0.8), 11.1 (0.5), 12.1 (1.5), 12.2 (1.0), and 10.6 (1.3) for FRE, FKGL, SMOG, CLI, GFI, NDC, FORCAST, FG, RRE, and NFC, respectively. All ten of the mean readability scores were above the recommended reading levels. CONCLUSIONS: These findings show that the average patient may have difficulty understanding educational information provided by ASOPRS patient brochures, thereby hindering their ability to make informed decisions on their healthcare. Revision with readability as a primary goal, with input from patients and caregivers, may be necessary to improve health literacy among patients who seek oculoplastic care.


Asunto(s)
Oftalmología , Procedimientos Quirúrgicos Reconstructivos , Comprensión , Humanos , Folletos , Plásticos , Estados Unidos
2.
Orbit ; 41(1): 79-83, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33121312

RESUMEN

PURPOSE: In March 2020, the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) advised the suspension of all non-emergent oculofacial patient care, imparting unprecedented interruptions in fellowship training. METHODS: ASOPRS fellows and program directors were asked to complete an anonymous survey regarding their perceived impact of the COVID-19 crisis. RESULTS: Forty ASOPRS fellows (70.2%) participated, including 20 first-year and 20 second-year trainees, from all country regions. During the social distancing restrictions, 100% of fellows continued to participate in surgical procedures, including orbital biopsy (77.5%), abscess drainage (55.0%), fracture repair (45.6%), eyelid lesion excision (70.0%) and temporal artery biopsy (57.5%). ASOPRS fellows evaluated patients, including in emergency room (84.6%) and inpatient hospital (76.9%) settings, wearing surgical (85.0%) or N-95 (40.0%) masks, gloves (80.0%) and eye protection (62.5%).Most ASOPRS fellows (87.5%) participated in virtual interinstitutional education sessions and indicated a desire to continue this curriculum. Fellows also used available time for research (85.0%), independent study (77.5%), personal health (70.0%) and social interaction (60.0%).ASOPRS fellows reported COVID-19 restrictions to have a mild (72.5%) to moderate (27.5%) impact on their overall training, and most (75.0%) felt their surgical confidence to decline. Fellowship program directors also asserted a mild (72.2%), moderate (19.4%) or significant (5.6%) impact on subspecialty training, and 94.4% predict adverse effects on graduation case logs. CONCLUSIONS: During the COVID-19 restrictions most ASOPRS fellows participated in emergent clinical activities and novel telemedicine curriculum. Most fellows and program directors expressed concern regarding a negative impact on overall subspecialty education and surgical confidence.


Asunto(s)
COVID-19 , Curriculum , Educación de Postgrado en Medicina , Becas , Humanos , SARS-CoV-2 , Encuestas y Cuestionarios , Estados Unidos
3.
Arq Bras Oftalmol ; 84(1): 51-57, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33470342

RESUMEN

PURPOSE: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. METHODS: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. RESULTS: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. CONCLUSION: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.


Asunto(s)
Extracción de Catarata , Catarata , Ceguera , Brasil/epidemiología , Femenino , Humanos , Lactante , Masculino , Agudeza Visual
4.
Arq. bras. oftalmol ; 84(1): 51-57, Jan.-Feb. 2021. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1153107

RESUMEN

ABSTRACT Purpose: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. Methods: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. Results: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. Conclusion: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.


RESUMO Objetivo: Determinar o impacto do uso de unidade móvel no acesso à saúde ocular e avaliar o perfil da população que necessita de cuidados oftalmológicos, as doenças oculares mais frequentes e o tratamento. Métodos: Estudo transversal realizado em 14 municípios da região sudoeste do Estado de São Paulo utilizando uma unidade móvel oftalmológica. Os participantes eram usuários do Sistema Único de Saúde que procuraram atendimento oftalmológico, sem restrição quanto a idade, gênero ou condição socioeconômica. Os dados foram transferidos para a tabela Excel para análise estatística. Resultados: Participaram do estudo 6.878 pessoas, com média de idade de 44 anos (variação de 4 meses a 96 anos) e 65,5% eram mulheres. Erros refrativos estavam presentes em 78,6% dos participantes, catarata em 9,6% e pterígio em 8,3%. Para 60% foram prescritos óculos, para 10% foi mantida a correção óptica em uso e para 28% foram necessárias apenas orientações. Exames especializados ou procedimentos cirúrgicos foram indicados para 18,1% dos casos que foram encaminhados para tratamento em serviço terciário. Dentre os pacientes referenciados, 36,4% necessitavam de cirurgia oculoplástica ou para tratar afecções externas do olho e 31,8%, de cirurgia de catarata. Conclusão: A grande maioria dos pacientes que procurou atendimento na unidade móvel necessitava de prescrição de óculos. A unidade móvel oftalmológica possui alto grau de resolutividade para os problemas oculares, com oportunidade de tratar os erros refrativos e referenciar os pacientes que necessitam de atendimento espe­cializado, geralmente relacionado a condições cirúrgicas. Unidades móveis podem ser uma alternativa aos cuidados oftalmológicos básicos, melhorando o acesso, atuando na promoção da saúde ocular e prevenindo a cegueira.


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Catarata/patología , Extracción de Catarata , Ceguera , Brasil/epidemiología , Agudeza Visual
5.
JAMA Ophthalmol ; 139(2): 157-162, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33300973

RESUMEN

Importance: Understanding whether statewide legislation, such as the Michigan Opioid Laws, is associated with reduction in postoperative opioid prescriptions is informative in guiding future legislation. Objective: To identify changes in opioid prescribing patterns for oculoplastic and orbital procedures associated with the enactment of the Michigan Opioid Laws in 2017 and 2018. Design, Setting, and Participants: This cross-sectional study included 3781 patients who underwent any of 10 common oculoplastic and orbital procedures between June 1, 2016, and November 30, 2019, at a tertiary care institution. Exposures: From 2017 to 2018, Michigan enacted a series of laws to address the state's worsening opioid epidemic. Two major components of this legislation enacted on June 1, 2018, required prescribers to review a report of patients' opioid use history and obtain signed consent after educating patients on the use and disposal of opioids prior to prescribing. Main Outcomes and Measures: Demographic information, type of surgery, type and amount of opioid prescriptions, and morphine milligram equivalent (MME) were analyzed. MME was calculated as the product of dose, quantity, and opioid-specific conversion factor for each prescription. Linear interpolation spline regression was used to evaluate the association of prescription MME with time. Results: Of 3781 patients, 1614 (42.7%) were male. The mean (SD) age at the time of surgery was 63.3 (16.6) years. Of 2026 patients undergoing surgery before June 1, 2018, 1782 (88.0%) were prescribed postoperative opioids; of 1755 patients undergoing surgery after June 1, 2018, 878 (50.0%) were prescribed postoperative opioids (P < .001). There was no difference in age, sex, race/ethnicity, surgery type, or opioids prescribed between these 2 cohorts. Linear interpolation spline regression showed a decrease of 26.025 MMEs (equivalent to a 36.2% reduction of mean MME) between June 1, 2017, and September 30, 2018 (ß, -1.735; 95% CI, -0.088 to -0.024; P < .001), stabilizing at a persistently reduced rate of MME prescribed through the end of the study period (October 1, 2018, to November 30, 2019; ß, -0.005; 95% CI, -0.039 to 0.016; P = .42). Changes in MME in the 12 months before or 12 months after the period of legislation enactment were not identified. Conclusions and Relevance: In this cross-sectional study, reduction in opioid prescriptions for oculoplastic and orbital procedures was observed during the enactment period of the Michigan Opioid Laws and appeared to be sustained through the end of the study period. Similar statewide or national legislations aimed at increasing prescriber awareness and patient education on opioid use may help curtail the prescription opioid epidemic.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Control de Medicamentos y Narcóticos , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Órbita/cirugía , Dolor Postoperatorio/prevención & control , Pautas de la Práctica en Medicina/tendencias , Programas de Monitoreo de Medicamentos Recetados , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Anciano , Analgésicos Opioides/efectos adversos , Estudios Transversales , Prescripciones de Medicamentos , Utilización de Medicamentos/tendencias , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Femenino , Humanos , Masculino , Michigan , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Formulación de Políticas , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Programas de Monitoreo de Medicamentos Recetados/legislación & jurisprudencia , Estudios Retrospectivos , Gobierno Estatal , Factores de Tiempo , Resultado del Tratamiento
6.
Int Ophthalmol ; 41(3): 991-994, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33201445

RESUMEN

PURPOSE: Epiblepharon is a congenital eyelid anomaly that occurs most frequently in Asian children. Recent literature has identified an association between obesity and increased rates of epiblepharon among Asian children. The purpose of our study was to determine whether obesity was also associated with epiblepharon in a non-Asian population. METHODS: The medical records of all children with a diagnosis of epiblepharon seen in the oculoplastic clinic at a single institution over a 2-year period were reviewed and included all the Caucasian children with epiblepharon. The average body mass index was calculated for all patients with epiblepharon. The rate of obesity among these children was compared with the national rate of childhood obesity in the United States as defined by the Center for Disease Control and Prevention. RESULTS: Our study included 10 Caucasian children with epiblepharon. There were 8 girls and 2 boys. The rate of obesity among non-Asian children with epiblepharon was 40%, which is substantially higher than the average rate of obesity among children in the USA. One child was overweight. CONCLUSIONS: This study suggests an association between obesity and epiblepharon in non-Asian children. Obesity likely contributes to anatomic variations in the midface and eyelids that can lead to the development of epiblepharon. Given the rising rates of childhood obesity, it is important to be aware of its association with epiblepharon in ethnic populations other than Asian.


Asunto(s)
Enfermedades de los Párpados , Niño , Párpados , Femenino , Humanos , Masculino , América del Norte , Obesidad/complicaciones , Obesidad/epidemiología , Pennsylvania , Estudios Retrospectivos , Centros de Atención Terciaria
7.
Can J Ophthalmol ; 55(3): 245-252, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31901307

RESUMEN

OBJECTIVE: The management of advanced basal cell carcinoma (BCC) in the periocular region remains a clinical challenge. Vismodegib (ErivedgeTM) has been approved in 2013 by Health Canada for adult patients with "histologically confirmed metastatic BCC or locally advanced BCC inappropriate for surgery or radiation." An expert consensus was sought to create a standardised approach in the use of this novel treatment. METHODS: Fourteen practicing oculoplastic surgeons across Canada were involved in formulating and reviewing guidelines until consensus was reached. A consultancy meeting was followed by further ratification of guidelines over email. Two voting surveys were performed of the group to objectively assess agreement over each statement within the guidelines. Ratification continued until at least two-thirds of the group agreed on every guideline statement. RESULTS: The guidelines summarize 21 statements in a major and minor criteria format. A multidisciplinary team review is suggested for each patient with the involvement of recommended specialists. The internal survey revealed 100% agreement over 9 statements, 91.7% agreement over 8 statements, 83.3% agreement over 4 statements, and 2 statements had 66.7% and 58.7% agreement each. All statements with less than 91.7% agreement were surveyed again, and they were kept, modified, or removed on the basis of a consensus of over 66.7%. CONCLUSIONS: These guidelines serve to act as a framework for physicians considering vismodegib for the medical management of patients with advanced or metastatic periocular BCC. Future applications, including neoadjuvant uses of the drug, may become apparent through further research.


Asunto(s)
Antineoplásicos , Carcinoma Basocelular , Neoplasias Cutáneas , Adulto , Anilidas , Antineoplásicos/uso terapéutico , Canadá , Humanos , Piridinas , Resultado del Tratamiento
8.
Rev. cir. (Impr.) ; 71(2): 129-135, abr. 2019. tab, ilus
Artículo en Español | LILACS | ID: biblio-1058245

RESUMEN

INTRODUCCIÓN: La cirugía oculoplástica estudia y trata los trastornos de párpados, órbita y vías lagrimales. Entre las patologías más importantes por frecuencia e impacto tenemos: ptosis palpebral, blefarochalasis, ectropión y entropión. OBJETIVO: Analizar la experiencia del Hospital El Pino en cuanto al manejo de patología oculoplástica en manos de un cirujano plástico. MATERIALES Y MÉTODO: Estudio descriptivo y retrospectivo. Se revisaron fichas de pacientes operados con diagnóstico de blefarochalasis, ptosis palpebral, ectropión y entropión entre los años 2010 y 2017. Se analizaron datos como edad, sexo, comorbilidades, causa del defecto, cirugía oculoplástica, tipo de anestesia, complicación posoperatoria, tiempo de seguimiento y resultados. RESULTADOS: Entre los años 2010 y 2017 se operaron 79 pacientes con patología oculoplástica, 17 por ptosis palpebral, 42 por blefarochalasis, 14 por ectropión y 6 por entropión, siendo la principal causa senil (93,7%). Las cirugías realizadas fueron: pexia del elevador para Ptosis palpebral, blefaroplastía para blefarochalasis y para ectropión-entropión tarsal strip. La principal técnica anestésica utilizada fue anestesia local + sedación (54,4%). Entre el total de complicaciones posoperatorias tenemos: lagoftalmo (2 casos), ectropión residual (3 casos), conjuntivitis (3 casos), dehiscencia de herida (2 casos) y hematoma palpebral (1 caso). Se reintervinieron 6 pacientes por complicaciones. Los resultados obtenidos según la evaluación subjetiva del cirujano plástico y pacientes fueron regular (5 casos), bueno (20 casos) y muy bueno (54 casos). CONCLUSIÓN: El manejo de la patología oculoplástica requiere en su mayoría de cirugías ambulatorias con buenos resultados y poca morbilidad, lo cual es factible de realizar en un hospital público. Creemos necesario el uso de algún instrumento objetivo para evaluar de mejor manera los defectos palpebrales y su corrección.


INTRODUCTION: The oculoplastic surgery studies and treats disorders of the eyelids, orbit and lacrimal ways. Among the most important pathologies by frequency and impact are: palpebral ptosis, blepharochalasis, ectropion and entropion. AIM: Analyze the experience of El Pino Hospital regarding the management of oculoplastic pathology in the hands of a plastic surgeon. MATERIALS AND METHOD: Descriptive and retrospective study. We reviewed files of patients operated with diagnosis of blepharochalasis, palpebral ptosis, ectropion and entropion between the years 2010 and 2017. Data were analyzed as age, sex, comorbidities, cause of the defect, oculoplastic surgery, type of anesthesia, postoperative complication, follow-up time and results. RESULTS: Between the years 2010 and 2017, 79 patients with oculoplastic pathology operated, 17 for palpebral ptosis, 42 for blefarochalasis, 14 for ectropion and 6 for entropion, being the main senile cause (93,7%). The surgeries performed were: elevator pexis for palpebral ptosis, blepharoplasty for blefarochalasis and for ectropion-entropion tarsal strip. The main anesthetic technique used was local anesthesia + sedation (54,4%). Among the total postoperative complications, we have: lagophthalmos (2 cases), residual ectropion (3 cases), conjunctivitis (3 cases), wound dehiscence (2 cases) and palpebral hematoma (1 case). Six patients were reoperated due to complications. The results obtained according to the subjective evaluation of the plastic surgeon were regular (5 cases), good (20 cases) and very good (54 cases). CONCLUSION: Management of oculoplastic pathology requires mostly ambulatory surgeries with good results and low morbidity, which is feasible to perform in a public hospital. We believe it is necessary to use some objective instrument to better evaluate the palpebral defects and their correction.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Oftalmopatías/cirugía , Órbita/cirugía , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Reconstructivos/estadística & datos numéricos , Enfermedades de los Párpados/cirugía
9.
Can J Ophthalmol ; 53(2): 139-144, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29631825

RESUMEN

OBJECTIVE: To study the patterns of usage and perception among U.S. oculoplastic surgeons regarding surgical loupes. METHODS: An anonymous 20-question survey was emailed out to the American Society of Ophthalmic Plastic and Reconstructive Surgery listserv. Data were compiled in Google Forms. SPSS was used for statistical analyses. This study was approved by the institutional review board. RESULTS: Of the 609 members contacted, 239 (39%) completed the survey; 95% of respondents owned loupes and 78% regularly used them. No association was observed between frequency of loupe usage and sex or years in practice. The most common magnification and brand were 2.5× and Designs for Vision, respectively. The most common problems associated with loupes were limited vision (33%) and lack of comfort (24%), with 11% citing neck and cervical spinal disorders. The most common benefits were magnification (93%) and increased visual accuracy (68%). Of the respondents, 56% believed improved patient care to be a benefit and 76% believed that loupes enhance surgical outcome. With regard to training, 67% supported incorporating loupes into residency, 35% believed in mandating loupe purchase, and 25% wanted residencies to provide loupes at no cost. Respondent support for the use of loupes in practice and training was directly correlated with how frequently they used loupes. CONCLUSIONS: The vast majority of respondents owned loupes. Although most loupe owners used loupes regularly, a sizable proportion operated with limited vision and lack of comfort. Overall, just over half of respondents believed that loupes improve patient care and should be integrated into residency.


Asunto(s)
Procedimientos Quirúrgicos Oftalmológicos/instrumentación , Oftalmólogos/estadística & datos numéricos , Óptica y Fotónica/estadística & datos numéricos , Procedimientos Quirúrgicos Reconstructivos/instrumentación , Instrumentos Quirúrgicos/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Oftalmopatías/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , América del Norte
10.
Ophthalmology ; 125(5): 631-641, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29342439

RESUMEN

PURPOSE: To describe characteristics of closed medical professional liability (MPL) claims against ophthalmologists in the United States. DESIGN: Retrospective analysis of MPL claims from 2006-2015. Data were obtained from the Physician Insurers Association of America (PIAA) Data Sharing Project (DSP). Comparison was made between ophthalmology and all healthcare specialties for physician demographics, prevalence and costs associated with closed claims, and resolution of claims. The most prevalent chief medical factor, presenting medical condition, operative procedure, outcomes, and resolution of ophthalmology claims were compared between the 2006-2010 and 2011-2015 periods. PARTICIPANTS: From 2006-2015, 90 743 MPL claims were closed: 2.6% (2325/90 743) of closed claims and 2.2% (564/24 670) of all paid claims were against ophthalmologists. METHODS: Retrospective analysis of MPL claims captured by the PIAA DSP over a 10-year period. MAIN OUTCOME MEASURES: Subspecialty pertaining to the claim, number of claims closed and paid, indemnity paid, allocated loss adjustment expenses, chief medical factor, presenting medical condition, operative procedure, outcome, and resolution. RESULTS: Only 24% of closed claims against ophthalmologists resulted in payment. Two-thirds were dropped, withdrawn, or dismissed. Ninety percent of claims that received a verdict were favorable toward the ophthalmologist. Cataract and cornea surgeries were the most prevalent and most costly operative procedures, accounting for 50% of all claims and $47 641 376 and $32 570 148 in total paid indemnity, respectively. Average indemnity was higher for corneal procedures ($304 476) than vitreoretinal procedures ($270 141) or oculoplastic procedures on the eyelid ($222 471) or orbit and eyeball ($183 467). The prevalence and cost of claims related to endophthalmitis declined from 2006-2010 (n = 38/1160 [3.3%]; average indemnity, $516 875) period to the 2011-2015 (n = 26/1165 [2.2%]; average indemnity, $247 083) period. Average indemnity paid ($280 227 vs. $335 578) and amount spent on legal defense ($41 450 vs. $46 391) was slightly lower among ophthalmologists compared with all healthcare specialties, respectively. CONCLUSIONS: Ophthalmology has a relatively low number of malpractice claims reported compared with other healthcare specialties and shows less spending on average indemnity and defense. Further studies are needed to investigate the reasons for the higher prevalence of claims related to cataract and corneal surgeries and the higher average indemnity paid for corneal procedures relative to vitreoretinal or oculoplastic procedures.


Asunto(s)
Responsabilidad Legal , Mala Praxis/estadística & datos numéricos , Oftalmólogos/legislación & jurisprudencia , Oftalmología/estadística & datos numéricos , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Adulto , Anciano , Competencia Clínica , Bases de Datos Factuales , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Errores Médicos/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos
11.
Int Ophthalmol ; 38(3): 1085-1093, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28528356

RESUMEN

AIM: A survey of ophthalmic plastic and reconstructive surgeons as well as seven-year data regarding claims made to the Ophthalmic Mutual Insurance Company (OMIC) is used to discuss operating room fires in periocular surgery. METHODS: A retrospective review of all closed claim operating room fires submitted to OMIC was performed. A survey soliciting personal experiences with operating room fires was distributed to all American Society of Oculoplastic and Reconstructive Surgeons. RESULTS: Over the last 2 decades, OMIC managed 7 lawsuits resulting from an operating room fire during periocular surgery. The mean settlement per lawsuit was $145,285 (range $10,000-474,994). All six patients suffered burns to the face, and three required admission to a burn unit. One hundred and sixty-eight surgeons participated in the online survey. Approximately 44% of survey respondents have experienced at least one operating room fire. Supplemental oxygen was administered in 88% of these cases. Most surgical fires reported occurred in a hospital-based operating room (59%) under monitored anesthesia care (79%). Monopolar cautery (41%) and thermal, high-temperature cautery (41%) were most commonly reported as the inciting agents. Almost half of the patients involved in a surgical fire experienced a complication from the fire (48%). Sixty-nine percent of hospital operating rooms and 66% of ambulatory surgery centers maintain an operating room fire prevention policy. CONCLUSIONS: An intraoperative fire can be costly for both the patient and the surgeon. Ophthalmic surgeons operate in an oxygen rich and therefore flammable environment. Proactive measures can be undertaken to reduce the incidence of surgical fires periocular surgery; however, a fire can occur at any time and the entire operating room team must be constantly vigilant to prevent and manage operating room fires.


Asunto(s)
Quemaduras/epidemiología , Incendios/estadística & datos numéricos , Calor/efectos adversos , Quirófanos/estadística & datos numéricos , Procedimientos Quirúrgicos Oftalmológicos , Oxígeno/análisis , Procedimientos Quirúrgicos Reconstructivos , Quemaduras/etiología , Humanos , Incidencia , Periodo Intraoperatorio , Estudios Retrospectivos , Estados Unidos/epidemiología
12.
Ophthalmic Plast Reconstr Surg ; 34(2): 114-122, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-28263248

RESUMEN

PURPOSE: This study was performed to characterize the frequency, causes, and possible risk factors of operating room (OR) fires experienced by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. METHODS: An online questionnaire was distributed to American Society of Ophthalmic Plastic and Reconstructive Surgery members, collecting data on surgical fires experienced by respondents throughout their careers. In addition, the questionnaire investigated viewpoints on OR fire safety, current practice patterns with oxygen delivery and surgical device usage, and management of patients referred after previous surgical fire exposure. RESULTS: There were 258 participants in the survey. Eighty-three surgeons (32.2%) experienced at least 1 surgical fire in their careers. Most OR fires occurred during monitored sedation cases with oxygen delivered by nasal cannula underneath drapes completely covering the head and use of a monopolar or battery-operated device. Patient hair and skin were the most common fuel sources, and most of the injuries were limited to singing of facial hair. Regarding current practice patterns, monopolar, bipolar, and battery-powered disposable devices were the most frequently used electrosurgery and electrocautery tools. Patients seen after an OR fire with another surgeon generally experienced more severe burns requiring hospitalization and subsequent procedures. CONCLUSIONS: Many oculoplastic surgeons have experienced OR fires during their careers. Certain surgical and anesthetic techniques, particularly the delivery of supplemental oxygen underneath surgical drapes and the use of monopolar electrosurgery and battery-powered electrocautery, may be associated with increased fire risk. While most of the reported OR fires did not result in significant patient injury, caution must be taken to prevent these potentially devastating events.


Asunto(s)
Quemaduras/etiología , Incendios/estadística & datos numéricos , Quirófanos/estadística & datos numéricos , Procedimientos Quirúrgicos Oftalmológicos , Procedimientos Quirúrgicos Reconstructivos , Quemaduras/epidemiología , Humanos , Incidencia , Oftalmología , Factores de Riesgo , Estados Unidos/epidemiología
13.
J Surg Educ ; 74(5): 837-842, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28284655

RESUMEN

OBJECTIVE: To develop a new oculoplastic curriculum that incorporates learning theory of skill acquisition. To develop and evaluate the effectiveness of instructional videos for an oculoplastic surgical wet laboratory. DESIGN: Proof of concept, randomized controlled trial. SETTING: New York Eye and Ear Infirmary of Mount Sinai-tertiary care academic institution. PARTICIPANTS AND METHODS: In total, 16 ophthalmology residents were randomly assigned to 1 of 2 groups and given either video and text or text instructions alone for the following 2 procedures: blepharoplasty and eyelid laceration repair. Operating time and esthetic result were measured, and the groups were statistically compared. A brief survey was administered. RESULTS: We developed a new 6 component oculoplastics curriculum that incorporates concepts of the Fitts and Posner skill acquisition model and mental imagery. In the wet laboratory pilot study, the group that watched the video of the laceration repair showed better esthetic grades than the group that received text alone (p = 0.038). This difference was not found for the blepharoplasty (p = 0.492). There was no difference between groups in operating time for the laceration repair (p = 0.722), but the group that watched the blepharoplasty video required more time to complete the task than those that reviewed text only (p = 0.023). In total, 100% of residents reported the videos augmented their learning. CONCLUSIONS: Methods to optimize surgical education are important given limited operating room time in oculoplastics, a subspecialty in which the number of surgeries performed during residency is relatively low. We developed a curriculum based on learning theory and sought to formally test one important aspect, surgical video for wet laboratories. Our pilot study, despite its limitations, showed that wet laboratory surgical videos can be effective tools in improving motor skill acquisition for oculoplastic surgery.


Asunto(s)
Blefaroplastia/educación , Competencia Clínica , Enfermedades de los Párpados/cirugía , Internado y Residencia/métodos , Procedimientos Quirúrgicos Oftalmológicos/educación , Centros Médicos Académicos , Adulto , Cadáver , Curriculum , Educación de Postgrado en Medicina/métodos , Femenino , Humanos , Masculino , Ciudad de Nueva York , Tempo Operativo , Proyectos Piloto , Grabación en Video
14.
Ophthalmic Plast Reconstr Surg ; 32(6): 434-437, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27828915

RESUMEN

PURPOSE: To assess current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) regarding preference in surgical techniques for orbital decompression in Graves' disease. METHODS: A 10-question web-based, anonymous survey was distributed to oculoplastic surgeons utilizing the ASOPRS listserv. The questions addressed the number of years of experience performing orbital decompression surgery, preferred surgical techniques, and whether orbital decompression was performed in collaboration with an ENT surgeon. RESULTS: Ninety ASOPRS members participated in the study. Most that completed the survey have performed orbital decompression surgery for >15 years. The majority of responders preferred a combined approach of floor and medial wall decompression or balanced lateral and medial wall decompression; only a minority selected a technique limited to 1 wall. Those surgeons who perform fat decompression were more likely to operate in collaboration with ENT. Most surgeons rarely remove the orbital strut, citing risk of worsening diplopia or orbital dystopia except in cases of optic nerve compression or severe proptosis. The most common reason given for performing orbital decompression was exposure keratopathy. The majority of surgeons perform the surgery without ENT involvement, and number of years of experience did not correlate significantly with collaboration with ENT. CONCLUSIONS: The majority of surveyed ASOPRS surgeons prefer a combined wall approach over single wall approach to initial orbital decompression. Despite the technological advances made in the field of modern endoscopic surgery, no single approach has been adopted by the ASOPRS community as the gold standard.


Asunto(s)
Descompresión Quirúrgica/tendencias , Enfermedad de Graves/cirugía , Oftalmología , Órbita/cirugía , Procedimientos Quirúrgicos Reconstructivos/tendencias , Sociedades Médicas , Encuestas y Cuestionarios , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Estados Unidos
15.
JAMA Ophthalmol ; 133(7): 778-84, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25905446

RESUMEN

IMPORTANCE: Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The literature regarding antibiotic use for eyelid surgery is lacking. OBJECTIVES: To determine standard care and assess factors influencing antibiotic prescribing practices for eyelid surgery. DESIGN, SETTING, AND PARTICIPANTS: A survey study was conducted from February 2, 2014, to March 24, 2014. The survey was distributed to 2397 oculoplastic surgeons in private and academic oculoplastic surgery practices in 43 countries. All surgeons were members of ophthalmic plastic and reconstructive surgery societies. Data were analyzed by geographic location. Linear regression was performed to quantify contributions to rates of prescribing postoperative antibiotics for routine eyelid surgical procedures. MAIN OUTCOMES AND MEASURES: Rates of prescribing prophylactic intravenous, oral, and topical antibiotics as well as factors that influence surgeons' prescribing practices. RESULTS: A total of 782 responses were received from 2397 surgeons (average response rate, 36.7%; 2.5% margin of error) from 43 countries. Topical antibiotic use was common in all regions (85.2%). Perioperative intravenous antibiotic use was uncommon in all regions (13.5%). Geographic location was the greatest predictor of antibiotic prescribing practices (range, 2.9% in the United Kingdom to 86.7% in India; mean, 24%). Within Europe, Italy had the highest rate of antibiotic prescriptions for eyelid surgery (41.7%) and the United Kingdom had the lowest rate (2.9%.) In South America, Venezuela had the highest rate of antibiotic prescriptions for eyelid surgery (83.3%) and Chile had the lowest rate (0%). The practice locations that were associated with routinely prescribing postoperative oral antibiotics were India (odds ratio [OR], 15.83; 95% CI, 4.85-51.68; P < .001), Venezuela (OR, 13.47; 95% CI, 1.43-127.19; P = .02), and Southeast Asia (OR, 2.80; 95% CI, 1.15-6.84; P = .02). Conversely, practice location in the United Kingdom (OR, 0.048; 95% CI, 0.0063-0.37; P = .004), Australia and New Zealand (OR, 0.15; 95% CI, 0.033-0.67; P = .01), and the United States and Canada (OR, 0.41; 95% CI, 0.23-0.72; P = .002) were associated with decreased rates of postoperative oral antibiotic use. Surgeons' concern for allergic reactions was associated with decreased rates of prescribing antibiotics (OR, 0.34; 95% CI, 0.23-0.49; P < .001), while surgeons' concern for infection was associated with increased rates of prescribing antibiotics (OR 1.80; 95% CI, 1.45-2.23; P < .001). CONCLUSIONS AND RELEVANCE: These results from members of ophthalmic plastic and reconstructive surgery societies confirm that antibiotic prescribing practices for routine eyelid surgical procedures vary widely throughout the world. No standard of care has been established that would require the routine use of postoperative prophylactic antibiotics following eyelid surgery.


Asunto(s)
Profilaxis Antibiótica/métodos , Actitud del Personal de Salud , Enfermedades de los Párpados/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Adulto , Profilaxis Antibiótica/estadística & datos numéricos , Argentina , Canadá , Intervalos de Confianza , Enfermedades de los Párpados/diagnóstico , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud , Humanos , India , Internacionalidad , Italia , Masculino , Persona de Mediana Edad , Nueva Zelanda , Oportunidad Relativa , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Oftalmología/normas , Oftalmología/tendencias , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/tendencias , Análisis de Regresión , Infección de la Herida Quirúrgica/prevención & control , Encuestas y Cuestionarios , Resultado del Tratamiento , Reino Unido , Estados Unidos
16.
J Oral Maxillofac Surg ; 73(4): 580-6, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25795577

RESUMEN

PURPOSE: We sought, first, to evaluate the operative experience of surgeons who have completed postresidency fellowships offered by the American Academy of Cosmetic Surgery (AACS), and second, to compare this cosmetic surgery training to other surgical residency and fellowship programs in the United States. Finally, we suggest how new and existing oral and maxillofacial surgeons can use these programs. MATERIALS AND METHODS: We reviewed the completed case logs from AACS-accredited fellowships. The logs were data mined for 7 of the most common cosmetic operations, including the median total number of operations. We then compared the cosmetic case requirements from the different residencies and fellowships. RESULTS: Thirty-nine case logs were reviewed from the 1-year general cosmetic surgery fellowships offered by the AACS from 2007 to 2012. The fellows completed a median of 687 total procedures. The median number of the most common cosmetic procedures performed was 14 rhinoplasties, 31 blepharoplasties, 21 facelifts, 24 abdominoplasties, 28 breast mastopexies, 103 breast augmentations, and 189 liposuctions. The data obtained were compared with the minimum cosmetic surgical requirements in residency and fellowship programs. The minimum residency requirements were as follows: no minimum listed for plastic surgery, 35 for otolaryngology, 20 for oral and maxillofacial surgery, 28 for ophthalmology, 0 for obstetrics and gynecology, and 20 for dermatology. The minimum fellowship requirements were as follows: 300 for the AACS cosmetic surgery fellowship, no minimum listed for facial plastic surgery and reconstruction, no minimum listed for aesthetic surgery, 133 for oculoplastic and reconstructive surgery, and 0 for Mohs dermatology. CONCLUSION: Dedicating one's practice exclusively to cosmetic surgery requires additional postresidency training owing to the breadth of the field. The AACS created comprehensive fellowship programs to fill an essential part in the continuum of cosmetic surgeons' education, training, and experience. This builds on the foundation of their primary board residency program. The AACS fellowships are a valuable option for additional training for qualified surgeons seeking proficiency and competency in cosmetic surgery.


Asunto(s)
Becas , Internado y Residencia , Cirugía Bucal/educación , Cirugía Plástica/educación , Abdominoplastia/estadística & datos numéricos , Blefaroplastia/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Femenino , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Humanos , Lipectomía/estadística & datos numéricos , Masculino , Mamoplastia/estadística & datos numéricos , Procedimientos Quirúrgicos Obstétricos/estadística & datos numéricos , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Procedimientos Quirúrgicos Orales/estadística & datos numéricos , Procedimientos Quirúrgicos Otorrinolaringológicos/estadística & datos numéricos , Procedimientos Quirúrgicos Reconstructivos/estadística & datos numéricos , Rinoplastia/estadística & datos numéricos , Ritidoplastia/estadística & datos numéricos , Cirugía Plástica/economía , Estados Unidos
17.
Plast Reconstr Surg ; 135(1): 92e-98e, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25539355

RESUMEN

BACKGROUND: Practitioners who are not board-certified by the American Board of Plastic Surgery are practicing cosmetic surgery. The extent of this issue across the United States has yet to be examined in detail. METHODS: A systematic search using Google was performed to evaluate the qualifications of clinicians marketing themselves as plastic surgeons. For every U.S. state, the following searches were performed: [state] plastic surgery, [state] cosmetic surgery, and [state] aesthetic surgery. The first 50 Web sites returned for each search were visited and scrutinized using the American Society of Plastic Surgeons and American Board of Plastic Surgery Web sites. RESULTS: In total, 7500 Web sites were visited, yielding 2396 board-certified plastic surgeons (77.9 percent of all practitioners). There were 284 board-certified ear, nose, and throat surgeons, 61 (21.5 percent) of whom practice outside their scope; 106 board-certified general surgeons, 100 (94.3 percent) of whom practice outside their scope; 104 board-certified oral and maxillofacial surgery surgeons, 68 (65.4 percent) of whom practice outside their scope; 70 board-certified ophthalmologists/oculoplastic surgeons, 49 (70 percent) of whom practice outside their scope; and 74 board-certified dermatologists, 36 (48.6 percent) of whom practice outside their scope. There were also 16 internal medicine doctors, 13 obstetrics and gynecology physicians, six emergency medicine physicians, three pediatricians, two urologists, two anesthesiologists, and finally one phlebotomist; all of these practitioners practice outside their scope as defined by Accreditation Council for Graduate Medical Education core competencies. CONCLUSIONS: Many clinicians performing cosmetic surgery are not board-certified. This finding has important implications for patient safety.


Asunto(s)
Certificación/estadística & datos numéricos , Cirugía Plástica/estadística & datos numéricos , Competencia Clínica , Internet , Estados Unidos
18.
Br J Dermatol ; 172(4): 1116-9, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25155197

RESUMEN

Sporothrix brasiliensis is the main species of the S. schenckii complex implicated in the zoonotic epidemics of sporotrichosis in Rio de Janeiro, Brazil. Epidemiological features have been already described, such as zoonotic transmission by cats and increased frequency of atypical clinical aspects. The involvement of the face by contact with cats is common in childhood; as a result, ophthalmic manifestations have increased. We report a case of acute dacryocystitis in a 9-year-old girl. A calmodulin-based molecular phylogeny was used to identify the agent as S. brasiliensis. This is a rare type of presentation, usually complicated with nasolacrimal duct occlusion. The patient was cured without sequelae after treatment with a low dose of saturated solution of potassium iodide and decompressive oculoplastic surgery. Therapeutic options and considerations of aetiological agents and serology are discussed.


Asunto(s)
Antifúngicos/administración & dosificación , Dacriocistitis/microbiología , Dermatosis Facial/tratamiento farmacológico , Yoduro de Potasio/administración & dosificación , Esporotricosis/tratamiento farmacológico , Enfermedad Aguda , Niño , Terapia Combinada , Dacriocistitis/tratamiento farmacológico , Dacriocistorrinostomía , Dermatosis Facial/cirugía , Femenino , Humanos , Obstrucción del Conducto Lagrimal/tratamiento farmacológico , Obstrucción del Conducto Lagrimal/microbiología , Conducto Nasolagrimal , Procedimientos Quirúrgicos Reconstructivos , Sporothrix , Esporotricosis/cirugía
19.
Ophthalmic Plast Reconstr Surg ; 30(2): 119-23, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24618906

RESUMEN

PURPOSE: To assess characteristics associated with various outcomes of malpractice litigation, resulting from injuries sustained during oculoplastic procedures. METHODS: The Westlaw legal database (Thomson Reuters, New York, NY, U.S.A.) was used to obtain jury verdicts and settlements. Pertinent data were extracted from 69 malpractice cases litigated from 1988 to 2012 involving oculoplastic procedures, including alleged cause of malpractice, outcome, and defendant specialty. RESULTS: The most commonly litigated surgical procedures were blepharoplasty (63.8% of total) and brow lift surgery (11.6%). The most commonly alleged complications included excessive scarring (24.6%), lagophthalmos (24.6%), visual defects (23.2%), and exposure keratitis (21.7%). Plastic surgeons were the most commonly named defendants (46.4%), followed by both comprehensive ophthalmologists and fellowship-trained ophthalmic plastic surgeons (17.3% each). A defense verdict was held in 60.9% of cases, a plaintiff verdict in 31.9% of cases, and a settlement was reached in 7.2% of cases. Blindness, cranial nerve injury, and the allegation of a permanent deficit increased the likelihood of a case being resolved with payment to the plaintiff (Fisher exact tests, p < 0.05). CONCLUSIONS: Most litigated oculoplastic malpractice cases were resolved in favor of the defendant, while settlements and plaintiff decisions averaged $455,703. Blepharoplasty constituted two-thirds of cases, with the most frequently cited associated complications being unsightly scarring, lagophthalmos, and visual deficits. An alleged lack of informed consent (30.4%) or the need for additional surgery (39.1%) was present in a considerable proportion of cases, emphasizing the importance of a detailed informed consent and clear communication preoperatively regarding patient expectations.


Asunto(s)
Mala Praxis/legislación & jurisprudencia , Procedimientos Quirúrgicos Oftalmológicos/legislación & jurisprudencia , Oftalmología/legislación & jurisprudencia , Cirugía Plástica/legislación & jurisprudencia , Bases de Datos Factuales , Femenino , Humanos , Enfermedad Iatrogénica , Consentimiento Informado , Masculino , Persona de Mediana Edad , Estados Unidos
20.
Ophthalmology ; 121(7): 1475-9, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24534753

RESUMEN

OBJECTIVE: To describe patient preferences regarding payment for blepharoplasty and blepharoptosis repair and physician practices before and after the 2009 change in reimbursement for these 2 procedures by the Centers for Medicare and Medicaid Services (CMS). DESIGN: Cross-sectional study. PARTICIPANTS: Fifty patients presenting for functional blepharoplasty and blepharoptosis repair at an academic oculoplastic practice and 198 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. METHODS: A 5-question paper survey was administered to patients, and a 5-question web-based survey was distributed to 510 unique physician e-mail addresses obtained from the American Society of Ophthalmic Plastic and Reconstructive Surgery mailing list server in 2010. MAIN OUTCOME MEASURES: The surveys elicited patient knowledge and attitudes regarding the reimbursement policy of the CMS and physician knowledge and behaviors before and after the reimbursement policy change. RESULTS: Ninety-one percent of patients would be opposed to having to pay out of pocket for blepharoplasty or having to wait at least 3 months after ptosis repair to have a blepharoplasty. When asked to choose between these options, 62% of the patients would rather have the 2 surgeries performed separately than pay out-of-pocket. Before the reimbursement policy change by the CMS, 77% of oculoplastic surgeons performed blepharoplasty and blepharoptosis repair in the same sitting, whereas 37% did so after the policy change (P<0.001). Compared with before the policy change by the CMS, more surgeons performed the 2 procedures at least 3 months apart (4% before vs. 29% after, P<0.001) and more often billed patients for a cosmetic blepharoplasty (5% before vs. 12% after, P = 0.009). CONCLUSIONS: Our study suggests that oculoplastic surgeons have made a change in the delivery of ptosis and blepharoplasty surgical services after the reimbursement policy change for these procedures by the CMS in 2009. This change, in which patients undergo separate surgical visits for ptosis repair and blepharoplasty, is not desirable to most patients.


Asunto(s)
Blefaroplastia/economía , Blefaroptosis/cirugía , Medicare/legislación & jurisprudencia , Pacientes/psicología , Médicos/psicología , Mecanismo de Reembolso/legislación & jurisprudencia , Anciano , Anciano de 80 o más Años , Centers for Medicare and Medicaid Services, U.S./legislación & jurisprudencia , Estudios Transversales , Femenino , Financiación Personal/estadística & datos numéricos , Encuestas de Atención de la Salud , Humanos , Masculino , Medicare/economía , Persona de Mediana Edad , Oftalmología/organización & administración , Prioridad del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Mecanismo de Reembolso/economía , Sociedades Médicas , Estados Unidos
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