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Panduro A, Roman S, Mariscal-Martinez IM, Jose-Abrego A, Gonzalez-Aldaco K, Ojeda-Granados C, Ramos-Lopez O, Torres-Reyes LA. Personalized medicine and nutrition in hepatology for preventing chronic liver disease in Mexico. Front Nutr 2024; 11:1379364. [PMID: 38784134 PMCID: PMC11113077 DOI: 10.3389/fnut.2024.1379364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic liver disease is a global health issue. Patients with chronic liver disease require a fresh approach that focuses on the genetic and environmental factors that contribute to disease initiation and progression. Emerging knowledge in the fields of Genomic Medicine and Genomic Nutrition demonstrates differences between countries in terms of genetics and lifestyle risk factors such as diet, physical activity, and mental health in chronic liver disease, which serves as the foundation for the implementation of Personalized Medicine and Nutrition (PerMed-Nut) strategies. Most of the world's populations have descended from various ethnic groupings. Mexico's population has a tripartite ancestral background, consisting of Amerindian, European, and African lineages, which is common across Latin America's regional countries. The purpose of this review is to discuss the genetic and environmental components that could be incorporated into a PerMed-Nut model for metabolic-associated liver disease, viral hepatitis B and C, and hepatocellular carcinoma in Mexico. Additionally, the implementation of the PerMed-Nut approach will require updated medicine and nutrition education curricula. Training and equipping future health professionals and researchers with new clinical and investigative abilities focused on preventing liver illnesses in the field of genomic hepatology globally is a vision that clinicians and nutritionists should be concerned about.
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Affiliation(s)
- Arturo Panduro
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Sonia Roman
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Irene M. Mariscal-Martinez
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Alexis Jose-Abrego
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Karina Gonzalez-Aldaco
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Claudia Ojeda-Granados
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana, Baja California, Mexico
| | - Luis A. Torres-Reyes
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
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Manz CR, Barnett ML. Are linchpin oncologists keeping the wheels from falling off cancer care? J Natl Cancer Inst 2024; 116:180-182. [PMID: 37944077 DOI: 10.1093/jnci/djad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Christopher R Manz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael L Barnett
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
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Wright B, Baker T, Lennox A, Waxman B, Bragge P. Optimising acute non-critical inter-hospital transfers: A review of evidence, practice and patient perspectives. Aust J Rural Health 2024; 32:5-16. [PMID: 38108541 DOI: 10.1111/ajr.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/05/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Patients who present to hospital with an acute non-critical illness or injury, which is considered outside the capability framework of that hospital to treat, will require inter-hospital transfer (IHT) to a hospital with a higher level of capability for that condition. Delays in IHT can negatively impact patient care and patient outcomes. OBJECTIVE To review and synthesis academic evidence, practitioner insights and patient perspectives on ways to improve IHT from regional to metro hospitals. DESIGN A rapid review methodology identified one review and 14 primary studies. Twelve practitioner interviews identified insights into practice and implementation, and the patient perspectives were explored through a citizen panel with 15 participants. FINDINGS The rapid review found evidence relating to clinician and patient decision factors, protocols, communication practices and telemedicine. Practitioner interviews revealed challenges in making the initial decision, determining appropriate destinations and dealing with pushback. Adequate support and communication were raised as important to improve IHT. The citizen panel found that the main concern with IHT was delays. Citizen panel participants suggested dedicated transfer teams, education and information transfer systems to improve IHT. DISCUSSION AND CONCLUSION Common challenges in IHT include making the initial decision to transfer and communicating with other health services and patients and families. In identifying the appropriateness of transferring acute non-critical patients, clear and effective communication is central to appropriate and timely IHT; this evidence review indicates that education, protocols and information management could make IHT processes smoother.
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Affiliation(s)
- Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, Deakin University, Burwood, Victoria, Australia
| | - Alyse Lennox
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Bruce Waxman
- Bass Coast Health and Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
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Thelen AE, George BC, Burkhardt JC, Khamees D, Haas MRC, Weinstein D. Improving Graduate Medical Education by Aggregating Data Across the Medical Education Continuum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:139-145. [PMID: 37406284 DOI: 10.1097/acm.0000000000005313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
ABSTRACT Meaningful improvements to graduate medical education (GME) have been achieved in recent decades, yet many GME improvement pilots have been small trials without rigorous outcome measures and with limited generalizability. Thus, lack of access to large-scale data is a key barrier to generating empiric evidence to improve GME. In this article, the authors examine the potential of a national GME data infrastructure to improve GME, review the output of 2 national workshops on this topic, and propose a path toward achieving this goal.The authors envision a future where medical education is shaped by evidence from rigorous research powered by comprehensive, multi-institutional data. To achieve this goal, premedical education, undergraduate medical education, GME, and practicing physician data must be collected using a common data dictionary and standards and longitudinally linked using unique individual identifiers. The envisioned data infrastructure could provide a foundation for evidence-based decisions across all aspects of GME and help optimize the education of individual residents.Two workshops hosted by the National Academies of Sciences, Engineering, and Medicine Board on Health Care Services explored the prospect of better using GME data to improve education and its outcomes. There was broad consensus about the potential value of a longitudinal data infrastructure to improve GME. Significant obstacles were also noted.Suggested next steps outlined by the authors include producing a more complete inventory of data already being collected and managed by key medical education leadership organizations, pursuing a grass-roots data sharing pilot among GME-sponsoring institutions, and formulating the technical and governance frameworks needed to aggregate data across organizations.The power and potential of big data is evident across many disciplines, and the authors believe that harnessing the power of big data in GME is the best next step toward advancing evidence-based physician education.
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Aljerian N, Alharbi A. Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia. Cureus 2024; 16:e53511. [PMID: 38314384 PMCID: PMC10838169 DOI: 10.7759/cureus.53511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Patient transfers in emergencies have been linked to reduced mortality rates and enhanced quality of care. The Saudi Medical Appointments and Referrals Centre (SMARC), an e-referral system in the Kingdom of Saudi Arabia (KSA) since 2019, plays a crucial role in ensuring quality and continuity of care. The findings of this study can provide valuable insights into the effectiveness of the e-referral system and identify potential areas for improvement in the management of emergency cases. Objective This study aims to examine e-referral patterns for emergency medical cases throughout all 13 administrative regions of KSA. Concurrently, it estimates the acceptance rate of medical emergency referrals and investigates associated factors among KSA hospitals. Methods This retrospective study utilized secondary data from the SMARC e-referral system, specifically focusing on medical emergency e-referral requests in the entire KSA during 2021. Descriptive univariate analyses were conducted to characterize the referral requests, followed by bivariate analyses to explore associations between factors and referral acceptance. Adjusted multiple logistic regression analyses were then performed to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals, controlling for potential confounding variables. Results A total of 29,660 medical emergency referral requests were initiated across all regions of KSA during the study time frame, and, of these, 20,523 (69.19%) were accepted. The average age of patients with a medical emergency referral was 52 years old, and referral requests were higher among Saudis (13,781; 54.18%), males (13,781; 54.18%), and those from the Western region (10,560; 35.60%). Nearly 20,854 (70%) were due to the unavailability of specialized doctors or specialties in facilities. Based on multi-logistic regression, referral request acceptance was high in some factors as follows: compared to the Central region, requests from the Northern, Southern, Eastern, and Western regions had higher acceptance rates at 123%, 64%, 54%, and 46%, respectively. In addition, referral requests that were due to the unavailability of a specialized doctor or medical equipment had higher acceptance rates (19% and 16%), respectively, than those due to the unavailability of a specific specialty. Conclusion This study provides valuable insights into regional variations, sociodemographic factors, and referral reasons within the medical emergency e-referral system in the KSA. By estimating the acceptance rate of medical emergency referrals and investigating associated factors, this analysis confirms the effectiveness of the e-referral system in facilitating access to quality care, particularly for marginalized patients. The study highlights the need for health policy improvements to ensure equitable resource allocation and reduce disparities in healthcare access.
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Affiliation(s)
- Nawfal Aljerian
- Emergency Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Emergency Medicine, Medical Referrals Centre, Ministry of Health, Riyadh, SAU
| | - Abdullah Alharbi
- Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
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Rilling WS. Society of Interventional Radiology 2023 Charles T. Dotter Lecture: "IR 2023: The Embarrassment of Riches". J Vasc Interv Radiol 2024; 35:1-6. [PMID: 38161064 DOI: 10.1016/j.jvir.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- William S Rilling
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Pool I, Hofstra S, van der Horst M, Ten Cate O. Transdisciplinary entrustable professional activities. MEDICAL TEACHER 2023; 45:1019-1024. [PMID: 36708704 DOI: 10.1080/0142159x.2023.2170778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Healthcare has become highly specialized. Specialists, in medicine as well as in nursing, determine much of the high quality of current health care. But healthcare has also become increasingly fragmented, with professionals trained in separate postgraduate silos, with boundaries often difficult to cross. While a century ago, generalists dominated patient care provision, now specialists prevail and risk becoming alienated from each other, losing the ability to adapt to neighboring professional domains. Current health care requires a flexible workforce, ready to serve in multiple contexts, as the COVID-19 crisis has shown.The new concept of transdisciplinary entrustable professional activities, EPAs applicable in more than one specialty, was recently conceived to enhance collaboration and transfer between educational programs in postgraduate nursing in the Netherlands.In this paper, we reflect on our experiences so far, and on practical and conceptual issues concerning transdisciplinary EPAs, such as: who should define, train, assess, and register transdisciplinary EPAs? How can different prior education prepare for similar EPAs? And how do transdisciplinary EPAs affect professional identity?We believe that transdisciplinary EPAs can contribute to creating more flexible curricula and hence to a more coherent, collaborative healthcare workforce, less determined by the boundaries of traditional specialties.
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Affiliation(s)
- Inge Pool
- Isala Academy, Isala Hospitals, Zwolle, The Netherlands
| | - Saskia Hofstra
- Health Academy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Barba-Martin R, Marco Martinez J, Canora Lebrato J, Plaza Canteli S, Zapatero Gaviria A. Analysis of infectious diseases care in Spanish hospitals from 2016-2020, including the first year of the SARS-CoV-2 pandemic. Rev Clin Esp 2023; 223:310-315. [PMID: 37024087 PMCID: PMC10072973 DOI: 10.1016/j.rceng.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023]
Abstract
AIMS This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. MATERIALS AND METHOD This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. RESULTS Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. CONCLUSIONS At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.
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Affiliation(s)
- R Barba-Martin
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain.
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Ulyte A, Mehrotra A, Huskamp HA, Grabowski DC, Barnett ML. Specialty care after transition to long-term care in nursing home. J Am Geriatr Soc 2023; 71:1058-1067. [PMID: 36435050 PMCID: PMC10089934 DOI: 10.1111/jgs.18129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing home residents face many barriers to accessing specialist physician outpatient care. However, little data exists on how specialty care use changes when individuals transition to a nursing home in the US. METHODS We studied specialist outpatient visits for new long-term care (LTC) residents within 1 year before and after their transition to nursing home residence using the Minimum Data Set v3.0 (MDS) and a 20% sample of Medicare fee-for-service claims in 2014-2018. To focus on residents requiring specialty care at baseline, we limited the cohort to residents with specialty care in the 13-24 months before LTC transition. We then measured the proportion of residents receiving at least one visit in the 12 months before the transition and the 12 months after the transition. We also examined subgroups of residents with a prior diagnosis likely requiring long-term specialty care (e.g., multiple sclerosis). Finally, we examined whether there was continuity of care within the same specialty care provider. RESULTS Among 39,288 new LTC transitions identified in 2016-2017, 17,877 (45.5%) residents had a prior specialist visit 13-24 months before the transition. Among them, the proportion of residents with specialty visits decreased consistently in all specialties in the 12 months after the transition, ranging from a relative decrease of 14.4% for orthopedics to 67.9% for psychiatry. The relative decrease among patients with a diagnosis likely requiring specialty care ranged from 0.9% for neurology in patients with multiple sclerosis to 67.1% for psychiatry in patients with severe mental illness. Among residents who continued visiting a specialist, 78.9% saw the same provider as before the transition. CONCLUSIONS The use of specialty care falls significantly after patients transition to a nursing home. Further research is needed to understand what drives this drop in use and whether interventions, such as telemedicine can ameliorate potential barriers to specialty care.
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Affiliation(s)
- Agne Ulyte
- Department of Health Care Policy, Harvard Medical School
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School
- Division of General Medicine, Beth Israel Deaconess Medical Center
| | | | | | - Michael L Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital
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Ormsby EL, Kojouri K, Chang PC, Lin TY, Vuong B, Ramirez RM, Schueler KM, Sweet CF, Herrinton LJ. Association of Standardized Radiology Reporting and Management of Abdominal CT and MRI With Diagnosis of Pancreatic Cancer. Clin Gastroenterol Hepatol 2023; 21:644-652.e2. [PMID: 35436626 DOI: 10.1016/j.cgh.2022.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Follow-up of abdominal computed tomography (CT) and magnetic resonance imaging (MRI) findings suspicious for pancreatic cancer may be delayed if documentation is unclear. We evaluated whether standardized reporting and follow-up of imaging results reduced time to diagnosis of pancreatic cancer. METHODS We used a quasi-experimental stepped-wedge cluster design to evaluate the effectiveness of newly implemented radiology reporting system. The system standardizes the reporting of CT and MRI reports using hashtags that classify pancreatic findings. The system also automates referral of patients with findings suspicious for pancreatic cancer to a multidisciplinary care team for rapid review and follow-up. The study examined 318,331 patients who underwent CT or MRI that included the abdomen from 2016 through 2019 who had not had an eligible CT or MRI in the preceding 24 months. We evaluated the association of the intervention with incidence of pancreatic cancer within 60 days and 120 days after imaging. RESULTS Thirty-eight percent of patients received the intervention, and 1523 patients (0.48%) were diagnosed with pancreatic cancer. In multivariable analysis accounting for age, race/ethnicity, sex, Charlson comorbidity, history of cancer, diabetes, and 4-month calendar period, the intervention was associated with nearly 50% greater odds of diagnosing pancreatic cancer within 60 days (adjusted odds ratio, 1.47; 95% confidence interval, 1.05-2.06) and 120 days (adjusted odds ratio, 1.46; 95% confidence interval, 1.04-2.06). CONCLUSIONS In this large quasi-experimental, community-based observational study, implementing standardized reporting of abdominal CT and MRI reports with clinical navigation was effective for increasing the detection and diagnosis of pancreatic cancer.
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Affiliation(s)
| | | | | | - Teresa Y Lin
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Brooke Vuong
- Department of Surgical Oncology, Oakland, California
| | | | | | | | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Muacevic A, Adler JR. Factors Influencing the Choice of Radiology Subspecialty Among Radiology Trainees in Sudan. Cureus 2022; 14:e32555. [PMID: 36531793 PMCID: PMC9753795 DOI: 10.7759/cureus.32555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background and objective There are numerous reasons why radiologists would be interested in seeking additional fellowship training, some of which are personal, such as the possibility of bettering their career prospects, while others are work-related. This study aimed to identify whether the Sudanese radiology trainees wanted to pursue fellowship and what were the motivating and restricting factors affecting their career choices. Methods This was a re-do research of a study from Saudi Arabia previously published in the Cureus journal in 2019. This was a descriptive cross-sectional study conducted among the radiology registrars training under Sudan Medical Specialization Board (SMSB) in 2022 (n=90). By using convenient sampling, 74 of the 90 registrars were contacted, and a response rate of 81% (n=60) was achieved. Data were collected using a pre-tested self-administered online questionnaire. Data were analyzed using IBM SPSS® Statistics version 25.0 (IBM Corp., Armonk, NY). A p-value ≤0.05 was considered statistically significant. Results The majority of the trainees in our study were females (61.7%, 37/60). More than 93% (n=56) of our participants were training in Khartoum, the capital of Sudan. The most commonly chosen subspecialties in our study were as follows: neuroradiology (33.3%, n=20) body imaging (26.7%, n=16), and interventional radiology (25%, n=15). In contrast, nuclear medicine (1.7%, n=1) and emergency radiology (3.3%, n=2) were among the least popular subspecialties. The top influencing factors among our trainees in choosing a subspecialty included "strong personal interest," "lifestyle," and "area of strong personal knowledge." The most common factors preventing trainees from opting for a fellowship were "financial restriction" (55%, n=33) and "family obligation" (28.3%, n=17). Of those with no plans to subspecialize, 75% (six out of eight) stated that the lack of a fellowship program in Sudan is a possible deterrent. A statistically significant association was found between gender and the choice of subspecialty in interventional radiology and women's/mammogram imaging. Our findings revealed that there are currently no trainees in the first year of radiology residency because the last selection exam had been conducted in 2019. Despite the current unavailability of subspecialty training in Sudan, 75% (n=45) of trainees in our study were interested in joining a local program for fellowship training in the future. Conclusion Radiology trainees in Sudan share similar interests and influencing and restricting factors when pursuing subspecialty training, as reported in the literature. Unlike other countries, females predominate in the field of radiology training in Sudan at the moment. Radiologists from Sudan who are interested in subspecializing usually travel abroad for training; and once they find better prospects, many of them may not return. Programs offering subspecialization locally could mitigate the attrition of radiologists in Sudan. When designing subspecialty training programs in Sudan, stakeholders should use knowledge of influential factors and understanding of subspecialty decision trends among radiology trainees as a reference point. To the best of our knowledge, this study is the first of its kind to be conducted in this field in Sudan.
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de Gans S, Penturij-Kloks M, Scheele F, van de Pol M, van der Zwaard B, Keijsers C. Combined interprofessional and intraprofessional clinical collaboration reduces length of stay and consultations: a retrospective cohort study on an intensive collaboration ward (ICW). J Interprof Care 2022; 37:523-531. [DOI: 10.1080/13561820.2022.2137117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simon de Gans
- Jeroen Bosch Academy, Jeroen Bosch Hospital, s-Hertogenbosch, The Netherlands
| | | | - Fedde Scheele
- School of medical sciences, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Marjolein van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Carolina Keijsers
- Department of geriatrics, Jeroen Bosch Hospital, s-Hertogenbosch, The Netherlands
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Öztürk N, Gençtürk M. A Research on the Factors Affecting the Preference of Medical Specialization Branches. JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.20883/medical.e691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim. The aim of this study is to determine the factors affecting the preferences of specialization in the field of medicine.
Materials and Methods. Mixed research and exploratory sequential research design were used. In the exploratory phase, data were collected from specialist physicians (n=14) and findings were analyzed by descriptive and content analysis. In the light of qualitative findings, a measurement tool was developed and applied to medical school students and the physicians who prepared specialty exams (n = 502).
Results. Qualitative findings were structured under 3 themes: individual, occupational and systemic factors. The measurement tool, which was named “Physicians' Preference Tendencies of Specialty Branch” was structured as 42 items and 7 dimensions: risk, comfort, health problems, status, emotional interest, gender, and marital status emerged.
Conclusions. Although there are many factors that affect preferences of the medical field, it is concluded that personality traits and idealism of individuals and mortality rates associated with branch or field of medicine are the most significant professional factors, while the risks and the exposure to violence and the application of the additional payment based on the performance of candidates are the systemic factors that affect selections and preferences. Also, it was concluded that qualitative data obtained in the research were supported with quantitative data.
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Sub-specialization among Nigerian ophthalmologists: status, disposition and barriers. Int Ophthalmol 2022; 42:3005-3015. [PMID: 35501541 DOI: 10.1007/s10792-022-02286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the status of sub-specialization among Nigerian ophthalmologists as well as their dispositions and barriers against sub-specialization with a view to providing valuable information for the purpose of human resources for eye care planning thereby providing useful insight into the future of ophthalmic practice in Nigeria. METHODS This was a web-based, cross-sectional study conducted among ophthalmologists in Nigeria. An online questionnaire was distributed through e-mails using Qualtrics software (Qualtrics, Provo, UT, USA). Information concerning socio-demographic characteristics, type of practice, location of practice, years of practice, status and disposition to sub-specialization as well as barriers to sub-specialization were obtained through the questionnaire. RESULTS Two hundred and four Nigerian ophthalmologists participated in the study out of which 118 (57.8%) were females. One hundred and ten (54.0%) respondents had undergone sub-specialty training. The sub-specialties with the highest number of patronage was Paediatric Ophthalmology and Strabismus (14.2%). Respondents who had practised for more than 7 years were three times more likely to have undergone sub-specialty training compared to respondents who had practised for 7 years and below [odds ratio (OR) = 3.01, 95% confidence interval (CI) = 1.33-6.83, p = 0.01]. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice were non-availability/inadequate trained specialist and inadequate equipment. CONCLUSION Nigerian ophthalmologists are well disposed to sub-specialization although the extent of sub-specialization among them was a little above average. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice in this study were non-availability/inadequate trained specialist and inadequate equipment.
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Levi M. Surprising outcomes of general internal medicine care versus specialty care in acutely admitted medical patients. Eur J Intern Med 2022; 98:39-40. [PMID: 35000805 DOI: 10.1016/j.ejim.2021.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Marcel Levi
- Amsterdam University Medical Center, Department of Vascular Medicine; Amsterdam, the Netherlands and University College London Hospitals NHS Foundation Trust, Department of Medicine; Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, United Kingdom.
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16
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Pietrangelo A. Internists or specialists-that is the question! Eur J Intern Med 2022; 98:41-42. [PMID: 35172943 DOI: 10.1016/j.ejim.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
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17
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Huepenbecker SP, Sun CC, Fu S, Zhao H, He W, Primm K, Giordano SH, Meyer LA. Temporal trends of healthcare system use between symptomatic presentation and ovarian cancer diagnosis in the United States. Int J Gynecol Cancer 2022; 32:899-905. [PMID: 35331992 DOI: 10.1136/ijgc-2021-003219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe trends in healthcare system use over time between onset of classic ovarian cancer symptoms and ovarian cancer diagnosis in the United States. METHODS A population-based study of the Surveillance, Epidemiology, and End Results-Medicare database was conducted on patients aged ≥66 years with stage II-IV epithelial ovarian cancer between 1992 and 2015 with at least one of the following diagnosis codes: abdominal pain, bloating, difficulty eating, and/or urinary symptoms. The outcomes were frequency of visit type, frequency of diagnostic modality, and Medicare reimbursement between first symptomatic claim and cancer diagnosis. Jonckheere-Terpstra and Cochran-Armitage tests were used to evaluate trends over time. RESULTS Among 13 872 women, 13 541 (97.6%) had outpatient, 6466 (46.6%) had inpatient, and 4906 (35.4%) had emergency room visits. The frequency of outpatient (p<0.001) and emergency room visits (p<0.001) increased while the frequency of inpatient visits (p<0.001) decreased between 1992 and 2015. The median number of outpatient visits (p<0.001) and physician specialties seen (p<0.001) increased over time. The median hospital length of stay decreased from 10 days in 1992 to 5 days in 2015 (p<0.001). Between 1992 and 2015, the frequency of ultrasound decreased (p<0.001) while the frequency of computed tomography, magnetic resonance imaging, positron emission tomography imaging, and cancer antigen 125 tumor immunoassay increased (p<0.001). Median monthly total (p<0.001), inpatient (p<0.001), and outpatient (p=0.006) reimbursements decreased while emergency room reimbursements increased (p<0.001) over time. CONCLUSION Healthcare reimbursement between symptomatic presentation and ovarian cancer diagnosis has decreased over time and may reflect the trends in fewer and shorter hospitalizations and increased use of emergency and outpatient management during the evaluation of symptoms of women with ovarian cancer.
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Affiliation(s)
- Sarah P Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Becton Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Weiguo He
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Ford Motor Company, Dearborn, Michigan, USA
| | - Kristin Primm
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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18
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Gedde SJ, Feuer WJ, Crane AM, Shi W. Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists. Am J Ophthalmol 2022; 234:285-326. [PMID: 34157277 DOI: 10.1016/j.ajo.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/12/2021] [Accepted: 06/12/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction. METHODS A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area. RESULTS Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life. CONCLUSIONS The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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19
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Merrill CB, Roe JM, Seely KD, Brooks B. Advanced Telemedicine Training and Clinical Outcomes in Type II Diabetes: A Pilot Study. TELEMEDICINE REPORTS 2022; 3:15-23. [PMID: 35720452 PMCID: PMC8989092 DOI: 10.1089/tmr.2021.0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 06/15/2023]
Abstract
Background: COVID-19 caused a dramatic increase in the scope and utilization of telemedicine. However, the sustainability of the permanent integration of telemedicine in the management of chronic disease beyond the pandemic is still enigmatic. The purpose of this retrospective chart review was to analyze the effect of advanced training in telemedicine on clinical outcomes in type II diabetes mellitus (T2DM) in the United States. Methods: A retrospective chart review was conducted in 104 deidentified patients with diabetes from 28 specialized telemedicine agency physicians who had received specialized telemedicine training. After establishing exclusion criteria, the charts of 59 T2DM patients were evaluated. Glycated hemoglobin (HbA1c) percentage and body mass index (BMI) were used as quantitative endpoints. Visit consistency, mediation data, and compliance data were also studied. Results: The mean change in HbA1c for the 42 patients who met the inclusion criteria for evaluating HbA1c (n = 42) was -0.429%. The largest decrease in HbA1c was 5.4%, and the most significant increase was 3.9%. The mean change in BMI for the 16 patients who met the inclusion criteria for evaluating BMI (n = 16) was -2.175 kg/m2. The largest decrease in BMI was 9.5 kg/m2 and the largest increase was +0.7 kg/m2. The average number of visits for patients with a decrease in HbA1c was 3.45. The average number of visits for patients with an increase in HbA1c was 2.62. Conclusions: Outcomes of telemedicine providers with training are comparable with the standard of care. Advanced telemedicine training and its effect on clinical outcomes in the management of chronic disease warrant further investigation. For telemedicine to become a mainstay in U.S. medicine, a standard of best practices should be evaluated and available for providers who wish to continue telehealth care delivery.
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Affiliation(s)
- Colton B. Merrill
- Rocky Vista University, Department of Research and Scholarly Activity, College of Osteopathic Medicine, Ivins, Utah, USA
| | - Jason M. Roe
- Rocky Vista University, Department of Research and Scholarly Activity, College of Osteopathic Medicine, Ivins, Utah, USA
| | - Kevin D. Seely
- Rocky Vista University, Department of Research and Scholarly Activity, College of Osteopathic Medicine, Ivins, Utah, USA
| | - Benjamin Brooks
- Rocky Vista University, Department of Research and Scholarly Activity, College of Osteopathic Medicine, Ivins, Utah, USA
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20
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Smith AG, Korb PJ. Clinical Neurophysiology Fellowships-They Can and Should Change. JAMA Neurol 2021; 79:115-116. [PMID: 34962507 DOI: 10.1001/jamaneurol.2021.4763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- A Gordon Smith
- Division of Neuromuscular Medicine, Virginia Commonwealth University, Richmond
| | - Pearce J Korb
- Epilepsy Division, Virginia Commonwealth University, Richmond
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21
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Gea J, Barrueco M, Martínez C, Jiménez-Ruíz C. Areas of Specific Subspecialization (ACE) in pulmonology. Arch Bronconeumol 2021; 57:733-734. [PMID: 35698978 DOI: 10.1016/j.arbr.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/26/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Joaquim Gea
- Comité de Grados de SEPAR, Ex-miembrodel Management Council del European Board for Accreditation inPneumology(EBAP,2015-19), Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universidad Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain.
| | - Miguel Barrueco
- Servicio de Neumología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Cristina Martínez
- Comisión Nacional de la Especialidad de Neumología, Hospital Universitario Central de Asturias, Facultad de Medicina, Instituto de Investigación Sanitaria del principado de Asturias (ISPA), Oviedo, Spain
| | - Carlos Jiménez-Ruíz
- Presidente de SEPAR, Unidad Especializada de Tabaquismo de la Comunidad de Madrid, Servicio de Neumología, Madrid, Spain
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22
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Barnett ML, Bitton A, Souza J, Landon BE. Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019. Ann Intern Med 2021; 174:1658-1665. [PMID: 34724406 PMCID: PMC8688292 DOI: 10.7326/m21-1523] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite the central role of primary care in improving health system performance, there are little recent data on how use of primary care and specialists has evolved over time and its implications for the range of care coordination needed in primary care. OBJECTIVE To describe trends in outpatient care delivery and the implications for primary care provider (PCP) care coordination. DESIGN Descriptive, repeated, cross-sectional study using Medicare claims from 2000 to 2019, with direct standardization used to control for changes in beneficiary characteristics over time. SETTING Traditional fee-for-service Medicare. PATIENTS 20% sample of Medicare beneficiaries. MEASUREMENTS Annual counts of outpatient visits and procedures, the number of distinct physicians seen, and the number of other physicians seen by a PCP's assigned Medicare patients. RESULTS The proportion of Medicare beneficiaries with any PCP visit annually only slightly increased from 61.2% in 2000 to 65.7% in 2019. The mean annual number of primary care office visits per beneficiary also changed little from 2000 to 2019 (2.99 to 3.00), although the mean number of PCPs seen increased from 0.89 to 1.21 (36.0% increase). In contrast, the mean annual number of visits to specialists increased 20% from 4.05 to 4.87, whereas the mean number of unique specialists seen increased 34.2% from 1.63 to 2.18. The proportion of beneficiaries seeing 5 or more physicians annually increased from 17.5% to 30.1%. In 2000, a PCP's Medicare patient panel saw a median of 52 other physicians (interquartile range, 23 to 87), increasing to 95 (interquartile range, 40 to 164) in 2019. LIMITATION Data were limited to Medicare beneficiaries and, because of the use of a 20% sample, may underestimate the number of other physicians seen across a PCP's entire panel. CONCLUSION Outpatient care for Medicare beneficiaries has shifted toward more specialist care received from more physicians without increased primary care contact. This represents a substantial expansion of the coordination burden faced by PCPs. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Michael L Barnett
- Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts (M.L.B.)
| | - Asaf Bitton
- Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts (A.B.)
| | - Jeff Souza
- Harvard Medical School, Boston, Massachusetts (J.S.)
| | - Bruce E Landon
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts (B.E.L.)
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23
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Iyawe EP, Idowu BM, Omoleye OJ. Radiology subspecialisation in Africa: A review of the current status. SA J Radiol 2021; 25:2168. [PMID: 34522434 PMCID: PMC8424752 DOI: 10.4102/sajr.v25i1.2168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background Radiology subspecialisation is well-established in much of Europe, North America, and Australasia. It is a natural evolution of the radiology speciality catalysed by multiple factors. Objectives The aim of this article is to analyse and provide an overview of the current status of radiology subspecialisation in African countries. Methods We reviewed English-language articles, reports, and other documents on radiology specialisation and subspecialisation in Africa. Results There are 54 sovereign countries in Africa (discounting disputed territories). Eighteen African countries with well-established radiology residency training were assessed for the availability of formal subspecialisation training locally. Eight (Egypt, Ethiopia, Kenya, Morocco, Nigeria, South Africa, Tanzania, and Tunisia) out of the 18 countries have local subspecialist training programmes. Data and/or information on subspecialisation were unavailable for three (Algeria, Libya, and Senegal) of the 18 countries. Paediatric Radiology (Ethiopia, Nigeria, South Africa, Tunisia) and Interventional Radiology (Egypt, Kenya, South Africa, Tanzania) were the most frequently available subspecialist training programmes. Except Tanzania, all the countries with subspecialisation training programmes have ≥ 100 radiologists in their workforce. Conclusion There is limited availability of subspecialist radiology training programmes in African countries. Alternative models of subspecialist radiology training are suggested to address this deficit.
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Affiliation(s)
- Efosa P Iyawe
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Bukunmi M Idowu
- Department of Radiology, Union Diagnostics and Clinical Services PLC, Yaba, Lagos State, Nigeria
| | - Olasubomi J Omoleye
- Department of General Medicine, LouisMed Hospital and Fertility Centre, Lekki Phase 1, Lagos State, Nigeria
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24
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Huepenbecker SP, Sun CC, Fu S, Zhao H, Primm K, Giordano SH, Meyer LA. Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States. Cancer 2021; 127:4151-4160. [PMID: 34347287 DOI: 10.1002/cncr.33829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with ovarian cancer often present with late-stage disease and nonspecific symptoms, but little is known about factors affecting the time to diagnosis (TTD) in the United States. METHODS A retrospective, population-based study of the Surveillance, Epidemiology, and End Results-Medicare database was conducted. It included women 66 years old or older with stage II to IV epithelial ovarian cancer with at least 1 code for abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of the cancer diagnosis. TTD was defined from the first claim with a prespecified symptom to the ovarian cancer diagnosis. Kruskal-Wallis tests were used to assess for differences in TTD by group medians. Univariate and generalized linear models with a log-link function evaluated TTD by covariables. RESULTS For the 13,872 women analyzed, the mean and median times to diagnosis were 2.9 and 1.1 months, respectively. The median TTD differed significantly by first symptom (P < .001), number of symptoms (P < .001), and first physician specialty seen (P < .001). In a multivariable analysis, TTD differed significantly according to race/ethnicity (P < .001), geographic region (P = .001), urban-rural location (P = .031), emergency room presentation (P < .001), and number of specialties seen (P < .001). A shorter TTD was associated with a diagnosis in 2006-2010 (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) or 2011-2015 (RR, 0.87; 95% CI, 0.81-0.93) in comparison with 1992-1999. CONCLUSIONS The time from a symptomatic presentation to care to a diagnosis of ovarian cancer is influenced by clinical and demographic variables. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to aid in diagnosis. LAY SUMMARY Ovarian cancer is often diagnosed once disease has spread because the classic symptoms of ovarian cancer-abdominal or pelvic pain, bloating, difficulty eating, and urinary issues-can be mistaken for other problems. This study examined the time between when women with classic ovarian cancer symptoms went to a physician and when they received a cancer diagnosis in a large database population. The authors found that the time to diagnosis differed according to the type and number of symptoms and what type of physician a woman saw as well as factors such as race, geographic location, and year of diagnosis.
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Affiliation(s)
- Sarah P Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristin Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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25
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Sarkar A, Ingram MCE, Tian Y, Many BT, Rizeq Y, Goldstein SD, Rigsby CK, Raval MV. A Retrospective Cohort Study of Optimal Contrast for Successful Intussusception Reduction: Institutional Practices Matter. J Surg Res 2021; 267:159-166. [PMID: 34147862 DOI: 10.1016/j.jss.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The first-line treatment for intussusception is radiologic reduction with either air-contrast enema (AE) or liquid-contrast enema (LE). The purpose of this study was to explore relationships between self-reported institutional AE or LE intussusception reduction preferences and rates of operative intervention and bowel resection. METHODS Pediatric Health Information System (PHIS) hospitals were contacted to assess institutional enema practices for intussusception. A retrospective study using 2009-2018 PHIS data was conducted for patients aged 0-5 y to evaluate outcomes. Chi-squared tests were used to test for differences in the distribution of surgical patients by hospital management approach. RESULTS Of the 45 hospitals, 20 (44%) exclusively used AE, 4 (9%) exclusively used LE, and 21 (46%) used a mixed practice. Of 24,688 patients identified from PHIS, 13,231 (54%) were at exclusive AE/LE hospitals and 11,457 (46%) were at mixed practice hospitals. Patients at AE/LE hospitals underwent operative procedures at lower rates than at mixed practice hospitals (14.8% versus 16.5%, P< 0.001) and were more likely to undergo bowel resection (31.1% versus 27.1%, P= 0.02). CONCLUSIONS Practice variation exists in hospital-level approaches to radiologic reduction of intussusception and mixed practices may impact outcomes.
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Affiliation(s)
- Arjun Sarkar
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Martha-Conley E Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Yao Tian
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Benjamin T Many
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Yazan Rizeq
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Cynthia K Rigsby
- Department of Medical Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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26
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AlAteeq MA, AlJoudi AS, AlKhadli YM. Subspecialization in Family Medicine: Opinions, Preferences, and Practices of Family Physicians in Saudi Arabia. J Prim Care Community Health 2021; 11:2150132720981307. [PMID: 33353464 PMCID: PMC7768869 DOI: 10.1177/2150132720981307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective In recent years, family medicine (FM) has shown many changes, including the development of sub-specialization. This study aimed to explore the opinions, preferences, and practices of Saudi family physicians with regard to sub-specialization within family practice. Methods This cross-sectional study was conducted from January to May 2018. Data were collected from 561 Saudi FM board-certified physicians and family medicine residents from all over SA via personal emails using a self-administered questionnaire consisting of questions aimed at examining participants’ opinions, preferences, and practices with regard to sub-specialization in family practice. Results Only 48 family doctors (20.2%) had the qualification of subspecialist. Diabetology was the most common clinical subspecialty. The majority of participants agreed with the statements in favor of sub-specialization in FM. About 73% approved of the idea of sub-specialization in FM, while 89% thought that sub-specialization would provide a source of expertise within the FM context. The most stated reasons to go for FM subspecialties were to earn more experience (65.1%), gain some sense of control of huge knowledge and skills of FM (53.7%), and earning extra money (47.8%). Conclusions This study revealed that majority of certified family physicians and FM residents in SA have positive attitude towards sub-specialization in FM and support the idea of sub-specialization to be practiced within the context of FM
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Affiliation(s)
- Mohammed A AlAteeq
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Yahia M AlKhadli
- Joint Program of Family Medicine, Ministry of Health, Aseer, Saudi Arabia
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27
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Watson TA, Barber J, Woodley H. Paediatric gastrointestinal and hepatobiliary radiology: why do we need subspecialists, and what is new? Pediatr Radiol 2021; 51:554-569. [PMID: 33743039 DOI: 10.1007/s00247-020-04778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
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Affiliation(s)
- Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Joy Barber
- Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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28
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Gea J, Barrueco M, Martínez C, Jiménez-Ruíz C. Areas of Specific Subspecialization (ACE) in Pulmonology. Arch Bronconeumol 2021; 57:S0300-2896(21)00097-1. [PMID: 33810897 DOI: 10.1016/j.arbres.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Joaquim Gea
- Comité de Grados de SEPAR. Ex-miembro del Management Council del European Board for Accreditation in Pneumology (EBAP, 2015-19). Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universidad Pompeu Fabra. CIBERES, ISCIII, Barcelona, España.
| | - Miguel Barrueco
- Servicio de Neumología, Hospital Universitario de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Departamento de Medicina, Universidad de Salamanca, Salamanca, España
| | - Cristina Martínez
- Comisión Nacional de la Especialidad de Neumología. Hospital Universitario Central de Asturias. Facultad de Medicina. Instituto de Investigación Sanitaria del principado de Asturias (ISPA), Oviedo, España
| | - Carlos Jiménez-Ruíz
- Presidente de SEPAR. Unidad Especializada de Tabaquismo de la Comunidad de Madrid. Servicio de Neumología, Madrid, España
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29
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Campbell RJ, El-Defrawy SR, Gill SS, Whitehead M, Campbell EDLP, Hooper PL, Bell CM, Ten Hove MW. Surgical Outcomes among Focused versus Diversified Cataract Surgeons. Ophthalmology 2021; 128:827-834. [PMID: 33637327 DOI: 10.1016/j.ophtha.2021.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/09/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Narrowly focused surgical practice has become increasingly common in ophthalmology and may have an effect on surgical outcomes. Previous research evaluating the influence of surgical focus on cataract surgical outcomes has been lacking. This study aimed to evaluate whether surgeons' exclusive surgical focus on cataract surgery influences the risk of cataract surgical adverse events. DESIGN Population-based cohort study. PARTICIPANTS All patients 66 years of age or older undergoing cataract surgery in Ontario, Canada, between January 1, 2002, and December 31, 2013. METHODS Outcomes of isolated cataract surgery performed by exclusive cataract surgeons (no other types of surgery performed), moderately diversified cataract surgeons (1%-50% noncataract procedures), and highly diversified cataract surgeons (>50% noncataract procedures) were evaluated using linked healthcare databases and controlling for patient-, surgeon-, and institution-level covariates. Surgeon-level covariates included both surgeon experience and surgical volume. MAIN OUTCOME MEASURES Composite outcome incorporating 4 adverse events: posterior capsule rupture, dropped lens fragments, retinal detachment, and suspected endophthalmitis. RESULTS The study included 1 101 864 cataract operations. Patients had a median age of 76 years, and 60.2% were female. Patients treated by the 3 groups of surgeons were similar at baseline. Adverse events occurred in 0.73%, 0.78%, and 2.31% of cases performed by exclusive cataract surgeons, moderately diversified surgeons, and highly diversified surgeons, respectively. The risk of cataract surgical adverse events for patients operated on by moderately diversified surgeons was not different than for patients operated on by exclusive cataract surgeons (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.00-1.18). Patients operated on by highly diversified surgeons had a higher risk of adverse events than patients operated on by exclusive cataract surgeons (OR, 1.52; 95% CI, 1.09-2.14). This resulted in an absolute risk difference of 0.016 (95% CI, 0.012-0.020) and a number needed to harm of 64 (95% CI, 50-87). CONCLUSIONS Exclusive surgical focus did not affect the safety of cataract surgery when compared with moderate levels of surgical diversification. The risk of cataract surgical adverse events was higher among surgeons whose practice was dedicated mainly to noncataract surgery.
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Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada.
| | - Sherif R El-Defrawy
- Department of Ophthalmology, University of Toronto, Toronto, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Division of Geriatric Medicine, Queen's University, Kingston, Canada; Division of Geriatric Medicine, Providence Care Hospital, Kingston, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Queen's University, Kingston, Canada
| | - Erica de L P Campbell
- Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Canada
| | - Philip L Hooper
- Department of Ophthalmology, University of Western Ontario, London, Canada; Department of Ophthalmology, St. Joseph's Hospital, London, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, Sinai Health System, Toronto, Canada
| | - Martin W Ten Hove
- Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Hotel Dieu Hospital site, Kingston, Canada
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Blázquez Cabrera JA, Sosa Henriquez M, Diaz-Curiel M, Sánchez Molini P, Arranz Garcia F, Montoya MJ, Filgueira J, Olmos JM, Coco-Martín MB, Castrillón JLP. Profile of patients who consult with internists for an osteoporosis assessment: The OSTEOMED registry. Rev Clin Esp 2021; 221:9-17. [PMID: 33998484 DOI: 10.1016/j.rceng.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; p<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; p<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; p<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.
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Affiliation(s)
| | - M Sosa Henriquez
- Servicio de Medicina Interna, Hospital Universitario Insular, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - M Diaz-Curiel
- Servicio de Medicina Interna, Fundación Jiménez Díaz, Madrid, Spain
| | - P Sánchez Molini
- Servicio de Medicina Interna, Hospital de la Princesa, Madrid, Spain
| | - F Arranz Garcia
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain
| | - M J Montoya
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Filgueira
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J M Olmos
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M B Coco-Martín
- Grupo de Investigación en Neurociencias Clínicas Aplicadas, Universidad de Valladolid, Valladolid, Spain
| | - J L Pérez Castrillón
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain.
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Blázquez Cabrera JA, Sosa Henriquez M, Diaz-Curiel M, Sánchez Molini P, Arranz Garcia F, Montoya MJ, Filgueira J, Olmos JM, Coco-Martín MB, Castrillón JLP. Profile of patients who visit medical internists for an osteoporosis assessment: The OSTEOMED registry. Rev Clin Esp 2021; 221:9-17. [PMID: 32682689 DOI: 10.1016/j.rce.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Osteoporosis is considered a generalised skeletal disorder in which there is impaired bone resistance, which predisposes the individual to a greater risk of fracture. The aim of this cross-sectional study was to collect and present data on the main clinical characteristics of patients who consult medical internists in Spain. Understanding these characteristics can help in implementing action plans to improve these patients' care more effectively and efficiently. MATERIAL AND METHODS Through an analysis of the Osteoporosis in Internal Medicine (OSTEOMED) registry, this study presents the main clinical characteristics of patients with osteoporosis who attended internal medicine consultations in 23 Spanish hospital centres between 2012 and 2017. We analysed the reasons for the consultations, the densitometric values, the presence of comorbidities, the prescribed treatment and other lifestyle-related factors. RESULTS In total, 2024 patients with osteoporosis were assessed (89.87% women, 10.13% men). The patients' mean age was 64.1±12.1 years (women, 64.7±11.5 years; men, 61.2±14.2 years). There was no significant difference between the sexes in their history of recent falls (9.1% and 6.7%); however, there were significant differences in the daily intake of calcium from milk products (553.8±332.6mg for women vs. 450.2±303.3mg for men; P<.001) and in the secondary causes of osteoporosis (13% of men vs. 6.5% of women; P<.001). In the sample, there were 404 fractures (20%), with a notable number of confirmed vertebral fractures (17.2%, 35.6% in men vs. 15.2% in women; P<.001). A large portion of the patients did not undergo the indicated treatment and presented low levels of physical activity and sun exposure. A significant percentage of the patients presented associated comorbidities, the most common of which were hypertension (32%) and dyslipidaemia (28%). CONCLUSIONS These results define the profile of patients with osteoporosis who attend internal medicine consultations in Spain. The results also show the multisystemic character of this condition, which, along with its high prevalence, determine that the specific internal medicine consultations dedicated to managing the condition are the appropriate place for caring for these patients.
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Affiliation(s)
| | - M Sosa Henriquez
- Servicio de Medicina Interna, Hospital Universitario Insular, Las Palmas de Gran Canaria, Las Palmas, España
| | - M Diaz-Curiel
- Servicio de Medicina Interna, Fundación Jiménez Díaz, Madrid, España
| | - P Sánchez Molini
- Servicio de Medicina Interna, Hospital de la Princesa, Madrid, España
| | - F Arranz Garcia
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, España
| | - M J Montoya
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J Filgueira
- Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J M Olmos
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - M B Coco-Martín
- Grupo de Investigación en Neurociencias Clínicas Aplicadas, Universidad de Valladolid, Valladolid, España
| | - J L Pérez Castrillón
- Servicio de Medicina Interna. Hospital Universitario Río Hortega, Valladolid, España.
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Ramos-Fresnedo A, Domingo RA, ReFaey K, Gassie K, Clifton W, Grewal SS, Chen SG, Chaichana KL, Quiñones-Hinojosa A. Neurosurgical Interactive Teaching Series: Multidisciplinary Educational Approach. World Neurosurg 2020; 144:e766-e773. [PMID: 32956889 PMCID: PMC7500337 DOI: 10.1016/j.wneu.2020.09.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The goal of this manuscript is to investigate the effects of a multidisciplinary multinational web-based teaching conference on trainee education, research, and patient care. METHODS We present the structure, case selection, and presentation of our educational lectures. We retrospectively reviewed our database to gather data on the number of presentations, type of presentation, and the pathology diagnosis from November 11, 2016 until February 28, 2020. To investigate attendee satisfaction, we analyzed our yearly continuing medical education evaluation survey results to report the impact that this series may have had on our attendees. We assigned a numeric value to the answers, and the mean overall scores were compared through an analysis of variance. Further analysis on specific questions was performed with a Fisher exact test. RESULTS We have hosted 150 lectures, in which we have presented 208 neurosurgical cases corresponding to 133 general session, 59 pituitary, and 16 spine cases, as well as 28 distinct lectures by guest speakers from institutions across the globe. We received 61 responses to our yearly continuing medical education evaluations over the course of 3 years. On these evaluations, we have maintained an excellent overall rating from 2017-2019 (two-sided P > 0.05) and received significantly less suggestions to improve the series comparing 2017 with 2019 (two-sided, P= 0.04). CONCLUSIONS As the world of medicine is constantly changing, we are in need of developing new tools to enhance our ability to relay knowledge through accredited and validated methods onto physicians in training, such as the implementation of structured, multidisciplinary, case-based lectures as presented in this manuscript.
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Affiliation(s)
| | | | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kelly Gassie
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - William Clifton
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Selby G Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
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Tamás G, Fabbri M, Falup-Pecurariu C, Teodoro T, Kurtis MM, Aliyev R, Bonello M, Brozova H, Coelho MS, Contarino MF, Corvol JC, Dietrichs E, Ben Djebara M, Elmgreen SB, Groppa S, Kadastik-Eerme L, Khatiashvili I, Kostić V, Krismer F, Hassan Mansour A, Odin P, Gavriliuc O, Olszewska DA, Relja M, Scheperjans F, Skorvanek M, Smilowska K, Taba P, Tavadyan Z, Valante R, Vujovic B, Waldvogel D, Yalcin-Cakmakli G, Chitnis S, Ferreira JJ. Lack of Accredited Clinical Training in Movement Disorders in Europe, Egypt, and Tunisia. JOURNAL OF PARKINSONS DISEASE 2020; 10:1833-1843. [PMID: 32651331 DOI: 10.3233/jpd-202000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa. OBJECTIVE To survey the accessible MD clinical training in these regions. METHODS We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs. RESULTS The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology. CONCLUSION Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.
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Affiliation(s)
- Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy.,Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | | | - Tiago Teodoro
- Instituto de Medicina Molecular, Lisbon, Portugal.,Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Ashford and St Peter's Hospital NHS Trust, Chertsey, Surrey, UK
| | - Mónica M Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Rahim Aliyev
- Department of Neurology and Clinical Neurophysiology, Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Baku, Republic of Azerbaijan
| | - Michael Bonello
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Hana Brozova
- Department of Neurology and Center of Clinical Neuroscience, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Miguel Soares Coelho
- Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal.,Department of Neurosciences, Neurology Service, Hospital Santa Maria, Lisbon, Portugal
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jean-Christophe Corvol
- Department of Neurology, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Institut du Cerveau et de la Moelle, Paris, France
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Mouna Ben Djebara
- Department of Neurology, Razi Hospital, Faculté de Médecine de Tunis, University Tunis-El Manar, Tunisia
| | | | - Sergiu Groppa
- Department of Neurology, Movement Disorders, Imaging and Neurostimulation, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Liis Kadastik-Eerme
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Irine Khatiashvili
- Department of Clinical Neurology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Vladimir Kostić
- Department of Neurology CCS, University of Belgrade, Belgrade, Serbia
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Alia Hassan Mansour
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Per Odin
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Olga Gavriliuc
- Department of Neurology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Republic of Moldova
| | - Diana Angelika Olszewska
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maja Relja
- Croatian Academy of Medical Sciences and School of Medicine, Zagreb University, Zagreb, Croatia
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital, and Department of Neurological Sciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Matej Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovak Republic.,Department of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic
| | | | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Zaruhi Tavadyan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia.,"Somnus" Sleep and Movement Disorders Clinic, Yerevan, Armenia
| | - Ramona Valante
- Department of Neurology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Balsa Vujovic
- Department of Neurology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Daniel Waldvogel
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Shilpa Chitnis
- Department of Neurology and Neurotherapeutics, Southwestern Medical Center, University of Texas, Dallas, Texas, US
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
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Exclusive cataract surgical focus among ophthalmologists: a population-based analysis. Can J Ophthalmol 2020; 55:359-365. [PMID: 32589916 DOI: 10.1016/j.jcjo.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/14/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE An important potential unintended consequence of the growth of surgical subspecialization is the narrowing of surgical practice among comprehensive ophthalmologists. We investigated trends in the narrowing of surgical practice and the exclusive provision of cataract surgery. DESIGN Population-based, retrospective study. PARTICIPANTS All ophthalmologists and all ophthalmologic surgical patients in Ontario from 1994 to 2016. METHODS We linked several health care databases to evaluate the proportion of ophthalmologists who exclusively provided cataract surgery (and no other ophthalmologic surgery) and the proportion who provided other types of ophthalmologic surgical care. To further investigate surgical focus, we evaluated the proportion of surgical cases within each surgical area for each ophthalmologist. RESULTS Between 1994 and 2016, the proportion of ophthalmologists who exclusively provided cataract surgery rose from 10.0% to 34.9% (p < 0.0001). In contrast, the proportions of ophthalmologists providing other types of subspecialized surgical care were stable over the study period. Cataract surgeons showed high degrees of focus with a median percentage of surgical cases approaching 100% in all years. Among exclusive cataract surgeons, the median annual cataract case volume increased from 138 (interquartile range: 87-214) to 529 (interquartile range: 346-643) between 1994 and 2009 (p < 0.0001) and then plateaued. CONCLUSIONS Between 1994 and 2016, exclusive cataract surgical focus among ophthalmologists in Ontario rose dramatically from 1 in 10 to 1 in 3 surgeons. This evolution was similar among recent graduates and established ophthalmologists. Our data may have important implications for policies regarding surgeon human resources as well as residency and fellowship training programs.
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Urbania TH, Dusendang JR, Herrinton LJ, Alexeeff S, Corley DA, Ely S, Patel A, Osinski T, Sakoda LC. Standardized Reporting and Management of Suspicious Findings on Chest CT Imaging Is Associated With Improved Lung Cancer Diagnosis in an Observational Study. Chest 2020; 158:2211-2220. [PMID: 32562611 DOI: 10.1016/j.chest.2020.05.595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Follow-up of chest CT scan findings suspicious for lung cancer may be delayed because of inadequate documentation. Standardized reporting and follow-up may reduce time to diagnosis and care for lung cancer. STUDY DESIGN AND METHODS We implemented a reporting system that standardizes tagging of chest CT scan reports by classifying pulmonary findings. The system also automates referral of patients with findings suspicious for lung cancer to a multidisciplinary care team for rapid review and follow-up. The system was designed to reduce the time to diagnosis, particularly for early-stage lung cancer. We evaluated the effectiveness of this system, using a quasi-experimental stepped wedge cluster design, examining 99,148 patients who underwent diagnostic (nonscreening) chest CT imaging from 2015 to 2017 and who had not received a chest CT scan in the preceding 24 months. We evaluated the association of the intervention with the incidence of diagnosis and surgical treatment of early-stage (I, II) and late-stage (III, IV) lung cancer within 120 days of chest CT imaging. RESULTS Forty percent of patients received the intervention. Among 2,856 patients (2.9%) who received diagnoses of lung cancer, 28% had early-stage disease. In multivariable analyses, the intervention was associated with 24% greater odds of early-stage diagnosis (OR, 1.24; 95% CI, 1.09-1.41) and no change in the odds of late-stage diagnosis (OR, 1.04; 95% CI, 0.95-1.14). The intervention was not associated with the rate of surgical treatment within 120 days. INTERPRETATION In this large quasi-experimental community-based observational study, implementation of a system that combines standardized tagging of chest CT scan reports with clinical navigation was effective for increasing the diagnosis of early-stage lung cancer.
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Affiliation(s)
- Thomas H Urbania
- Department of Radiology, Kaiser Permanente Northern California, Oakland, CA
| | | | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sora Ely
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Ashish Patel
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA
| | - Todd Osinski
- Department of Radiology, Kaiser Permanente Northern California, Oakland, CA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Current state of Grand Rounds in U.S. pathology training programs. Ann Diagn Pathol 2020; 46:151484. [PMID: 32172216 DOI: 10.1016/j.anndiagpath.2020.151484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
Abstract
Grand Rounds are held with variable frequency in many academic pathology departments, but their exact goal is uncertain, and the type of subjects covered, and presenters have not been studied. We aimed to gather information about the current state of pathology grand rounds (PGR). We identified all US pathology residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and searched their websites for information regarding PGR, extracting data on their existence, frequency and timing. For a representative subgroup of institutions from all US regions and program sizes, we tabulated the 2017-2018 PGR titles and presenters (gender, degree(s), resident/fellow, faculty academic rank). We found that 71 of 142 (50%) ACGME-accredited programs had PGR, more often in programs with >12 residents (53/88, 60%). PGR were scheduled most commonly weekly, on Thursdays, and at noon. We analyzed 1019 PGR presentations from 41 institutions located in 26 US states. Among the 1105 presenters, 183 (16.56%) were trainees, 74 (6.7%) were non-academic, and 848 (76.7%) were faculty, 559 male and 289 female (M/F = 1.93). M/F ratio increased with academic rank, from 1.0 (117/115) for assistant, to 2.0 (135/68) for associate, and 2.9 (307/106) for full professors. Topics covered by PGR belonged to anatomic pathology (357), clinical pathology (209), research (184) or other medical or surgical specialties (149). Our study suggests that trainees are a major intended audience of pathology grand round. Unfortunately, there is a gender gap among pathology grand round presenters that widens with increasing academic rank of presenters.
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Sambasivan CN, Stein SL. General surgery: Should you do it or not? SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2019.100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ramachandran V, Loya A, Shah KP, Goyal S, Hansoti EA, Caruso AC. Myers-Briggs Type Indicator in Medical Education: A Narrative Review and Analysis. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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40
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Oren O, Gersh BJ, Bhatt DL. On the Pearls and Perils of Sub-Subspecialization. Am J Med 2020; 133:158-159. [PMID: 31369725 DOI: 10.1016/j.amjmed.2019.06.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ohad Oren
- Division of Hematology and Oncology, Mayo Clinic Rochester, Minn
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minn
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass.
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Bassendine MF, Taylor-Robinson SD, Fertleman M, Khan M, Neely D. Is Alzheimer's Disease a Liver Disease of the Brain? J Alzheimers Dis 2020; 75:1-14. [PMID: 32250293 PMCID: PMC7306895 DOI: 10.3233/jad-190848] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
Clinical specialization is not only a force for progress, but it has also led to the fragmentation of medical knowledge. The focus of research in the field of Alzheimer's disease (AD) is neurobiology, while hepatologists focus on liver diseases and lipid specialists on atherosclerosis. This article on AD focuses on the role of the liver and lipid homeostasis in the development of AD. Amyloid-β (Aβ) deposits accumulate as plaques in the brain of an AD patient long before cognitive decline is evident. Aβ generation is a normal physiological process; the steady-state level of Aβ in the brain is determined by balance between Aβ production and its clearance. We present evidence suggesting that the liver is the origin of brain Aβ deposits and that it is involved in peripheral clearance of circulating Aβ in the blood. Hence the liver could be targeted to decrease Aβ production or increase peripheral clearance.
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Affiliation(s)
- Margaret F. Bassendine
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Hepatology & Gastroenterology, Division of Surgery and Cancer, Imperial College London, St Mary’s Campus, UK
| | - Simon D. Taylor-Robinson
- Department of Hepatology & Gastroenterology, Division of Surgery and Cancer, Imperial College London, St Mary’s Campus, UK
| | - Michael Fertleman
- Department of Hepatology & Gastroenterology, Division of Surgery and Cancer, Imperial College London, St Mary’s Campus, UK
- Department of Bioengineering, Imperial College London, UK
| | - Michael Khan
- University of Warwick & University Hospitals of Coventry and Warwickshire NHS Trust, UK
| | - Dermot Neely
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Saxen MA, Peterson DE, Mashni M. Point: A 21st-century paradigm for the recognition of dental specialties in the United States: Historical review, lessons learned, looking forward. J Am Dent Assoc 2019; 150:193-199. [PMID: 30803491 DOI: 10.1016/j.adaj.2019.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/20/2018] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Specialty-based practice is a fundamental component of US medicine and dentistry, yet the recognition of new dental specialties has markedly diminished in the past 50 years while medical specialization has flourished. METHODS This article reviews the history of specialty development while focusing on the underlying scientific, educational, and cultural changes in both professions. The process of dental specialty recognition is also examined. RESULTS The current dental specialty recognition process provides a set of criteria aspiring specialties need to fulfill at the time of application, yet the relationship between the criteria and the sequence for attaining them is undefined. Scientific development and evidence-based practice have grown to become the cornerstone of contemporary health care specialization. CONCLUSIONS A new paradigm for specialty and subspecialty development in dentistry is needed. A model is presented herein that recognizes scientific development as the basis for specialization and describes a formal, sequenced process for the development of emerging specialties and subspecialties. PRACTICAL IMPLICATIONS This new paradigm for dental specialty recognition builds on the current criteria for specialization while encouraging cross-disciplinary interaction and nurturing the development of emerging specialties and subspecialties in dentistry. Doing so will allow dentistry to maintain its lead role in the maintenance of oral health and oral disease treatment in the US population.
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Abstract
OBJECTIVE Subspecialisation is increasingly a fundamental part of the contemporary practice of medicine. However, little is known about how medical trainees learn in the modern era, and particularly in growing and relatively new subspecialties, such as adult CHD. The purpose of this study was to assess institutional-led and self-directed learning strategies of adult CHD fellows. METHODS This international, cross-sectional online survey was conducted by the International Society for Adult Congenital Heart Disease and consisted primarily of categorical questions and Likert rating scales. All current or recent (i.e., those within 2 years of training) fellows who reported training in adult CHD (within adult/paediatric cardiology training or within subspecialty fellowships) were eligible. RESULTS A total of 75 fellows participated in the survey: mean age: 34 ± 5; 35 (47%) female. Most adult CHD subspecialty fellows considered case-based teaching (58%) as "very helpful", while topic-based teaching was considered "helpful" (67%); p = 0.003 (favouring case-based). When facing a non-urgent clinical dilemma, fellows reported that they were more likely to search for information online (58%) than consult a faculty member (29%) or textbook (3%). Many (69%) fellows use their smartphones at least once daily to search for information during regular clinical work. CONCLUSIONS Fellows receiving adult CHD training reported a preference for case-based learning and frequent use of online material and smartphones. These findings may be incorporated into the design and enhancement of fellowships and development of online training resources.
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Schnurman Z, Golfinos JG, Roland JT, Kondziolka D. Knowledge silos: assessing knowledge sharing between specialties through the vestibular schwannoma literature. J Neurosurg 2019; 129:1278-1285. [PMID: 29192857 DOI: 10.3171/2017.6.jns171182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIt is common for a medical disorder to be managed or researched by individuals who work within different specialties. It is known that both neurosurgeons and neurotologists manage vestibular schwannoma (VS) patients. While overlap in specialty focus has the potential to stimulate multidisciplinary collaboration and innovative thinking, there is a risk of specialties forming closed-communication loops, called knowledge silos, which may inhibit knowledge diffusion. This study quantitatively assessed knowledge sharing between neurosurgery and otolaryngology on the subject of VS.METHODSA broad Web of Science search was used to download details for 4439 articles related to VS through 2016. The publishing journal's specialty and the authors' specialties (based on author department) were determined for available articles. All 114,647 of the article references were categorized by journal specialty. The prevalence of several VS topics was assessed using keyword searches of titles.RESULTSFor articles written by neurosurgeons, 44.0% of citations were from neurosurgery journal articles and 23.4% were from otolaryngology journals. The citations of otolaryngology authors included 11.6% neurosurgery journals and 56.5% otolaryngology journals. Both author specialty and journal specialty led to more citations of the same specialty, though author specialty had the largest effect. Comparing the specialties' literature, several VS topics had significantly different levels of coverage, including radiosurgery and hearing topics. Despite the availability of the Internet, there has been no change in the proportions of references for either specialty since 1997 (the year PubMed became publicly available).CONCLUSIONSPartial knowledge silos are observed between neurosurgery and otolaryngology on the topic of VS, based on the peer-reviewed literature. The increase in access provided by the Internet and searchable online databases has not decreased specialty reference bias. These findings offer lessons to improve cross-specialty collaboration, physician learning, and consensus building.
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Affiliation(s)
| | | | - J Thomas Roland
- 2Otolaryngology Head and Neck Surgery, NYU Langone Medical Center, New York, New York
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Cate OT, Carraccio C. Envisioning a True Continuum of Competency-Based Medical Education, Training, and Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1283-1288. [PMID: 31460916 DOI: 10.1097/acm.0000000000002687] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The existing structure of physician education has developed in siloed stages, with consecutive degrees and certifications and progressively longer training programs. As further fragmentation of health care and training systems will not improve the quality of care and education, the authors argue that a new vision of education, training, and practice as a continuum is needed.They advocate for a model of competency-based medical education that merges with competency-based medical practice. In this system, education and training will result in individual, dynamic portfolios of valid entrustable professional activities (EPAs) for which physicians are certified. Physicians can maintain and renew that entrustment as long as the EPAs remain within their scope of practice. Entrustment occurs initially during training but is then granted for new activities as physicians' careers evolve.This model accounts for the need to keep pace with changes in population health needs and expectations of competence over time. It de-emphasizes the divides between the stages of training and views the continuum from undergraduate medical education until retirement as a whole. Key obligations of self-regulating medical professionals include both the reception and the provision of supervision from and for others, respectively. Learning must be embedded in practice to address expectations regarding new knowledge and skills as they evolve with scientific and technological advances.Entrusting physicians to deliver effective and safe care, based on their performance of the requisite EPAs without supervision, should ensure that they provide high-value, quality care to patients.
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Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780. C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-5473-8914
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Dragan IF, Pirc M, Rizea C, Yao J, Acharya A, Mattheos N. A global perspective on implant education: Cluster analysis of the "first dental implant experience" of dentists from 84 nationalities. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:251-265. [PMID: 30710398 DOI: 10.1111/eje.12426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this cross-sectional study was to explore the demographic and educational patterns related to the dentists' first implant dental experience. MATERIAL AND METHODS Participants of a Massive Open Online Course in implant dentistry who have placed and restored implants completed a 25-item online questionnaire investigating their pathway of education and assessing their experience with the "first implant placement." Exploratory analysis included hierarchical clustering using 9 demographic categorical factors. RESULTS A total of 1015 respondents from 84 countries formed 5 distinct clusters. Age and work experience were dominant clustering traits, decreasing from Cluster 1 to Cluster 5. Clusters 1 and 3 represented "senior" and "younger" general dental practitioners, respectively, whilst Clusters 2 and 4 represented post-graduate educated clinicians. Cluster 5 represented recent graduates. Asia, South America and Africa were over-represented in "younger" clusters. Time in practice was a significant determinant of attitudes, followed by completion of post-graduate education. There were significant differences in reported patterns of challenges and complications depending on dentists' time in practice, age and post-graduate education. Challenge in implant positioning was more frequently identified by "young post-graduate" educated dentists. Recent graduates reported having the fewest complications of all clusters. Obtaining implant education in University settings was most frequently recommended by clusters of dentists with post-graduate education. CONCLUSIONS Time in practice is a parameter to be considered when designing implant education. The absence of structured education and mentorship might lead to inability to properly assess treatment outcomes and identify complications. Quality-assured and practice-directed education is needed at a global level, to support in particular, recent graduates who now seem to engage with implant dentistry early in their career.
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Affiliation(s)
- Irina F Dragan
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Miha Pirc
- Dental Medicine Section, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Cristina Rizea
- Removable Prosthodontics Department, Faculty of Dentistry, University of Medicine and Pharmacy, Bucharest, Romania
| | - Jie Yao
- Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Aneesha Acharya
- Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Periodontology, Dr. D Y Patil Dental College and Hospital, Dr. D Y Patil Vidyapeeth, Pune, India
| | - Nikos Mattheos
- Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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Schreiner AD, Holmes-Maybank KT, Zhang J, Marsden J, Mauldin PD, Moran WP. Specialty Physician Designation in Referrals from a Vertically Integrated PCMH. Health Serv Res Manag Epidemiol 2019; 6:2333392819850389. [PMID: 31205980 PMCID: PMC6537229 DOI: 10.1177/2333392819850389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of
the specialist, the quality of past communication, and previous consultative
experiences. As health systems vertically integrate, patterns of specialty physician
referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the
proportion of referrals with named specialists. All outpatient specialty referrals from
the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients
were randomly selected for chart review. The outcome of interest was specialty physician
designation. Other variables of interest included PCMH provider experience, the reason
for referral, and time to specialty visit. Univariate analysis was performed with Fisher
exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical
specialties, and 14.6% to ancillary specialties. Resident physicians placed 224
referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice
providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a
specific physician. No differences appeared in the reason for referral, the referral
destination, the proportion of visits scheduled and attended, or the time to schedule
between those referrals with and without specialty physician designation. Faculty
physicians identified a specific specialist in 21.4% of referrals compared to residents
doing so in 4.9% (P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician
infrequently, suggesting a shift from the historical reliance on the individual
characteristics of the specialist in the referral process.
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Affiliation(s)
- Andrew D Schreiner
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Jingwen Zhang
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Marsden
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D Mauldin
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - William P Moran
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Subspecialization in radiology: effects on the diagnostic spectrum of radiologists and report turnaround time in a Swiss university hospital. Radiol Med 2019; 124:860-869. [PMID: 31011996 DOI: 10.1007/s11547-019-01039-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the changes in the work profiles of radiologists and the reporting time after the implementation of professional subspecialization in the radiology department of a Swiss university hospital. METHODS In a retrospective analysis, the overall number of different radiologic examinations performed in the department of radiology of the largest Swiss university hospital was documented for 2014 and 2016 before and after the implementation of subspecialized reporting (subspecialities: abdominal, musculoskeletal, cardiothoracic, emergency, and pediatric imaging) in May 2015. For six selected radiologists, the number and types of reported examinations as well as the related radiology report turnaround times (RTATs) were analyzed in detail and compared between the two 1-year periods. RESULTS Overall, there was a significant increase of 10.3% in the total number of examinations performed in the whole department in 2016 compared with 2014. For four of the six radiologists, the range of different types of examinations significantly decreased with the introduction of subspecialized reporting (p < 0.05). Furthermore, there was a significant change in the subset of the ten most commonly reported types of examinations reported by each of the six radiologists. Mean overall RTATs significantly increased for five of the six radiologists (p < 0.05). CONCLUSIONS Implementation of subspecialized reporting led to a change in the structure and a decrease in the range of different examination types reported by each radiologist. Mean RTAT increased for most radiologists. Subspecialized reporting allows the individual radiologist to focus on a special field of professional competence but can result in longer overall RTAT.
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Delaigue S, Bonnardot L, Steichen O, Garcia DM, Venugopal R, Saint-Sauveur JF, Wootton R. Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value. J Glob Health 2019; 8:020414. [PMID: 30574293 PMCID: PMC6292825 DOI: 10.7189/jogh.08.020414] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Médecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings. Methods We studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013. Results During the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases. Conclusions The quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.
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Affiliation(s)
| | - Laurent Bonnardot
- Department of Medical Ethics and Legal Medicine, Paris Descartes University, Paris, France.,Fondation Médecins Sans Frontières, Paris, France
| | - Olivier Steichen
- Department of Internal Medicine AP-HP, Hôpital Tenon, Paris, France.,Faculty of Medicine Sorbonne Universités, UPMC University Paris, Paris, France
| | | | | | | | - Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
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Affiliation(s)
- James E Dalen
- Dean Emeritus, University of Arizona College of Medicine, Tucson.
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