CHOICE OF MEDICAL SPECIALTY: ANALYSIS OF STUDENTS' NEEDS

1992 ◽  
Vol 71 (5) ◽  
pp. 215 ◽  
Author(s):  
PAUL HENRY
Keyword(s):  
Medical Specialty

Organizational aspects of osteopathic care provision in a specialized clinic of Moscow

2018 ◽  
pp. 6-13
Author(s):  
D. E. Mokhov ◽  
M. Y. Gerasimenko ◽  
O. V. Yaschina ◽  
L. V. Tumbinskaya ◽  
E. S. Tregubova
Keyword(s):  
Quality Criteria ◽  
Medical Specialty ◽  
Organizational Analysis ◽  
Care Provision ◽  
Sources Of Information ◽  
Research Papers ◽  
Regulatory Documents ◽  
Methodological Approaches ◽  
Intensive Development ◽  
Osteopathic Physicians

Introduction. Nowadays osteopathy is an offi cial medical specialty. Many years of experience accumulated by osteopathic physicians in our country have proven its effectiveness. The analysis of research papers of those countries where osteopathy is widely used allows to draw the following conclusion: osteopathy is one of the least dangerous therapeutic methods provided that patients deal with well-trained and certifi ed specialists who work in the frame of possibilities of osteopathy. Due to the intensive development of this specialty in Russia it is necessary to provide scientifi c justifi cation to organizational and methodological approaches aimed at ensuring effective and high-quality osteopathic care to the population.Goal of research - to develop proposals in order to improve the quality and effectiveness of osteopathic care provision for the population, taking into account the current situation in health care.Materials and methods. Authors used the following research methods: historical and medico-organizational analysis, literary data analysis, content analysis as well as methods of descriptive statistics.Results. The research presents characteristics of clinics declaring osteopathic care provision, as well as qualities of osteopathic physicians. It also describes patients seeking osteopathic care, and sources of information they use.Conclusion. Authors propose a number of measures aimed at improving the availability and effectiveness of osteopathic care for patients such as training of doctors, creating of regulatory documents, developing quality criteria for osteopathic care provision and popularization of osteopathy among patients.

Survey on European postgraduate medical assessments by the Council for European Medical Specialty Assessments (UEMS-CESMA)

MedEdPublish ◽  
2014 ◽  
Author(s):  
John Boorman ◽  
Danny G.P. Mathysen ◽  
Julie-Lyn Noël ◽  
Konrad Bloch ◽  
Jean-Baptiste Rouffet ◽  
...  
Keyword(s):  
Medical Specialty

Variation in the management of Kawasaki disease

2019 ◽  
Vol 105 (10) ◽  
pp. 1004-1006 ◽  
Author(s):  
Audrey Dionne ◽  
David Burgner ◽  
Sarah De Ferranti ◽  
Davinder Singh-Grewal ◽  
Jane Newburger ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Initial Treatment ◽  
Coronary Aneurysm ◽  
Medical Specialty ◽  
Primary Treatment ◽  
Management Options ◽  
Necrosis Factor Alpha ◽  
Coronary Aneurysms ◽  
Factor Alpha ◽  
Collaborative Efforts

Intravenous immunoglobulin (IVIG) reduces coronary aneurysms in patients with Kawasaki disease (KD), but additional management options remain challenging, with no generalisable evidence-based recommendations. We performed a survey of 724 physicians from 73 countries to assess variation in practice. IVIG was the preferred initial treatment by 659 (91%) of respondents. Criteria for adjunctive primary treatment varied considerably and definitions of IVIG resistance varied markedly by geographical continent, Human Development Index tiers and medical specialty. A second dose of IVIG was used most often for patients with coronary aneurysm non-responsive to initial treatment (572, 79%), but corticosteroids (379, 52%) and tumour necrosis factor alpha inhibitors (208, 29%) were also frequently used. Our findings highlight the need for international collaborative efforts to optimise management of patients with KD worldwide.

scholarly journals Decreased Medical Care During the COVID-19 Pandemic – A Comprehensive Analysis of Radiological Examinations

2021 ◽  
Author(s):  
Annette Aigner ◽  
Bernd Hamm ◽  
Florian Nima Fleckenstein ◽  
Tazio Maleitzke ◽  
Georg Böning ◽  
...  
Keyword(s):  
Medical Care ◽  
Control Period ◽  
Surrogate Marker ◽  
Medical Specialty ◽  
Case Volume ◽  
Medical Specialties ◽  
Key Points ◽  
Depth Analysis ◽  
The Impact ◽  
Radiological Examinations

Objectives As a cross-section discipline within the hospital infrastructure, radiological departments might be able to provide important information regarding the impact of the COVID-19 pandemic on healthcare. The goal of this study was to quantify changes in medical care during the first wave of the pandemic using radiological examinations as a comprehensive surrogate marker and to determine potential future workload. Methods A retrospective analysis of all radiological examinations during the first wave of the pandemic was performed. The number of examinations was compared to time-matched control periods. Furthermore, an in-depth analysis of radiological examinations attributed to various medical specialties was conducted and postponed examinations were extrapolated to calculate additional workload in the near future. Results A total of 596,760 examinations were analyzed. Overall case volumes decreased by an average of 41 % during the shutdown compared to the control period. The most affected radiological modalities were sonography (–54 %), X-ray (–47 %) followed by MRI (–42 %). The most affected medical specialty was trauma and orthopedics (–60 % case volume) followed by general surgery (–49 %). Examination numbers increased during the post-shutdown period leading to a predicted additional workload of up to 22 %. Conclusion This study shows a marked decrease in radiological examinations in total and among several core medical specialties, indicating a significant reduction in medical care during the first COVID-19 shutdown. Key Points: Citation Format

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

scholarly journals Testing for non-inferior mortality: a systematic review of non-inferiority margin sizes and trial characteristics

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e044480
Author(s):  
Sandra Pong ◽  
Martin Urner ◽  
Robert A Fowler ◽  
Nicholas Mitsakakis ◽  
Winnie Seto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Absolute Risk ◽  
Methodological Issue ◽  
Medical Specialty ◽  
Risk Difference ◽  
Baseline Risk ◽  
Industry Funding ◽  
Eligibility Criteria ◽  
Randomised Controlled

ObjectiveTo describe the size and variability of non-inferiority margins used in non-inferiority trials of medications with primary outcomes involving mortality, and to examine the association between trial characteristics and non-inferiority margin size.DesignSystematic review.Data sourcesMedline, Medline In Process, Medline Epub Ahead of Print and Embase Classic+Embase databases from January 1989 to December 2019.Eligibility criteriaProspective non-inferiority randomised controlled trials comparing pharmacological therapies, with primary analyses for non-inferiority and primary outcomes involving mortality alone or as part of a composite outcome. Trials had to prespecify non-inferiority margins as absolute risk differences or relative to risks of outcome and provide a baseline risk of primary outcome in the control intervention.Results3992 records were screened, 195 articles were selected for full text review and 111 articles were included for analyses. 82% of trials were conducted in thrombosis, infectious diseases or oncology. Mortality was the sole primary outcome in 23 (21%) trials, and part of a composite primary outcome in 88 (79%) trials. The overall median non-inferiority margin was an absolute risk difference of 9% (IQR 4.2%–10%). When non-inferiority margins were expressed relative to the baseline risk of primary outcome in control groups, the median relative non-inferiority margin was 1.5 (IQR 1.3–1.7). In multivariable regression analyses examining the association between trial characteristics (medical specialty, inclusion of paediatric patients, mortality as a sole or part of a composite primary outcome, presence of industry funding) and non-inferiority margin size, only medical specialty was significantly associated with non-inferiority margin size.ConclusionAbsolute and relative non-inferiority margins used in published trials comparing medications are large, allowing conclusions of non-inferiority in the context of large differences in mortality. Accepting the potential for large increases in outcomes involving mortality while declaring non-inferiority is a challenging methodological issue in the conduct of non-inferiority trials.

scholarly journals Mycosis fungoides and Sézary syndrome: a population-wide study on prevalence and health care use in Finland in 1998–2016

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaana Keto ◽  
Sonja Hahtola ◽  
Miika Linna ◽  
Liisa Väkevä
Keyword(s):  
Health Care ◽  
Mycosis Fungoides ◽  
Hospital Costs ◽  
Fold Increase ◽  
Medical Specialty ◽  
Health Care Use ◽  
Sézary Syndrome ◽  
Sezary Syndrome ◽  
Outpatient Visits

Abstract Background Information about health care use and costs of cutaneous T-cell lymphoma (CTCL) patients is limited, particularly in a European setting. Methods In this population-wide study we set out to investigate prevalence, and trends in health care use in two CTCL subtypes, mycosis fungoides (MF) and Sézary syndrome (SS) over a time period of 19 years in 1998–2016 by using a nation-wide patient register containing data on all diagnosed MF and SS cases in Finland. Results The prevalence of diagnosed MF and SS rose from 2.04 to 5.38/100000, and from 0.16 to 0.36/100000 for MF and SS respectively during 1998–2016. We found a substantial decrease in inpatient treatment of MF/SS in the past two decades with a mean of 2 inpatient days/patient/year due to MF/SS in 2016, while the mean numbers of MF/SS related outpatient visits remained stable at 8 visits/year/patient. Most MF/SS-related outpatient visits occurred in the medical specialty of dermatology. In a ten-year follow-up after MF/SS diagnosis, the main causes for outpatient visits and inpatient stays were MF/SS itself, other cancers, and other skin conditions. Also cardiovascular disease and infections contributed to the number of inpatient days. Mean total hospital costs decreased from 11,600 eur/patient/year to 3600 eur/patient/year by year 4 of the follow-up, and remained at that level for the remainder of the 10-year follow-up. MF/SS accounted for approximately half of the hospital costs of these patients throughout the follow-up. Conclusions The nearly 3-fold increase in prevalence of diagnosed MF/SS during 1998–2016 puts pressure on the health care system, as this is a high-cost patient group with a heavy burden of comorbidities. The challenge can be in part answered by shifting the treatment of MF/SS to a more outpatient-based practice, and by adapting new pharmacotherapy, as has been done in Finland.

Practice Guidelines: How Good are Medicine's New Recipes?

1995 ◽  
Vol 23 (1) ◽  
pp. 47-48 ◽  
Author(s):  
Alexander Morgan Capron
Keyword(s):  
Health Care ◽  
Nonprofit Organizations ◽  
Medical Knowledge ◽  
Medical Specialty ◽  
Therapeutic Interventions ◽  
Medical Interventions ◽  
Practice Parameters ◽  
Wide Range ◽  
Standard Of Practice

Over the last decade, standards for when and how to undertake a wide range of medical interventions have poured forth from medical specialty groups, commercial and nonprofit organizations, and state and federal panels. Known by a variety of names—from practice parameters to clinical guidelines—and intended for a range of purposes—from diminishing the incidence of maloccurences in hospitals to cutting the costs of health care—these guidelines share one important feature: the intention of decreasing the range of variation in medical practice. Such standardization immediately appeals to anyone interested in improving the quality of health care and, in particular, reducing inappropriate medical interventions, in light of the difficulties for a conscientious physician today in adhering to the best standard of practice when faced with ever increasing medical knowledge and the growing number and complexity of diagnostic, preventive, and therapeutic interventions.

scholarly journals Determinants of successful guideline implementation: a national cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-hui Jin ◽  
Li-Ming Tan ◽  
Khalid S. Khan ◽  
Tong Deng ◽  
Chao Huang ◽  
...  
Keyword(s):  
Guideline Development ◽  
Guideline Implementation ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
The West ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Multi Stage ◽  
Geographical Regions ◽  
Tertiary Hospitals

Abstract Background CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China. Methods This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2–5 provinces were selected from each region. 2–3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P < 0.001; the west P = 0.02; the middle P < 0.001 compared with the east), hospital grades (P = 0.028), length of practitioners’ practice (P = 0.006), education background (Ph.D., P = 0.027; Master, P = 0.002), evidence-based medicine skills acquired in work unit (P = 0.012), and medical specialty of practitioner (General Practice, P = 0.006; Surgery, P = 0.043). Conclusion Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

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