Inter-specialty collaboration in the formalization of a new foregut subspecialty

Historical context and converging market conditions present a unique opportunity to study the factors contributing to the formalization of foregut, or upper gastrointestinal, surgery as a new subspecialty in United States healthcare. The aim of this study was to examine the justifications of those pursuing the formalization of a foregut subspecialty and to extract lessons for healthcare leaders on the evolving relationships between competing providers. This was a qualitative, cross-sectional study consisting of interviews, secondary survey data, and observation of society meetings between October 2018 and June 2019. Thirty interviews with healthcare professionals were conducted, transcribed, and analyzed for themes using qualitative coding software. Themes were correlated with observational field notes and archival data and compared against established social theories on professions and medical specialization. Analysis revealed that traditionally competing surgeons and gastroenterologists articulate a professional need to qualify foregut surgical expertise based on superior knowledge and outcomes, to define the allocation of certain tasks and procedures, and to foster collaboration across specialties. Converging market conditions precipitate individual and organizational decisions to pursue formal specialization. Participants in the formalization of this subspecialty should consider the history of professional competition and turf wars to achieve meaningful collaboration. Advocacy for multi-specialty societies and organizational movements could be a model for reduced conflict in other specialties as well.

Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women

Objective The study was conducted to determine the prevalence of dysmenorrhea and investigate factors associated with dysmenorrhic pain among university students in Lahore, Pakistan. Design and Setting A cross-sectional study was conducted across various public and private sector universities in Lahore. Methods A self-administered structured questionnaire was used to collect data from 600 randomly selected female university students. Results The prevalence of dysmenorrhea was 91.5%. Age at menarche (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.10–3.50) was the only significant factor associated with dysmenorrhea. The mean pain severity score among dysmenorrhic students was 5.62 ± 2.28. Most of the participants (65.8%) were experiencing moderate/severe pain. Univariate analysis showed that irregular cycle (OR [95% CI] = 1.62 [1.13–2.33]), age at menarche of ≤14 years (OR [95% CI] = 1.46 [1.05–2.04]), duration of menses of more than 5 days (OR [95% CI] = 1.42 [1.02–1.99]), stress (OR [95% CI] = 2.16 [1.54–3.03]), moderate meat/protein consumption (OR [95% CI] = 1.55 [1.08–2.21]), and medical specialization (OR [95% CI] = 1.72 [1.17–2.52]) were significantly associated with pain severity among dysmenorrhic female students. Multivariate binary logistic regression analysis revealed that medical specialization (OR [95% CI] = 1.83 [1.22–2.73]), age at menarche (OR [95% CI] = 0.603 [0.42–0.86]), regularity of menses (OR [95% CI] = 1.52 [1.04–2.22]), moderate meat/protein consumption (OR [95% CI] = 1.69 [1.16–2.45]), and stress (OR [95% CI] = 1.87 [1.32–2.66]) were independent predictors of moderate/severe dysmenorrhic pain. Conclusion The study revealed an alarmingly high prevalence of dysmenorrhea among university students. High levels of stress and early menarche were the potent determinants of moderate/severe dysmenorrhea that disturbs quality of life.

The values, perception and attitudes of potential domestic tourists regarding the medical tourism offer of Romania

Introduction. Apparently medicine and tourism have represented for a while distinct domains, both in terms of research and even in popular culture. While medicine is widely known as dedicated exclusively to healing and treating patients suffering from various diseases, tourism, popular since ancient times in relation to healing, is based on a person’s motivation towards obtaining a pleasant experience in optimal conditions that already require the existence of a good state of health. Considering the emergence of new challenges in medicine, mostly in terms of demand, there is a phenomenon of directing preferences or needs in order to obtain medical services in a relaxing touristic environment. Due to the rapid development of medical tourism, we consider opportune to study this phenomenon, both from the perspective of a social and economic impact and from the need to reorganize the tourism activity, emphasized with new forms and modern concepts. Material and method. As a limited number of research can be found related to medical tourism, and generally covers travelling for medical treatments or interventions, and also a few publications are dealing with theoretical aspects of this form of tourism, the main purpose of the article is to bring a scientific contribution to the global field of medical tourism, especially regarding the tourist expectations and attitudes towards an internal medical tourism offer. Using a quantitative research methodology, we aimed to achieve the following secondary objectives: identifying the interest, intention and reasons of respondents to practice medical tourism, establishing the level of confidence in the medical specialization of certain cities, assessing the level of knowledge and general perception on a treatment specifics in spa resorts structured in galaxy clusters. Results and discussions. Focusing on both national and international research, we have reached the conclusion that there is a lack of specific statistical indicators to analyze or compare the phenomenon of medical tourism. The shortcomings that are considered in the research may be caused mainly by inconsistencies of defining different concepts related to medical tourism or the confusion generated by the use of terms specific to medical or health tourism. Thus, the main objective of our research is to identify relevant aspects regarding the values, perception and attitudes of potential domestic medical tourists towards Romania’s medical tourism offer. Conclusions. There are certain limitations to our research, but it can surely become a basis for further developments regarding galaxy clusters and their impact in relation to a tourist’s needs. Keywords: medical tourism, spa resorts, medical providers, medical services demand, balneary tourism,

Medical School Performance as A Predictor of Scores in the National Medical Specialization Exam in Turkey

Background Medical educators and assessors like to include predictive validity in their validity arguments but relevant evidence may be difficult to find. External standardized examinations may have a role in validating both the educational process of medical schools and their assessment results and outcomes. A strong correlation between medical school and external exam performances may also lend evidence of validity to the external examination. This work from one of Turkey’s top medical schools explored the correlations between students’ medical school performances and scores from the Specialization in Medicine Exam (TUS). The TUS is a post-graduate national ranking examination. Methods A total of 246 students from two different programs of a medical school, which have identical curricula but different admission scores were studied retrospectively. Students’ year based Grade Point Averages (GPAs) and end-of-school (graduating) GPAs were calculated using a weighted mean method. Bivariate correlations were calculated between year specific GPAs, graduating GPAs and TUS scores. Results Students’ inter-year GPAs showed strong significant correlations (“r” ranging from 0.59 to 0.86, p < 0.001). Their graduating GPA also had a strong significant correlation with TUS scores (r = 0.65, p < 0.001). Linear regression models showed the significant relation between medical school performance and post-graduation national exam performance. Conclusion Student success has a high degree of consistency throughout the medical school and students’ performance across all domains of assessment in the undergraduate program might be a good predictor of cognitive skills in an external national examination in the early postgraduate phase.

Cardioneurology: specialization, integration and interdisciplinary practice

The article deals with modern problems of integrative medicine. The authors give a critical evaluation of medical specialization and explain the need to develop interdisciplinary areas. The historical aspects of the problem are shown by the example of the development of one of the first interdisciplinary areas in medicine — cardioneurology.

Private surgery clinics in an open medical market: Barcelona, 1880s-1936

The main purpose of this article is to examine how a new medical technology – the operating room- resulted in the establishment of a model of private clinics in late 19th – century Barcelona. This research explains that this kind of private medical care happened in an open medical market and successfully met a growing demand. Since its origins in the 1880s, private surgery clinics rose to more than 50 in just half-a-century. Here, several business strategies put at work by those surgeons-entrepreneurs are considered, especially those related to publicity and the search of patients/customers. Several aspects played a paramount role in that success: medical technology, domestic comfort, and surgical efficacy. In a context where medical care delivered at hospital was provided by the city-state or the local bourgeoisie as a part of the medieval model of charity, a potential customer for the private surgery clinics was formed by the urban, popular and working classes through the model of mutual aid societies and health insurance companies. Moreover, private clinics also showed how the process of medical specialization was configured and what kind of relationships surgeons-entrepreneurs established with general practitioners to attract their patients. Here, medical directories and medical journals reveal as a useful source of information.

MANAGEMENT OF UKRAINIAN HEALTH CARE ORGANIZATIONS

The article analyses the construction of the health care system of Ukraine, the historical preconditions of its current state. The reasons that hinder the development of the industry, one of which is the urgent need for effective management, the development of which is complicated by a number of subjective and objective factors, including gaps in the legal field, insufficient competence of management, and their undesirable development and implementation of new management technologies. Positive changes in government regulations, promising areas of training have been identified. The educational and scientific program “Management in health care” (specialty 073 “Management”) and the requirements for the competence of specialists are also analyzed. The issue of the need to build and develop a new model of health care, which should correspond to the modern market economy, comprehensive and intensive reform of the health care system, related to the methods of management, financing, reorganization of medical institutions. In Ukraine, the heads of health care institutions are staffed mainly by doctors who, undoubtedly, have significant experience and high qualification in medical specialization, no longer have special training in management and economics of health care. It becomes obvious that the presence of special education is NOT a priority sign during the appointment to the position of head of a medical institution. Health care reforms in Ukraine began much later than in other post-Soviet countries, almost two decades after independence. Transformations in this area, first of all, the acquisition of autonomy by institutions in administrative activities, the ability to raise funds from various sources, etc., necessitate effective management of medical organizations. The international experience of countries with developed health care systems shows that it is expedient to lead organizations and institutions with specialists in the field of management, economics and health care. The inconsistency of the training of specialists with the needs of practical health care and the tasks of structural adjustment of this type of economic activity is the main thing that hinders the effective management of health care organizations, as a result of which the quality of medical care deteriorates. Improving the management of health care organizations in Ukraine will allow you to effectively manage human resources and financial flows, which will result in both economic and social results of the individual, team, organization and the country as a whole.