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The current demand for adult hematologists in the United States is projected to exceed the existing supply. However, no national study has systematically evaluated factors affecting the adult hematology workforce. In collaboration with the American Society of Hematology (ASH), we performed a mixed methods study consisting of surveys from the annual ASH In-Service Exam for adult hematology/oncology fellows from 2010 to 2016 (8789 participants); interviews with graduating or recently graduated adult hematology/oncology fellows in a single training program (8 participants); and 3 separate focus groups for hematology/oncology fellowship program directors (12 participants), fellows (12 participants), and clinicians (10 participants) at the 2016 ASH annual meeting. In surveys, the majority of fellows favored careers combining hematology and oncology, with more fellows identifying oncology, rather than hematology, as their primary focus. In interviews with advanced-year fellows, mentorship emerged as the single most important career determinant, with mentorship opportunities arising serendipitously, and oncology faculty perceived as having greater availability for mentorship than hematology faculty. In focus group discussions, hematology, particularly benign hematology, was viewed as having poorer income potential, research funding, job availability, and job security than oncology. Focus group participants invariably agreed that the demand for clinical care in hematology, particularly benign hematology, exceeded the current workforce supply. Single-subspecialty fellowship training in hematology and the creation of new clinical care models were offered as potential solutions to these workforce problems. As a next step, ASH is conducting a national, longitudinal study of the adult hematology workforce to improve recruitment and retention in the field.

The aim of the study was to investigate the effect of a phonemic and phonological awareness program, on the Arabic reading performance of first grade basic education students in Oman. To achieve this aim, a quasi-experimental research design was adopted. An Arabic phonemic and phonological awareness test was designed together with training program for Arabic teachers. A sample of 205 students was selected from 4 schools and divided into two groups. The experiment was conducted in 10 weeks during which teachers taught using the program. A post-test was administered after the intervention and then the students were tested for the third time after six months to determine the delayed effect. Results showed that there were significant differences in the mean of the test scores between the control and the experimental groups in favor of the experimental group. Similarly, significant differences were indicated in the mean of the test scores among the experimental group between the pre and the post-test. On the other hand, no significant differences were noted between male and female students. Results also showed significant differences in the mean of the test scores among the experimental group in the third testing which was intended to measure the delayed effect.

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires training programs to demonstrate that fellows are achieving competence in medical knowledge (MK), as part of a global assessment of clinical competency. Passing American Board of Internal Medicine (ABIM) certification examinations is recognized as a metric of MK competency. This study examines several in-training MK assessment approaches and their ability to predict performance on the ABIM Hematology or Medical Oncology Certification Examinations. Results of a Hematology In-Service Examination (ISE) and an Oncology In-Training Examination (ITE), program director (PD) ratings, demographic variables, United States Medical Licensing Examination (USMLE), and ABIM Internal Medicine (IM) Certification Examination were compared. Stepwise multiple regression and logistic regression analyses evaluated these assessment approaches as predictors of performance on the Hematology or Medical Oncology Certification Examinations. Hematology ISE scores were the strongest predictor of Hematology Certification Examination scores (β = 0.41) (passing odds ratio [OR], 1.012; 95 % confidence interval [CI], 1.008-1.015), and the Oncology ITE scores were the strongest predictor of Medical Oncology Certification Examination scores (β = 0.45) (passing OR, 1.013; 95 % CI, 1.011-1.016). PD rating of MK was the weakest predictor of Medical Oncology Certification Examination scores (β = 0.07) and was not significantly predictive of Hematology Certification Examination scores. Hematology and Oncology ITEs are better predictors of certification examination performance than PD ratings of MK, reinforcing the effectiveness of ITEs for competency-based assessment of MK.

Der diabetische Fuss definiert sich durch die Präsenz eines Ulkus zusammen mit einer Neuropathie oder peripherer arterieller Verschlusskrankheit bei Patienten mit einem Diabetes mellitus. Da bei 85% der Amputationen an der unteren Extremität ein Ulkus primär vorhanden war, ist Prävention extrem wichtig. Schon bei einem beginnenden Ulkus muss eine sofortige Behandlung beginnen, idealerweise durch ein spezialisiertes, interdisziplinäres Team. Wundheilungsstörung und erhöhtes Infektrisiko sind normalerweise durch die vaskuläre Erkrankung bedingt. Obwohl es eine sehr grosse Vielfalt von verschiedenen Wundverbänden gibt, hat sich bis jetzt kein «Goldstandard» durchsetzen können. Die Behandlung basiert weiterhin auf der Analyse der Wunde, der vaskulären Abklärung, der Wundbehandlung und der Entlastung des erkrankten Areals.

Symptome und Lebensqualität wurden bei 78 Patienten mit primärer oberflächlicher venöser Insuffizienz (POVI; mittleres Alter 49,5±13,3 Jahre; 54 Frauen) vor und ein Jahr nach chirurgischer Behandlung (56 Patienten) oder endovenöser Laserablation (EVLA, 22 Patienten) mittels VEINES-QOL Fragebogen evaluiert. Beide Methoden verbesserten im Beobachtungszeitraum nach Intervention signifikant den Symptom-Score (Differenz 10,6±9,9 für Chirurgie und 9,9±8,2 Punkte für EVLA; p

The definition for the diabetic foot is infection, ulceration or destruction of deep tissues of the foot associated with neuropathy or peripheral vascular disease in the lower extremity of people with diabetes. Non-diabetic patients may suffer the same risks when neuropathy and arteriopathy are present. Knowing that 85% of amputations are preceded by foot ulcers, prevention is primordial. At the onset of an ulcer, immediate treatment must be undertaken and preferably by an interdisciplinary team. Delayed healing and increased risk of infection are often due to an associated vascular disease. While the array of dressings is expansive there is no «gold standard» treatment or «miracle dressing» described for foot ulcers. The management consists of wound analysis, debridement, woundcare and especially offloading.

Venous symptoms and quality of life (QOL) of 78 patients (54 women, mean age 49,5±13,3 years) with primary superficial venous insufficiency (PSVI) were compared at one year after treatment with crossectomy and stripping (C/S, 56 patients) or endovenous laser ablation (EVLA, 22 patients) using the VEINES-QOL questionnaire. Both treatments significantly (p0,001) improved the scores for venous symptoms (difference 10,6±9,9 and 9,9±8,2 score points for C/S and EVLA, respectively) and QOL (difference 10,3±8,7 and 8,4±6,6 score points for C/S and EVLA, respectively). No difference was found between treatments regarding symptoms or QOL improvement (p=0,30). We conclude that C/S and EVLA are equally effective in improving symptoms and QOL in PSVI.

The American Society of Clinical Oncology (ASCO) developed its own test—the Medical Oncology In-Training Examination (MedOnc ITE)—as a tool to assess trainees' knowledge of the clinical oncology subspecialty, establish consistency in educational standards across training programs, identify areas of strength and weakness in individual programs, and stimulate intraprogrammatic reading and discussion. The Accreditation Council for Graduate Medical Education Outcome Project provided additional incentive for ASCO to develop an ITE. The examination was developed in 4 years. The concept of the examination and the budget were approved by the ASCO governing board. The National Board of Medical Examiners was selected to work with ASCO. Fellowship programs were contacted to determine if they had the information technology support to hold the examination. A blueprint for the examination was developed. The test format, including the number of questions and the selection of case-based single best answers, was determined. Physician volunteers to write the questions were solicited from among program directors, various ASCO committees, and disease experts. A workshop was held to teach volunteers how to write proper case-based questions. From this pool, a smaller group of physicians was selected to develop the test and review all test questions. The final examination was developed and administered in February 2008, with scores provided to fellows and program directors in April 2008. Feedback received after the examination will be helpful for developing future MedOnc ITEs. The process ASCO went through to develop the MedOnc ITE serves as a model for other subspecialties interested in developing their own ITEs.

Adult intussusception represents 5% of all intussusceptions and 1% of all bowel obstructions. In adults, it is often associated with a systemic disease, such as acquired immune deficiency syndrome (AIDS), and is usually caused by a focal pathologic process at the point of the intussusceptum. In these patients, diagnosis is often delayed, mainly because of the nonspecific and prolonged nature of the symptoms and because of the extensive differential diagnosis of nonsurgical abdominal conditions. Leucocyte count is rarely increased because of the depressed immune response. We present here the case of a patient with AIDS, who developed an ileocolic intussusception after laparoscopic appendectomy. The clinical and radiographic findings are described.

Projected demands for oil and gas in the near term provide E&P companies with confidence to engage in aggressive field development expansions of production capacity over the next 10 years. Upper Zakum is a giant offshore field that has been in production since 1982. The strategic target for further development is to increase plateau production rate by 50% within the next 10 years while maintaining industry-best-practice reservoir management techniques and shareholder's economic guidelines. Like most existing carbonate fields in the Gulf Region this aggressive rate of field development will encounter challenges related to reservoir management and facility capacity uncertainties. The challenges require both organizational and technological responses in many areas and at multiple levels. The aggressiveness of strategic production goals demands that the technological and organizational issues be viewed in an integrated way that aligns and focuses competency requirements, work processes and technology implementation with strategic targets. In practice this requires that organizational structure must support the technological requirements for fully integrated multidisciplinary work processes. The presentation will describe the detailed organizational development processes used by the Upper Zakum Field Development Department and the resulting project-based organization model chosen for implementation.

Between 1976 and 1991, we observed lesions of the small bowel or colon in 39 patients having sustained blunt abdominal trauma. 70% of the patients presented with concomitant injuries. Except for 3 cases, all the patients presented with abdominal pain on admission. All the patients were operated on. The delay between admission and operation varied between a few minutes and 48 hours. Indication was hemoperitoneum, peritonitis or progressive abdominal pain. Overall morbidity is high, often related to associated disease. 4 patients died (mortality 10%), including 2 patients with isolated intestinal trauma who were operated on after 20 and 36 hours. Due to the lack of specific laboratory or X-ray test, we suggest a high index of suspicion for bowel lesions in blunt abdominal trauma, especially in unconscious patients. Close observation is mandatory. Indication for laparotomy must not be delayed if any doubt exists regarding the integrity of hollow viscus.