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Previous studies suggested that surgeon sex is associated with differential patient outcomes. Whether this also applies to anaesthesia providers is unclear. We hypothesised that female sex of the primary anaesthesia provider is associated with lower risk of perioperative complications. The first case for all adult patients undergoing anaesthesia care between 2008 and 2022 at two academic healthcare networks in the USA was included in this retrospective cohort study. The primary exposure was the sex of the anaesthesia provider who spent the most time in the operating theatre during the case. The primary outcome was intraoperative complications, defined as hypotension (mean arterial blood pressure <55 mm Hg for ≥5 cumulative minutes) or hypoxaemia (oxygen saturation <90% for >2 consecutive minutes). The co-primary outcome was 30-day adverse postoperative events (including complications, readmission, and mortality). Analyses were adjusted for a priori defined confounders. Among 364,429 included patients, 57,550 (15.8%) experienced intraoperative complications and 55,168 (15.1%) experienced adverse postoperative events. Care by female compared with male anaesthesia providers was associated with lower risk of intraoperative complications (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.94–0.97, P <0.001), which was magnified among non-trainees (aOR 0.84, 95% CI 0.82–0.87, P -for-interaction<0.001). Anaesthesia provider sex was not associated with the composite of adverse postoperative events (aOR 1.00, 95% CI 0.98–1.02, P =0.88). Care by a female anaesthesia provider was associated with a lower risk of intraoperative complications, which was magnified among non-trainees. Future studies should investigate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Occupational stress can affect specialty nurses' quality of work, especially for those working in care units. This study, therefore, investigated role stress and its related factors among specialty nurses working in tertiary general hospitals. Methods: This cross-sectional descriptive study used convenience sampling to recruit 795 Chinese specialty nurses in 11 tertiary general hospitals (from February to March 2023). A questionnaire survey was conducted using the Basic Information Questionnaire and the Role Stress Scale. Multiple linear regression analyses were performed on the survey data to explore the factors affecting role stress. Results: The total role stress score of specialty nurses in tertiary general hospitals was 52.05 ± 19.98. The highest mean item score was quantitative overload, followed by qualitative overload, role conflict, and role ambiguity, which had the lowest score. Multiple linear regression analysis revealed that gender (β = -0.085, p < 0.05), educational background (β = 0.077, p < 0.05), and work experience (β = -0.104, p < 0.05) were the main factors influencing role stress among specialty nurses. Conclusions: Specialty nurses in tertiary general hospitals had higher levels of role stress than general nurses. Their role stress was primarily reflected in role overload, followed by role conflict and ambiguity. The factors affecting specialty nurses' role stress included gender, work experience, and educational background. Nursing managers should monitor the role stress experienced by specialty nurses in tertiary general hospitals. Providing psychological support for male specialty nurses, performance rewards and learning opportunities for highly educated specialty nurses, and continuous training for inexperienced specialty nurses are essential measures to relieve role stress. [ABSTRACT FROM AUTHOR]

Abstract Background Occupational stress can affect specialty nurses’ quality of work, especially for those working in care units. This study, therefore, investigated role stress and its related factors among specialty nurses working in tertiary general hospitals. Methods This cross-sectional descriptive study used convenience sampling to recruit 795 Chinese specialty nurses in 11 tertiary general hospitals (from February to March 2023). A questionnaire survey was conducted using the Basic Information Questionnaire and the Role Stress Scale. Multiple linear regression analyses were performed on the survey data to explore the factors affecting role stress. Results The total role stress score of specialty nurses in tertiary general hospitals was 52.05 ± 19.98. The highest mean item score was quantitative overload, followed by qualitative overload, role conflict, and role ambiguity, which had the lowest score. Multiple linear regression analysis revealed that gender (β = -0.085, p

ObjectiveThe Certified Flight Registered Nurse (CFRN) credential independently validates a registered nurse's advanced knowledge, skills, and abilities in the unique specialty of flight nursing. Introduced in 1993 and celebrating its 30th anniversary in July 2023, the CFRN is held by over 5,500 registered nurses. The purpose of the 2022 CFRN pulse survey was to better understand the ways CFRN-certified registered nurses value this national flight nursing specialty credential. The CFRN survey is a companion to the 2022 Certified Transport Registered Nurse pulse survey, which focused on the Certified Transport Registered Nurse critical care ground transport nursing credential.MethodsThe Board of Certification for Emergency Nursing e-mailed individuals in its database of CFRN credential holders and asked them to respond to a 14-question online survey between October 17, 2022, and November 8, 2022. Participation in the survey was voluntary. Of the 5,275 verified CFRN holders who received the survey, 992 responded, for a response rate of 18.8%. The survey instrument included discrete field and open-ended questions. Data were deidentified for analysis, and institutional review board exemption was received. Counts and percentages were reported, and descriptive statistics were used.ResultsThe highest percentage of flight nurses who responded have more than 10 years of experience in flight nursing (35.3%) and are employed by a stand-alone transport program (42.7%). Flight nurses reported they spent a mean of 70% of their work hours transporting via rotor wing aircraft, with a predominantly adult patient population. The top perceived benefits of being a CFRN-certified nurse were a sense of accomplishment and pride (90.7%) followed by flight physiology knowledge (85.4%), flight nursing clinical knowledge (83.4%), and confidence as a flight nurse (80.6%).ConclusionThe 2022 CFRN pulse survey identified current CFRN demographics, practice environments including transport percentage by mode and patient population types, and perceived benefits of the CFRN credential. The findings suggest CFRNs are very experienced, provide care for patients across the age continuum, and perceive multiple intrinsic and extrinsic benefits of CFRN certification, all of which are essential to safe, evidence-based advanced nursing practice in the unique, complex, autonomous, and dynamic flight environment.

Background: The COVID‐19 pandemic disrupted the provision of surgical services in Australia. To prepare for a surge of COVID‐19 patients, elective surgery was mandatorily reduced or ceased at multiple timepoints in Australian states between 2020 and 2022. Operative exposure is a critical component of surgical training in general surgery, and readiness for practice is an ongoing priority. However, the impact of COVID‐19 on operative exposure in Australian General Surgical Trainees (AGST) has not been quantified. Methods: This study was a retrospective longitudinal cohort study using de‐identified operative logbook data for Australian General surgical Trainees (AGST) from the Royal Australasian College of Surgeons (RACS) Morbidity and Audit Logbook Tool (MALT) system between February 2019 and July 2021. Bivariate analysis was used to determine the impact of COVID‐19 on general surgical trainees' exposure to operative surgery and trainees' operative autonomy. Results: Data from 1896 unique 6‐month training terms and 543 285 surgical cases was included over the data collection period. There was no statistically significant impact of the COVID‐19 pandemic on AGST operative exposure to major, minor operations, endoscopies, or operative autonomy. Conclusions: The impact of COVID‐19 on surgical trainees globally has been significant. Although this study does not assess all aspects of surgical training, this data demonstrates that there has not been a significant impact of the pandemic on operative exposure or autonomy of AGST. [ABSTRACT FROM AUTHOR]

ObjectivesSpecialty nurses play a crucial role in specialized nursing practice, teaching, management, and research. These nurses often face significant work pressure; therefore, scientifically and effectively assessing their job stress and its sources is vital for enhancing the quality of their work. However, there is currently a dearth of verified assessment tools for measuring job stressors among specialty nurses. Therefore, this study aimed to develop and test an instrument to assess the job stressors applicable to specialty nurses.MethodsWe conducted a multiphase mixed-methods study. The initial scale items were developed from a literature review and structured interviews. The scale was then refined through two rounds of expert consultation (N = 14) and a primary test (N = 20). A main survey (N = 552) was then conducted to evaluate the scale’s construct validity and reliability using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).ResultsThe final scale comprises four dimensions with 27 items. The factors included “specialized nursing and work,” “workload and time allocation,” “patient care,” and “work resources and environment.” The EFA explained 69.10% of the variance, while the CFA confirmed a good model fit. The content validity index was 0.980 at the scale level and 0.790–1.000 at the item level. The scale’s reliability was supported by its high Cronbach’s α (0.958), test–retest reliability (0.946), and split-half reliability (0.868).ConclusionOur findings indicate that the job stressor scale developed in this study is valid and reliable, and is recommended for use among specialty nurses to assess their stressors.

Introduction. The article is devoted to the study of the consumption of traditional food products by tourists of the Baikal region. The study of the food traditions of different countries and regions of the world is an actual scientific topic. The field of gastronomic tourism has been actively developing in the recent years. The Baikal region is a unique region of Russia. The development of tourism in this region is possible through gastronomic tourism. It is known that traditional dishes play an important role in increasing the popularity of tourist destinations. In this regard, the purpose of this work is to study the consumer preferences for traditional food products (on the example of tourists from the Baikal region). Methods of research. For assessment of the satisfaction and consumer preferences of tourists in the Baikal region in relation to traditional food products, a questionnaire was developed (in Russian and English languages). During the study, 43 respondents were interviewed ― tourists of the Baikal region, permanently residing in other regions of Russia or foreign countries. Statistical processing of the results was carried out using standard methods of mathematical statistics. Results and its discussion. It has been found that buuzy, shulen, traditional green tea (nogoon sai), buchler are the most popular foods for the tourists of the Baikal region. The majority of respondents are satisfied with the quality of these products. At the same time, the study has shown that there is a list of traditional food products that the respondents haven’t tried during their stay in the Baikal region. For example, products from Baikal omul and products from wild-growing plants were tried only 79 % and 86 % of respondents respectively. Despite of this fact, the most of the surveyed tourists would like to purchase a fermented product from the Baikal omul. The most important consumer indicators of the quality of fermented Baikal omul are pleasant taste, reasonable price, pronounced aroma and health benefits. Conclusions. The majority of the respondents were satisfied with the quality of traditional food products of the Baikal region. Products from Baikal omul and fermented omul, in particular, were tasted only by a small percentage of respondents. It can be related to the fact that the commercial fishery was prohibited when the survey was conducted. Successful development of the Baikal fermented omul brand requires marketing support.

Curriculum ideology and politics is an important measure to implement the fundamental task of cultivating morality and cultivating people. Since Shanghai first began practical exploration in 2014, it has become an important component of university curriculum construction. In 2020, the Ministry of Education issued the “Guiding Outline for the Ideological and Political Construction of Curriculum in Higher Education Institutions”, emphasizing “promoting the ideological and political construction of curriculum based on characteristics of different specialties”. The ideological and political education of each course should be based on requirements as well as the ideological and political goals of different specialties. Under this background, the teachers of the Biochemistry curriculum group carried out curriculum ideology and politics guided by specialty requirement, highlighting the cultivation of medical humanistic literacy. The organization, allocation of class hours and teaching methods of case materials were performed according to the ideological and political objectives. Adhering to the student-centered teaching philosophy, we adopted online and offline blended teaching approach. The curriculum ideology and politics education was fully integrated into the “ pre class, in class and post class” teaching process. By combining diverse teaching methods such as lecturing, case teaching, exploratory teaching and discussion teaching, we aimed to achieve a gradual progression of ideology and politics education through “laying the groundwork, implementation and improvement”. By conducting problem discussion, case study and extracurricular task, students could fully participate in the teaching process. Immersive and autonomous learning was achieved and the effectiveness of ideology and politics education was improved. The questionnaires survey data showed that most students enjoyed the integration of ideology and politics education into courses, and generally approved the effectiveness. However, the data also reflected some problems, for example, low recognition of scientific research progress and low favorite of self-learning methods. These problems need to be improved in future teaching. Overall, the curriculum ideology and politics of Biochemistry from the perspective of specialty has preliminarily achieved the dual teaching goals of professional skill cultivation and value guidance. [ABSTRACT FROM AUTHOR]

Introduction. Pediatric Surgery studies in Spanish universities are not regulated, and their situation varies significantly from one region to another. Materials and methods. A descriptive study by means of a survey directly addressed to the heads of the 47 Spanish healthcare units was carried out. Results. Only 33 pediatric surgeons currently teach at the university level. Most of them are employed (associate professors) and assigned to non-surgical departments. The degree of teaching accreditation of these professionals is meager. Conclusion. It is necessary to reflect deeply on the absence of our specialty in universities and, conversely, on the scarce presence of university studies and research in healthcare units. [ABSTRACT FROM AUTHOR]

BackgroundThe time course and longitudinal impact of the COVID -19 pandemic on surgical education(SE) and learner well-being (LWB)is unknown.Material and methodsCheck-in surveys were distributed to Surgery Program Directors and Department Chairs, including general surgery and surgical specialties, in the summer and winter of 2020 and compared to a survey from spring 2020. Statistical associations for items with self-reported ACGME Stage and the survey period were assessed using categorical analysis.ResultsStage 3 institutions were reported in spring (30%), summer (4%) [p

ObjectiveTo describe the development and implementation of virtual vascular surgery rotations among 6 integrated vascular surgery programs.DesignA collaborative teleconference retrospectively discussing 6 independently developed virtual vascular surgery rotations to make a framework for future use.SettingUniversity of California Davis initiated a joint teleconference among the various integrated vascular surgery programs.ParticipantsVascular surgery faculty and residents from 6 programs participated in the teleconferences and drafting of a framework for building a virtual vascular surgery rotation.ResultsFour specific domains were identified in discussing the framework to build a virtual vascular surgery rotation: planning, development, curriculum, and feedback. Each domain has specific aspects in making a virtual rotation that has applicability to other surgical rotations that seek to do the same.ConclusionVirtual vascular surgery rotations are feasible and important; these electives can be established and implemented successfully with appropriate planning and consideration. This work hopes to help programs navigate this new space in education by making it more transparent and highlighting potential pitfalls.

BackgroundOrthopaedic surgery training programs have lagged behind other surgical specialties in increasing their representation of women and people from under-represented minority (URM) groups. Comparative data between orthopaedic surgery and other specialties are needed to help identify solutions to closing the diversity gap.Questions/purposes(1) Which surgical specialties have the greatest representation of women residents and residents from URM groups? (2) How have the proportions of women residents and residents from URM groups changed across the surgical specialties during the past decade?MethodsThis was a retrospective evaluation of a large, longitudinally maintained survey database. Resident data by gender and ethnicity were retrieved from the Accreditation Council for Graduate Medical Education Data Resource Books for the 2011 to 2012 through 2019 to 2020 academic years. The Accreditation Council for Graduate Medical Education database is updated annually; thus, it is the most up-to-date and complete database available for gender and ethnicity data for all surgical residents. Data were obtained and analyzed for seven different surgical specialties: orthopaedic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, general surgery, and urology. No sampling was necessary, and thus descriptive statistics of the data were completed. Because the entire population of residents was included for the period of time in question, no statistical comparisons were made, and the reported differences represent absolute differences between the groups for these periods. Linear regression analyses were performed to estimate the annual growth rates of women residents and residents from URM groups in each specialty.ResultsAmong the seven surgical specialties, representation of women residents increased from 28% (4640 of 16,854) of residents in 2012 to 33% (6879 of 20,788) in 2020. Orthopaedic surgery had the lowest representation of women residents every year, with women residents comprising 16% of residents (700 of 4342) in 2020. Among the seven surgical specialties, representation of residents from URM groups increased from 8.1% (1362 of 16,854) in 2012 to 9.7% (2013 of 20,788) in 2020. In 2020, the representation of residents from URM groups in orthopaedic surgery was 7.7% (333 of 4342). In 2020, general surgery had the highest representation of women residents (42%; 3696 of 8809) as well as residents from URM groups (12%; 1065 of 8809). Plastic surgery (1.46% per year) and general surgery (0.95% per year) had larger annual growth rates of women residents than the other specialties did. In each surgical specialty, the annual growth rate of residents from URM groups was insignificant.ConclusionDuring the past decade, there was only a small increase in the representation of women in orthopaedic surgery, while the representation of people from URM groups did not change. In contrast, by 2020, general surgery had become the most diverse among the seven surgical specialties. To increase diversity in our field, we need to evaluate and implement some of the effective interventions that have helped general surgery become the diverse surgical specialty that it is today.Clinical relevanceGeneral surgery has substantially reduced gender and ethnic disparities that existed in the past, while those in orthopaedic surgery still persist. General surgery residencies have implemented a holistic review of resident applications and longitudinal mentoring programs to successfully address these disparities. Orthopaedic surgery programs should consider placing less emphasis on United States Medical Licensing Examination score thresholds and more weight on applicants' non-academic attributes, and put more efforts into targeted longitudinal mentorship programs, some of which should be led by non-minority faculty.

Background: Over the years, anaesthetic practice has evolved, with attention paid to safety guidelines and quality assurance. This has resulted in reductions in anaesthesia-related complications. Objectives: This retrospective study examines surgical procedures and anaesthetic complications recorded in a tertiary hospital. Methodology: Anaesthetic records of all patients who had surgery during the study period were retrieved. The number of cases done by each surgical specialty, the anaesthetic techniques, and the anaesthetic complications encountered during anaesthesia and before discharge from the recovery room were recorded. Preoperatively, all patients were categorised according to the American Society of Anaesthesiologists (ASA) physical status classification. Cases were grouped according to surgical specialties. Data was analyzed with Statistical Package for the Social Sciences (SPSS) version 25. Results: Over a 2-year period, 1784 surgeries were conducted, General and Cardiothoracic surgeries accounted for the highest 354 (19.80%) and lowest 6 (0.30%) cases, respectively. The most common anaesthetic techniques employed were general anaesthesia with endotracheal intubation 731 (43.00%), subarachnoid block 559 (32.90%), and general anaesthesia with facemask 190 (11.20%). Seventy five (4.20%) cases had complications, 19 (1.07%) had hypotension, 15 (0.84%) had delayed recovery from anaesthesia, 9 (0.50%) cases had cardiac arrests and 5(0.28%) had laryngeal. Death on the table occurred in 5 cases (0.28%), bronchospasm, local anaesthetic (LA) toxicity and also nausea and vomiting occurred in 3 cases (0.17%) respectively. Coughing and vomiting, hypoxia and post spinal shivering occurred in 2 cases (0.11%), while total spinal, apnoea, failed intubation, bradycardia, pulmonary oedema, extrapyramidal side effects of metoclopamide and shock occurred in 1 patient (0.06%) each. Conclusion: Hypotension, delayed recovery and cardiac arrest were the most common complications in our environment. There was no association between the ASA physical status and the occurrence of anaesthetic complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent literature suggests that the future of surgeon-scientists in the US has been threatened for the past several decades. However, we documented an overall increase in NIH funding for surgeon-scientists, as well as the number of NIH-funded surgeons, from 2010 to 2020. STUDY DESIGN: NIH-funded principal investigators (PIs) were identified for June 2010 and June 2020 using the NIH internal data platform iSearch Grants (version 2.4). Biographical sketches were searched for key terms to identify surgeon-scientists. Grant research types and total grant costs were collected. American Association of Medical Colleges data were used to determine total surgeon and physician populations. Bivariate chi-square analyses were performed using population totals and were corroborated using z-tests of population proportions using JMP (version 13.0.0). A 2-tailed p value

BackgroundThe COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication was to report the impact of the pandemic on surgical training and learner well-being and to document adaptations made by surgery departments.Study designA 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic, as defined by the ACGME. Statistical associations for items with stage were assessed using categorical analysis.ResultsThe response rate was 21% (472 of 2,196). US stage distribution (n = 447) was as follows: stage 1, 22%; stage 2, 48%; and stage 3, 30%. Impact on clinical education significantly increased by stage, with severe reductions in nonemergency operations (73% and 86% vs 98%) and emergency operations (8% and 16% vs 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7% and 13% vs 37%). Severity of impact on didactic education increased with stage (14% and 30% vs 46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner well-being increased by stage-physical safety (6% and 9% vs 31%), physical health (0% and 7% vs 17%), and emotional health (11% and 24% vs 42%). Regardless of stage, most but not all made adaptations to support trainees' well-being.ConclusionsThe pandemic adversely impacted surgical training and the well-being of learners across all surgical specialties proportional to increasing ACGME stage. There is a need to develop education disaster plans to support technical competency and learner well-being. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have a considerable impact on the future of surgical education.

This is a recommended management algorithm from the Western Trauma Association addressing the management of victims of burn injury. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published retrospective studies, clinical guidelines, and the expert opinion of members of the Western Trauma Association in conjunction with partner members of the American Burn Association. The algorithm and accompanying comments represent one safe and sensible approach that can be followed at most trauma centers. We recognize that there may be patient or institutional factors that warrant deviation from the published algorithm. We would encourage institutions to use this document as a starting point toward a dialog with local burn centers to collaboratively create a patient-centered care experience for the victims of minor burn injuries arriving at local trauma centers.

Objective: To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO. Material and Methods: Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination. Results: The total of 932 CEO’s were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO’s had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases. Conclusion: Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO’s actions was evidenced, mainly related to the work processes. [ABSTRACT FROM AUTHOR]

Guideline summaryChronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

BackgroundRecommendations by the Lancet Commission on Global Surgery regarding surgical care in low- and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles.MethodsThree global meetings convened providers of surgical services for children. Through working group meetings, participants reviewed the status of global children's surgery to develop priorities and identify necessary resources for implementation. Working groups were formed under LMIC leadership to address specific priorities. By creating networking opportunities, GICS has promoted the development of LMIC-LMIC and HIC-LMIC partnerships.ResultsGICS members identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research. Guidelines for provision of care at every healthcare level based on these pillars were created. Seventeen subspecialty, LMIC chaired working groups developed the Optimal Resources for Children's Surgery (OReCS) document. The guidelines are stratified by subspecialty and level of health care: primary health center, first-, second- and third-level hospitals, and the national children's hospital. The OReCS document delineates the personnel, equipment, facilities, procedures, training, research and quality improvement components at all levels of care.ConclusionWorldwide collaboration with leadership by providers from LMICs holds the promise of improving children's surgical care. GICS will continue to evolve in order to achieve the vision of safe, affordable, timely surgical care for all children.

BackgroundCurrent studies in cardiothoracic clinical research frequently fail to use end points that are most meaningful to patients, including measures associated with quality of life. Patient-reported outcomes (PROs) represent an underused but important component of high-quality patient-centered care. Our objective was to highlight important principles of PRO measurement, describe current use in cardiothoracic operations, and discuss the potential for and challenges associated with integration of PROs into large clinical databases.MethodsWe performed a literature review by using the PubMed/EMBASE databases. Clinical articles that focused on the use of PROs in cardiothoracic surgical outcomes measurement or clinical research were included in this review.ResultsPROs measure the outcomes that matter most to patients and facilitate the delivery of patient-centered care. When effectively used, PRO measures have provided detailed and nuanced quality-of-life data for comparative effectiveness research. However, further steps are needed to better integrate PROs into routine clinical care.ConclusionsIncorporation of PROs into routine clinical practice is essential for delivering high-quality patient-centered care. Future integration of PROs into prospectively collected registries and databases, including that The Society of Thoracic Surgeons National Database, has the potential to enrich comparative effectiveness research in cardiothoracic surgery.

Background: Physicians are always exposed to work-related risk factors that may result in many diseases. Many studies showed the high prevalence of LBP (LBP) among physicians in comparison to other musculoskeletal diseases. The present study aims to estimate the prevalence of LBP among physicians in Erbil city and to detect its related risk factors. Subjects and methods: a cross-sectional study was conducted among physicians from all specialties inside two tertiary hospitals from Feb 1st, 2021 to Aug 2021. A questionnaire prepared by the investigator was used for data collection. The severity of LBP was assessed by a visual analog scale: from 1-3 was considered mild pain, 4-6 was moderate, and 7-10 was severe pain. Results: It has been found that the mean BMI difference between the two groups, with and without LBP, was (27.84 ± 1.18Vs 25.46 ± 1.28) with a significant p= 0.003. The proportion with irregular sleep was (83.07% Vs 22.53%) among both groups respectively with a statistically significant p=0.032. The overall prevalence rate of LBP among physicians was 78.6%; 71.4% were males and only 28.6% were females with a significant p=0.001. The result of logistic regression for the overweight, obese, regular sleeping, and lifting heavy objects, OR with 95% confidence intervals, were; 3.40 (0.37-30.6), 2.36(0.5-10.3), 1.57(0.99-2.48), and 2.63(1.63-4.25) respectively. Conclusion: the prevalence of LBP among physicians appears to be high and constitutes a major health concern. The BMI, lifting heavy objects, and sleep patterns were good predictors of LBP among physicians. [ABSTRACT FROM AUTHOR]

More than a quarter of physicians in the United States are international medical graduates (IMGs). This statistic, although large, does not fully capture the importance of IMGs in certain specialties and locations. We provide a comprehensive profile of IMGs documenting where and in what specialties they work and how these distributions have changed over time. Estimates show that IMGs disproportionately work in densely populated, low-income communities with sicker residents and low physician density. IMGs are overrepresented in primary care and the lowest paying specialties, and their concentration in these specialties is growing. Calculations show that U.S. medical graduates exit the workforce at 2.5 times the exit rate of IMGs suggesting that in the near future IMGs will likely provide care for an increasingly larger share of Americans. [ABSTRACT FROM AUTHOR]

Abstract Background The choice of specialty in medicine is an important decision for the individual, but also for health system. This choice combined personals reasons, professional desires and needs of the health system. The number of specialists in the country depends of this choice. Very few studies have focused on factors influencing the choice of specialties among medical students in Africa. Also, in the absence of specialist needs planning in Togo. This study, aims to determine the factors influencing the choice of specialty among students at the Faculty of Health Sciences of the University of Lomé (FSS-UL). Methods This was a descriptive cross-sectional study that took place from June 1 to June 30, 2019 with medical students of the doctoral cycle and doctors in specialization studies in the various Diploma of Special Study (DSS) available at the FSS-UL. Data collection was done at the surveyed’s training sites. Pre-established and pre-tested fact sheets were giving and explained to the students by data collection team. Data collection team return at the surveyed’s training sites 72 h after to collect pre-established fact sheets. Following variables study including: factors (individual; related to the medical curriculum); the advantages and attractiveness of the specialty that can influence students’ choice. Data analysis was carried out using Epi Info 6.0 software. The significance threshold was 5%. Results At the time of the survey, the FSS-UL had 147 doctoral students and 211 specialty students. A total of 251 participants responded to the questionnaires. These included 140 doctoral students and 111 specialty students. The choice of specialties requiring night work such as gynecology, surgery was significantly associated with the male sex (p = 0.001). There was significant association between having financial support (p = 0.001), remuneration related to the specialty (p = 0.0001) and the decision to beginning specialty studies immediately completing general medical studies. Interest in lectures (p = 0.003), teacher support as a mentor in the specialty (p = 0.01) and easy accessibility to teachers (p = 0.008) were medical curriculum factors significantly associated with specialty choice. Facility to work in public and private sector was mentioned by 55.3% of respondents who chose gynecology (p = 0.03). Interest in lectures (p = 0.003), was significantly associated with choice of fundamental sciences; and work in international fields was significantly associated with the choice of pediatric and public health (p = 0.0001). Conclusion Factors influencing the choice of certain specialty were balance between family and professional life; financial support to studies, the remuneration opportunities related to the specialty, access to university career. Intervention on these factors will allow a balance between the numbers of doctors trained in the different specialties.

Abstract Choosing a surgical specialty can be a hard decision for a medical student. Several studies present data showing that most medical students fear the surgical field and end up switching to another specialty. For cardiovascular surgery, the scenario is very similar. In the last decades, the interest in cardiovascular surgery has been decreasing worldwide and the cardiothoracic surgical societies across the globe have been trying to understand the factors that push away medical students and general surgical residents from the specialty. In this regard, our work aims to focus on describe the access of students to cardiovascular surgery, especially during medical school, as well as to provide a brief report of our current data regarding the specialty.

Background: There is increasing evidence that individuals with psychosis are at increased risk for cardiovascular disease, diabetes, metabolic syndrome, and several other medical comorbidities. In delusional disorder (DD), this is particularly so because of the relatively late onset age. Aims: The aim of this narrative review is to synthesize the literature on the necessity for medical collaboration between psychiatrists and other specialists. Methods: A non-systematic narrative review was carried out of papers addressing referrals and cooperation among specialists in the care of DD patients. Results: Psychiatrists, the primary care providers for DD patients, depend on neurology to assess cognitive defects and rule out organic sources of delusions. Neurologists rely on psychiatry to help with patient adherence to treatment and the management of psychotropic drug side effects. Psychiatrists require ophthalmology/otolaryngology to treat sensory deficits that often precede delusions; reciprocally, psychiatric consults can help in instances of functional sensory impairment. Close collaboration with dermatologists is essential for treating delusional parasitosis and dysmorphophobia to ensure timely referrals to psychiatry. Conclusions: This review offers many other examples from the literature of the extent of overlap among medical specialties in the evaluation and effective treatment of DD. Optimal patient care requires close collaboration among specialties. [ABSTRACT FROM AUTHOR]

The low consumption of game meat is directly related to the insufficient exploration of data on game meat processing and handling. Taking into account these considerations as well as the fact that in the practice of the meat processing industry methods and assessing game meat for processing have not yet been developed, the main aim of the paper is to highlight how this is done from a practical and applied point of view in the main game meat processing operations in terms of cutting, deboning, and selection of game meat for processing, associated with the determination of the carcass yields of the main sliced anatomical regions of the higher quality classes used to obtain traditional specialty products. To this end, following the primary processing of the game carcasses, the weighting of each anatomical portion will be assessed, both at the level of the region and of the carcass as a whole. The reasoning behind the processing of game meat into traditional specialties encompasses the complex features of the anatomical regions intended for the production of these products as well as the species of origin. For these reasons, the present study will concentrate on the cutting and deboning capacity of wild boar meat in accordance with the methods of processing the anatomical regions of the higher quality classes of their carcasses. [ABSTRACT FROM AUTHOR]

Objectives: Specialty nurses play a crucial role in specialized nursing practice, teaching, management, and research. These nurses often face significant work pressure; therefore, scientifically and effectively assessing their job stress and its sources is vital for enhancing the quality of their work. However, there is currently a dearth of verified assessment tools for measuring job stressors among specialty nurses. Therefore, this study aimed to develop and test an instrument to assess the job stressors applicable to specialty nurses., Methods: We conducted a multiphase mixed-methods study. The initial scale items were developed from a literature review and structured interviews. The scale was then refined through two rounds of expert consultation ( N  = 14) and a primary test ( N  = 20). A main survey ( N  = 552) was then conducted to evaluate the scale's construct validity and reliability using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA)., Results: The final scale comprises four dimensions with 27 items. The factors included "specialized nursing and work," "workload and time allocation," "patient care," and "work resources and environment." The EFA explained 69.10% of the variance, while the CFA confirmed a good model fit. The content validity index was 0.980 at the scale level and 0.790-1.000 at the item level. The scale's reliability was supported by its high Cronbach's α (0.958), test-retest reliability (0.946), and split-half reliability (0.868)., Conclusion: Our findings indicate that the job stressor scale developed in this study is valid and reliable, and is recommended for use among specialty nurses to assess their stressors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Lin, Li, Li, Wei, Zhang, Zhang, Fang, Guo and Zhang.)

There is a dearth of trained library personnel in the government-owned special school for the visually impaired libraries in South-East, Nigeria. This study x-rayed the visually impaired training centers available in South-East Nigeria to find out the number of personnel trained within the period of 2015-2019 as well as the causative factors. The study employed oral organized interviews, statistical records, and an observation checklist. From the findings, out of the 4 Organized Special Need Persons Care-takers Training Centers, only 2 had training, while the remaining 2 had no training. Records show that within five years, a total of 367 persons were trained in different specialties: Special Education Teachers 315; Special Librarian 0; Victims of Eye Injury or Disease 25; and Persons with Special Interest 27. From the records, there is no recorded graduation of trainees for special librarians. The observation checklist conducted showed the dearth of state-ofthe-arts-facilities in the centers. Poor functionality and utilization of the training centers and Special Librarian ranking zero in the training were the major cause of human resource challenges bedeviling the special school library for the visually impaired in South-East, Nigeria. It becomes a great burden in the provision of information needs of this fast-growing number of visually impaired student library users. It is therefore imperative that the South-East Government provides specialized personnel to tackle these challenges through the utilization of the various training centers; creation of wider special education librarians' awareness in professional meetings, conferences, seminars, and workshops, establishing special library/training centers in all special educational institutions in Nigeria among others. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this review is to compare the effectiveness of different peripheral nerve blocks and general anesthesia (GA) in controlling postoperative pain after arthroscopic rotator cuff repair (ARCR).Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted for the period of January 1, 2005, to February 16, 2021, by searching the following databases: PubMed, Cochrane, Embase, and Arthroscopyjournal.org. The primary outcomes of interest included 1-hour, 24-hour, and 48-hour pain scores on a numeric rating scale or visual analog scale (VAS). Inclusion criteria were English language studies reporting on adults (≥18 years) undergoing ARCR with peripheral nerve blockade. To synthesize subjective pain score data at each evaluation time point across studies, we performed random-effects network meta-regression analyses accounting for baseline pain score as a covariate.Results: A total of 14 randomized controlled trials with 851 patients were included in the meta-analysis. Data from six different nerve block interventions, single-shot interscalene brachial plexus nerve block (s-ISB; 37.8% [322/851]), single-shot suprascapular nerve block (s-SSNB; 9.9% [84/851]), continuous ISB (c-ISB; 17.5% [149/851]), continuous SSNB (c-SSNB; 6.9% [59/851]), s-ISB combined with SSNB (s-ISB+SSNB; 5.8% [49/851]), s-SSNB combined with axillary nerve block (s-SSNB+ANB; 4.8% [41/851]), as well as GA (17.3% [147/851]) were included. Our meta-analysis demonstrated that c-ISB block had a significant reduction in pain score relative to GA at 1-hour postoperation (mean difference [MD]: -1.8; 95% credible interval [CrI] = -3.4, -.08). There were no significant differences in VAS pain scores relative to GA at 24 and 48 hours postoperatively. However, s-ISB+SSNB had a significant reduction in 48-hour pain score compared to s-ISB (MD = -1.07; 95% CrI = -1.92, -.22).Conclusions: It remains unclear which peripheral nerve block strategy is optimal for ARCR. However, peripheral nerve blocks are highly effective at attenuating postoperative ARCR pain and should be more widely considered as an alternative over general anesthesia alone.Level Of Evidence: Level II Systematic review and meta-analysis of Level I and II studies. [ABSTRACT FROM AUTHOR]

Industry payments to physicians are common, but it is unknown how the payments in different categories to radiologists compare to other specialties. The aim of this study is to assess the proportion of industry payments to physicians in radiology in certain categories relative to other specialties. The Open Payments Database was analyzed from January 1, 2017 to December 31, 2021 for industry payments to all allopathic & osteopathic physicians, and classified into distinct clinical specialties. Payments to physicians in three categories were calculated in relation to total payments in each specialty during the study period: consulting fees, research, and royalties/ownership (royalty, license, or current or prospective ownership or investment). The total value of industry payments to physicians across all specialties was just under $13 billion over the six-year period from 2017 to 2022. During this period, 51.4 million total payments were made to 791,746 physicians. US physicians in radiology received 452,027 payments for a total value of $357 million (2.8 % of total value). For radiologists, 32.8 % of industry payment value was attributed to royalties/ownership and 9.9 % to research, collectively adding up to 42.7 % of all industry payment. The only specialties with higher payments in these two categories considered reflective of innovation payments were the surgical specialties with higher royalty payments. The proportion of industry payments in radiology in categories reflecting innovation (royalty/ownership and research fees) is high and second only to surgical specialties. • Royalty/ownership (31.0 %) constituted the largest categories of industry payments to radiologists. • Research constituted 9.9 % of total industry payments by value in radiology and was amongst the highest amongst specialties. • Radiology had the fourth highest proportion of all industry payments in these categories combined. [ABSTRACT FROM AUTHOR]

Objectives/hypothesisThe American College of Surgeons Thyroid and Parathyroid Ultrasound Skills-Oriented Course (TPUSC) was designed to teach surgeons how to interpret and perform office-based head and neck ultrasound (HNUS). The objective of this study was to survey attendees of the TPUSC to evaluate the usefulness of the course, to track surgeon performed HNUS practice patterns, and to help identify potential roadblocks to incorporation of HNUS into a surgeon's practice.Study designCross-sectional survey.MethodsA Web-based survey was sent to 952 surgeons who completed the TPUSC between 2010 and 2014. Questions included surgeon specialty, practice type, Likert scale rating of the TPUSC, competency with different HNUS procedures, and current HNUS practice patterns.ResultsThe response rate was 24%. On a scale from 1 (not useful) to 5 (extremely valuable), the mean course usefulness rating was 4.2. Educational goals were met for 194 (92%) surgeons, and 162 (77%) surgeons reported performing HNUS in their practice. Of 48 surgeons not performing HNUS, 24 (50%) attributed insufficient time in their clinic schedule, and 21 (44%) attributed high equipment costs.ConclusionsThe TPUSC is a valuable educational experience for surgeons seeking to gain proficiency in HNUS. The majority of TPUSC graduates gain competency with at least one type of HNUS procedure following the course.Level of evidenceNA Laryngoscope, 127:1950-1958, 2017.

ImportanceDespite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs.ObjectiveTo examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room.Design, setting, and participantsThe OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186).InterventionsFrom January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal.Main outcomes and measuresThe primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey.ResultsThe median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls.Conclusions and relevanceCost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.

PurposeBoth pediatric urologists and pediatric surgeons perform hernia repairs, hydrocelectomies and orchiopexies. We hypothesized that surgeons perform more incarcerated and female hernia repairs while urologists perform more orchiopexies and hydrocelectomies.MethodsThe Vizient-AAMC Faculty Practice Solutions Center® database was queried from January 2009 to December 2014 to identify patients 10years or younger who underwent the above procedures performed by pediatric specialists. Age, gender, race, insurance, geographic region and surgeon volume were examined.ResultsIn the study 55,893 surgeries were identified: 26,073 primary hernia repairs, 462 recurrent hernia repairs, 3399 laparoscopic hernia repairs, 9414 hydrocele repairs and 16,545 orchiopexies. Pediatric surgeons performed 89% of primary hernia repairs with an annual median surgeon volume of 4 cases/year. Pediatric urologists performed 62% of hydrocelectomies and 83% of orchiopexies with annual median surgeon volumes of 6 and 24, respectively. Pediatric surgeons performed all procedures in younger patients and performed more female and incarcerated hernia repairs.ConclusionsPediatric surgeons operate on younger patients and treat more patients with inguinal hernias while pediatric urologists care for more boys with undescended testes and hydroceles. This knowledge of referral patterns and care between specialties with overlapping expertise will allow improvements in training and access.Levels of evidenceCost Effectiveness Study, Level of Evidence III.

Ukrainian higher education is in a state of reforming, which aimes at improving its quality and is accompanied by a reduction in its generality. During the admission campaign in 2020, the concept of «indicative self-cost of educational services» was for the first time used, the purpose of which was to reduce the demand for training at the expense of individuals (contract) in the State-owned higher education institutions. The publication considers the study of the efficiency of the State regulation of qualifying for a government scholarship as to certain specialties. For this purpose, data on the results of the 2020 admission campaign from the unified State electronic database on education were used. The educational space was divided into several subspaces, for each of these the ratio between the number of applications submitted and the license volume was obtained. It was found that the most in demand for a long time are specialties related to jurisprudence, in the smallest demand are specialties of engineering, where the competition is two applications for three budget places (1.50). The publication uses econometric methods of analysis of digital information, assessments of the elasticity of the introductory score according to the general competition and its marginal value are carried out. Recommendations on refusal of expert assessments in the regulation of the students’ admission and redistribution of financial resources in favor of high-demand specialties are provided.

Alexandria was both an important city and a place of inspiration in the history of medicine since the 3rd century BC until 7th century AD. Its fertile intellectual and scientific environment gave rise to a radical and new thinking and understanding of the disease process. King Ptolemy I (323−285 BC) established the Museion and the Great Library of Alexandria fabled in Antiquity for its treasures of wisdom. This complex interaction between Greeks and Egyptians before and under the Ptolemies gave scientists an opportunity to live and work under royal patronage with excellent repercussions. Scholars were attracted to take part in scientific research, especially in medicine and mathematics, developing different known areas and programs. Furthermore scholars in Alexandria also brought back new ideas and activities each with specialized knowledge of the subjects.As the medical science of ancient Greece plunged into political decadence and setbacks - scientific work was renewed in this city with the arriving of the greatest minds of the day. The ‘Faculty’ of Medicine in Alexandria seems to be an integral part of the Mouseion. In the 3rd century BC, the Ptolemaic capital caught the different trends and became the seat of divergent and independent schools. The debt of the Alexandrian physicians to the native Egyptian doctors, highly specialized, was very considerable. Coan school in this time had general professionals who recommended therapeutic and nutricional strategies and diets while Alexandria science provided academic specialization.On the other hand the court physicians, involved in high politics, could be medical specialists meanwhile the teachers of advanced medicine were sometimes left undisturbed in the pursuit of their research. Being able to commit poisoning crimes with drugs by political interests, they were scared of them. Animal and plants toxins became an accepted and divulged study, very fashionable, and Alexandrian school developed scientific research in iology, name given later to this science. Greek sources on toxicology became a special and developed branch in medical literature and from Apollodorus of Tarentum onwards, the father of iology and his book Peri thêriōn, the interest in Greek treatises spread.

Objective: There is a lack of diversity in the dental workforce. Efforts to enhance underrepresented minority (URM) recruitment and retention within dental school exist, but little effort has been made to track URM providers through education and practice. This study assesses the status of workforce diversity in the dental specialties and the predictors of URM dentist specialization.Methods: The primary data used were a 2012 national sample survey of Hispanic/Latino (H/L), Black, or American Indian/Alaska Native (AI/AN) dentists in the US, supplemented by publicly available workforce data. Descriptive and multivariate statistical analyses were performed to describe the demographic composition of URM clinical general and specialist dentists and analyze changes in proportions of URMs specializing among age cohorts, differences in specific type of specialization, and racial concordance between specialists and their patients.Results: The pathway continues to winnow with fewer URM dentists in specialty practice. Among all URM clinical dentists being first in his/her family to obtain a college degree, having a strong desire to work in his/her own cultural community or joining a loan repayment program due to debt load independently predicted lower odds of specialization. Alternatively, being initially foreign trained as a dentist and valuing professional training were independently predictive of higher odds of specialization.Conclusion: The lack of diversity within the dental specialties is a critical flaw in our education and care delivery systems demanding clear actions toward improving the pathway into residency programs for URM students. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to characterise the most common injury profiles and interventions in older major trauma patients, and how they change with age. Methods: This is a retrospective review of interventions, injury profiles and outcomes of major trauma patients aged 65 years and older from 2007 to 2018, using data from the Victorian State Trauma Registry. A latent class analysis (LCA) was used to identify homogenous injury groups. Results: The LCA identified five injury profiles: isolated head injury; chest/upper limb injuries; multi‐trauma; isolated spine; and head/chest/upper limb. Among 10,001 patients, 50% had an isolated head injury, and 83% of patients received definitive treatment at a major trauma centre. 50% of patients received a surgical or non‐surgical intervention, and 36% underwent surgery. These proportions declined with increasing age. Conclusions: Older patients with major trauma are a heterogeneous group, whose mechanisms and patterns of injury, and clinical management change with increasing age. [ABSTRACT FROM AUTHOR]

Objective: There is a growing recognition of the impact of lockdowns on non‐COVID‐19 demand for critical care services. While a reduction in demand has been postulated, there remains a paucity of quantitative data on the extent and nature of this reduction. The present study aims to quantify the impact of lockdown on critical care services, namely ED, intensive care unit (ICU), medical emergency team (MET) and emergency theatre (ET) demand, during the lockdown in Victoria, Australia. Methods: This is a single‐centred, retrospective observational study on critical service demand, comparing activity levels during the lockdown (31 March to 27 October 2020) with the matched time period from 1 year prior. Results: There was a reduction in presentations to ED (27.2%), MET calls (27.4%), ICU patient episodes (14.5%) and ET bookings (5.8%). There was an unexpected increase in ICU admissions for metabolic diagnoses, comprising drug overdoses and diabetic ketoacidosis, and a reduction in respiratory ICU admissions. There was a reduction across all ED triage categories, which included triage 1 and 2 patients, indicating a reduction even in life‐threatening and emergency presentations. Conclusion: Lockdowns lead to a significant reduction in ICU, MET call and ED demand, and to a lesser extent ET demand. This pattern should be considered in surge capacity and workforce redeployment planning. There are also impacts on public health epidemiology, with potential adverse consequences on mental health and chronic disease management. Further research on the impact of lockdowns on long‐term disease outcomes is needed. [ABSTRACT FROM AUTHOR]

Objective: To identify the preferences of dental graduates in the field of post-graduate specialty, factors that may influence their decision to select a particular specialty, and the effect of counselling on specialty preferences. Material & Method: A pre-counselling and post-counselling questionnaire based study was carried out among final year students and House surgeons of Khyber College of Dentistry, Peshawar, between May to June 2020. A self-administered questionnaire, inquiring about the preference of specialty program, specialty subject and the reason for the preference, was given to the students. After filling the questionnaire, the participants were given a session on dental career counselling. After the session, they were again asked about their preference for a specialty for their future career. Both results were then compared. Results: The most prevalent specialty before counselling was Endodontics (36.2%). The second one was Oral and Maxillofacial Surgery (21.3%) and then Periodontics (16.3%). After counselling, preference for Oral and Maxillofacial Surgery remained the same, however, Endodontics and Periodontics were reduced to 33.8% and 13.8%, respectively. Among post-graduation specialty programs, FOPS was the most prevalent program (77.5%). Conclusion: Endodontics is the most preferred specialty among graduates followed by Oral and Maxillofacial Surgery. The most preferred program was FOPS. A single counselling session did not change the preference significantly. The reason most likely behind the preference was possession of unique set of skills for the specialty. [ABSTRACT FROM AUTHOR]

BackgroundGiven more emphasis on training primary care physicians for underserved areas, we hypothesized that students self-identifying as "disadvantaged" would be less likely to pursue surgical training.MethodsWe retrospectively reviewed medical school data on students graduating 2005-2014. Students were stratified into "disadvantaged" and "nondisadvantaged". Data were recorded on age, grade point average, Medical College Admission Test (MCAT), gender, surgery grade, United States Medical Licensing Examination step 1 score, and residency match into a surgical field. A comparison of the proportion of students matching into a surgical field was assessed with chi-square test. Multivariate logistic regression was performed to assess the factors that predict the choice of general surgery versus another surgical field.ResultsOf the 1140 students who graduated during the study period, 219 (19.2%) students self-identified as "disadvantaged". Of all students, 158 (13.9%) chose a surgical field. The disadvantaged group was older at entry and had lower grade point average and total MCAT scores. Twenty-seven (12.3%) disadvantaged students chose a surgical residency versus 130 (14.1%) nondisadvantaged students (P = 0.56). On multivariate logistic regression, female gender (odds ratio [OR] = 3.9; 95% confidence interval = [1.9-8.3], P

The increasing demand for primary care services and the current health care workforce shortage is predicted to cause drastic reductions in the number of clinicians who are competent to provide HIV care. For the past decade, the University of California, San Francisco (UCSF) School of Nursing has provided HIV specialty education for Advanced Practice Nursing students in the Master's curriculum. In 2013, UCSF was funded by the Health Resources Services Administration to establish a nurse practitioner (NP) HIV primary care education program to expand the number of NPs prepared to provide culturally appropriate comprehensive HIV primary care. To this end, UCSF faculty have developed and validated a set of HIV Primary Care entry-level NP competencies, integrated general HIV knowledge into the NP curriculum, and enhanced our current HIV Specialty curriculum and clinical training. Described herein is UCSF's Integrated HIV/AIDS Primary Care Capacity Nurse Practitioner Program.

Background: The choice of specialty in medicine is an important decision for the individual, but also for health system. This choice combined personals reasons, professional desires and needs of the health system. The number of specialists in the country depends of this choice. Very few studies have focused on factors influencing the choice of specialties among medical students in Africa. Also, in the absence of specialist needs planning in Togo. This study, aims to determine the factors influencing the choice of specialty among students at the Faculty of Health Sciences of the University of Lomé (FSS-UL). Methods: This was a descriptive cross-sectional study that took place from June 1 to June 30, 2019 with medical students of the doctoral cycle and doctors in specialization studies in the various Diploma of Special Study (DSS) available at the FSS-UL. Data collection was done at the surveyed's training sites. Pre-established and pre-tested fact sheets were giving and explained to the students by data collection team. Data collection team return at the surveyed's training sites 72 h after to collect pre-established fact sheets. Following variables study including: factors (individual; related to the medical curriculum); the advantages and attractiveness of the specialty that can influence students' choice. Data analysis was carried out using Epi Info 6.0 software. The significance threshold was 5%. Results: At the time of the survey, the FSS-UL had 147 doctoral students and 211 specialty students. A total of 251 participants responded to the questionnaires. These included 140 doctoral students and 111 specialty students. The choice of specialties requiring night work such as gynecology, surgery was significantly associated with the male sex (p = 0.001). There was significant association between having financial support (p = 0.001), remuneration related to the specialty (p = 0.0001) and the decision to beginning specialty studies immediately completing general medical studies. Interest in lectures (p = 0.003), teacher support as a mentor in the specialty (p = 0.01) and easy accessibility to teachers (p = 0.008) were medical curriculum factors significantly associated with specialty choice. Facility to work in public and private sector was mentioned by 55.3% of respondents who chose gynecology (p = 0.03). Interest in lectures (p = 0.003), was significantly associated with choice of fundamental sciences; and work in international fields was significantly associated with the choice of pediatric and public health (p = 0.0001). Conclusion: Factors influencing the choice of certain specialty were balance between family and professional life; financial support to studies, the remuneration opportunities related to the specialty, access to university career. Intervention on these factors will allow a balance between the numbers of doctors trained in the different specialties. [ABSTRACT FROM AUTHOR]

The art of medicine is as old as the very origin of life, it has been implicit in many cultures around the world, beginning in each of them as a magical-religious concept, and evolving over the centuries, and the presence of great characters in different moments and cultures, with the contribution of knowledge and techniques that today have consolidated medicine as a science that has transcended and has been perfected over the centuries to give rise to each of the specialties that we currently know, all of them equally important and essential among themselves. [ABSTRACT FROM AUTHOR]

Objective: to analyse the differences in the profile of attitudes towards death between specialist nurses in rehabilitation nursing and specialist nurses in other areas. Method: comparative, quantitative, cross-sectional study, with the participation of 223 specialist nurses from a hospital in northern Portugal. A questionnaire was applied as a data collection instrument. For data analysis, descriptive and analytical statistics were used. Results: as for attitudes towards death, in nurses who specialize in rehabilitation, those of approach, neutrality, fear, avoidance and escape predominated. In nurses with expertise in other areas, attitudes of approach, fear, neutrality, avoidance and escape prevailed. Conclusion: although the positive attitudes towards death, of nurses specializing in rehabilitation, acquired a higher percentage value, the difference was not significant. In addition, negative attitudes signal the need to rethink training strategies in the academic, but also in the professional context.

This study compares different approaches to measuring the number of nurse practitioners (NPs) providing primary care services using data from the 2012 U.S. National Sample Survey of Nurse Practitioners, North Carolina licensing data from 2011, and a 2010 California survey of nurse practitioners and nurse midwives. Estimates of the number and share of NPs providing primary care depend on how one defines primary care. If the definition is based on the field of NP education, the estimated shares in primary care specialties are 83.5% in North Carolina and 90.7% in California; if the definition is based on current or past fields of certification, the estimated shares are 79.9% in North Carolina and 74.5% nationally. The estimated number is even smaller if one considers employment setting (58.4% in North Carolina, 66.8% in California, and 67.8% nationally), and shrinks to about half of NPs if focusing on current field of clinical specialization.