Physician's Role

医师的角色
  • DOI:
    文章类型: Journal Article
    海底和高压医学学会(UHMS)在高压医学领域处于推进医学知识和促进患者安全的最前沿。在医疗保健的动态格局中,医生在监督高压氧治疗(HBO2)中的关键作用不可低估。此立场声明旨在强调医生参与提供HBO2的重要性,并阐明UHMS致力于为接受高压治疗的患者保持最高的护理和安全标准。
    高压氧治疗需要细致的患者管理方法。随着高压患者的复杂性不断发展,对合格医师的直接监督对于确保最佳患者治疗效果和防范潜在风险至关重要.在这份声明中,我们概述了医生参与在HBO2的每个方面都至关重要的关键原因,解决了治疗的技术复杂性和更广泛的患者护理.
    医生对高压氧治疗的监督根植于治疗的技术复杂性和与临床患者护理相关的更广泛的责任。下文概述的职责描述了医生在治疗接受高压氧治疗的患者方面的内在服务。
    UNASSIGNED: The Undersea and Hyperbaric Medical Society (UHMS) is at the forefront of advancing medical knowledge and promoting patient safety in the field of hyperbaric medicine. In the dynamic landscape of healthcare, physicians\' critical role in overseeing hyperbaric oxygen treatment (HBO2) cannot be overstated. This position statement aims to underscore the significance of physician involvement in delivering HBO2 and articulate UHMS\'s commitment to maintaining the highest standards of care and safety for patients undergoing hyperbaric treatments.
    UNASSIGNED: Hyperbaric oxygen treatment demands a meticulous approach to patient management. As the complexity of hyperbaric patients continues to evolve, the direct oversight of qualified physicians becomes paramount to ensuring optimal patient outcomes and safeguarding against potential risks. In this statement, we outline the key reasons physician involvement is essential in every facet of HBO2, addressing the technical intricacies of the treatment and the broader spectrum of patient care.
    UNASSIGNED: Physician oversight for hyperbaric oxygen treatment is rooted in the technical complexities of the treatment and the broader responsibilities associated with clinical patient care. The responsibilities outlined below delineate services intrinsic to the physician\'s duties for treating patients undergoing hyperbaric oxygen treatments.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    目的:泌尿科医师代表移植外科医生的功能选择,但他们的参与很少.评估泌尿科医师对移植的兴趣并确定相关因素可能有助于确定招募更多泌尿科提供者是否是解决美国移植外科医生短缺的可行策略。
    方法:我们通过电子邮件向在美国从事泌尿外科工作的个人进行了10个问题的调查,并收集了人口统计数据,教育和培训背景,以及对拟议的综合居留计划和缩写的移植研究金的偏好。我们根据移植兴趣(是/否)对受访者进行了分层;我们通过对连续变量使用t检验和对分类变量使用Fisher精确检验进行了比较。我们使用多变量逻辑回归来确定与对移植手术的兴趣相关的因素。
    结果:在104名受访者中,98个被纳入最终分析,47%的人表示目前或先前对移植感兴趣。男性受访者感兴趣的可能性是女性受访者的3.7倍(比值比=4.675;95%CI,1.411-15.495;P=0.012)。年龄<30岁的参与者对移植感兴趣的可能性比年龄较大的参与者低93%(比值比=0.071;95%CI,0.006-0.779;P=0.03)。与受过美国培训的同行相比,国际医学毕业生对移植的热情更高(89%对42%)。具有显著性趋势(P=.06)。几乎所有(93%,43/46)表示有兴趣的人赞同拥有综合培训途径。只有70%(32/46)支持缩写的研究金(<24个月)。生活方式的担忧和居住期间的暴露不足是缺乏兴趣的最常见原因。
    结论:与男性和老年泌尿外科学员相比,女性和年轻的泌尿科学员不太倾向于进行移植手术。尽管如此,泌尿科医生代表了未开发的移植外科医生。为泌尿科医师提出综合培训计划,并在泌尿科住院期间增加对移植的接触,是减少移植外科医生短缺的潜在策略。
    OBJECTIVE: Urologists represent functional alternatives for transplant surgeons, but their involvement is minimal. Evaluating urologists\' interests in transplant and identifying associated factors may help to determine whether recruitment of more urological providers is a viable strategy to address transplant surgeon shortages in the United States.
    METHODS: We emailed a 10-question survey to individuals pursuing urology in the United States and collected demographic data, education and training backgrounds, and preferences for proposed integrated residency programs and abbreviated transplant fellowships. We stratified respondents based on transplant interest (yes/no); we made comparisons by using t-tests for continuous variables and Fisher exact tests for categorical variables. We used multivariable logistic regression to identify factors associated with interest in transplant surgery.
    RESULTS: Of 104 respondents, 98 were included in the final analysis, with 47% indicating a current or prior interest in transplantation. Male respondents were 3.7 times more likely than female respondents to be interested (odds ratio = 4.675; 95% CI, 1.411-15.495; P = .012). Participants aged <30 years were 93% less likely than older participants to be interested in transplantation (odds ratio = 0.071; 95% CI, 0.006-0.779; P = .03). International medical graduates reported higher enthusiasm for transplantation compared with US-trained counterparts (89% vs 42%), with a trend toward significance (P = .06). Nearly all (93%, 43/46) who expressed interest endorsed having an integrated training pathway. Only 70% (32/46) supported an abbreviated fellowship (<24 mo). Lifestyle concerns and insufficient exposure during residency were the most frequently cited reasons for lack of interest.
    CONCLUSIONS: Compared with male and older urology trainees, female and younger urology trainees were less inclined to pursue transplant surgery. Nonetheless, urologists represent an untapped pool of transplant surgeons. Proposing an integrated training program for urologists and increasing exposure to transplantation during urology residency represent potential strategies to decrease transplant surgeon shortages.
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  • 文章类型: Journal Article
    三级临床中心泌尿科患者的高周转率可导致更多伴随并发症,各种程序的1%到55%不等,血管损伤的发生率从0.43%到9.5%不等。在肾功能受损的患者中,必须防止正常肾功能的丧失和潜在的血液透析。微创,血管内手术,如肾动脉栓塞(RAE)可以治疗严重和危及生命的并发症,但是泌尿科医师和介入放射科医师之间良好而及时的沟通对于快速有效的治疗是必要的。RAE的绝对禁忌症是存在急性感染和先前已知的对碘造影剂的过敏反应,而先前对碘造影剂的轻度或中度过敏反应不是RAE的禁忌症。目前使用的栓塞剂可分为暂时性栓塞剂和永久性栓塞剂。虽然可用的临时栓塞剂是明胶海绵,可用作补充材料或独立使用,对于永久性栓塞,介入放射科医生使用微粒,微球,液体栓塞剂,线圈,和微线圈。RAE手术被认为是安全的,并发症发生率低。非目标栓塞是最严重的。栓塞后综合征被认为是最常见的不良反应,涉及约90%的患者。总体结果表明,RAE是一种安全的,微创手术,可有效治疗其他泌尿外科手术引起的重大并发症,报告的成功率为87%-100%。
    Higher turnaround of urologic patients in the tertiary clinical center can lead to more accompanying complications, ranging from 1% to 55% for various procedures, with the incidence of vascular injuries varying from 0.43% up to 9.5%. In patients with impaired renal function, it is imperative to prevent the loss of normal kidney function and potential hemodialysis. Being minimally invasive, endovascular procedures such as renal artery embolization (RAE) can treat major and life-threatening complications, but good and prompt communication between urologists and interventional radiologist is necessary for fast and effective treatment. Absolute contraindications for RAE are the presence of acute infection and previously known anaphylactic reaction to the iodine contrast media, while previous mild or moderate allergic reactions to iodine contrast media are not contraindications for RAE. Currently used embolic agents can be divided into temporary and permanent embolization agents. While the temporary embolization agent available is a gelatin sponge that could be used as complementary material or stand-alone, for permanent embolization interventional radiologists use microparticles, microspheres, liquid embolic agents, coils, and microcoils. RAE procedures are considered to be safe with a low incidence of complications, with non-target embolization being the most serious one. Postembolization syndrome is considered to be the most common adverse effect and it involves around 90% of patients. The overall results show that RAE is a safe, minimally invasive procedure that can effectively treat significant complications caused by other urologic procedures, with the reported success rates of 87%-100%.
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  • 文章类型: Journal Article
    枪支暴力(GV)和安全在美国是一个有争议的话题,尽管儿童和青少年的发病率和死亡率不断上升。对于医生来说,在预防未来GV方面发挥作用是很重要的。本文旨在介绍几种医生可以用来在自己的社区中预防GV的方法,从实施大规模干预计划到简单的筛查和预期指导。由于GV的问题仍然存在,对于医生来说,重要的是要利用他们的角色来识别高危人群,并倡导有利于他们未来健康的改变。
    Gun violence (GV) and safety is a contentious topic in the United States, despite increasing morbidity and mortality among children and adolescents. It is important for physicians to take a role in preventing future GV. This article aims to present several methods that physicians can use to prevent GV in their own communities, ranging from implementation of large-scale intervention programs to simple screenings and anticipatory guidance. As the problem of GV persists, it is important for physicians to use their role to identify individuals who are at high-risk and advocate for changes that will benefit their future health.
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  • 文章类型: Journal Article
    本文总结了血管神经病学领域的培训途径和职业机会。它强调了开创性的临床试验,这些试验改变了急性中风护理,并因此增加了对现成的血管神经病学专业知识的需求。本文强调需要在亚专科培训更多不同的医生,以及血管神经科医师在改善人口和地理领域的结果方面的作用。
    The article summarizes the training pathways and vocational opportunities within the field of vascular neurology. It highlights the groundbreaking clinical trials that transformed acute stroke care and the resultant increased demand for readily available vascular neurology expertise. The article emphasizes the need to train a larger number of diverse physicians in the subspecialty and the role of vascular neurologists in improving outcomes across demographic and geographic lines.
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  • 文章类型: Journal Article
    目的:描述气候变化对妇女健康影响的知识现状,并强调医疗保健提供者作为倡导者和主题专家的机会。
    结果:医疗保健提供者是社会上唯一受人尊敬的声音,但没有利用这一优势来倡导其社区并参与缓解措施,适应,以及代表患者和社区的弹性努力。
    结论:医疗保健提供者认为气候变化是真实的,是人类造成的,目前或不久将对患者产生负面影响。由于时间限制和知识差距,他们感到没有准备好担任领导者和倡导者。当前气候运动中的资源可以帮助缩小这一差距。
    OBJECTIVE: To describe the current state of knowledge on the impact on climate change on women\'s health and to highlight opportunities for healthcare providers to serve as advocates and subject matter experts.
    RESULTS: Healthcare providers are a uniquely respected voice in society but have not used this advantage to advocate for their communities and participate in mitigation, adaptation, and resiliency efforts on behalf of their patients and communities.
    CONCLUSIONS: Healthcare providers feel that climate change is real, is human caused, and is currently or will shortly negatively impact their patients. They feel unprepared to serve as leaders and advocates due to time limitations and a knowledge gap. Resources in the current climate movement can help close this gap.
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  • 文章类型: Journal Article
    背景和目的:这项研究的目的是确定医生在全麻下择期手术患者戒烟的强化干预和教育中的作用。材料和方法:在家庭医生诊所进行了一项随机前瞻性研究,其中男女吸烟者,21-65岁,没有认知障碍,并且没有对精神活性物质上瘾的人自愿参加。术前四周,将120名吸烟者随机分为两个相等的组;干预组(IG)进行了戒烟干预,对照组(CG)不进行干预。生化测试是为了确定随机阶段参与者的吸烟状况,术前一周,以及术后40、120和180天和12个月。IG的考生与医生交谈了五次,收到了140条电话信息,小叶,和激励信件以及药物治疗,而CG的参与者很少或根本没有得到戒烟的建议。结果:与CG相比,这项研究的结果证实了干预和教育对IG中戒烟的显着影响(p<0.001)。在12个月的随访中,IG中的吸烟者的禁欲几率是CG中吸烟者的7.31倍(95%CI:2.32-23.04)。与CG中的吸烟者相比,IG中未停止吸烟的吸烟者的依赖性较低,并且吸烟较少(p<0.0001),以及短期和长期禁欲的多倍患病率。结论:强化干预和教育可以激励择期手术患者短期和长期戒烟。
    Background and Objectives: The aim of this study was to determine the role of physicians in the intensive intervention and education regarding the smoking cessation of patients undergoing elective surgery under general anaesthesia. Materials and Methods: A randomised prospective study was conducted in family physicians\' clinics in which smokers of both sexes, aged 21-65 years, without cognitive impairments, and who were not addicted to psychoactive substances voluntarily participated. Four weeks preoperatively, 120 smokers were randomised into two equal groups; the intervention group (IG) underwent an intervention for the purpose of smoking cessation and the control group (CG) underwent no intervention. Biochemical tests were performed in order to determine the smoking status of the participants in the phase of randomisation, one week preoperatively, as well as 40, 120, and 180 days and 12 months postoperatively. The examinees of the IG talked to the physician five times and received 140 telephone messages, leaflets, and motivational letters along with the pharmacotherapy, while the participants in the CG received little or no advice on smoking cessation. Results: The results of this study confirmed a significant influence of the intervention and education on the smoking abstinence in the IG compared to the CG (p < 0.001). The smokers in the IG had 7.31 (95% CI: 2.32-23.04) times greater odds of abstinence upon the 12-month follow-up than the smokers in the CG. The smokers in the IG who did not stop smoking had a lower degree of dependence and smoked fewer cigarettes (p < 0.0001) compared to those in the CG, as well as a multiple times higher prevalence of short- and long-term abstinence. Conclusions: It can be concluded that the intensive intervention and education can motivate patients preparing for elective surgery to stop smoking in the short- and long term.
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  • 文章类型: Historical Article
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  • 文章类型: Letter
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