Equity, diversity, and inclusion in the Multinational Association for Supportive Care in Cancer: a global membership survey.

Equity, diversity, and inclusion (EDI) are essential for healthcare organizations since they allow for the development of programs and initiatives that bring together diverse perspectives and knowledge. Global multidisciplinary organizations, such as the Multinational Association for Supportive Care in Cancer (MASCC), need to understand the perspective of their members regarding EDI to identify opportunities to enhance diversity and inclusiveness and to better meet the needs of members from different backgrounds and resources. The MASCC Health Disparities Committee designed a survey to identify issues related to disparities faced by MASCC members when providing supportive care to patients with cancer and to examine the EDI landscape within the organization. Here, we report results related to EDI initiatives within the organization. Two-hundred and eighteen MASCC members responded to the survey (response rate 10.2%). The results indicated that respondents were generally satisfied with how MASCC manages leadership, membership, and organization-related EDI issues. Opportunities for improvement noted by respondents included developing strategies to foster a more diverse membership, improving communication regarding diversity in the organization, and increasing EDI content in educational sessions and publications. The results of this survey represent the first attempt at understanding how to improve EDI within MASCC and will be utilized to guide further initiatives and programs.

Why should Medical Societies increasingly attend to their Specialist Title exams and why should medical professionals obtain it? / Por que as Sociedades Médicas devem cada vez mais cuidar de suas provas de Título de Especialista e porque os profissionais médicos devem obtê-lo?

ABSTRACT Medical societies must maintain high standards of competence and quality when awarding specialist titles, defining the certification criteria, taking into account the needs and realities of the health system and medical practice.

RESUMO As Sociedades Médicas devem manter padrões elevados de competência e qualidade na concessão dos Títulos de Especialista, com definição dos critérios de certificação, considerando as necessidades e realidades do sistema de saúde e da prática médica.

Pioderma gangrenoso: atualização e orientação / Pyoderma gangrenosum: update and guidance

Introdução: O pioderma gangrenoso (PG) é uma doença neutrofílica, rara, porém de consequências danosas. O Capítulo de Feridas da Sociedade Brasileira de Cirurgia Plástica (SBCP) foi instado a compilar as melhores práticas, tanto diagnósticas como terapêuticas, junto às Sociedades Brasileiras de Dermatologia e Reumatologia para um melhor esclarecimento dos seus membros. Métodos: Ampla revisão de artigos publicados na literatura médica e compilação das novas diretrizes de diagnóstico e tratamento por dois membros indicados por cada uma das Sociedades Brasileiras de Cirurgia Plástica, Dermatologia e Reumatologia. Resultados: O PG deixou de ser uma doença de exclusão, tendo os critérios diagnósticos bem definidos e a orientação terapêutica delineada pelos autores, incluindo o uso de terapia biológica. Conclusão: O PG permanece desafiador, mas sistematizar a investigação e o uso dos novos medicamentos, bem como o manejo das feridas, abre novas perspectivas, interferindo na fisiopatologia de modo positivo, com maior precocidade e menos efeitos colaterais do que a terapia imunossupressora de forma isolada.

Introduction: The pyoderma gangrenosum (PG) is a neutrophilic disease, rare but with a poor outcome. The Capitulum of Wound treatment of the Brazilian Society of Plastic Surgery (SBCP) promoted a discussion with the Brazilian societies of Dermatology and Rheumatology to extract the best procedures in diagnostic and treatment. Methods: Broad review of published articles related to the subject and compilation of guidelines of diagnostic and treatment by two advisors of each involved society, plastic surgery, dermatology and rheumatology. Results: The PG is not an exclusion disease anymore, with well defined criteria for its diagnostic and literature based treatment, refined by the authors, including the use of biological therapies. Conclusion: The PG remains challenging, but systematizing the investigation and the use of new drugs has opened a new horizon of treatments, interfering in the pathophysiology in a positive manner with fewer side effects than immunosuppressive therapy alone.

A conformidade jurídica das penalidades impostas por sociedades médicas de especialidades / The legal compliance of penalties imposed by specialty medical societies

Introdução: O estudo doravante desenvolvido propõe analisar as penalidades impostas por Sociedades de Especialidades Médicas, entidades organizadas sob a forma de associações civis, sobretudo se configuram usurpação legal de competência dos Conselhos Profissionais. Será investigada a natureza dessas punições e seus efeitos e alcances, no intuito de verificar se há efetivo prejuízo ao exercício profissional da medicina pelo galeno. Métodos: Para a referida análise, foram levantadas as normas aplicáveis dentro ordenamento jurídico brasileiro, sua sistematização e conflitos aparentes, a fim de situar as punições associativas e sua conformidade com a ordem jurídica vigente. Resultados/Conclusão: Verificou-se do estudo que não há qualquer óbice à aplicação de tal modalidade de sanções, uma vez respeitadas as garantias legais e constitucionais da ampla defesa, contraditório e devido processo legal.

Introduction: The study developed hereafter proposes to analyze the penalties imposed by Societies of Medical Specialties, entities organized in the form of civil associations, specially if they constitute legal usurpation of the competence of Professional Councils. The nature of these punishments and their effects and scope will be investigated, in order to verify whether there is effective damage to the professional practice of medicine by physicians. Methods: For this analysis, the applicable rules within the Brazilian legal system were raised, their systematization and apparent conflicts, in order to locate the associative punishments and their compliance with the current legal order. Results/Conclusion: It was verified from the study that there is no obstacle to the application of this type of sanctions, once the legal and constitutional guarantees of ample defense, contradictory and due process are respected.

Do 'Mais Médicos' à pandemia de Covid-19: duplo negacionismo na atuação da corporação médica brasileira / From 'More Doctors' to the COVID-19 pandemic: dual denialism in the Brazilian medical corporation's performance

RESUMO O ensaio analisa a dinâmica de atuação corporativa da medicina brasileira na pandemia de Covid-19, de março de 2020 a julho de 2021, a partir de documentos e material institucional das entidades médicas nacionais, de organizações estudantis e de coletivos de médicos de expressão nacional, além de matérias jornalísticas e publicações da literatura científica sobre o tema. O período é marcado pela politização da agenda corporativa e pelo alinhamento com os discursos negacionistas do governo de Jair Bolsonaro. Argumenta-se que esse processo é resultado de uma politização anterior: o embate contra o Programa Mais Médicos no período de 2013, ano de seu lançamento, a 2019, quando foi encerrado pelo governo. Os dois momentos históricos revelam um duplo negacionismo da corporação médica - acentuando fragilidades, contradições e dilemas da encruzilhada da profissão - que exigirá diálogos internos e com a sociedade, para novos consensos da identidade corporativa e do projeto profissional da medicina. A compreensão dos entrelaçamentos, disputas e sentidos das dinâmicas e rumos da atuação corporativa da medicina permitem identificar problemas estruturais de raízes políticas que impedem maiores avanços na consolidação do Sistema Único de Saúde.

ABSTRACT This essay analyzes the dynamics of Brazilian medical practice's corporate action in the COVID-19 pandemic, from March 2020 to July 2021, from documents and institutional material of national medical entities, student organizations, groups of nationally reputed physicians, and journalistic articles and scientific literature publications on the subject. This period is marked by the politicization of the corporate agenda and the alignment with the denialist discourses of Jair Bolsonaro's administration. It is argued that this process stems from a previous politicization: the clash against the More Doctors Program from 2013, the year of its launch, to 2019, when the Government deactivated it. The two historical moments reveal the dual denialism of the medical corporation, emphasizing weaknesses, contradictions, and dilemmas of the profession's crossroads, which will require internal and social dialogues for a new consensus on corporate identity and the professional project of Medicine. Understanding the intertwining, disputes, and meanings of the dynamics and directions of the corporate action of Medicine allows identifying structural problems of political roots that prevent further advances in the consolidation of the Unified Health System.

[Gender Distribution in Medical Leadership Roles in Portugal: The Example of Candidacy to Bodies of the Portuguese Medical Association 2017-2019]. / Distribuição de Género em Cargos de Liderança na Área Médica em Portugal: O Exemplo das Candidaturas aos Órgãos da Ordem dos Médicos 2017-2019.

INTRODUCTION: Gender equality is one of the sustainable development goals. Low participation of women in leadership roles is an example of gender inequality. In Portugal, there are few studies regarding gender inequality in medical leadership roles. Therefore, we aimed to analyse gender distribution of candidates to regional bodies of the Portuguese Medical Association. MATERIAL AND METHODS: We extracted data from the candidates to the regional bodies of the Portuguese Medical Association (2017 - 2019 mandate) from the Association's magazine (issue number 175). We calculated the percentage of women candidates, overall and stratified by list, region and roles. We obtained observed-vs-expected ratios overall and by region, and respective 95% confidence intervals, assuming a Poisson distribution. Finally, we conducted a sensitivity analysis, excluding substitute candidates. RESULTS: Women accounted for 37% of the candidates (regional variation: 29% - 51%). The national observed-vs-expected ratio was 0.74 (95% confidence interval: 0.58; 0.92), mainly driven by the ratio from the South Region: 0.58 (95% confidence interval: 0.41; 0.80). Women ran mainly for alternate candidates and secretary positions (56% and 54% respectively). DISCUSSION: Gender differences were identified, particularly in the South, regarding the frequency and type of candidacy. Previous works have identified maternity, the social role of women and perceptions regarding the leadership roles as possible reasons to explain such differences. Our analysis is limited to specific leadership roles and an election moment; further studies should be pursued. CONCLUSION: We identified a lower than expected participation of women in the elections for the Portuguese Medical Association. When they run, women are found mainly in less relevant positions or with less potential to be elected (secretary or alternate candidate). A deeper understanding and measures to fight gender inequality in leadership roles are required.

Introdução: A igualdade de género constitui um dos objetivos de desenvolvimento sustentável. Uma manifestação de desigualdade de género é a baixa participação de mulheres em cargos de liderança. Em Portugal, são escassos os estudos sobre a desigualdade de género na liderança na área médica. Assim, o presente trabalho pretendeu analisar a distribuição de género em candidaturas aos órgãos regionais da Ordem dos Médicos.Material e Métodos: Foram extraídos da Revista da Ordem dos Médicos (número 175) os dados dos candidatos aos órgãos regionais da Ordem dos Médicos (mandato de 2017 - 2019). Obtiveram-se as percentagens de mulheres candidatas, globalmente, por lista, regiões e cargos. Calcularam-se razões observado-versus-esperado por secção regional e intervalos de confiança a 95% assumindo uma distribuição de Poisson. Foi realizada análise de sensibilidade, excluindo os candidatos a suplentes.Resultados: Trinta e sete por cento dos candidatos eram médicas (variação por região: 29% - 51%). A nível nacional a razão observado-versus-esperado foi de 0,74 (intervalo confiança a 95%: 0,58; 0,92), principalmente influenciada pela razão da região Sul de 0,58 (intervalo confiança a 95%: 0,41; 0,80). Existiu uma predominância de mulheres nas candidaturas para suplentes e secretário (56% e 54% respetivamente).Discussão: A diferença entre géneros é particularmente acentuada na região Sul, na frequência e tipo de cargos a que se candidatam. As razões apontadas na literatura relacionam-se com a maternidade, o papel social da mulher e perceções sobre o desempenho dos cargos de lideraça. Este estudo é limitado à análise de um tipo de liderança e um momento eleitoral, sendo necessárias análises mais abrangentes.Conclusão: Houve menor participação do que o expectável por parte das médicas no processo eleitoral da Ordem dos Médicos. Quando participam, as mulheres tendem a fazê-lo em cargos de menor relevância ou com menos potencial para eleição (secretário ou suplente). É necessário aprofundar o estudo e introduzir medidas de combate à desigualdade de género em cargos de liderança.

As ligas acadêmicas e sua aproximação com sociedades de especialidades: um movimento de contrarreforma curricular? / Academic leagues and their approach to specialty societies: a movement of curricular counter-reform?

Resumo: Introdução: As Diretrizes Curriculares Nacionais para os Cursos de Medicina estimulam uma formação generalista do médico, alterando o paradigma fragmentado de formação vigente até o século passado. A residência médica é considerada complementar à graduação, porém sem vagas nas quantidades desejadas, gerando competição entre estudantes. Simultaneamente, as ligas acadêmicas ganharam espaço dentro das escolas médicas. Desenvolvimento: Trata-se de um ensaio com análise crítica sobre a relação entre as sociedades de especialidades e as ligas acadêmicas, e sobre os efeitos dessa relação na formação dos futuros médicos. As sociedades de especialidade possuem ações de estímulo à criação de ligas acadêmicas, bem como reservam espaços dedicados a elas. Desse modo, elas aproximam-se dos estudantes por meio das ligas e novamente se inserem na graduação na forma de currículo paralelo, em que haviam sido relegadas a segundo plano com o programa generalista de formação. Conclusão: Há um movimento de aproximação entre ligas e sociedades de especialidades que deve ser acompanhado com atenção, reflexão e crítica para que não se tolha dos estudantes a liberdade de explorar diversas realidades da prática médica e conhecer diversas especialidades, mas também não se subverta a proposta pedagógica de formação médica geral.

Abstract: Introduction: The national curricular guidelines for medical courses encourage generalist training for doctors, changing the fragmented training paradigm that existed up until the last century. Medical residency is considered complementary to undergraduate training, but without sufficient vacancies to meet the demand, competition is generated among students. At the same time, academic leagues have gained presence within medical schools. Development: This essay presents a critical analysis of the relationship between specialty medical societies and academic leagues, and the effects of this relationship on medical training. Specialty societies encourage the creation of academic leagues, and reserve spaces dedicated to them. In this way, they approach students through the leagues and reenter the undergraduate course in the form of a parallel curriculum, having previously been relegated to the background by the generalist training program. Conclusion: There is a movement of approximation between leagues and specialty societies, which must be monitored and reflected on closely and critically to ensure that students are not deprived of the freedom to explore different realities of medical practice and medical specialties, and to safeguard the pedagogical proposal of medical training from being subverted.

[Brief introduction of surgical development of esophageal cancer in Japan].

Esophageal cancer surgery originated in the early 20(th) century. However, the true meaning of trans-thoracic esophagectomy and digestive tract reconstruction began in the 1930s. Almost at the same time, Japan and Western countries began the surgical exploration of esophageal cancer. Based on the pathological type of esophageal cancer in Asia, squamous cell carcinoma is the majority, and its biological characteristics and treatment strategies are different from those of European and American patients. After more than eighty years of development, the surgical treatment of esophageal cancer in Japan has been developed from the initial attempt, deep cultivation practice to the pursuit of excellence, and explored a set of more advanced surgical techniques and diagnostic strategies, which is unique in the world. On the basis of the establishment of the Japanese Society of Esophagus, Japanese scholars have developed and irregularly updated the Japanese Classification of Esophageal Cancer and published the professional academic journal Esophagus. The Japanese Clinical Oncology Group organized a number of phase Ⅲ clinical studies on esophageal cancer, providing strong evidence for the diagnosis and treatment of esophageal squamous carcinoma. Focused on the origin, development, current situation and future of esophageal cancer surgery in Japan, this paper summarized the development of esophageal cancer surgery in Japan through literature review, interviews with senior experts and Hot topics of esophageal cancer surgery-questionnaire survey of Japanese experts.

Brief introduction of surgical development of esophageal cancer in Japan / 中华外科杂志

Esophageal cancer surgery originated in the early 20th century. However, the true meaning of trans-thoracic esophagectomy and digestive tract reconstruction began in the 1930s. Almost at the same time, Japan and Western countries began the surgical exploration of esophageal cancer. Based on the pathological type of esophageal cancer in Asia, squamous cell carcinoma is the majority, and its biological characteristics and treatment strategies are different from those of European and American patients. After more than eighty years of development, the surgical treatment of esophageal cancer in Japan has been developed from the initial attempt, deep cultivation practice to the pursuit of excellence, and explored a set of more advanced surgical techniques and diagnostic strategies, which is unique in the world. On the basis of the establishment of the Japanese Society of Esophagus, Japanese scholars have developed and irregularly updated the Japanese Classification of Esophageal Cancer and published the professional academic journal Esophagus. The Japanese Clinical Oncology Group organized a number of phase Ⅲ clinical studies on esophageal cancer, providing strong evidence for the diagnosis and treatment of esophageal squamous carcinoma. Focused on the origin, development, current situation and future of esophageal cancer surgery in Japan, this paper summarized the development of esophageal cancer surgery in Japan through literature review, interviews with senior experts and Hot topics of esophageal cancer surgery-questionnaire survey of Japanese experts.

Sociedade brasileira de cardiologia a carta das mulheres / Brazilian society of cardiology the women's letter

O objetivo primordial desse documento é estimular a melhoria das condições de saúde das mulheres brasileiras, com foco na doença cardiovascular (DCV). A DCV é responsável por 17,5 milhões de mortes prematuras/ano no mundo, com previsão de aumento para 23 milhões em 2030. As DCV são responsáveis por um terço de todas as mortes no Brasil, com semelhança entre homens e mulheres após a menopausa. Esses dados revestem-se de maior importância quando consideramos que 80% das mortes prematura. (AU)

Sociedades científicas en Cienfuegos: el Centro Médico Farmacéutico (1881-1885) / Scientific Societies in Cienfuegos: The Pharmaceutical Medical Center. (1881-1885)

Es indudable que el estudio de la actividad científica a través del devenir histórico nacional puede ayudar a comprender mejor los procesos sustantivos de nuestra cultura e identidad nacionales. El presente trabajo tiene como objetivo explicar el proceso de fundación y desarrollo del Centro Médico Farmacéutico de Cienfuegos. A partir de fuentes documentales, se analiza la actividad de dicho centro y se revelan aspectos inéditos de su integración, funcionamiento y contribución a la sociedad cienfueguera, por lo cual el trabajo contribuirá a la construcción de una historia social de la ciencia en la provincia de Cienfuegos.

Unquestionably the scientific activity study throughout the national historical evolution can provide a better understanding of the substantive due process of our national cultural and national identity. The present paper is aimed at explaining the process of foundation and development of the Cienfuegos pharmaceutical medical center. On the basis of documentary sources, the activity of the center is analyzed and unpublished elements are shown on its integration, functioning and contribution to the Cienfuegos society. Therefore this work will contribute to the construction of a science social history in the province.

[German neurology and neurologists during the Third Reich: Preconditions and general framework before and after 1933]. / Neurologie und Neurologen in der NS-Zeit: Voraussetzungen und Rahmenbedingungen vor und nach 1933.

This article focuses on the institutional development of neurology in Germany up to the rise to power of the National Socialists and the radical sociopolitical changes after 1933. A wide range of scattered secondary literature was assessed and evaluated. Additionally, some original sources are literally quoted and interpreted according to the context. Since the end of the nineteenth century a complicated process of separation from internal medicine and psychiatry led to the formation of a self-conscious discipline of neurology. The first generation of German neurologists succeeded in founding the German Journal for Neurology ("Deutsche Zeitschrift für Nervenheilkunde") in 1890 and their own neurological association, the Society of German Neurologists ("Gesellschaft Deutscher Nervenärzte", GDN) in 1907. On an international scale, however, the institutional implementation of neurology with only a small number of chairs and few neurology departments remained more than modest. The ambitions for autonomy ended 2 years after the change of power in 1933. Regulatory interventions by the government and psychiatric interests led to the fusion of the GDN with the psychiatric specialist society, the new association being called the Society of German Neurologists and Psychiatrists ("Gesellschaft Deutscher Neurologen und Psychiater", GDNP) in 1935. In this group psychiatrists dominated the discourse. The expulsion, imprisonment and murder of physicians declared as non-Aryan or Jewish along with the forced consolidation ("Gleichschaltung") at the universities prompted profound changes in medical and academic life. It remains an ongoing challenge of neurological historical research to measure the impact of this upheaval on the few neurology departments in hospitals and private practices.

Ligas Acadêmicas de Medicina: perfil e contribuições para o ensino médio / Academic Leagues of Medicine: profile and contributions to medical education

Estudo transversal, descritivo e observacional, que teve como objetivo identificar o perfil das Ligas Acadêmicas de Medicina atuantes na Universidade do Estado do Pará, de maneira a analisar a relevância e as contribuições dessas instituições no contexto universitário. A amostra foi composta por 17 ligas acadêmicas. A coleta de dados foi realizada por meio de entrevistas com os representantes destas entidades (presidente, vice-presidente ou coordenador-geral), mediante o auxílio de questionários semiestruturados, no período de abril a maio de 2014. As atividades realizadas por estas Ligas Acadêmicas de Medicina incluíam estágios extracurriculares (70,5%), projetos de extensão (70,5%) e projetos de pesquisa (82,3%). O número de membros variava de 7 a 50. Todas as associações apresentavam participação de docentes. Em relação a critérios de seleção, 16 Ligas Acadêmicas de Medicina (94,2%) afirmaram possuir algum tipo de processo seletivo. Quanto à filiação, 17,6% eram filiadas à Associação Brasileira de Ligas Acadêmicas de Medicina e 58,8% a uma associação nacional referente a sua especialidade. As ligas acadêmicas tinham em média 21 membros discentes e 2 docentes. Os membros, em sua maioria, dedicavam-se a especialidades clínicas com foco em pesquisas científicas, contando com seu próprio financiamento.

Cross-sectional, descriptive and observational study that aims to identify the profile of the Academic Leagues of Medicine which act in the University of the State of Pará, in order to understand the importance and contributions of these organizations in college context. The sample was composed for 17 academic associations. Data collection was conducted through interviews with representatives of these entities (president, vice presidente or general coordinator) using semi-structured questionnaires, from April to May 2014. The activities performed by these associations include extracurricular training (70.5%), extension projects (70.5%) and research projects (82.3%). The number of members ranged from 7 to 50. All associations had the participation of professors. Regarding selection criteria, 16 academic associations (94.2%) reported having some type of selection process. Concerning affiliation, 17.6% of leagues were affiliated to Associação Brasileira de Ligas Acadêmicas de Medicina and 58.8% to a national association for their specialties. The academic leagues had an average of 21 student members and 2 teachers. The members were mainly dedicated to clinical specialties, focusing on scientific research, and their funding came from their own members.

As bases da reformulação da presença digital da Sociedade Brasileira de Cirurgia Plástica / A basis for a reformulation of the digital presence of the Brazilian Association of Plastic Surgery

INTRODUÇÃO: Com o crescimento exponencial da internet, observou-se o grande potencial da rede como ferramenta eficaz no provimento de informações e acesso difundido. Desenvolver portais que respondam as necessidades informacionais de seus associados e usuários configuram uma preocupação das sociedades de classe. O objetivo deste estudo foi reavaliar a estrutura do portal da Sociedade Brasileira de Cirurgia Plástica, além da necessidade de implementação de uma nova dinâmica de interação de seus associados e usuários. MÉTODO: Realizou-se pesquisa qualitativa com seus associados e formadores de opinião previamente selecionados. RESULTADOS: As considerações mais frequentes foram: aporte de melhor conteúdo científico, necessidade de atualização do portal, divulgação de pesquisas, acesso a periódicos e instrumento de treinamento e/ou aperfeiçoamento. CONCLUSÃO: Essa pesquisa possibilitou a modernização do portal da Sociedade Brasileira de Cirurgia Plástica, além de definir diretrizes de sua presença contínua nas redes sociais.

INTRODUCTION: The exponential growth of the Internet has revealed its great potential as an effective tool for providers to access information. The development of websites that meet associates' and other users' needs to be informed is a concern of professional associations. This study aimed to assess the structure of the SBCP website and the need to implement a new dynamic interaction between associates and other users. METHOD: A qualitative study was conducted by surveying previously selected associates and opinion makers. RESULTS: The most common considerations were as follows: (1) the need to improve scientific content, (2) update the website, (3) disseminate research, (4) access journals, and (5) training and/or development of tools. CONCLUSION: This study promoted the modernization of the SBCP website and defined guidelines for its ongoing presence in social networks.

Perioperative management of anticoagulant users scheduled for glaucoma surgery: a survey among the Brazilian Glaucoma Society members / Condução de pacientes usuários de anticoagulantes no perioperatório de cirurgia antiglaucomatosa: uma pesquisa entre os membros da Sociedade Brasileira de Glaucoma

PURPOSE: To investigate and describe, among the members of the Brazilian Glaucoma Society (BGS), the practices regarding the perioperative management of anticoagulants (warfarin and aspirin) use in patients scheduled for glaucoma surgery. METHODS: The active members of the Brazilian Glaucoma Society answered a questionnaire evaluating different aspects of their current perioperative management of glaucomatous patients taking warfarin or aspirin. RESULTS: A total of 52 participants returned a complete questionnaire. Warfarin or aspirin was routinely interrupted prior to glaucoma surgery by 82.7% of the respondents. The majority of the surgeons who discontinued these medications reported doing so 7 days prior to surgery and resumed their use the day after the procedure. Almost half of our interviewees reported hemorrhagic complications that could be related to anticoagulant therapy. A large number of the surgeons (86.5%) preferred a particular surgical technique for anticoagulated patients; however, most of them (88.5%) do not change the anesthetic planning in such patients. Finally, the majority of the participants (90.4%) refer their anticoagulated patients to a preoperative appointment with a cardiologist or a general practitioner before the surgery. CONCLUSIONS: The majority of Brazilian Glaucoma Society members participating in this study interrupt either warfarin or aspirin prior to glaucoma surgery. Although there is scant information available in the literature to offer definitive guidance, most participants from the Brazilian Glaucoma Society seem to share the same opinion when it comes to perioperative management of anticoagulant users.

OBJETIVO: Investigar e descrever, entre os membros da Sociedade Brasileira de Glaucoma (SBG), as práticas relativas ao manejo de anticoagulantes (varfarina e aspirina) em pacientes agendados para cirurgia antiglaucomatosa. MÉTODOS: Foi enviado um questionário objetivo aos membros ativos da Sociedade Brasileira de Glaucoma avaliando diferentes aspectos da forma como conduzem seus pacientes em uso de varfarina ou aspirina durante o período perioperatório de uma cirurgia antiglaucomatosa. RESULTADOS: Cinquenta e dois participantes retornaram o questionário preenchido adequadamente. O uso de varfarina ou aspirina foi rotineiramente interrompido antes da cirurgia antiglaucomatosa por 82,7% dos entrevistados. A maior parte dos cirurgiões, quando interromperam o uso destes medicamentos, o fez sete dias antes da cirurgia e os reintroduziram no dia seguinte ao procedimento. Aproximadamente metade dos entrevistados disse ter observado complicações hemorrágicas que poderiam ser relacionados à terapia anticoagulante. Embora a maioria dos cirurgiões (86,5%) referiu utilizar alguma técnica cirúrgica em particular para esses pacientes anticoagulados, quase todos (88,5%) não alteram seu planejamento anestésico de rotina nesses mesmos casos. Finalmente, a maior parte dos participantes (90,4%) relatou referir seus pacientes anticoagulados para uma avaliação pré-operatória com um cardiologista ou um clínico geral. CONCLUSÃO: A maior parte dos membros da Sociedade Brasileira de Glaucoma que participou desse estudo refere interromper o uso de anticoagulantes (varfarina ou aspirina) antes de uma cirurgia antiglaucomatosa. Embora existam poucas informações disponíveis na literatura para oferecer uma orientação definitiva, a maioria dos participantes parece compartilhar da mesma opinião quando se trata do manejo perioperatório de anticoagulantes.

Familiarity and self-reported compliance with American Urological Association best practice recommendations for use of thromboembolic prophylaxis among American Urological Association members.

PURPOSE: Thromboprophylaxis with subcutaneous heparin or low molecular weight heparin is now an integral part of national surgical quality and safety assessment efforts, and has been incorporated into the current AUA Best Practice Statement. We evaluated familiarity and compliance with the AUA Best Practice Statement, assessed practice patterns in terms of perioperative thromboprophylaxis and specifically examined self-reported compliance in high risk patients undergoing radical cystectomy. MATERIALS AND METHODS: An electronic survey was sent to AUA members with valid e-mail addresses (10,966). Associations between AUA Best Practice Statement adherence and factors such as urological specialty, graduation year and guideline familiarity were assessed using chi-square analyses and generalized estimating equations. RESULTS: With 1,210 survey responses the largest group of respondents was urological oncologists and/or laparoscopic/robotic specialists (26.0%). This group was more likely to use thromboprophylaxis than nonurological oncologists and/or laparoscopic/robotic specialists in high risk patients (OR 1.3, CI 1.1-1.5). Respondents aware of the AUA Best Practice Statement guidelines (50.7%) were more likely to use thromboprophylaxis (OR 1.4, CI 1.2-1.6). Although 18.1% of urological oncologists and/or laparoscopic/robotic specialists and 34.2% of nonurological oncologists and/or laparoscopic/robotic specialists avoided routine thromboprophylaxis in patients undergoing radical cystectomy, the former were more likely to use thromboprophylaxis (p <0.0001) than other respondents. Urologists graduating after the year 2000 used thromboprophylaxis in high risk patients undergoing radical cystectomy more often than did earlier graduates (79.2% vs 63.4%, p <0.0001). CONCLUSIONS: Although younger age and self-reported urological oncologist and/or laparoscopic/robotic specialist status correlated strongly with thromboprophylaxis use, self-reported adherence to AUA Best Practice Statement was low, even in high risk cases with clear AUA Best Practice Statement recommendations such as radical cystectomy. These data identify opportunities for quality improvement in patients undergoing major urological surgery.

Historias de la profesión médica: Argentina y Estados Unidos en el siglo XX / Histories of the medical profession: Argentina and the United States in the 20th century

El contenido de este artículo se orienta hacia la búsqueda de explicaciones para determinados paralelismos y significativas diferencias en la posición de las profesiones médicas argentina y estadounidense en los respectivos servicios de atención médica. Mi interés en este texto no radica en la presentación de un relato histórico original. La información empírica que recupero sobre el desempeño de ambas profesiones no tiene relevancia en sí misma, sino como objeto de un ejercicio metodológico que la utiliza como vehículo de un análisis comparativo destinado a iluminar el impacto de las instituciones del régimen político, las ideas dominantes sobre salud y atención médica, y las estrategias de las organizaciones representativas de los intereses profesionales sobre los procesos de construcción de los respectivos sistemas de atención médica y el poder relativo de cada una de la profesiones en la construcción de las reglas de juego que a lo largo del siglo XX ordenaron su actividad.

This article is rooted in the search for explanations for particular parallelisms and significant differences in the relative positions of the medical professions in Argentina and the USA in different health care services. My intention in this text is not to present an original historical account, as the empirical data about the performance of both professions that I uncover is not relevant in itself. Rather, this data serves as the object of a methodological exercise, which uses the information as a vehicle for a comparative analysis highlighting the impact of political institutions, dominant ideas on health and health care, and strategies of professional associations in the construction of each health care system, as well as the relative power of each profession in establishing the rules of the game which organized their activities throughout the 20th century.