2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030.

OBJECTIVE: To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. METHODS: The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. RESULTS: The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). CONCLUSION: The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients.

Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant.

BACKGROUND: Despite effective antiviral treatment, hundreds of kidneys from deceased donors with hepatitis C virus (HCV) are discarded annually. Little is known about the determinants of willingness to accept HCV-infected kidneys among HCV-negative patients. METHODS: At 2 centers, 189 patients undergoing initial or reevaluation for transplant made 12 hypothetical decisions about accepting HCV-infected kidneys in which we systematically varied expected HCV cure rate, allograft quality, and wait time for an uninfected kidney. RESULTS: Only 29% of the participants would accept an HCV-infected kidney under all scenarios, whereas 53% accepted some offers and rejected others, and 18% rejected all HCV-infected kidneys. Higher cure rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.33-5.24 for 95% vs 75% probability of HCV cure), younger donor (OR, 2.34; 95% CI, 1.91-2.88 for a 20-year-old vs a 60-year-old hypertensive donor), and longer wait for an uninfected kidney (OR, 1.43; 95% CI, 1.22-1.67 for 5 years vs 2 years) were associated with greater willingness to accept an HCV-infected kidney. Black race modified the effect of HCV cure rate, such that willingness to accept a kidney increased less for blacks versus whites as the cure rate improved. Patients older than 60 years and prior kidney recipients showed greater willingness to accept an HCV-infected organ. CONCLUSIONS: Most patients will consider an HCV-infected kidney in some situations. Future trials using HCV-infected kidneys may enhance enrollment by targeting older patients and prior transplant recipients, but centers should anticipate that black patients' acceptance of HCV-infected kidneys will be reduced compared with white patients.

Reacciones adversas a medicamentos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres / Adverse reactions to drugs in Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital

Se efectuó un estudio descriptivo y transversal, con vistas a identificar las reacciones adversas a medicamentos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, durante el 2014. Se notificaron 107 reacciones adversas, 73 (68,2 por ciento) por los licenciados en enfermería y 29 (27,1 por ciento) por los médicos; entre ellas sobresalieron: escalofríos, ansiedad y tos. El sexo femenino y las enfermedades concomitantes condicionaron la aparición de dichas reacciones. Primaron los antibacterianos y antihipertensivos como los grupos farmacológicos principales, el factor de crecimiento y el captopril como los medicamentos con mayor incidencia y árnica como remedio homeopático(AU)

A descriptive and cross-sectional study was carried out, aimed at identifying the adverse reactions to drugs in Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, during 2014. One hundred and seven adverse effects were notified, 73 (68.2 percent) by the Licentiates in Nursing and 29 (27.1 percent) by the doctors; among them chills, anxiety and cough highlighted. The female sex and the concomitant diseases conditioned the emergence of these reactions. The antibacterial and antihypertensive prevailed as the main pharmacological groups, the growth factor and captopril as the drugs with higher incidence and arnica as homeopathic remedy(AU)

Reacciones adversas a medicamentos en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" / Adverse reactions to drugs in "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital

Se efectuó un estudio descriptivo y transversal, con vistas a identificar las reacciones adversas a medicamentos en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, durante el 2014. Se notificaron 107 reacciones adversas, 73 (68,2 %) por los licenciados en enfermería y 29 (27,1 %) por los médicos; entre ellas sobresalieron: escalofríos, ansiedad y tos. El sexo femenino y las enfermedades concomitantes condicionaron la aparición de dichas reacciones. Primaron los antibacterianos y antihipertensivos como los grupos farmacológicos principales, el factor de crecimiento y el captopril como los medicamentos con mayor incidencia y árnica como remedio homeopático.

A descriptive and cross-sectional study was carried out, aimed at identifying the adverse reactions to drugs in "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, during 2014. One hundred and seven adverse effects were notified, 73 (68.2%) by the Licentiates in Nursing and 29 (27.1%) by the doctors; among them chills, anxiety and cough highlighted. The female sex and the concomitant diseases conditioned the emergence of these reactions. The antibacterial and antihypertensive prevailed as the main pharmacological groups, the growth factor and captopril as the drugs with higher incidence and arnica as homeopathic remedy.

Calidad de la prescripción de propanonol en el área de salud Dr Carlos Juan Finlay / Quality of the propanolol prescription in Dr Carlos Juan Finlay health area

Se efectuó un estudio descriptivo y transversal de todos pacientes que consumían propanolol, independientemente de la edad, sexo, raza e indicación, a fin de evaluar la calidad de la prescripción de este medicamento por los facultativos (endocrinólogo, neurólogo y cardiólogo) responsables en el área de salud Dr Carlos Juan Finlay" de Santiago de Cuba. Los especialistas de medicina general integral tuvieron los peores resultados en cuanto a prescripción inadecuada durante el proceso, a diferencia de lo realizado por profesionales de las ramas de neurología y medicina interna. La evaluación de los resultados de la satisfacción de los proveedores de salud fue inadecuada y de los usuarios, adecuada

A descriptive and cross sectional study of all patients that were prescribed propanolol, independently of the age, sex, race and indication was carried out, in order to evaluate the quality of the prescription for this medication by doctors (endocrinologist, neurologist and cardiologist) who worked in Dr Carlos Juan Finlay health area from Santiago de Cuba. The specialists in Comprehensive General Medicine had the worst results regarding inappropriate prescription during the process, contrary to what professionals from the neurology and internal medicine specialities do. The evaluation of the satisfaction results for the health providers was inappropriate and that of the users was appropriate

Calidad de la prescripción de propanonol en el área de salud Dr Carlos Juan Finlay / Quality of the propanolol prescription in Dr Carlos Juan Finlay health area

Se efectuó un estudio descriptivo y transversal de todos pacientes que consumían propanolol, independientemente de la edad, sexo, raza e indicación, a fin de evaluar la calidad de la prescripción de este medicamento por los facultativos (endocrinólogo, neurólogo y cardiólogo) responsables en el área de salud Dr Carlos Juan Finlay" de Santiago de Cuba. Los especialistas de medicina general integral tuvieron los peores resultados en cuanto a prescripción inadecuada durante el proceso, a diferencia de lo realizado por profesionales de las ramas de neurología y medicina interna. La evaluación de los resultados de la satisfacción de los proveedores de salud fue inadecuada y de los usuarios, adecuada(AU)

A descriptive and cross sectional study of all patients that were prescribed propanolol, independently of the age, sex, race and indication was carried out, in order to evaluate the quality of the prescription for this medication by doctors (endocrinologist, neurologist and cardiologist) who worked in Dr Carlos Juan Finlay health area from Santiago de Cuba. The specialists in Comprehensive General Medicine had the worst results regarding inappropriate prescription during the process, contrary to what professionals from the neurology and internal medicine specialities do. The evaluation of the satisfaction results for the health providers was inappropriate and that of the users was appropriate(AU)