Subspecialty training in Europe:a report by the European Network of Young Gynaecological Oncologists

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Integrating teamwork, clinician occupational well-being and patient safety – development of a conceptual framework based on a systematic review

BACKGROUND: There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review. METHODS: We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes. RESULTS: The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked. CONCLUSION: Knowledge about the mechanisms underlying the relationships between these concepts helps to identify avenues for future research, aimed at benefiting clinicians and patients by using the synergies between teamwork, clinician occupational well-being and patient safety. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1535-y) contains supplementary material, which is available to authorized users

Humani epididimisni protein 4 u predikciji ovarijalnog karcinoma kod pacijentkinja sa tumorom jajnika

Background In the Unites States of America, near 10% of women in their lifetime will be hospitalized and operated on because of ovarian mass suspected for an ovarian cancer. Diagnostic options are limited for a gynecologist to detect ovarian cancer in its early stages. As a result, around 70% of ovarian cancer cases are diagnosed in the advanced disease stages, when 5-year survival is sometimes less than 30%. The prognosis is better, if the surgery is performed by gynecological oncologist in specialized cancer care centers. In that direction, a proper triage is of pivotal importance for an optimal surgical treatment and consequently a better survival. Objectives To find out the validity of tumor marker HE4 in diagnosis of ovarian cancer and compare it with the validities of CA125 and ultrasound. To find out the validity of our Algorithm for prediction of ovarian malignancy (APOM) and compare it with validities of biochemical tumor markers previously mentioned, algorithms, ultrasound scores and doppler indices (ROMA, CPH-I, RMI, MI, PI and RI). Material and methods Prospective clinical trial included 200 cases in the study group with detected ovarian tumor by ultrasound. Inclusion criteria were: women 18 years of age and older with an ovarian mass, scheduled for surgical intervention. Exclusion criteria: pregnant women, women during lactation, women with prior unilateral and/or bilateral oophorectomy, women with history of current or past malignancy and advanced chronic diseases. The control group represented by healthy women included 100 women with normal ultrasound scan of the ovaries. Ultrasonography was performed using GE Voluson Е8 ultrasound machine with a transvaginal ultrasound probe RIC5-9D, 4-9 MHz (ovarian tumor morphology and doppler of the tumor vasculature). Afterward, patients were scheduled for vein blood sampling for HE4 and CA125 determination. After the surgery and histology verification of the operative material, patients were grouped according to the finding in a group with malign ovarian tumor and a group with benign ovarian tumor. Results Out of 181 cases with ovarian tumor, 40 were diagnosed with epithelial ovarian cancer, 2 with stromal malign tumor, 6 “borderline”, and 133 with benign ovarian tumor. We have analyzed in total 79 healthy women. Validities of tumor markers HE4 and CA125 were calculated only for epithelial ovarian cancer cases and benign ovarian tumors. Sensitivity, Specificity, PPV, NPV and Accuracy for HE4: 75,00%; 87,69; 65,22; 91,94 and 84,71; respectively. For CA125: 80,80%; 59,23%; 37,65%; 90,59 and 64,12; respectively. For ROMA: 97,50%; 69,23%; 49,37%; 98,90 and 75,88. For CPH-I: 92,50%; 84,62%; 64,91% 97,35% and 86,47%. For RMI: 92,50%; 83,85%; 63,79%; 97,32% and 85,88%. For MI: 85,00%; 56,23%; 92,77% and 65,29%. For PI: 65,00%; 52,31%; 29,55%, 82,93% and 55,29%. For RI: 52,50%; 90,77%; 63,64; 86,13 and 81,76%. For APOM: 90,00%; 97,69%; 92,31%; 96,95% and 95,88%. ROC – AUC analyses for the tested parameters as follows: HE4 AUC = 0,946; CA125 AUC = 0,876; ROMA AUC = 0,957; CPH-I AUC = 0,956; RMI AUC = 0,934; MI AUC = 0,836; PI AUC = 0,717; RI AUC = 0,746; APOM AUC = 0,977. Conclusions On the whole population tested (both pre- and postmenopausal together), CA125 appeared to more sensitive than HE4, but, HE4 was far more specific. Of all tested parameters, ROMA was the most sensitive, and APOM was the most specific in the prediction of epithelial ovarian cancer in patients with ovarian tumor

Humani epididimisni protein 4 u predikciji ovarijalnog karcinoma kod pacijentkinja sa tumorom jajnika

Background In the Unites States of America, near 10% of women in their lifetime will be hospitalized and operated on because of ovarian mass suspected for an ovarian cancer. Diagnostic options are limited for a gynecologist to detect ovarian cancer in its early stages. As a result, around 70% of ovarian cancer cases are diagnosed in the advanced disease stages, when 5-year survival is sometimes less than 30%. The prognosis is better, if the surgery is performed by gynecological oncologist in specialized cancer care centers. In that direction, a proper triage is of pivotal importance for an optimal surgical treatment and consequently a better survival. Objectives To find out the validity of tumor marker HE4 in diagnosis of ovarian cancer and compare it with the validities of CA125 and ultrasound. To find out the validity of our Algorithm for prediction of ovarian malignancy (APOM) and compare it with validities of biochemical tumor markers previously mentioned, algorithms, ultrasound scores and doppler indices (ROMA, CPH-I, RMI, MI, PI and RI). Material and methods Prospective clinical trial included 200 cases in the study group with detected ovarian tumor by ultrasound. Inclusion criteria were: women 18 years of age and older with an ovarian mass, scheduled for surgical intervention. Exclusion criteria: pregnant women, women during lactation, women with prior unilateral and/or bilateral oophorectomy, women with history of current or past malignancy and advanced chronic diseases. The control group represented by healthy women included 100 women with normal ultrasound scan of the ovaries. Ultrasonography was performed using GE Voluson Е8 ultrasound machine with a transvaginal ultrasound probe RIC5-9D, 4-9 MHz (ovarian tumor morphology and doppler of the tumor vasculature). Afterward, patients were scheduled for vein blood sampling for HE4 and CA125 determination. After the surgery and histology verification of the operative material, patients were grouped according to the finding in a group with malign ovarian tumor and a group with benign ovarian tumor. Results Out of 181 cases with ovarian tumor, 40 were diagnosed with epithelial ovarian cancer, 2 with stromal malign tumor, 6 “borderline”, and 133 with benign ovarian tumor. We have analyzed in total 79 healthy women. Validities of tumor markers HE4 and CA125 were calculated only for epithelial ovarian cancer cases and benign ovarian tumors. Sensitivity, Specificity, PPV, NPV and Accuracy for HE4: 75,00%; 87,69; 65,22; 91,94 and 84,71; respectively. For CA125: 80,80%; 59,23%; 37,65%; 90,59 and 64,12; respectively. For ROMA: 97,50%; 69,23%; 49,37%; 98,90 and 75,88. For CPH-I: 92,50%; 84,62%; 64,91% 97,35% and 86,47%. For RMI: 92,50%; 83,85%; 63,79%; 97,32% and 85,88%. For MI: 85,00%; 56,23%; 92,77% and 65,29%. For PI: 65,00%; 52,31%; 29,55%, 82,93% and 55,29%. For RI: 52,50%; 90,77%; 63,64; 86,13 and 81,76%. For APOM: 90,00%; 97,69%; 92,31%; 96,95% and 95,88%. ROC – AUC analyses for the tested parameters as follows: HE4 AUC = 0,946; CA125 AUC = 0,876; ROMA AUC = 0,957; CPH-I AUC = 0,956; RMI AUC = 0,934; MI AUC = 0,836; PI AUC = 0,717; RI AUC = 0,746; APOM AUC = 0,977. Conclusions On the whole population tested (both pre- and postmenopausal together), CA125 appeared to more sensitive than HE4, but, HE4 was far more specific. Of all tested parameters, ROMA was the most sensitive, and APOM was the most specific in the prediction of epithelial ovarian cancer in patients with ovarian tumor

Предоперативна употреба на интраортна балон пумпа кај пациенти за бајпас хирургија

Да се направи евалуација на ефективноста на предоперативната употреба на интраортна балон пумпа (IABP) кај пациенти за бајпас хирургија (CABG). Главна цел да се проследи морталитетот, втора цел е да се проследи инциденцата од можните компликации поврзани со IABP-(крварење, исхемоја на нога, аортна дисекција)

Gender-related differences in career development among gynecologic oncology surgeons in Europe. European Network of Young Gynecologic Oncologists' Survey based data

Gender-related differences in career development are well known issues in various professions. An international survey on gender-related differences was performed among young gynecologic oncology surgeons in Europe to identify potential gender inequalities in career development. A survey on demographics, clinical and academic working environment, family/parenting, career development, salary and leadership was sent to all members of the European Network of Young Gynecologic Oncologists (ENYGO), which is a network within the European Society of Gynecologic Oncology (ESGO). Gynecologic oncology surgeons and obstetricians/gynecologists who actively work in this field in Europe were included in the study. Responses were analyzed from 192 gynecologic oncology surgeons of whom 65.1% (125/192) were female (median age 37, IQR: 34 - 42) and 34.9% (67/192) were male (median age 38, IQR: 36 - 41). Male reported to perform a median of 15 and female a median of 10 operations per month (p =. 007). Among female, 24.8% had a leadership position vs. 44.8% among male, crude OR = 2.46, 95% CI 1.31-4.62, p<.01. When stratifying for age under 41 and having children, 36.7% of male and 5.6% of female had a leadership position, adjusted OR 10.8, 95% CI 3.28-35.64, p <.001. A significantly higher proportion of female compared to male believed they earned less than their gender counterparts at the same clinical position and with same qualifications (30.4% vs. 2.5%, p<.001). There was not a statistically significant gender difference in the academic qualification PhD degree or professorship (p =.92 and p =.64, respectively). In the previous year, male published more peer-reviewed articles than female (median 3 vs. median 2; p =.017). This first comprehensive survey on gender-differences in gynecologic oncology in Europe revealed that there are gender gaps concerning several aspects during the critical time of career development in the young generation of gynecologic oncology surgeons. These gender gaps are particularly reflected by a lower rate of female leadership positions. ENYGO and ESGO are dedicated to work on solution to overcome the identified obstacles and to support closing gender gap

Evaluating risk, safety and efficacy of novel reproductive techniques and therapies through the EuroGTP II risk assessment tool

STUDY QUESTION Can risks associated with novelties in assisted reproduction technologies (ARTs) be assessed in a systematic and structured way? SUMMARY ANSWER An ART-specific risk assessment tool has been developed to assess the risks associated with the development of novelties in ART (EuroGTP II-ART). WHAT IS KNOWN ALREADY How to implement new technologies in ART is well-described in the literature. The successive steps should include testing in animal models, executing pre-clinical studies using supernumerary gametes or embryos, prospective clinical trials and finally, short- and long-term follow-up studies on the health of the offspring. A framework categorizing treatments from experimental through innovative to established according to the extent of the studies conducted has been devised. However, a systematic and standardized methodology to facilitate risk evaluation before innovations are performed in a clinical setting is lacking. STUDY DESIGN, SIZE, DURATION The EuroGTP II-ART risk assessment tool was developed on the basis of a generic risk assessment algorithm developed for tissue and cell therapies and products (TCTPs) in the context of the project 'Good Practices for demonstrating safety and quality through recipient follow-up European Good Tissue and cells Practices II (EuroGTP II)'. For this purpose, a series of four meetings was held in which eight ART experts participated. In addition, several tests and simulations were undertaken to fine-tune the final tool. PARTICIPANTS/MATERIALS, SETTING, METHODS The three steps comprising the EuroGTP II methodology were evaluated against its usefulness and applicability in ART. Ways to improve and adapt the methodology into ART risk assessment were agreed and implemented. MAIN RESULTS AND THE ROLE OF CHANCE Assessment of the novelty (Step 1), consisting of seven questions, is the same as for other TCTPs. Practical examples were included for better understanding. Identification of potential risks and consequences (Step 2), consisting of a series of risks and risk consequences to consider during risk assessment, was adapted from the generic methodology, adding more potential risks for processes involving gonadic tissues. The algorithm to score risks was also adapted, giving a specific range of highest possible risk scores. A list of strategies for risk reduction and definition of extended studies required to ensure effectiveness and safety (Step 3) was also produced by the ART experts, based on generic EuroGTP II methodology. Several explanations and examples were provided for each of the steps for better understanding within this field. LIMITATIONS, REASONS FOR CAUTION A multidisciplinary team is needed to perform risk assessment, to interpret results and to determine risk mitigation strategies and/or next steps required to ensure the safety in the clinical use of novelties. WIDER IMPLICATIONS OF THE FINDINGS This is a dynamic tool whose value goes beyond assessment of risk before implementing a novel ART in clinical practice, to re-evaluate risks based on information collected during the process

. Evaluating risk, safety and efficacy of novel reproductive techniques and therapies through the EuroGTP II risk assessment tool.

Study question: Can risks associated with novelties in assisted reproduction technologies (ARTs) be assessed in a systematic and structured way? Summary answer: An ART-specific risk assessment tool has been developed to assess the risks associated with the development of novelties in ART (EuroGTP II-ART). What is known already: How to implement new technologies in ART is well-described in the literature. The successive steps should include testing in animal models, executing pre-clinical studies using supernumerary gametes or embryos, prospective clinical trials and finally, short- and long-term follow-up studies on the health of the offspring. A framework categorizing treatments from experimental through innovative to established according to the extent of the studies conducted has been devised. However, a systematic and standardized methodology to facilitate risk evaluation before innovations are performed in a clinical setting is lacking. Study design, size, duration: The EuroGTP II-ART risk assessment tool was developed on the basis of a generic risk assessment algorithm developed for tissue and cell therapies and products (TCTPs) in the context of the project 'Good Practices for demonstrating safety and quality through recipient follow-up European Good Tissue and cells Practices II (EuroGTP II)'. For this purpose, a series of four meetings was held in which eight ART experts participated. In addition, several tests and simulations were undertaken to fine-tune the final tool. Participants/materials, setting, methods: The three steps comprising the EuroGTP II methodology were evaluated against its usefulness and applicability in ART. Ways to improve and adapt the methodology into ART risk assessment were agreed and implemented. Main results and the role of chance: Assessment of the novelty (Step 1), consisting of seven questions, is the same as for other TCTPs. Practical examples were included for better understanding. Identification of potential risks and consequences (Step 2), consisting of a series of risks and risk consequences to consider during risk assessment, was adapted from the generic methodology, adding more potential risks for processes involving gonadic tissues. The algorithm to score risks was also adapted, giving a specific range of highest possible risk scores. A list of strategies for risk reduction and definition of extended studies required to ensure effectiveness and safety (Step 3) was also produced by the ART experts, based on generic EuroGTP II methodology. Several explanations and examples were provided for each of the steps for better understanding within this field. Limitations, reasons for caution: A multidisciplinary team is needed to perform risk assessment, to interpret results and to determine risk mitigation strategies and/or next steps required to ensure the safety in the clinical use of novelties. Wider implications of the findings: This is a dynamic tool whose value goes beyond assessment of risk before implementing a novel ART in clinical practice, to re-evaluate risks based on information collected during the process. Study funding / competing interest(s): This study was called EUROGTP II and was funded by the European Commission (Grant agreement number 709567). The authors declare no competing interests concerning the results of this study