Boletín de la Asociación Médica de Puerto Rico
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Renal stones (nephrolithiasis) are a relatively common problem and a frequent Emergency Department (ED) diagnosis in patients who present with acute flank/abdominal pain. The goal of this topic review is to provide physicians with an evidence-based diagnostic approach for the evaluation and management of patients with nephrolithiasis. ⋯ Pain management can be achieved by using NSAIDs, opioids or a combination of both. Several factors will help you determine if emergent urology evaluation is warranted; size and location of renal calculi, persistence of colic pain, impaired renal function and signs of infection.
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Historical Article
[The University of Puerto Rico Emergency Medicine Program: 15th anniversary, its history and contribution to health care in Puerto Rico].
Emergency medicine is a newly created specialty in Puerto Rico. The first training program began in 1977. Unfortunately this program was decertified by ACGME in 30 July 30 1993. ⋯ Approximately 25% of emergency rooms directors in PR are graduates. About 27% of graduates have subspecialties. It is also important to note that graduates of the program have helped to improve the quality of health care offered in emergency rooms in the country.
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The utilization of different reconstructive techniques for rotator cuff arthropathy, complex fractures of the proximal humerus and pathologies that involve the glenohumeral joint, has become a controversial issue in orthopaedic surgery nowadays. The purpose of the current study was to evaluate early outcomes of reverse total shoulder arthroplasty for primary osteoarthritis with a rotator cuff tear, rotator cuff arthropathy three and four part humerus fractures and proximal comminuted displaced humerus fractures in a group of Latin-American patients. ⋯ In our study we have shown that the reverse total shoulder replacement is a successful surgery, the mean improvement in the outcome scores have been significant in all patients, been the greatest improvement in the arthropathy groip. (Table II and Table III).
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Marital satisfaction has been previously associated with job satisfaction although few studies have addressed this issue among Hispanic physicians. Marital and job satisfaction were assessed in a sample of 92 legally married non-residents physicians working at a Hispanic Academic Medical Center during the 2006-2007 academic year. Marital satisfaction was assessed using the Dyadic Adjustment Scale (DAS) and job satisfaction was measured using a 18-item scale. ⋯ The percentage of participants that reported to be "very satisfied" with their job, was higher among the group of surgical specialists (23.3%) than among the non-surgical specialists (13.0%) There was no significant relationship between marital satisfaction and job satisfaction. Also, no statistically significant difference was observed in the level of marital satisfaction and job satisfaction when surgical and non-surgical physicians were compared. The findings on marital satisfaction obtained in this sample were similar to those observed in a previous study of resident physicians at the same academic medical center.
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The article analyzes the challenge that the health professionals encounter when trying to protect their patient's confidentiality, considering the increasing demand for globalization of the information. It discusses the importance that confidentiality has for the therapeutic alliance and how the government has protected it throughout time. It identifies weak areas in the protection of confidentiality, especially in the psychiatry field. Finally, it invites the reader to consider the real benefits of sharing patient's information when deciding whether to brake or not the patient's confidentiality.