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AEMIR Action Guide in the ER. Second Edition

This guide is made by residents in Spain, is intended for residents of all specialties and was born at the initiative of the English Association of resident physicians.
Its goal is to become a resource for easy reference to the diagnostic and therapeutic emergency situations that most commonly we can find in our daily practice. When an emergency situation to attack us doubt about the diagnosis and treatment.
try to emulate and somehow replace the classic "Book of the resident" that most of us carry in the bag coat as a protective shield of our still fragile knowledge.
On the other hand, for the authors is a rare opportunity to start in the publishing world, which is a considerable challenge in these very early stages of our career, we try to overcome the illusion of bringing new tools to our group.
We are aware of the imperfections that must necessarily be in the first three editions so we appealed to the understanding of the readers to judge us kindly. We hope to improve, update and expand it annually, to which we invite all residents to participate in future editions (Preview .)

• print Price: 15 € (shipping included in Spain)

To purchase the print version of the guide aemirmail@gmail.com send an email indicating name and mailing address. Pdf now also "Guide to Emergency Action AEMIR" is given away to all members of Medicalia.org

• or download the eBook for Kindle .

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SECTION WE HAVE TO BE RESIDENTS!

In the corridors of hospitals and healthcare facilities often hear comments about working conditions residents, the guards do not warrant, cuts in allowances and the number of guards, the general supervision, etc. Years ago we tried to join forces through partnerships, national first and then given the fragmented nature of our NHS, regional level. These platforms have played a key role in the reform of legislation on residents, their training and employment. However, and once gained half the targets set, the problems are still there because the medium we use to communicate with government was not that these institutions required by legal mandate. We needed union support and collegial. Section Residents born with the desire to be a bridge to between residents and the administration of the Community of Madrid. No ideological label, or other large electoral program promises difficult to meet, the only aspiration is to occupy the Residents Section empty place in our representation on the Company with the Madrid Health Service, so that we can maintain fluid communications with the administration about our concerns and issues that affect us.

At present these issues of concern to residents (MIR, FIR, BIR, etc.) are cleared by stewards have nothing to do with us and completely ignore the reality of our duality-care training. Under the umbrella of AMYTS (CESM) and full freedom of action, Section Residents aspires to be in those tables you should always have been, which is the Health Sector and General Public of Madrid .

It's time. Residents have to be in any body or institution where decisions are made that affect us. From Section Residents, a platform formed exclusively by residents, we commit ourselves to the weak value Residents voice and defend our system of policy formation and short-term decisions that can be taken at all times.

Website http://seccionresidentes. Blogspot.com

Facebook: http://www.facebook.com/ seccionresidentes

Twitter: @ seccionresident

Email: seccionresidentes@gmail.com

Youtube: http:/ / www.youtube.com/ SeccionResidentes

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before the end of the year with four new specialties: infectious diseases, genetics, child and adolescent psychiatry, urgent and emergency

L he Minister of Health, Social Policy and Equality, Leire Pajin, today announced at the plenary session of Congress before the end of the year will be dealt a royal decree allowing the creation of four new specialty: Infectious diseases, Genetics, Psychiatry infant and youth, and urgencies and emergencies.

This decision reflects the commitments made by the Ministry of Health, Social Policy and Equality and the interest of many groups of professionals and patients who may benefit from these specialties, for example, people with HIV and AIDS (in the case of infectious diseases) and patients with rare diseases (in the case of the specialty of genetics).

Leire Pajin also explained that the Ministry is working for the specialties of Medicine, Physical Education and Sport, and Forensic Medicine, which is now under a student enrolled in some schools medicine as specialties can strengthen the system of internal MIR.

According to the minister, "the medical specialty of Physical Education and Sport is essential to strengthen preventive work, which is consistent with the provisions of the General Bill of Health Public. "

also indicated that the specialty of Legal Medicine and Forensic not least because it has an important role in prevention and assistance in cases of gender violence.

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Of the 1,000 first MIR only 5 chose Family Medicine

Among the top 1,000 points out that only 5 people have Legido the specialty of Family Medicine (less than 1 percent of the positions offered to FCM) and that in the coming days wannabes not eligible for Dermatology, spaces are finished with the election of the person who had the number 1015, and will make the specialty in the Hospital Clinico Universitario de Valladolid.

also stressed in this ranking of less popular specialties, Lung, with 1.75 percent of their allotted places, ie, chose only 2 people in the top 1,000 and the offer is for 114 posts. And finally, Physical Medicine and Rehabilitation, with a square cover the 98 existing 1 percent.

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AMERICAN PHYSICIANS IN SPAIN

A word I shall be healed: AMERICAN PHYSICIANS IN SPAIN. EDUARDO CA ... : "The first time I really felt what it meant emigration was 20. By then I was a gullible young man, an alcoholic and ... "

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Legitimate cement. A history of medicine and a half of love in San Carlos de Bariloche, Argentina

This is an account of the licenses that gives you the everyday life and people call happiness. Happiness comes as elections every four or five years, and as the orgasm, you need to know to see it coming. This is an account of the heartbeat and pulse of a country. De losers and losers who appear but in the background are winners. Of winners who pretend they are because they are actually losers. Roberto Sánchez is a English general practitioner who had been all his life and Argentina did not know until 28 years went to work one month at a Center Cheers for the city of San Carlos de Bariloche. There was a feeling that they have adopted children when compared to their biological parents and do not know. The feeling of women while pregnant and still do not know. The feeling he will die in the next breath and do not know. From his vantage point of deep anti-hero, will describe the geography, sociology, health services ... but above all human relationships, feelings, and ultimately, of course, love, which is a gas, the air moving Waving Argentina Flag (Read more ).

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Possible movie

The popular video game 'Devil May Cry' prepares his leap to the big screen. Screen Gems, a production company belonging to the framework of the giant Sony already made into a movie in the series Resident Evil, Capcom's license also has acquired the film rights to the game.

Ins a revealing to a report by Variety is the intention of the study, as it did with 'Resident Evil', create a story that for several movies. To this end have already begun work on the script to Kyle Ward, one of the screenwriters of the film 'Kane & Lynch' (another video game this time from Eidos) whose script is still in a drawer waiting for someone to haul in production.

The saga created by Capcom in 2001 for PlayStation 2 tells the story of Dante, the protagonist half human and half demon, son of Eva, a human, and Sparda, one of the demons powerful than ever. After the death of his mother, Dante hunts demons to sword and also his twin pistols Ebony and Ivory. Do not skimp.

After losing the success and impact of the first rendition of 'Devil May Cry, Capcom plans to reinvention of the series with a new release which will have a completely different aesthetic. Dante will also undergo a thorough facelift.

There are no cast or director, or even start date for shooting the film 'Devil May Cry. " Yes, the producers want the first installment of the saga is in theaters in summer 2013.

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Devil May Cry Resident Evil 5! Krusty

The company Sony Pictures has just confirmed that the series set in the blockbuster film franchise Resident Evil come back to screens around the world next year. According to the release of the producer, will be on September 14, 2012 when the fifth installment of the series that tells the zombie apocalypse created by Capcom comes to U.S. theaters.


Among the details surrounding the film, Sony Pictures will provide an opportunity for viewers to enjoy it in 3D, which is common in commercial release today. The current name of the project is a brief 'Resident Evil 5', and count the events that occurred after the fourth film, Resident Evil: Ultratumba, a film that grossed $ 236 million exceeding two times the amount of profits by Resident Evil: Extinction.

Residents: Workers or Students in the Eyes of the Law? Extinction

Aaron S. Kesselheim, MD, J.D., M.P.H., and Kirsten E. Austad, B.S.

NEJM on their educational development.

In the eyes of the law, however, the answer may be different. For example, in malpractice cases, residents can be judged according to the same standard of care as more senior physicians. In 1999, the National Labor Relations Board (NLRB) declared residents to be employees, and thus able to join unions, on the basis of their direct patient care and receipt of compensation and standard employment-related benefits. The NLRB found that the educational component of residency “complements, indeed enhances, the considerable services the Hospital receives from the house staff, and for which the house staff are compensated.”

1

Now, in the case of ^{Mayo Foundation for Medical Education and Research, et al. v. United States,} the Supreme Court has added its weighty voice to the question of whether residents are workers or students. The centerpiece of the controversy was the 1935 Federal Insurance Contributions Act (FICA), which provided for supplemental taxes on employers and employees that fund the Social Security program. An amendment in 1939 created a student exemption for a “service performed in the employ of . . . a school, college, or university . . . if such service is performed by a student enrolled in and regularly attending classes at such school, college, or university.” In its regulations, the U.S. Treasury announced that the student exemption would apply for a service performed “incident to and for the purpose of pursuing a course of study” at the institution.

The issue of whether medical residents fit under the student exemption lay quiescent — with many hospitals paying FICA taxes on residents as if they were employees — until the 1990s, when the Social Security Administration sought to recover unpaid taxes from the University of Minnesota, which had long considered its house staff to be exempt from FICA. The case reached the Eighth Circuit Court of Appeals, which ruled in favor of the university because an analysis of the particular residency program led to the conclusion that “the primary purpose for the residents’ participation in the program is to pursue a course of study rather than to earn a livelihood.” 2 After that 1998 decision, sponsors of residency programs throughout the country filed thousands of claims to recover paid FICA taxes. In the resulting litigation, other Circuit Courts held that residents could qualify for the student exemption. The Treasury ultimately compromised by conceding existing refund claims and promulgating a new prospective regulation. Its “clarifying” regulation — which became effective April 1, 2005 — states that in all cases “the services of a full-time employee are not incident to and for the purpose of pursuing a course of study” and specifies that residents working more than 40 hours per week are categorically ineligible for the student exemption.

The Mayo Foundation and the University of Minnesota sued to overturn the Treasury’s new regulation. Supported by numerous hospitals and academic medical centers in friend-of-the-court briefs, Mayo and Minnesota offered both functional and structural reasons why house officers should legally be considered students. They compared a residency’s function to that of an undergraduate degree: a residency is usually chosen on the basis of academic opportunities, and completion of an accredited program is required for practicing medicine in the United States. They also argued that residency training involves characteristics of other programs of learning, including supervised work, educational curricula, and numerous lectures and conferences. In fact, they claimed that “the academic program of a medical resident is virtually indistinguishable from that of a third- or fourth-year medical student,” because both learn from a combination of hands-on care and didactics. ³

In defense of the Treasury regulation declaring residents to be employees, government lawyers pointed to residents’ vast patient care responsibilities, which absorb 85 to 90% of their time and take precedence over educational conferences. Legislative history also arguably supported the Treasury, including the fact that although the 1939 FICA amendments contained an additional clause specifically excluding from the definition of employment the “service performed as an interne in the employ of a hospital,” the intern-specific language was dropped in 1965. An accompanying report noted that the rationale was to “give young doctors an earlier start in building up social security protection”: exempting residents from paying FICA taxes could be detrimental, since certain minimum contributions (depending on a person’s age) are required for eligibility for disability benefits.

At stake in

Mayo v. United States

were substantial financial implications for academic medical centers and their house staff. The taxes at issue amount to about $700 million per year for U.S. hospitals and academic medical centers.

4

These resources may otherwise be well spent on patient care and medical education. FICA taxes also amount to about $4,000 a year in an individual resident’s salary, a sum that could certainly benefit residents, whose high levels of debt can influence their specialty and career choices.

On January 11, 2011, the Supreme Court ruled in an 8-to-0 decision (Justice Elena Kagan was recused) that the Treasury regulation making residents categorically ineligible for the student exemption was a “perfectly sensible” way of distinguishing education from service for the purposes of the tax code. Chief Justice John Roberts wrote that residents could reasonably be construed as “the kind of workers that Congress intended to both contribute to and benefit from the Social Security system.”

Indeed, although residencies allow physicians to learn by serving as physicians in an environment of structured oversight, a resident differs in notable ways from a “student” who is “enrolled in and regularly attending classes.” Whereas medical students participate in a multidisciplinary plan of study and engage in clinical clerkships to learn from residents and attending physicians without any true service obligations (except when they are acting as sub-interns), residents serve as a workforce. Mayo and Minnesota have denied receiving economic value from the work of residents, arguing that they “permit their residents to care for patients purely for

educational

purposes . . . residents do not provide a net economic benefit.”

3

This contention, however, is implausible: residents are clearly indispensable to the care provided at the hospitals where they are employed, even if their work is reviewed by supervising physicians. Moreover, the ACGME requirements regarding didactic time and educational benchmarks for residents face objections from many hospitals that need to find costly replacement providers for lost work time.

5

The Supreme Court’s decision in ^{Mayo v. United States} may have other, indirect legal implications as well. Residents could find additional support in the Court’s unambiguous holding for efforts to enforce other workplace rights, such as unemployment benefits (e.g., after hospital closure) or protection under the Family Medical Leave Act. Residents may not be fully trained physicians, but there are benefits to not being labeled as “students” in the eyes of the law.

This article (10.1056/NEJMp1100414) was published on January 12, 2011, at NEJM.org.

Disclosure forms

provided by the authors are available with the full text of this article at NEJM.org.

Source Information

From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston (A.S.K., K.E.A.), and the Edmond J. Safra Center for Ethics at Harvard University, Cambridge, MA (K.E.A.).

References

Boston Medical Center Corporation and House Officers’ Association/Committee of Interns and Residents. 330 N.L.R.B. 30 (1999).

Minnesota v. Apfel, 151 F.3d 742 (8th Circuit, 1998).

Brief for the Petitioners, Mayo Foundation for Medical Education and Research, et al. v. U.S., No. 09-837 (Aug. 2010).
Brief for the United States, Mayo Foundation for Medical Education and Research, et al. v. U.S., No. 09-837 (Sept. 2010).
Nuckols TK, Bhattacharya J, Wolman DM, Ulmer C, Escarce JJ. Cost implications of reduced work hours and workloads for resident physicians. N Engl J Med
4. 2009;360:-2215
Full Text SPECIALTY

"Since we learned of this decision by the Ministry of Health has made an enormous effort to explain the importance of this specialty in our society, in their

multifaceted but especially in what relates to the use of exercise as the first diagnostic tool in the management of a large number of chronic diseases, some scourge epidemic as obesity and high blood pressure, our developed society.

2. The extraordinary progress of English sport in recent years is not justified without the great contribution of sports medicine in improving health conditions and training of athletes.

3. The disappearance of the specialty will have an incalculable negative impact on many aspects, but you can say that will mean a significant increase
results

positive doping in our sport and the consequent international prestige.

4. The prevention of athlete's sudden death, which has been the subject of great attention from the public, will be deprived of an essential tool as is the specialty of

Sports Medicine.

5. The disappearance of the private specialist to amateur athletes, who can not go to public services in this field, leaving their benefits only for those sports structures or people with financial availability.

6. It is incomprehensible that the Ministry of Health acting back to society, showing that lack of sport, taking a unilateral decision without precedent, when

society, the world of sport and sport policy makers have repeatedly expressed its willingness to maintain the specialty Sports Medicine.

7. Hopefully the Ministry of Health to reconsider this decision which puts it in front of the society that has to do with sport and physical activity (one third of the English population) and not incur a liability which surely must be corrected in the near future. "

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The experiences of the rotation of a English resident physician of Family and Community Medicine at San Carlos de Bariloche, Argentina.

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Legitimate sports medicine specialty cement. A history of medicine and a half of love in San Carlos de Bariloche, Argentina

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"Rigging" in the MIR! National Investigation Board

doctors in training: 70% of residents who started the resid English ...

: "The feminization of the medical profession is a growing reality: According to official data, 70 percent of the 4,568 English MIR have ..."