metricas
covid
Buscar en
Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
Toda la web
Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) New Nomenclature: a long and tortuous road
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
New Nomenclature: a long and tortuous road
Nuevo Nomenclator: un largo y tortuoso camino
R. Arriaza Loureda
Arriaza y Asociados Medical Institute, Traumatology Member of the Board of Directors of UNIPROMEL, Spain
Read
878
Times
was read the article
224
Total PDF
654
Total HTML
Share statistics
 array:23 [
  "pii" => "S1988885621000626"
  "issn" => "19888856"
  "doi" => "10.1016/j.recote.2021.05.011"
  "estado" => "S300"
  "fechaPublicacion" => "2021-07-01"
  "aid" => "966"
  "copyrightAnyo" => "2021"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "edi"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2021;65:237-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S1888441521000849"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2021.05.001"
      "estado" => "S300"
      "fechaPublicacion" => "2021-07-01"
      "aid" => "966"
      "copyright" => "SECOT"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "edi"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2021;65:237-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Nuevo Nomenclator&#58; un largo y tortuoso camino"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "237"
            "paginaFinal" => "238"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "New Nomenclator&#58; a long and winding road"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rafael Arriaza Loureda"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "Arriaza Loureda"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1988885621000626"
          "doi" => "10.1016/j.recote.2021.05.011"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885621000626?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441521000849?idApp=UINPBA00004N"
      "url" => "/18884415/0000006500000004/v1_202107020652/S1888441521000849/v1_202107020652/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S1988885621000365"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2021.04.002"
    "estado" => "S300"
    "fechaPublicacion" => "2021-07-01"
    "aid" => "912"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2021;65:239-47"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Risk factors in total hip arthroplasty and hemiarthroplasty&#58; Infection and mortality"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "239"
          "paginaFinal" => "247"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores de riesgo en artroplastia total y parcial de cadera&#58; infecci&#243;n y mortalidad"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Hern&#225;ndez-Aceituno, M&#46; Ruiz-&#193;lvarez, R&#46; Llorente-Calder&#243;n, P&#46; Portilla-Fern&#225;ndez, A&#46; Figuerola-Tejerina"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Hern&#225;ndez-Aceituno"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Ruiz-&#193;lvarez"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Llorente-Calder&#243;n"
            ]
            3 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Portilla-Fern&#225;ndez"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Figuerola-Tejerina"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441520301600"
        "doi" => "10.1016/j.recot.2020.08.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441520301600?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885621000365?idApp=UINPBA00004N"
    "url" => "/19888856/0000006500000004/v1_202106080544/S1988885621000365/v1_202106080544/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "New Nomenclature&#58; a long and tortuous road"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "237"
        "paginaFinal" => "238"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "R&#46; Arriaza Loureda"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Arriaza Loureda"
            "email" => array:1 [
              0 => "arriazarafael@gmail.com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Arriaza y Asociados Medical Institute&#44; Traumatology Member of the Board of Directors of UNIPROMEL&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Nuevo Nomenclator&#58; un largo y tortuoso camino"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">For many historians&#44; 1989 was a year when events accelerated&#46; These events included the death of Ayatollah Khomeini&#44; the Tiananmen massacre&#44; the defeat of Augusto Pinochet&#44; and the fall of the Berlin Wall&#44; which heralded the dissolution of the Soviet Union&#46; And if that were not enough&#44; the World Wide Web was born that year&#44; which today it would seem impossible to live without&#46; That was 32 years ago and&#44; to put it in perspective&#44; traumatologists have graduated who were not even born when all this was happening&#46; In April 1989&#44; the Collegiate Medical Organisation of Spain &#40;OMC&#41; published the &#8220;Terminological Classification of Medical Techniques and Procedures&#8221; &#40;for use by health insurance companies&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> According to the foreword it was intended as &#8220;a first step in the organisation of the liberalised part of public healthcare&#8221;&#46; Its authors considered it not to be &#8220;a closed work&#44; but a first edition whose dynamism and updating in successive editions will rely on the constant spirit of collaboration of the Scientific Societies of the medical specialities&#8221;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since then&#44; this classification&#44; the &#8220;Nomenclature&#8221;&#44; has been widely used and its use has expanded not only in free insurance companies&#44; but also in the field of work&#44; sports and even traffic accidents&#46; Of course&#44; it is unrealistic to look at today&#8217;s world through the eyes of 1989&#44; and attempting to confine such a dynamic and extensive speciality as today&#8217;s orthopaedic and trauma surgery to the limits of what was done then would seem foolish&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">However&#44; for various reasons&#44; it has never been updated&#46; The reasons &#40;and let&#8217;s put them in order according to our own personal criteria&#44; adding or subtracting those we wish&#41; could be listed to include the indoctrination of a collective accustomed to high social standing&#44; which would make any type of protest to improve their conditions not very appropriate&#59; the traditional lack of initiative on the part of doctors in anything other than the direct practice of their profession&#59; the historical disunity of the collective&#59; the lack of a culture of association among a large proportion of doctors&#44; who in many cases are accustomed to seeing their colleagues as enemies rather than competitors&#44; without realising that the real enemies are others&#59; the lack of business education among doctors&#44; added to the convenience of using familiar terminology which&#44; although obsolete&#44; provided a comfortable framework&#44; like the armchair in your home that you are so used to that&#44; 32 years later&#44; you do not see as old&#44; worn and tarnished&#44; and which you do not notice has become uncomfortable because it is part of your everyday life&#59; the Scientific Societies having become comfortable&#44; more accustomed to looking only towards the public practice of the profession&#59; the lack of a defined leadership to propose changes&#44; due to the effort&#44; involvement and time that this work would entail&#59; the lack of interest on the part of the OMC&#44; dedicated to other less mundane matters&#44; accompanied by the lack of interest on the part of insurers&#8230; In short&#44; everything has conspired to ensure that orthopaedic and trauma surgery nomenclature has not been updated in 32 years&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The 2017 survey showed that at least a third of SECOT members work&#44; either part-time or full-time&#44; in a private practice setting&#44; and although SECOT&#8217;s own statutes prevent it from participating in claims related to the professional scope of traumatology practice&#44; there is no doubt that the definition of the specialty&#39;s own acts falls squarely within SECOT&#8217;s remit&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2017&#44; a group of orthopaedic surgeons proposed by the OMC and SECOT came up with a new nomenclature&#44; which was no easy task and took many hours of work&#46; At the first meeting in the OMC headquarters with the representatives of the different health insurance companies&#44; their intention to boycott any significant change and to control the process was so obvious that we left the table&#44; making it clear that we would not tolerate their interference in a purely medical area&#59; the definition and classification of medical acts into difficulty groups&#46; When things had settled down&#44; we held three more meetings&#46; Before each meeting&#44; the insurers were sent the proposals we intended to discuss&#44; but nothing effective was ever achieved&#46; Sometimes because &#8220;they had not had time to study them&#8221;&#44; and sometimes because they considered them &#8220;unacceptable&#8221; because it would be disruptive for them to adapt their IT systems to new procedural codes&#44; or because of the possible economic cost of raising the difficulty group of a process&#46; This we were told by representatives of an insurance company that systematically has annual profits in excess of 300 million euros&#33; In the end&#44; tired of spending time and effort on a task destined to fail&#44; we abandoned the whole charade&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2019&#44; the Private Care Committee of the OMC conducted a survey among many practitioners and published a report stating &#8220;Private medical practice is no longer free under current market conditions&#46; Insurance companies have changed the classical model of private medical care and&#44; in addition to their insurance work&#44; have gained an increasingly prominent presence in healthcare work&#44; largely at the cost of undermining the ability of private medical practitioners to compete&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The initial position of the OMC was to attempt to change the nomenclature of 5 specialties every year&#44; leaving the most complex to last&#44; given the difficulty of the process&#46; With luck&#44; the updated orthopaedic and trauma surgery nomenclature could be a reality by 2030&#46; Can anyone imagine what it would have meant to be forced to restrict the orthopaedic and trauma surgery of 2000 &#40;to use a round number&#41; to the criteria of 1959&#63; Furthermore&#44; and as if this were not enough&#44; medical fees have been frozen since before 2000&#44; meaning that what insurers paid on average for a consultation before the Euro was adopted remains virtually unchanged&#46; Following the example of other specialities&#44; such as ophthalmology&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> the idea of updating the nomenclature was driven under the direct responsibility of the orthopaedic surgeons&#44; for it to be presented and approved by the OMC&#46; The nomenclature of 2017 was taken as a basis and&#44; after multiple working meetings throughout 2020&#44; a new proposal for the nomenclature was drawn up&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thanks to work that I believe is considered impeccable by everyone&#44; the new version of the nomenclature was drawn up using three objective criteria to calculate the degree of difficulty of each process&#46; Firstly&#44; the time&#44; difficulty &#40;effort&#41; and resources &#40;investment&#41; deployed to achieve the training and level of professional development necessary to perform the professional act with skill&#44; agility&#44; and safety&#46; Secondly&#44; the level of responsibility taken on by the practitioner in carrying it out&#44; as an expression of the degree to which a complication of the surgical act may result in loss of structure and&#47;or function of a limb or the patient&#59; and finally&#44; the average time that the medical or surgical act requires&#44; not counting the time between cleaning or staff breaks&#46; The inclusion of this last factor adds consistency to the difference in process fees between subspecialties&#46; For an understanding of its possible impact&#44; suffice it to say that 118 new codes were introduced&#44; 174 were maintained &#40;sometimes changing their name for a more current one&#41;&#44; and 45 acts were removed because they were obsolete or belonged to the scope of other specialties&#46; Some modifiers were introduced&#44; which would be added to the main procedure&#44; such as the use of navigators or robotic surgery in an intervention&#44; as a way of anticipating a future that is already with us&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Arriaza Loureda R&#46; Nuevo Nomenclator&#58; un largo y tortuoso camino&#46; Rev Esp Cir Ortop Traumatol&#46; 2021&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.recot.2021.05.001">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;recot&#46;2021&#46;05&#46;001</span></p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "titulo" => "Clasificaci&#243;n Terminol&#243;gica de Actos y T&#233;cnicas M&#233;dicas &#40;Para Uso de la Entidades de Seguro Libre de Enfermedad&#41;"
                        "fecha" => "1989"
                        "editorial" => "Consejo General de los Colegios de M&#233;dicos de Espa&#241;a"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Condiciones de competencia en el mercado del ejercicio libre de la medicina&#46; Informe de Resultados&#46; Consejo General de los Colegios de M&#233;dicos de Espa&#241;a&#46; Junio 2019&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevo nomencl&#225;tor estandarizado en oftalmolog&#237;a&#58; Criterios e indicadores cuantitativos de baremaci&#243;n de actos m&#233;dicos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Geg&#250;ndez-Fern&#225;ndez"
                            1 => "A&#46; Pi&#241;ero-Bustamante"
                            2 => "J&#46;M&#46; Ben&#237;tez-del-Castillo"
                            3 => "J&#46; Garc&#237;a-Feijoo"
                            4 => "F&#46;J&#46; Mu&#241;oz-Negrete"
                            5 => "M&#46;S&#46; Figueroa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.oftal.2020.07.019"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Soc Esp Oftalm&#46;"
                        "fecha" => "2020"
                        "volumen" => "95"
                        "paginaInicial" => "591"
                        "paginaFinal" => "602"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/19888856/0000006500000004/v1_202106080544/S1988885621000626/v1_202106080544/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7613"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006500000004/v1_202106080544/S1988885621000626/v1_202106080544/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885621000626?idApp=UINPBA00004N"
]
Article information
ISSN: 19888856
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 3 0 3
2024 October 6 1 7
2024 September 12 3 15
2024 August 9 0 9
2024 July 15 3 18
2024 June 14 1 15
2024 May 22 5 27
2024 April 11 5 16
2024 March 15 4 19
2024 February 7 4 11
2024 January 14 4 18
2023 December 9 7 16
2023 November 9 2 11
2023 October 10 5 15
2023 September 9 3 12
2023 August 10 3 13
2023 July 11 1 12
2023 June 13 3 16
2023 May 21 7 28
2023 April 26 2 28
2023 March 9 2 11
2023 February 7 1 8
2023 January 6 5 11
2022 December 7 4 11
2022 November 9 6 15
2022 October 14 8 22
2022 September 12 6 18
2022 August 46 8 54
2022 July 42 17 59
2022 June 12 17 29
2022 May 10 6 16
2022 April 13 7 20
2022 March 20 9 29
2022 February 28 3 31
2022 January 32 6 38
2021 December 19 5 24
2021 November 10 5 15
2021 October 29 12 41
2021 September 36 12 48
2021 August 16 7 23
2021 July 20 8 28
2021 June 11 7 18
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos