Los organismos que representan a los médicos de los hospitales Clínic y Bellvitge se han pronunciado, en términos que reflejan gran indignación, contra el recorte asistencial que han empezado a sufrir ambos centros a consecuencia del ahorro que les ha impuesto la Conselleria de Salut. La junta clínica que agrupa a los 300 médicos del Hospital de Bellvitge, y las dos asociaciones que representan a los 450 facultativos del Clínic coinciden en destacar la «falsedad» de los mensajes que emite Salut sobre la repercusión del recorte en la asistencia médica que reciben los ciudadanos. Aunque oficialmente aún no están aprobados sus planes de ajuste, en ambos centros se ha reducido ya la actividad.
"Los políticos dicen que los recortes causarán ciertas molestias por la centralización de servicios y el aplazamiento de operaciones de bajo riesgo vital, pero eso está lejos de ser toda la verdad --indica la junta clínica de Bellvitge--. La población debe saber que habrá una importante reducción de las unidades de cuidados intensivos, que algunas cerrarán para siempre, y que se reducirá drásticamente la presencia de cirujanos en los servicios de urgencias y en los cuerpos de guardia del hospital".
Los especialistas del Clínic advierten de que las medidas previstas "reducirán notablemente las prestaciones sanitarias" que se ofrecen en Catalunya y exponen la "indignación" del colectivo médico por las "falsedades" emitidas desde la Generalitat. "No es cierto que el cierre definitivo de más de 300 camas entre todos los hospitales de Barcelona, y la supresión de quirófanos, no afecte a la calidad de la asistencia", indicaron.
**Publicado en "EL PERIODICO DE CATALUNYA"
19 April 2011
CD image import reduces unnecessary imaging exams in emergency rooms
Each year, more than two million critically ill patients are transferred from one hospital emergency department (ED) to another for appropriate care. With the ability to successfully import data from a CD-ROM containing the patient's diagnostic medical images, hospitals may be able to significantly reduce unnecessary medical imaging tests, some of which expose patients to radiation. These findings are reported in a new study published in the July issue of Radiology. According to researchers at Brigham and Women's Hospital in Boston, the implementing a system to upload CD images of emergency transfer patients into the receiving institution's picture archiving and communication system (PACS) decreased the rate of subsequent imaging by 17 percent.
"Because there is no central repository for medical images or a large-scale system to transfer images electronically between hospitals, a CD with diagnostic imaging is among the most critical components in the hand-off of clinical information for patients transferred between hospitals," said lead researcher Aaron Sodickson, M.D., Ph.D., interim director of emergency radiology at Brigham and Women's Hospital.
When CD images are imported into PACS, the images can be efficiently reviewed by multiple members of the healthcare team, even if they are in different locations. When the receiving hospital does not have that import ability, or when an import is unsuccessful because a CD is damaged, lost or in a non-standard image format, repeat imaging is often performed.
"We know that a substantial portion of imaging performed on ED transfer patients is repeated at the receiving institution, which drives up healthcare costs, delays patient care and often exposes patients to additional ionizing radiation and intravenous contrast material," Dr. Sodickson said.
In July 2008, Brigham and Women's Hospital implemented a system to import outside imaging sent on CD into the institution's PACS 24 hours a day. Receiving physicians were required to place a CD import order with the patient's history in the hospital's electronic radiology ordering system and deliver the CD to the emergency radiology support staff, who would subsequently import the CD contents into PACS using a software application that identifies and imports Digital Imaging and Communication in Medicine (DICOM) format files.
For the study, researchers reviewed the medical records of 1,487 consecutive patients who were transferred to the Brigham and Women's Hospital ED between February and August 2009 with a CD containing medical images acquired elsewhere. CD import to PACS was attempted for all patients and was successful for 1,161, or 78 percent, of the patients. Incompatible image formats or CD malfunction resulted in 326 unsuccessful CD imports.
Compared with the patients whose imaging could not be imported, patients with successfully imported CDs had a 17 percent decrease in imaging rates during the subsequent 24 hours (2.7 versus 3.3 exams per patient) and a 16 percent decrease (1.2 versus 1.4 scans per patient) in subsequent CT scans.
"Implementing CD import procedures has provided us with a far more efficient way to take care of our patients," Dr. Sodickson said.
Extrapolating these results to the approximately 2.2 million patient transfers between American EDs each year, the estimated annual reduction in CT utilization due to successful CD import to PACS would be on the order of 484,000 CT scans.
"One of the goals of our healthcare delivery system must be to provide access to diagnostic imaging results to all locations involved in a patient's care, either through implementation of a universal electronic medical record, image repositories, or robust image transfer networks," Dr. Sodickson said. "But until those solutions reach maturity, ensuring that medical images can be downloaded from CDs in a standard, PACS-compatible format will help to streamline care, reduce costs and protect patients from unnecessary imaging exams."
**Source: Radiological Society of North America
"Because there is no central repository for medical images or a large-scale system to transfer images electronically between hospitals, a CD with diagnostic imaging is among the most critical components in the hand-off of clinical information for patients transferred between hospitals," said lead researcher Aaron Sodickson, M.D., Ph.D., interim director of emergency radiology at Brigham and Women's Hospital.
When CD images are imported into PACS, the images can be efficiently reviewed by multiple members of the healthcare team, even if they are in different locations. When the receiving hospital does not have that import ability, or when an import is unsuccessful because a CD is damaged, lost or in a non-standard image format, repeat imaging is often performed.
"We know that a substantial portion of imaging performed on ED transfer patients is repeated at the receiving institution, which drives up healthcare costs, delays patient care and often exposes patients to additional ionizing radiation and intravenous contrast material," Dr. Sodickson said.
In July 2008, Brigham and Women's Hospital implemented a system to import outside imaging sent on CD into the institution's PACS 24 hours a day. Receiving physicians were required to place a CD import order with the patient's history in the hospital's electronic radiology ordering system and deliver the CD to the emergency radiology support staff, who would subsequently import the CD contents into PACS using a software application that identifies and imports Digital Imaging and Communication in Medicine (DICOM) format files.
For the study, researchers reviewed the medical records of 1,487 consecutive patients who were transferred to the Brigham and Women's Hospital ED between February and August 2009 with a CD containing medical images acquired elsewhere. CD import to PACS was attempted for all patients and was successful for 1,161, or 78 percent, of the patients. Incompatible image formats or CD malfunction resulted in 326 unsuccessful CD imports.
Compared with the patients whose imaging could not be imported, patients with successfully imported CDs had a 17 percent decrease in imaging rates during the subsequent 24 hours (2.7 versus 3.3 exams per patient) and a 16 percent decrease (1.2 versus 1.4 scans per patient) in subsequent CT scans.
"Implementing CD import procedures has provided us with a far more efficient way to take care of our patients," Dr. Sodickson said.
Extrapolating these results to the approximately 2.2 million patient transfers between American EDs each year, the estimated annual reduction in CT utilization due to successful CD import to PACS would be on the order of 484,000 CT scans.
"One of the goals of our healthcare delivery system must be to provide access to diagnostic imaging results to all locations involved in a patient's care, either through implementation of a universal electronic medical record, image repositories, or robust image transfer networks," Dr. Sodickson said. "But until those solutions reach maturity, ensuring that medical images can be downloaded from CDs in a standard, PACS-compatible format will help to streamline care, reduce costs and protect patients from unnecessary imaging exams."
**Source: Radiological Society of North America
BIDMC researchers recommend 'dual citizenship' on social media
With ubiquitous social media sites like Facebook and Twitter blurring private and professional lines, there is an increasing need for physicians to create a healthy distance between their work and home online identities, two Beth Israel Deaconess Medical Center physicians assert. Writing for the Annals of Internal Medicine's April 19 Ideas and Opinions section, physicians Arash Mostaghimi, MD, MPA and Bradley H. Crotty, MD call attention to the challenges created by the expanded use of Internet tools by physicians to reach patients at work, while simultaneously using the same tools to keep in touch with friends and family in their personal lives.
"Unlike previous advances in communication, such as the telephone and e-mail, the inherent openness of social media and self publication, combined with improved online searching capabilities, can complicate the separation of professional and private digital personae," they write.
"This online presence presents a host of challenges for physicians including the demand to "proactively review and maintain their digital lives," and also the need to create boundaries that both protect the doctor-patient relationship and help prevent awkward moments such as fielding a friend request from a patient.
"We're not suggesting that physicians should be prohibited from using social media sites. Doctors just need to be savvy regarding the content and tone of what they post online. People share information openly using social media, but posts intended for one audience may be embarrassing or inappropriate if seen by another," said Mostaghimi.
Physicians should assume that all posted materials are public and therefore take care to protect themselves and patient privacy. A 2010 study by the Mostaghimi and Crotty published in the Journal of General Internal Medicine showed that over 30 percent of physicians have some type of personal information on the Internet. The authors also cite research showing that 17 percent of physician blogs contain information that could reveal the identity of the patient or the doctor. They suggest that, "social networks may be considered the new millennium's elevator: a public forum where you have little to no control over who hears what you say, even if the material is not intended for the public."
Mostaghimi and Crotty recommend that institutions develop standards and educational materials to guide physicians and that physicians be both knowledgeable about social media and protective of their online presence. They advise physicians to regularly perform "electronic self-audits" of their online identity and create "dual citizenship" with a distinct professional profile intended to come up early on a search engine query.
The authors go on to discourage the use of sites like Facebook and Twitter for direct communication with patients since the information is controlled by the social media companies. These types of sites, they say, should be reserved for general announcements like flu vaccination.
Mostaghimi and Crotty caution that in spite of these measures, personal and professional lines will continue to be blurred, but proactive steps can help physicians maintain professionalism throughout this modern information age.
"Physicians are just beginning to understand the opportunities and challenges of social media. At this juncture, physicians should be aware of their online personae and behavior, and consider that they may have an impact on their relationship with patients," said Crotty.
**Source: Beth Israel Deaconess Medical Center
"Unlike previous advances in communication, such as the telephone and e-mail, the inherent openness of social media and self publication, combined with improved online searching capabilities, can complicate the separation of professional and private digital personae," they write.
"This online presence presents a host of challenges for physicians including the demand to "proactively review and maintain their digital lives," and also the need to create boundaries that both protect the doctor-patient relationship and help prevent awkward moments such as fielding a friend request from a patient.
"We're not suggesting that physicians should be prohibited from using social media sites. Doctors just need to be savvy regarding the content and tone of what they post online. People share information openly using social media, but posts intended for one audience may be embarrassing or inappropriate if seen by another," said Mostaghimi.
Physicians should assume that all posted materials are public and therefore take care to protect themselves and patient privacy. A 2010 study by the Mostaghimi and Crotty published in the Journal of General Internal Medicine showed that over 30 percent of physicians have some type of personal information on the Internet. The authors also cite research showing that 17 percent of physician blogs contain information that could reveal the identity of the patient or the doctor. They suggest that, "social networks may be considered the new millennium's elevator: a public forum where you have little to no control over who hears what you say, even if the material is not intended for the public."
Mostaghimi and Crotty recommend that institutions develop standards and educational materials to guide physicians and that physicians be both knowledgeable about social media and protective of their online presence. They advise physicians to regularly perform "electronic self-audits" of their online identity and create "dual citizenship" with a distinct professional profile intended to come up early on a search engine query.
The authors go on to discourage the use of sites like Facebook and Twitter for direct communication with patients since the information is controlled by the social media companies. These types of sites, they say, should be reserved for general announcements like flu vaccination.
Mostaghimi and Crotty caution that in spite of these measures, personal and professional lines will continue to be blurred, but proactive steps can help physicians maintain professionalism throughout this modern information age.
"Physicians are just beginning to understand the opportunities and challenges of social media. At this juncture, physicians should be aware of their online personae and behavior, and consider that they may have an impact on their relationship with patients," said Crotty.
**Source: Beth Israel Deaconess Medical Center
Alzheimer's diagnostic guidelines updated for first time in decades
For the first time in 27 years, clinical diagnostic criteria for Alzheimer's disease dementia have been revised, and research guidelines for earlier stages of the disease have been characterized to reflect a deeper understanding of the disorder. The National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease outline some new approaches for clinicians and provides scientists with more advanced guidelines for moving forward with research on diagnosis and treatments. They mark a major change in how experts think about and study Alzheimer's disease. Development of the new guidelines was led by the National Institutes of Health and the Alzheimer's Association. The original criteria were the first to address the disease and described only later stages, when symptoms of dementia are already evident. The updated guidelines announced today cover the full spectrum of the disease as it gradually changes over many years. They describe the earliest preclinical stages of the disease, mild cognitive impairment, and dementia due to Alzheimer's pathology. Importantly, the guidelines now address the use of imaging and biomarkers in blood and spinal fluid that may help determine whether changes in the brain and those in body fluids are due to Alzheimer's disease. Biomarkers are increasingly employed in the research setting to detect onset of the disease and to track progression, but cannot yet be used routinely in clinical diagnosis without further testing and validation. "Alzheimer's research has greatly evolved over the past quarter of a century. Bringing the diagnostic guidelines up to speed with those advances is both a necessary and rewarding effort that will benefit patients and accelerate the pace of research," said National Institute on Aging Director Richard J. Hodes, M.D. "We believe that the publication of these articles is a major milestone for the field," said William Thies, Ph.D., chief medical and scientific officer at the Alzheimer's Association. "Our vision is that this process will result in improved diagnosis and treatment of Alzheimer's, and will drive research that ultimately will enable us to detect and treat the disease earlier and more effectively. This would allow more people to live full, rich lives without—or with a minimum of—Alzheimer's symptoms." The new guidelines appear online April 19, 2011 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association. They were developed by expert panels convened last year by the National Institute on Aging (NIA), part of the NIH, and the Alzheimer's Association. Preliminary recommendations were announced at the Association's International Conference on Alzheimer's Disease in July 2010, followed by a comment period. **Source: NIH/National Institute on Aging
East Wenatchee lung recipient suffers kidney failure
One day after Heather Best took her first breath with a new set of lungs, her kidneys failed and her condition suddenly became serious, her mother said on Friday afternoon. “Last night we were laughing. Today, it’s tears and sadness,” Bobbie Best said. “How fast things can change.” Heather, a 25-year-old East Wenatchee resident, underwent a successful double lung transplant on Wednesday at the University of Washington Medical Center. On Thursday, doctors took her off the ventilator, and she took a deep breath with her new, donated lungs. But sometime in the night, her blood pressure plummeted and her kidneys shut down. On Friday, doctors started her on dialysis, and expect it will be at least two weeks before they know if the dialysis is working, and whether her kidneys can continue to function. She also has a fever. Best said there’s also a chance that Heather has an infection in her blood, so doctors put her on antibiotics as a precaution. “They told me it is very serious. Right now, we can just take it day by day,” she said. “We’re being very positive. We’ve overcome so many obstacles in our life, and this is another one.” Heather Best suffers from cystic fibrosis, a chronic disease that affects the lungs and digestive system. About two years ago, she got swine flu and it became progressively more difficult to breathe. Best said her family — including Heather’s daughter, Mackinzie — were so elated when Heather came off the ventilator on Thursday. “She took a big breath and she looked at me with these big eyes. I said, ‘You can breathe, can’t you?’ and she just started bawling. She said, ‘Mom, I can actually breathe!’” The change in her condition was difficult news after the relief of a successful operation, Best said. “It’s not even related to her lungs, that’s the hard part,” she said. “Her oxygen is good and her lungs are still working.” Best said her daughter is still conscious and aware of what happened, and is keeping faith. She said she knows her daughter has some of the best doctors in the world helping her, and lots of friends and family arrived Friday to see Heather. “We’re at the right place,” she said. “Just keep her in your prayers. That’s all we can really do until they get this under control.”
**Published in "THE WENATCHEE WORLD"
El Reino Unido ensaya utilizar una píldora anti-VIH diaria para gays
Las autoridades sanitarias de Reino Unido han decidido ensayar una terapia de prevención intensiva combinada con la población de hombres que tienen sexo con hombres. Como en España, los gais representan aproximadamente la mitad de las nuevas infecciones (aunque no sean, como mucho, más del 10% de la población). Por eso se va a ensayar un abordaje nuevo: darles una píldora preventiva al día. La medicación no es nueva: se trata de la llamada profilaxis preexposición que consiste en tomar una píldora de las que se usan para combatir la infección (tenofovir) antes de que el organismo entre en contacto con el virus. De esta manera se impide que el VIH se afiance. Este tipo de abordaje ha demostrado en otros ensayos una protección cercana al 40%, y se combinaría con vistas pautadas a centros sanitarios y programas de información en prevención, ha dicho la Agencia de Protección de la Salud en la conferencia sobre sida de la semana pasada en Bournemouth. La fase piloto durará dos años. Se trata de un enfoque casi a la desesperada. Aunque hace tiempo que se sabe que este tipo de tratamientos funcionan al menos parcialmente, ningún país los receta de manera sistemática, entre otras cosas porque cuesta 500 euros al mes. Lo que las autoridades tienen claro es que en un país como España, donde se calcula que el 10% de los homosexuales conviven con el virus, hay que tomar medidas drásticas para frenar su avance. La última tomada en España fue una campaña destinada a jóvenes que se presentó la semana pasada. **Publicado en "EL PAIS"
El cáncer de mama se oculta en senos cada vez más jóvenes
El cáncer más frecuente en la mujer se esconde en mamas cada vez más jóvenes. "En mi caso fue por partida doble", cuenta Estefanía Soriano a quien, con 33 años, le extirparon dos tumores de golpe, uno en cada pecho. La eficacia de la tecnología digital y el aumento de diagnósticos fuera del programa de detección precoz han reabierto el debate sobre la posibilidad de empezar antes las revisiones. Por regla general, se efectúan a partir de los 50 años, aunque hay comunidades que lo adelantan. La medicina preventiva se escuda en la "falta de rentabilidad económica" y en los efectos negativos que pueden desarrollarse por acumulación de pruebas clínicas. En 2008 murieron 6.121 personas por cáncer de mama, según los últimos datos del INE. Casos como el de Estefanía se incrementan, según los oncólogos consultados, a partir de los 40 años. Un estudio del Instituto de Salud Carlos III de Madrid, publicado el año pasado en la revista europea Annals of Oncology 21, refleja que la incidencia de este cáncer en mujeres menores de 45 años aumentó un 1,7% por año en el periodo 1980-2004. "Son los datos más recientes que hay", dice Josep María Borrás, director del Plan de Oncología de Cataluña. Ante la falta de información oficial por parte del Gobierno central, este periódico rastreó los registros por comunidades. En cuatro de las ocho que han contestado (Castilla y León, Extremadura, Cantabria y Cataluña) se notificaron, en los tres últimos años, mayores casos de este tumor fuera del cribado. En 2008 se detectaron 918 tumores cancerígenos en el grupo de prevención en Cataluña, mientras fuera de esta la cifra asciende a 2.177, informan desde el departamento de Salud. Un aumento notable, aun teniendo en cuenta a las mayores de 70 años y a aquellas que, perteneciendo al grupo de prevención, no se hicieron la prueba previa cita. Además de la herencia genética existen otros factores que influyen en la aparición del tumor, como son tener la primera regla más temprano, retrasar la maternidad, una menopausia tardía o adoptar hábitos no saludables, como el consumo de alcohol en exceso. Algunos se pueden controlar, pero otros, como la genética, no. "Mi abuela tuvo cáncer, mis dos hermanas también", dice Estefanía quien, recuperada de la enfermedad, pasará por la cirugía para reconstruirse un pecho. Mientras pasea a su hija de seis meses, cuenta por teléfono que era la más joven de las pacientes del hospital: "Una señora creía que me había equivocado de consulta", recuerda. Los nuevos mamógrafos digitales (aún por implantarse en todo el territorio) "han mejorado la eficacia sobre todo en el grupo de mayor incidencia, pero también en las más jóvenes. Ahora son más transparentes para detectar a tiempo y reducir la mortalidad", afirma Josep Alfons Espinas, coordinador de la oficina de cribado del Plan de Oncología catalán. Los senos jóvenes, al ser más densos, ocultan mejor un posible tumor. Es lo que le ocurrió a Arantxa Llano, de 31 años, que se notó "un bultito" en la mama derecha y los médicos no lo detectaron hasta seis meses después. "Al principio creía que tenía que ver con la menstruación y no le di importancia", recuerda. "Podrían detectarse más casos, pero no forma parte de la política sanitaria global", zanja Miguel Ángel Quintela, jefe de investigaciones cancerígenas del Centro Nacional de Investigaciones Oncológicas (CNIO). Con esta expresión, el profesional señala que el cribado no solo se justifica por la detección de la enfermedad sino por la eficacia. Para los profesionales que gestionan la sanidad pública, "el número de casos que se encuentran [por debajo del cribado] no justifica el número de pruebas realizadas y la tecnología empleada". Graciela García, oncóloga de la Asociación Española Contra el Cáncer, encamina su discurso a la seguridad sanitaria: "No podemos someter a una mujer a una serie de pruebas médicas sin más, no solo por el gasto económico, sino por el humano". La acumulación de pruebas (rayos X) en el organismo no es un problema para la Sociedad Española de Ginecología y Obstetricia (SEGO): "Por pocos casos que se encuentren entre tantas mamografías que se hagan, valdrá la pena", apunta Jordi Xercavins, presidente de la sección de ginecología oncológica y cáncer de mama de la SEGO. El tumor, según Xercavins, está más desarrollado cuando se detecta a una mujer más joven que a una mayor de 50. "Sanidad no debería recortar nada con la crisis". ¿Y qué ocurre con las que superan los 70 años? "Están un poco olvidadas. No tiene sentido parar el cribado a esa edad. Las de 80 años tienen más riesgos de sufrir un cáncer de mama que las de 40", dice Xercavins. "Esto tiene que cambiar porque las mayores solo acuden cuando se notan un bulto, y entonces puede que sea demasiado tarde", presagia. Del total de muertes, 6.051 fueron mujeres, y 70 hombres; un 1,1% más que el año anterior. Representaron el 16% de todas las defunciones por cáncer y el 3,2% de todas las mujeres fallecidas, según Sanidad. Los datos, sin embargo, no son desesperanzadores. La mortalidad por este tumor en España es un 23% inferior a la media de la Unión Europea (UE), según Sanidad. La mortalidad en Dinamarca (la más alta de la UE) es 1,5 veces superior a la española, la más baja de los 27 países europeos. Si se detecta a tiempo, existe un 100% de probabilidades de curarse, apuntan desde la asociación del cáncer. Ese es el caso de las jóvenes entrevistadas, Estefanía, que además ha podido concebir una hija, y Arantxa Llano, que asegura que su vida "ha cambiado al cáncer", y no al revés. Ambas coinciden en que el miedo reside en la ignorancia, "ese no saber si te vas a morir". "El 50% de la enfermedad es cómo te enfrentes a ella", asegura por teléfono esta última. Una joven roquera que nunca tiró la toalla, incluso un par de semanas antes de entrar en quirófano por segunda vez, se subió al escenario con su grupo. Calva, pero con la seguridad puesta en la guitarra: "No iba a permitir que el cáncer me impidiera hacer lo que más me gusta". Y lo consiguió. Ahora se recupera de la quimioterapia. **Publicado en "EL PAIS"
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