The stroke rate among Manitoba Metis is nearly 25 percent higher than for other Manitobans, according to a study by the University of Manitoba and the Manitoba Metis Federation (MMF) presented October 4 at the Canadian Stroke Congress. The higher stroke rate is driven by a 53 percent higher smoking rate, 34 percent higher rate of diabetes, and 13 percent higher rate of high blood pressure among Metis aged 40 years and older, compared to all other Manitobans. High blood pressure, smoking and diabetes are leading risk factors for stroke.
"Being historically of both First Nation and European ancestries, but not really identifying as either one, Metis are a very unique people, but little research has been done on this population," says Dr. Judith Bartlett of the University of Manitoba and the MMF. "It's really difficult for a health system to put in place Metis-specific programs if they don't understand what that means. Our job through this study is to link the health authorities with the Metis to bridge that knowledge gap."
The study linked the MMF membership list and several Canadian Community Health Survey cycles with Manitoba Health's hospital records throughout the province to create the Metis Population Data-Base, a one-of-a-kind registry of the 73,000 Metis in the province.
"Despite universal health care, it is clear that stroke and related conditions are even more significant issues for Manitoba Metis than for all other residents in the province," the study says.
What are called "knowledge networks" of Metis and provincial Regional Health Authority (RHA) staff have now been established in each of the Manitoba Metis Federation's seven regions to look at the information from the study and interpret it within a local context, says Julianne Sanguins, Ph.D, of the Faculty of Medicine at the University of Manitoba and the MMF.
During the first few meetings of these knowledge networks, Metis Regions learned about available resources and the health-care providers discovered the strength of the Metis presence in their community, Dr. Sanguins says.
The ultimate purpose of these networks is to raise awareness about existing health services and then to make any necessary changes to the programs in each of the MMF/RHA regions to better meet the cultural needs of the Metis citizens.
"It is important to learn more about the unique health challenges of Canada's Metis population in order to control risk factors and prevent stroke," says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. "This study provides valuable information to create targeted education and outreach initiatives.''
"Aboriginal people are twice as likely to die from stroke than the general Canadian population," says Heart and Stroke Foundation spokesperson Dr. Michael Hill. "They are more likely to have high blood pressure and type 2 diabetes, putting First Nations, Inuit and Metis people at an even greater risk of stroke than the general population."
He says that culturally appropriate prevention strategies and novel health-care solutions will improve outcomes. "Awareness of how to control risk factors such as high blood pressure, obesity, physical activity, diabetes, and smoking is essential."
**Source: Heart and Stroke Foundation of Canada
05 October 2011
El sindicato médico alerta: los recortes hacen la sanidad pública "insostenible
Los recortes de la Generalitat han empujado la sanidad pública catalana al borde de cruzar la línea roja: la que marca la incapacidad de mantener la calidad asistencial de los usuarios del servicio. Así lo han denunciado hoy representantes del sindicato médico de los ocho grandes hospitales de Cataluña. Estos mantienen cerca del 30% de camas cerradas y cuatro de cada diez quirófanos clausurados, lo que unido al recorte de personal, horas extra y turnos de guardia ha dejado a los hospitales bajo mínimos. "Pedimos al presidente de la Generalitat, Artur Mas, que de forma urgente dote a la sanidad pública de los 77 millones de euros que necesita desesperadamente para poder trabajar a pleno rendimiento y con la calidad asistencial que se merecen los usuarios", ha resumido la representante del Sindicato de Médicos en el hospital barcelonés Vall d'Hebron, Rosa Boyé.
Los médicos también han acusado al consejero de Salud, Boi Ruiz, de intentar "maquillar" los efectos del recorte en las listas de espera. Ruiz anunció ayer la aplicación de un nuevo modelo de gestión de la lista de espera que suprime el tiempo de garantía de seis meses para las intervenciones más comunes y que fijará ese tiempo de garantía en función de la gravedad del paciente.
En solo seis meses, el mismo periodo que lleva CiU en el Gobierno y durante el que empezó a aplicar recortes en sanidad, la lista de espera ha aumentado el 23% pasando de unos 56.000 pacientes a casi 70.000. La única vía para conservar la sanidad pública, han señalado los médicos, consiste en tratarla como al sector bancario, que ha sido financiado en momentos de dificultades de liquidez. "Nos obligan a convocar una huelga", ha protestado Boyé. "Así no podemos funcionar".
Todos los hospitales de referencia mantienen cerradas camas, quirófanos y servicios. El hospital de Bellvitge ha cerrado 100 camas, mantiene clausurados 6 quirófanos de 35 y ha dejado de operar a entre 2.000 y 3.000 personas por efecto de los recortes, pacientes que han pasado a engrosar la lista de espera. En Vall d'Hebron han cerrado 120 camas, desde abril se opera un 50% menos y se prevé que este año se dejen de realizar 5.000 operaciones quirúrgicas. El hospital Trias i Pujol mantiene cerradas 112 camas y ha reducido la actividad quirúrgica el 2,5% este año. En el Virgen de la Cinta Tortosa, por su parte, el 32% de las 250 camas están cerradas y las intervenciones se han reducido el 68%. "Es un retrato de lo que está ocurriendo en todos los hospitales públicos", destacó la representante sindical.
**Publicado en"EL PAIS"
Los médicos también han acusado al consejero de Salud, Boi Ruiz, de intentar "maquillar" los efectos del recorte en las listas de espera. Ruiz anunció ayer la aplicación de un nuevo modelo de gestión de la lista de espera que suprime el tiempo de garantía de seis meses para las intervenciones más comunes y que fijará ese tiempo de garantía en función de la gravedad del paciente.
En solo seis meses, el mismo periodo que lleva CiU en el Gobierno y durante el que empezó a aplicar recortes en sanidad, la lista de espera ha aumentado el 23% pasando de unos 56.000 pacientes a casi 70.000. La única vía para conservar la sanidad pública, han señalado los médicos, consiste en tratarla como al sector bancario, que ha sido financiado en momentos de dificultades de liquidez. "Nos obligan a convocar una huelga", ha protestado Boyé. "Así no podemos funcionar".
Todos los hospitales de referencia mantienen cerradas camas, quirófanos y servicios. El hospital de Bellvitge ha cerrado 100 camas, mantiene clausurados 6 quirófanos de 35 y ha dejado de operar a entre 2.000 y 3.000 personas por efecto de los recortes, pacientes que han pasado a engrosar la lista de espera. En Vall d'Hebron han cerrado 120 camas, desde abril se opera un 50% menos y se prevé que este año se dejen de realizar 5.000 operaciones quirúrgicas. El hospital Trias i Pujol mantiene cerradas 112 camas y ha reducido la actividad quirúrgica el 2,5% este año. En el Virgen de la Cinta Tortosa, por su parte, el 32% de las 250 camas están cerradas y las intervenciones se han reducido el 68%. "Es un retrato de lo que está ocurriendo en todos los hospitales públicos", destacó la representante sindical.
**Publicado en"EL PAIS"
Circadian clock may impact organ transplant success
Health care providers assess blood and tissue type as well as organ size and health to enhance transplant success. New research indicates that checklist might also need to include the circadian clock. While some human studies have shown the time of day transplant surgery is performed can influence the outcome, this study of mice with dysfunctional internal clocks is the first correlating circadian clocks with transplant success, said Dr. Daniel Rudic, vascular biologist at Georgia Health Sciences University and corresponding author of the study published in the Proceedings of the National Academy of Sciences.
The GHSU researchers found that arteries of mice with circadian clock dysfunction became thick and diseased within a few weeks of being transplanted to healthy mice. Arteries transplanted from healthy mice to the mutant mice remained healthy.
Blood vessel disease, and resulting blood loss to donated organs, is a key pitfall for transplant patients, potentially leading to organ failure and rejection.
"You take an organ out of a human, you don't think about it having a bad clock," Rudic said. "But the fact is the time at which you do the organ transplant may influence overall success and, if you have a donor who has a sleep disorder or is a night shift worker, it may affect it as well."
Since even healthy clocks produce variability in tissue function across the span of a day, transplantation might be best performed during optimal organ function, he said.
In addition to enabling sleep/wake cycles, circadian clocks are found throughout the body and involved in a lot more than sleep. "The clock is expressed not only in the brain but everywhere in the body and can function autonomously in different areas," Rudic said.
"Our research shows it's the clock within the blood vessel that is key to conferring the disease response in this case," said Dr. Bo Cheng, GHSU postdoctoral fellow and the study's first author.
While the researchers can determine whether clock gene expression is up, down or mutated, there is currently no way to do the tests in humans. Until screening tests are identified, donors could be screened for signs of dysfunction such as a sleep disorder or even aberrant behaviors that can impair healthy clocks, such as shift work, Rudic said. "Ideally this will open up some new research avenues," he said.
Interestingly, when blood vessels from the mutant mouse stay in that mouse, disease progression is much slower. "We believe that bad clock function worsens when it intersects with disease, so if you are eating a high-fat diet or if you undergoing a serious surgery like a transplant, and you have a bad clock, disease may occur and may occur quickly," Rudic said.
In 2009, he reported in the journal Circulation that mice with mutated or missing clock genes were prone to vascular disease similar to smokers and people with high blood pressure and cholesterol. That study showed the blood vessel clocks regulate key signaling that enables blood vessel dilation and remodeling.
**Source: Georgia Health Sciences University
The GHSU researchers found that arteries of mice with circadian clock dysfunction became thick and diseased within a few weeks of being transplanted to healthy mice. Arteries transplanted from healthy mice to the mutant mice remained healthy.
Blood vessel disease, and resulting blood loss to donated organs, is a key pitfall for transplant patients, potentially leading to organ failure and rejection.
"You take an organ out of a human, you don't think about it having a bad clock," Rudic said. "But the fact is the time at which you do the organ transplant may influence overall success and, if you have a donor who has a sleep disorder or is a night shift worker, it may affect it as well."
Since even healthy clocks produce variability in tissue function across the span of a day, transplantation might be best performed during optimal organ function, he said.
In addition to enabling sleep/wake cycles, circadian clocks are found throughout the body and involved in a lot more than sleep. "The clock is expressed not only in the brain but everywhere in the body and can function autonomously in different areas," Rudic said.
"Our research shows it's the clock within the blood vessel that is key to conferring the disease response in this case," said Dr. Bo Cheng, GHSU postdoctoral fellow and the study's first author.
While the researchers can determine whether clock gene expression is up, down or mutated, there is currently no way to do the tests in humans. Until screening tests are identified, donors could be screened for signs of dysfunction such as a sleep disorder or even aberrant behaviors that can impair healthy clocks, such as shift work, Rudic said. "Ideally this will open up some new research avenues," he said.
Interestingly, when blood vessels from the mutant mouse stay in that mouse, disease progression is much slower. "We believe that bad clock function worsens when it intersects with disease, so if you are eating a high-fat diet or if you undergoing a serious surgery like a transplant, and you have a bad clock, disease may occur and may occur quickly," Rudic said.
In 2009, he reported in the journal Circulation that mice with mutated or missing clock genes were prone to vascular disease similar to smokers and people with high blood pressure and cholesterol. That study showed the blood vessel clocks regulate key signaling that enables blood vessel dilation and remodeling.
**Source: Georgia Health Sciences University
Algunos anticonceptivos inyectables duplican el riesgo de transmitir y contraer VIH
Un estudio realizado en siete países africanos -Botsuana, Kenia, Ruanda, Sudáfrica, Tanzania, Uganda y Zambia- con 3.790 parejas heterosexuales serodiscordantes (aquellas en las que uno de los miembros está infectado por el VIH y el otro no) concluye que las mujeres que toman anticonceptivos inyectables multiplican por dos su riesgo de adquirir la infección por VIH así como de transmitirla a los hombres con los que se acuestan. El por qué no está del todo claro, pero parece, según apuntan los investigadores, que este método provoca ciertos cambios en la estructura de la vagina y en la forma en la que se regulan algunas proteínas que favorecen la entrada del virus.
El hallazgo, publicado en la revista 'The Lancet', plantea un dilema, sobre todo en África: "Por una parte, la promoción de estos anticonceptivos en áreas con una alta incidencia de VIH podría contribuir a propagar aún más la epidemia de sida, con consecuencias trágicas. Por otro lado, limitar el acceso a uno de los métodos anticonceptivos más usados en África subsahariana podría aumentar la mortalidad materna e infantil, con consecuencias igualmente trágicas", escribe en un comentario Charles S. Morrison, de Clinical Sciences en Durham (EEUU).
¿Cómo salir de esta encrucijada? Para Renee Heffron, uno de los autores de la investigación de la Universidad de Washington, se necesitarían con urgencia dos cosas. "Primero es imprescindible realizar un ensayo clínico a gran escala destinado a conocer mejor la relación entre este sistema anticonceptivo y el riesgo de contraer VIH. Y, además, es importante que se lancen programas destinados a promover la importancia de seguir utilizando el preservativo, junto a otros métodos de anticoncepción".
De las 3.790 parejas que participaron en el estudio, en 1.314 era el hombre el que tenía el VIH mientras que en las 2.476 restantes, la seropositiva era la mujer. En el momento de iniciar la investigación, el 15% de las mujeres sin el virus usaba anticoncepción hormonal, al igual que el 17% de quienes sí estaban infectadas. Después, durante el estudio, los porcentajes aumentaron a un 21% y un 33%, respectivamente. Tras 24 meses de seguimiento, los investigadores comprobaron que esta anticoncepción, por sí sola -tras descartar factores como el sexo de riesgo o la edad, por ejemplo- duplicaba el riesgo tanto de contraer la infección como de transmitirla.
Aunque el trabajo tiene limitaciones, como el hecho de fiarse de la palabra de las participantes y no haber medido si utilizaban bien el método anticonceptivo, los autores señalan que "es el primer estudio prospectivo que muestra que esta anticoncepción hormonal aumenta el riesgo de que los hombres, parejas de mujeres infectadas, contraigan el VIH". A la inversa, ya se había comprobado en estudios anteriores.
En cualquier caso, "nuetros datos son lo suficientemente importantes como para tenerlos en cuenta en los programas de planificación familiar y de prevención del VIH", explica Jared Baeten, otro de los investigadores, también de la Universidad de Washington.
En el mundo, más de 140 millones de mujeres utilizan la anticoncepción hormonal. En África subsahariana, donde viven 16 millones de seropositivas, los anticonceptivos hormonales inyectables son de los más extendidos.
**Publicado en "EL MUNDO"
El hallazgo, publicado en la revista 'The Lancet', plantea un dilema, sobre todo en África: "Por una parte, la promoción de estos anticonceptivos en áreas con una alta incidencia de VIH podría contribuir a propagar aún más la epidemia de sida, con consecuencias trágicas. Por otro lado, limitar el acceso a uno de los métodos anticonceptivos más usados en África subsahariana podría aumentar la mortalidad materna e infantil, con consecuencias igualmente trágicas", escribe en un comentario Charles S. Morrison, de Clinical Sciences en Durham (EEUU).
¿Cómo salir de esta encrucijada? Para Renee Heffron, uno de los autores de la investigación de la Universidad de Washington, se necesitarían con urgencia dos cosas. "Primero es imprescindible realizar un ensayo clínico a gran escala destinado a conocer mejor la relación entre este sistema anticonceptivo y el riesgo de contraer VIH. Y, además, es importante que se lancen programas destinados a promover la importancia de seguir utilizando el preservativo, junto a otros métodos de anticoncepción".
De las 3.790 parejas que participaron en el estudio, en 1.314 era el hombre el que tenía el VIH mientras que en las 2.476 restantes, la seropositiva era la mujer. En el momento de iniciar la investigación, el 15% de las mujeres sin el virus usaba anticoncepción hormonal, al igual que el 17% de quienes sí estaban infectadas. Después, durante el estudio, los porcentajes aumentaron a un 21% y un 33%, respectivamente. Tras 24 meses de seguimiento, los investigadores comprobaron que esta anticoncepción, por sí sola -tras descartar factores como el sexo de riesgo o la edad, por ejemplo- duplicaba el riesgo tanto de contraer la infección como de transmitirla.
Aunque el trabajo tiene limitaciones, como el hecho de fiarse de la palabra de las participantes y no haber medido si utilizaban bien el método anticonceptivo, los autores señalan que "es el primer estudio prospectivo que muestra que esta anticoncepción hormonal aumenta el riesgo de que los hombres, parejas de mujeres infectadas, contraigan el VIH". A la inversa, ya se había comprobado en estudios anteriores.
En cualquier caso, "nuetros datos son lo suficientemente importantes como para tenerlos en cuenta en los programas de planificación familiar y de prevención del VIH", explica Jared Baeten, otro de los investigadores, también de la Universidad de Washington.
En el mundo, más de 140 millones de mujeres utilizan la anticoncepción hormonal. En África subsahariana, donde viven 16 millones de seropositivas, los anticonceptivos hormonales inyectables son de los más extendidos.
**Publicado en "EL MUNDO"
This is your brain on estrogen
It's no secret that women often gain weight as they get older. The sex hormone estrogen has an important, if underappreciated, role to play in those burgeoning waistlines. Now, researchers reporting in the October Cell Metabolism, a Cell Press publication, have traced those hormonal effects on metabolism to different parts of the brain. The findings may lead to the development of highly selective hormone replacement therapies that could be used to combat obesity or infertility in women without the risks for heart disease and breast cancer, the researchers say.
"When women approach menopause, they gain weight in fat and their energy expenditure goes down," says Deborah Clegg of the University of Texas Southwestern Medical Center. Estrogen levels decline and women grow increasingly susceptible to obesity and metabolic syndrome.
Estrogen acts on receptors found throughout the body, in fat, on ovaries and in muscle. But when it comes to the hormone's influence on metabolism, Clegg suspected receptors in the brain.
Others had traced the effects of estrogen on energy balance specifically to estrogen receptor-α (ERα). When her team deleted those receptors from the entire brains of mice, "we got very, very fat mice," Clegg said. The animals consumed more calories and burned less.
The researchers showed female mice lacking ERα in one part of the brain (the hypothalamic steroidogenic factor-1 or SF1 neurons) gained weight without eating any more. Loss of ERα from another brain area (the hypothalamic pro-opiomelanocortin or POMC neurons) had the opposite effect: animals ate more without gaining weight. Loss of ERα receptors in those same neurons also led to various problems in ovulation and fertility.
The findings suggest that drugs developed to specifically target estrogen receptors in the brain might offer a useful alternative to hormone replacement therapies that hit receptors throughout the body. The researchers say they would like to continue to isolate other estrogen-related effects and symptoms, for instance, on hot flashes and cognition.
"The more we know about estrogen's sites of action, the more likely it is we could develop designer hormone replacement therapies targeting tissue X, Y or Z," Clegg said.
**Source: Cell Press
"When women approach menopause, they gain weight in fat and their energy expenditure goes down," says Deborah Clegg of the University of Texas Southwestern Medical Center. Estrogen levels decline and women grow increasingly susceptible to obesity and metabolic syndrome.
Estrogen acts on receptors found throughout the body, in fat, on ovaries and in muscle. But when it comes to the hormone's influence on metabolism, Clegg suspected receptors in the brain.
Others had traced the effects of estrogen on energy balance specifically to estrogen receptor-α (ERα). When her team deleted those receptors from the entire brains of mice, "we got very, very fat mice," Clegg said. The animals consumed more calories and burned less.
The researchers showed female mice lacking ERα in one part of the brain (the hypothalamic steroidogenic factor-1 or SF1 neurons) gained weight without eating any more. Loss of ERα from another brain area (the hypothalamic pro-opiomelanocortin or POMC neurons) had the opposite effect: animals ate more without gaining weight. Loss of ERα receptors in those same neurons also led to various problems in ovulation and fertility.
The findings suggest that drugs developed to specifically target estrogen receptors in the brain might offer a useful alternative to hormone replacement therapies that hit receptors throughout the body. The researchers say they would like to continue to isolate other estrogen-related effects and symptoms, for instance, on hot flashes and cognition.
"The more we know about estrogen's sites of action, the more likely it is we could develop designer hormone replacement therapies targeting tissue X, Y or Z," Clegg said.
**Source: Cell Press
Same-day discharge after elective PCI not associated with increased risk of death, rehospitalization
Among selected low-risk Medicare patients who underwent an elective percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), same-day discharge was rarely implemented, but was not associated with an increased risk of being rehospitalized or having a higher risk of death at 2 days or at 30 days, than patients who remained in the hospital overnight, according to a study in the October 5 issue of JAMA. "Percutaneous coronary intervention is one of the most commonly performed cardiac procedures with more than 1 million episodes of care annually among Medicare recipients. Risks associated with PCI are highest within the first 24 to 48 hours after the procedure and include periprocedural myocardial infarction [MI; heart attack], acute stent thrombosis [blood clot formation within the stent], bleeding, or renal failure," according to background information in the article. "However, short- and long-term outcomes after PCI have improved because of the evolution in device technology and pharmacotherapy. Despite this improvement, patients are usually observed overnight in the hospital after elective PCI to monitor for PCI-related complications." The safety of same-day discharge among older individuals undergoing this procedure is not known. Same-day discharge would increase bed availability for the hospital and reduce medical expenses.
Sunil V. Rao, M.D., of the Duke Clinical Research Institute, Durham, N.C., and colleagues conducted a study to examine the prevalence of same-day discharge among older individuals following PCI and the rates of death or rehospitalization. The study included data from 107,018 patients 65 years or older undergoing elective PCI procedures at 903 sites participating in the CathPCI Registry between November 2004 and December 2008 and were linked with Medicare Part A claims. Patients were divided into 2 groups based on their length of stay after PCI: same-day discharge or overnight stay. The primary outcomes measured were rehospitalization or death occurring within 2 days and by 30 days after PCI.
The researchers found that prevalence of same-day discharge was 1.25 percent (n = 1,339 patients), with significant variation across facilities. There was no significant difference in the rates of procedural success between the 2 groups. Patient characteristics were similar between the 2 groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. Patients who were discharged home the same day were more often categorized in the lowest quintile of predicted risk for death or rehospitalization, while there were approximately equal proportions of lower- and higher-risk patients observed overnight.
"There were no significant differences in the rates of death or rehospitalization at 2 days (same-day discharge, 0.37 percent vs. overnight stay, 0.50 percent or at 30 days (same-day discharge, 9.63 percent vs. overnight stay, 9.70 percent). Among patients with adverse outcomes, the median [midpoint] time to death or rehospitalization did not differ significantly between the groups (same-day discharge, 13 days vs. overnight stay, 14 days). After adjustment for patient and procedure characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization," the authors write.
The researchers note that despite the apparent safety of same-day discharge for selected patients, the present analysis demonstrates that this approach is rarely practiced among sites represented in the National Cardiovascular Data Registry. "This may reflect reluctance on the part of clinicians to discharge patients the same day as the PCI procedure because of concerns over early post-PCI complications. Although these concerns are well founded, the rates of vascular or bleeding complications were extremely low (less than 1 percent) among the patients in our analysis, with no clinically significant differences between groups."
"These data suggest that a proportion of low-risk patients currently observed overnight may be eligible for same-day discharge without an increase in early or intermediate-term adverse events."
The authors add that according to published guidelines, same-day discharge can be considered for patients undergoing PCI who have low-risk clinical features, successful procedures without prolonged post-procedure use of parenteral (by injection) antithrombotic agents, and adequate social support.
**Source: JAMA and Archives Journals
Sunil V. Rao, M.D., of the Duke Clinical Research Institute, Durham, N.C., and colleagues conducted a study to examine the prevalence of same-day discharge among older individuals following PCI and the rates of death or rehospitalization. The study included data from 107,018 patients 65 years or older undergoing elective PCI procedures at 903 sites participating in the CathPCI Registry between November 2004 and December 2008 and were linked with Medicare Part A claims. Patients were divided into 2 groups based on their length of stay after PCI: same-day discharge or overnight stay. The primary outcomes measured were rehospitalization or death occurring within 2 days and by 30 days after PCI.
The researchers found that prevalence of same-day discharge was 1.25 percent (n = 1,339 patients), with significant variation across facilities. There was no significant difference in the rates of procedural success between the 2 groups. Patient characteristics were similar between the 2 groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. Patients who were discharged home the same day were more often categorized in the lowest quintile of predicted risk for death or rehospitalization, while there were approximately equal proportions of lower- and higher-risk patients observed overnight.
"There were no significant differences in the rates of death or rehospitalization at 2 days (same-day discharge, 0.37 percent vs. overnight stay, 0.50 percent or at 30 days (same-day discharge, 9.63 percent vs. overnight stay, 9.70 percent). Among patients with adverse outcomes, the median [midpoint] time to death or rehospitalization did not differ significantly between the groups (same-day discharge, 13 days vs. overnight stay, 14 days). After adjustment for patient and procedure characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization," the authors write.
The researchers note that despite the apparent safety of same-day discharge for selected patients, the present analysis demonstrates that this approach is rarely practiced among sites represented in the National Cardiovascular Data Registry. "This may reflect reluctance on the part of clinicians to discharge patients the same day as the PCI procedure because of concerns over early post-PCI complications. Although these concerns are well founded, the rates of vascular or bleeding complications were extremely low (less than 1 percent) among the patients in our analysis, with no clinically significant differences between groups."
"These data suggest that a proportion of low-risk patients currently observed overnight may be eligible for same-day discharge without an increase in early or intermediate-term adverse events."
The authors add that according to published guidelines, same-day discharge can be considered for patients undergoing PCI who have low-risk clinical features, successful procedures without prolonged post-procedure use of parenteral (by injection) antithrombotic agents, and adequate social support.
**Source: JAMA and Archives Journals
Una nueva combinación de quimioterapia duplica la supervivencia en casos de cáncer de páncreas avanzado
No todo son malas noticias para un cáncer del que se suele hablar en tono trágico. La revista científica «Journal of Clinical Oncology» publica una investigación que avala la utilización de una combinación de fármacos para luchar contra el cáncer de páncreas avanzado. Los resultados demuestran que con ese cóctel de quimioterapia («gemcitabina» más «nab-paclitaxel») se consigue una supervivencia global de 12 meses y una tasa de supervivencia a un año del 48% en el cáncer de páncreas ductal, uno de los tumores de peor pronóstico.
Arañar un año de vida más en esta enfermedad tan compleja no es un resultado menor. «Este tipo de cáncer es una patología letal con una media de supervivencia de seis meses. Y los datos que hemos recogido son muy buenos. Este es el tratamiento con más actividad en páncreas que hemos visto en los últimos 20 años», asegura Manuel Hidalgo, director del Centro Oncológico Clara Campal y uno de los investigadores que ha participado en el estudio.
Manuel Hidalgo: «Es el tratamiento con más actividad frente al cáncer pancreático de los últimos 20 años»Otra buena noticia es que el tratamiento, probado en 67 pacientes de cuatro hospitales estadounidenses, muestra también que los efectos adversos con un dosis eficaz son tolerables por lo que la investigación puede continuar con mayor número de enfermos. La idea es probarlo en medio millar de pacientes en una nueva fase que contará con pacientes españoles.
Los dos fármacos no son ajenos para los oncólogos. La «gemcitabina» se utilizaba ya frente al cáncer de páncreas y con «nab-paclitaxel», el último en llegar, se está tratando ya a personas con melanoma, cáncer de mama y pulmón como uso compasivo. De momento, parece una combinación acertada que suma a la quimioterapia clásica la actividad de un nuevo mecanismo de acción. El tratamiento actúa atacando al estroma, un tejido formado por células no tumorales que se convierte en un escudo protector del tumor. «El fármaco elimina parte del estroma y permite que la quimioterapia se difunda mejor en el tumor», explica Hidalgo.
Con la dosis semanal máxima tolerada, se obtuvo respuesta en asi la mitad de los pacientes ; en 21 de 44 pacientes y dos tercios experimentaron control de la enfermedad. La media de supervivencia libre de progresión se situó en 7,9 meses, la media de supervivencia global 12,2 meses y la tasa de supervivencia a un año fue del 48%.
Arañar un año de vida más en esta enfermedad tan compleja no es un resultado menor. «Este tipo de cáncer es una patología letal con una media de supervivencia de seis meses. Y los datos que hemos recogido son muy buenos. Este es el tratamiento con más actividad en páncreas que hemos visto en los últimos 20 años», asegura Manuel Hidalgo, director del Centro Oncológico Clara Campal y uno de los investigadores que ha participado en el estudio.
Manuel Hidalgo: «Es el tratamiento con más actividad frente al cáncer pancreático de los últimos 20 años»Otra buena noticia es que el tratamiento, probado en 67 pacientes de cuatro hospitales estadounidenses, muestra también que los efectos adversos con un dosis eficaz son tolerables por lo que la investigación puede continuar con mayor número de enfermos. La idea es probarlo en medio millar de pacientes en una nueva fase que contará con pacientes españoles.
Los dos fármacos no son ajenos para los oncólogos. La «gemcitabina» se utilizaba ya frente al cáncer de páncreas y con «nab-paclitaxel», el último en llegar, se está tratando ya a personas con melanoma, cáncer de mama y pulmón como uso compasivo. De momento, parece una combinación acertada que suma a la quimioterapia clásica la actividad de un nuevo mecanismo de acción. El tratamiento actúa atacando al estroma, un tejido formado por células no tumorales que se convierte en un escudo protector del tumor. «El fármaco elimina parte del estroma y permite que la quimioterapia se difunda mejor en el tumor», explica Hidalgo.
Con la dosis semanal máxima tolerada, se obtuvo respuesta en asi la mitad de los pacientes ; en 21 de 44 pacientes y dos tercios experimentaron control de la enfermedad. La media de supervivencia libre de progresión se situó en 7,9 meses, la media de supervivencia global 12,2 meses y la tasa de supervivencia a un año fue del 48%.
**Publicado en "ABC"
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