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This Viewpoint discusses differing opinions on whether precision medicine can help improve US population health and if so, potential approaches to implementing a coordinated and effective effort between the medical and public health communities.
PRECISION MEDICINE IS UNLIKELY TO IMPROVE POPULATION HEALTH, but perhaps health of individuals or small groups of individual
People who develop chronic kidney disease may have some or all of the following tests and measurements. If you have kidney disease ask your doctor which tests you will have and how often they will be done. Speak to your doctor about your results. If your numbers are not in the normal range, ask how to improve them.
Surgeon specialization and operative mortality in United States: retrospective analysis | The BMJ – Quando selezionate un chirurgo si dovrebbe considerare il volume di attività e cosi’ come le competenze. Ma non basta una interdivisionale e chi c’e’ c’e’? – Questo non succede solo ai chirurghi ma a tutti i medici.
L’assurdità di considerare tutti uguali e competenti porta a danni come questa analisi del BMJ dimostra, fino alla morte dei pazienti e non vengono considerate le complicazioni. Questo succede anche ai medici agli internisti dove non tutti sono competenti di patologie specialistiche. Il mettere insieme nefrologi, diabetologi, gastroenterologhi in un ospedale di riferimento significa correre il rischio di far morire i pazienti, Vuol dire non avere conoscenze e chiarezza di cosa sia la diagnosi, come vine fatta, come si arriva al ragionamento e come si prendono i provvedimenti del caso.
Murri A. Quattro lezioni e una perizia. Il problema del metodo in medicina e in biologia, Zanichelli,Bolgna, 1972 ,10-11
Poli E. Metodologia Medica: Principi di logica e pratica clinica. Rizzoli, Milano, 1965, 40-41
Come non si possono affidare interventi complessi frutto di anni di esperienza ad equipe non formate. il tempo della formazione comporta rischi spesso inaccettabili e la strada giusta e’ l’affiancamento e la progressiva condivisione di procedure e protocolli e di pratica clinica chirurgica.
E allora perché’ ci sono tante ammucchiate di guardie in comune? capisco nei piccolo ospedali ma negli ospedali di riferimento non si possono avere reparti specialistici con pazienti gravi e complessi di giorno e di notte e domeniche lasciati in balia del primo vento che non sa nulla e non capisce la strategie ne’ i risvolti di patologie spesso complesse e pericolose. Negli ospedali di riferimento le specialistiche, se le si vogliono, devono essere coperte h24. la spesa non e’ enorme e basterebbe ridurre esami inutili, complicanze evitabili (che spesso vengono provocate da cattiva organizzazione), uso incongruo di farmaci (es albumina etc) od antibiotici che il conto tornerebbe.
In campo internistico ci sono diversi lavori: in nefrologia sono drammatici: soprattutto quando non ci sono i nefrologi a gestire la dialisi.
Objective To measure the association between a surgeon’s degree of specialization in a specific procedure and patient mortality. Design Retrospective analysis of Medicare data. Setting US patients aged 66 or older enrolled in traditional fee for service Medicare. Participants 25 152 US surgeons who performed one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695 987 patients in 2008-13. Main outcome measure Relative risk reduction in risk adjusted and volume adjusted 30 day operative mortality between surgeons in the bottom quarter and top quarter of surgeon specialization (defined as the number of times the surgeon performed the specific procedure divided by his/her total operative volume across all procedures). Results For all four cardiovascular procedures and two out of four cancer resections, a surgeon’s degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure. Conclusion For several common procedures, surgeon specialization was an important predictor of operative mortality independent of volume in that specific procedure. When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon’s procedure specific volume as well as the degree to which a surgeon specializes in that procedure.
Health Apps, Social Diseases and Social Media
Su Internet tutti condividono, ma nessuno legge. Ecco perché succede.
As physicians, our success in treating illness depends mostly on our ability to diagnose what is the matter with the patient. An emphasis on diagnostic skill sets alone, however, has led to approaches in which care is designed around disease and the doctor dictating treatment to the patient. Sosena Kebede explains why we need to start asking patients “What matters to you?” rather than “What’s the matter
This can help reframe interactions in a more patient centered way Maureen Bisognano, one of the keynote speakers at this year’s International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden, told delegates that we should ask our patients, “What matters to you?” rather than, “What is the matter?” The question “What matters to you?” tries to get to the essence of patient centered care, which the Institute of Medicine has listed as one of the priorities for quality improvement. As physicians, our success in treating illness depends mostly on our ability to diagnose what the matter is with the patient. Pattern recognition, attention to verbal and visual cues from the patient, deductive reasoning, and good clinical judgment are time revered skills that good physicians spend years perfecting. The emphasis on diagnostic skill sets alone, however, has led …
Since dialysis treatments cannot clean your blood 24/7, wastes can build up in your blood between treatments and make you sick. This is why it is important to watch what you eat and drink.
Il Sole di Marzo – Associazione Onlus / A casa dopo il trapianto
What is a nephrectomy? Nephrectomy (nephro = kidney, ectomy = removal) is the surgical removal of a kidney. The procedure is done to treat kidney cancer as well as other kidney diseases and injuries. Nephrectomy is also done to remove a healthy kidney from a donor (either living or deceased) for transplantation. Thousands of nephrectomies are performed every year in the U.S.