ABSTRACT
Antecedentes: En el año 2014 se inició Telemedicina desde el Policlinico de Tratamiento Anticoagulante oral del Hospital San Juan de Dios y el Hospital de Curacaví, evitando así el traslado de pacientes a Santiago para el control con el médico especialista. Métodos: Se utilizó licencia de video conferencia en el Hospital San Juan de Dios, dispositivo móvil, equipo de INR capilar y stock de Acenocumarol en el Hospital de Curacaví. Resultados: En total se han realizado 2.174 consultas vía Telemedicina (junio 2014 a diciembre 2015). Esta estrategia ha sido bien evaluada por los pacientes. La mejora en la calidad del tratamiento ha sido evidente: 58,3% de los pacientes del Hospital de Curacaví se encuentran en rango terapéutico, superior al 50,8% de los pacientes del Hospital San Juan de Dios (p < 0,05). En cuanto al Tiempo en Rango Terapéutico (TTR) 50,6% de los pacientes del Hospital de Curacaví se encuentran en rango versus 46,2% de los pacientes del Hospital San Juan de Dios (p< 0,05). Conclusiones: La Telemedicina utilizada por equipos comprometidos es capaz de mantener indicadores de calidad de la atención que la validan como herramienta de atención clínica a distancia. La Telemedicina, en cuanto es una herramienta que acerca el especialista a comunidades alejadas de centros hospitalarios complejos, es valorada y muy bien calificada por los usuarios.
Background: Starting in 2014 telemedicine has been used to control oral anticoagulant treatment (OAT) in patients attending a peripheral hospital (Curacaví), in connection with Hospital San Juan de Dios, based in Santiago. Methods: A license for video conference was available to communicate both hospitals. Capillary INR and medications were available at Curacaví Hospital. Results: Between June 2014 and December 2015, 2174 indications for OAT have been made through tele-medicine. Different estimates of quality of care and user satisfaction have been rated > 6.7 (1-7 scale). Percent of INR measurements in therapeutic range was 58.3% in Curacavi and 50.8% at Hospital San Juan de Dios (p<0.05) and time in therapeutic range was 50.6% vs 42.6%, respectively (p<0.05) Conclusion: Tele-medicine allowed a close relationship between remote medical facilities and a complex medical center and was fully validated as a means of controlling OAT with a high degree of acceptance by patients.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Drug Monitoring , Telemedicine/methods , Anticoagulants/administration & dosage , Time Factors , Capillaries , Administration, Oral , Surveys and Questionnaires , Patient Satisfaction , International Normalized RatioABSTRACT
DWI/ADC is a completely non-invasive technique that has been successfully conducted for many years in brain imaging and is currently being studied for the assessment of other organs, such as the abdomen and pelvis and in particular the head and neck structures. Even though DWI and the ADC measurement are able provide tissue information at the cellular level, most imaging centers have not yet adopted them as part of their routine evaluation of the head and neck. DWI has demonstrated usefulness to discriminate specific histological tumor types, especially to differentiate benign solid lesions from malignant masses, to evaluate lymph nodes, particularly to differentiate benign disease from malignancy, to differentiate postradiation changes from residual tumor and potentially to predict therapy success. Moreover DWI seems to be a safer and more affordable method considering the absence of radiation and to the higher cost of FDG-PET to localize tumors and to differentiate benign from malignant masses. Given all these advantages and strengths, DWI will certainly become part of the routine in the MR imaging of the head and neck.
DWI é uma técnica totalmente não invasiva que tem sido utilizada com sucesso por muitos anos em imagens do cérebro e recentemente incluída como parte da avaliação de outros sistemas, por exemplo, no abdome e pelve e na cabeça e pescoço. Apesar de a DWI e a medida dos valores de ADC serem capazes de fornecer informações de tipos histológicos específicos de tumores, a maioria dos centros de imagem ainda não os adotaram como parte da rotina na avaliação da cabeça e pescoço. A medida de ADC demonstrou ser útil para discriminar tipos específicos de tumores histológicos, especialmente para diferenciar lesões benignas sólidas de massas malignas, importante na avaliação de linfonodos cervicais, principalmente para diferenciar processos nodais benignos de malignos, para diferenciar as alterações pós-radioterapia de tumor residual e ter uso potencial para predizer sucesso terapêutico. Além disso, DWI/ADC parece ser um método mais seguro e mais acessível, considerando a ausência de radiação ionizante e ao maior custo do FDG-PET na localização de tumores e diferenciar massas benignas de malignas. Com todas essas vantagens e potencialidades, DWI/ADC certamente fará parte da rotina na avaliação por imagem da cabeça e pescoço.