ABSTRACT
The Choosing Wisely initiative has become a significant benchmark as a strategy to reduce low value tests and therapies. An original initiative of the American Board of Internal Medicine (ABIM) which has been growing gradually and is now present in over 18 countries, with the support of more than 80 scientific societies around the world. In Colombia, the strategy is being accepted by the Colombian Association of Scientific Societies (ACSC), which with the support of six pioneer Colombian scientific societies, have encouraged the development and implementation of "do not do recommendations", with a view to fulfil the right to self-regulation of human resources in healthcare, reducing those medical behaviors that could be ineffective or harmful to the patient. This article is an overview of the most significant items of the initiative which has been conducted by the ACSC, with the support of the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.) as a pioneer.
La iniciativa Choosing Wisely se ha convertido en un significativo referente como estrategia para reducir pruebas y tratamientos de bajo valor. Planteada originalmente por la American Board of Internal Medicine (ABIM), ha ido creciendo gradualmente y ya se encuentra en más de 18 países, y cuenta con el apoyo de más de 80 sociedades científicas del mundo. En Colombia, la estrategia está siendo adaptada por la Asociación Colombiana de Sociedades Científicas (ACSC), quienes, con el apoyo de seis sociedades científicas colombianas como pioneras, han motivado la elaboración e implementación de "recomendaciones de no hacer", con el objetivo de materializar el derecho a la autorregulación del talento humano en salud, reduciendo aquellas conductas médicas que pueden ser inefectivas u ocasionar daño al paciente. En este artículo hacemos un recuento de los puntos más importantes de la iniciativa, cuál ha sido la labor de la ACSC, y el papel que la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) ha tenido como sociedad pionera.
ABSTRACT
Introduction: Perioperative hypothermia is a common condition associated with serious complications and perioperative mortality. The incidence of perioperative hypothermia is between 30 and 70%. Objective: To determine the status of perioperative monitoring and thermal protection in clinics and hospitals of high complexity in Colombia and the establishment of minimum safety standards of the Colombian Society of Anesthesiology to this respect. Methods: A survey with voluntary answers was administered to leaders of anesthesiology departments and surgical services of high complexity institutions in Colombia. The questionnaire had 20 items with an adaptive structure and was sent by email to a randomized list. Only fully completed questionnaires were analyzed. Results: 135 surveys were analyzed. Measurement of temperature is reported always or almost always in 27% of cases, while 45% have at least one method of intraoperative thermal protection. Barriers for monitoring temperature and for thermal protection were explored. Conclusions: Temperature monitoring and perioperative thermal protection is insufficient in the sample studied. The reasons are: limited availability of devices for monitoring and protection and lack of interest toward the subject. There is no acceptance of minimum safety standards of the Colombian Society of Anesthesiology (S.C.A.R.E.) because of the limited availability of thermometers, poor monitoring of intraoperative temperature and misuse of heating strategies.
Introducción: La hipotermia perioperatoria es una condición frecuente que se asocia a complicaciones serias que en algunos casos pueden ser potencialmente letales. La incidencia de hipotermia perioperatoria oscila entre 30 y 70%. Objetivo: Determinar la situación de la monitorización y protección térmica perioperatoria en instituciones prestadoras de servicios de salud de alta complejidad en Colombia y la apropiación de las normas mínimas de seguridad de la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) sobre este aspecto. Métodos: Se realizó una encuesta cerrada por internet de diligenciamiento voluntario. El cuestionario de 20 ítems tenia una estructura adaptativa, fue administrado por correo electrónico, y se dirigió a líderes de departamentos de anestesiología y servicios quirúrgicos de alta complejidad en Colombia. Solo se analizaron cuestionarios completamente respondidos. Resultados: Se analizaron 135 encuestas. Los encuestados refirieron realizar la medición de la temperatura siempre o casi siempre en 27% de los casos, mientras que 45% disponen de al menos un método de protección térmica intraoperatoria. Se exploraron las barreras para la monitorización y la protección térmica perioperatoria. Conclusiones: La monitorización de la temperatura y la protección térmica perioperatoria es insuficiente en la muestra estudiada. Esto como consecuencia de poca disponibilidad de dispositivos para monitorización y protección y por falta de interés frente al tema. No hay apropiación de las normas mínimas de seguridad de la S.C.A.R.E., dada la poca disponibilidad de termómetros, la escasa monitorización de la temperatura intraoperatoria y el uso inadecuado de las estrategias de calentamiento.
Subject(s)
HumansABSTRACT
In this article, we compare quantitatively the efficiency of three different protocols commonly used in commercial defibrillators. These are based on monophasic and both symmetric and asymmetric biphasic shocks. A numerical one-dimensional model of cardiac tissue using the bidomain formulation is used in order to test the different protocols. In particular, we performed a total of 4.8 × 10(6) simulations by varying shock waveform, shock energy, initial conditions, and heterogeneity in internal electrical conductivity. Whenever the shock successfully removed the reentrant dynamics in the tissue, we classified the mechanism. The analysis of the numerical data shows that biphasic shocks are significantly more efficient (by about 25%) than the corresponding monophasic ones. We determine that the increase in efficiency of the biphasic shocks can be explained by the higher proportion of newly excited tissue through the mechanism of direct activation.
Subject(s)
Arrhythmias, Cardiac/physiopathology , Electric Countershock , Models, Cardiovascular , Myocardium , Arrhythmias, Cardiac/therapy , HumansABSTRACT
The cytotoxic T lymphocyte antigen 4 gene (CTLA4) is a critical regulator of T-cell activation and it is an important therapeutic target for cancer and autoimmune diseases. Here, we analyzed the genomic regulation of CTLA4 gene expression in order to identify single nucleotide polymorphisms (SNPs) that affect its expression and splicing, and to assess their association with Multiple Sclerosis (MS). We analyzed 152 healthy subjects and 146 patients with MS, of which 52 controls and 51 patients were used for gene expression analysis. We genotyped 17 SNPs in the CTLA4 gene using the SNaPshot Multiplex Kit, and in addition gene expression of the soluble (sCTLA4) and full length (flCTLA4) isoforms was quantified by real-time PCR, while protein levels of sCTLA4 were measured by ELISA. We found that the SNPs at -1577, +6230, +10242, +10717 and +12310 influence CTLA4 expression and the combination of the -1577 GG and +6230 GG genotypes provokes the strongest decrease in CTLA4 gene expression. We found that the SNP at -658 only acted as a regulatory SNP in patients with MS, suggesting the existence of epigenetic changes due to this disease. We also identified a decrease in CTLA4 gene expression levels in patients receiving chemotherapy, although no association was observed between MS and any of the polymorphisms studied. In conclusion, we have identified several SNPs in the CTLA4 gene and studied their influence on its genetic regulation. The involvement of CTLA4 in the pathogenesis of MS may be subtle and related to the functional changes in its pathway rather than predisposing genetic polymorphisms.
