Paediatric tumour boards in Spain: a national survey

Purpose: Multidisciplinary tumour boards (MDTs) are conducted worldwide for the management of patients with cancer, and they deliver a higher standard of care by simultaneously involving different specialists in diagnosis and treatment planning. However, information of paediatric MDTs functioning is scarce. A pilot study was conducted in Spain in the frame of the European Expert Paediatric Oncology Reference Network for Diagnostics and Treatment (ExPO-r-Net). Methods: A specific questionnaire was designed regarding various features of MDT practice. Data collected included information on the centres and the team, infrastructure for meetings, MDT organization/logistics and clinical decision-making. The survey was distributed to all Paediatric Oncology Units that register patients in the Spanish Registry of Childhood Tumours (RETI-SEHOP). Results: 32 out of 43 contacted centres responded the questionnaire (74 % response rate; 88 % response rate for centres with [25 new patients/year). All units with [25 new patients/year have a dedicated Paediatric MDT compared to 76 % of units with B25 new patients/year. MDTs should be improved at institutional level by clear protected time in service planning for all specialists involved, incentives for attendance and attendance registration. Clinical decision-making process and follow-up of recommendation adherence should be assessed and potential legal responsibilities for physicians participating in Tumour Board defined. Network collaboration through virtual MDTs, using available videoconferencing tools, is an opportunity to share expertise among centres (AU)

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Paediatric tumour boards in Spain: a national survey.

PURPOSE: Multidisciplinary tumour boards (MDTs) are conducted worldwide for the management of patients with cancer, and they deliver a higher standard of care by simultaneously involving different specialists in diagnosis and treatment planning. However, information of paediatric MDTs functioning is scarce. A pilot study was conducted in Spain in the frame of the European Expert Paediatric Oncology Reference Network for Diagnostics and Treatment (ExPO-r-Net). METHODS: A specific questionnaire was designed regarding various features of MDT practice. Data collected included information on the centres and the team, infrastructure for meetings, MDT organization/logistics and clinical decision-making. The survey was distributed to all Paediatric Oncology Units that register patients in the Spanish Registry of Childhood Tumours (RETI-SEHOP). RESULTS: 32 out of 43 contacted centres responded the questionnaire (74 % response rate; 88 % response rate for centres with >25 new patients/year). All units with >25 new patients/year have a dedicated Paediatric MDT compared to 76 % of units with ≤25 new patients/year. MDTs should be improved at institutional level by clear protected time in service planning for all specialists involved, incentives for attendance and attendance registration. Clinical decision-making process and follow-up of recommendation adherence should be assessed and potential legal responsibilities for physicians participating in Tumour Board defined. Network collaboration through virtual MDTs, using available videoconferencing tools, is an opportunity to share expertise among centres.

[Spontaneous Subarachnoid Haemorrhage multicenter database from the Group for the Study of Vascular Pathology of the Spanish Society for Neurosurgery: presentation, inclusion criteria and development of an internet-based registry]. / Base de datos multicéntrica de hemorragia subaracnoidea espontánea del Grupo de Trabajo de Patología Vascular de la Sociedad Española de Neurocirugía: presentación, criterios de inclusión y desarrollo de una base de datos en internet.

INTRODUCTION: Subarachnoid haemorrhage is one of the most severe neurosurgical diseases. Its study is crucial for improving the care of these patients in our environment. With this goal the Group for the Study of Neurovascular Pathology of the Spanish Society for Neurosurgery (SENEC) decided to create a multicenter registry for the study of this disease. MATERIALS AND METHODS: In this database we have prospectively included all cases with spontaneous subarachnoid haemorrhage admitted to the participant hospitals from November 2004 to November 2007. The fields to be included in the database were selected by consensus, including age, past medical history, clinical characteristics at admission, radiological characteristics including presence or absence of an aneurysm and its size and location, type and complications of the aneurysm treatment, outcome assessed by the Glasgow Outcome Scale (GOS) at discharge and six months after the bleeding as well as the angiographic result of the aneurysm treatment. All fields were collected by means of an electronic form posted in secure web page. RESULTS: During the three years of study a total of 1149 patients have been included by 14 Hospitals. The time needed to fill in a patient in the registry is approximately 3.4 minutes. This series of patients with spontaneous SAH is similar to other non-selected in-hospital series of SAH. The mean age of the patients is 55 years and there is a 4:3 female to male ratio. In relation to the severity of the bleeding 32% of the patients were in poor clinical grade at admission (WFNS 4 or 5). 5% of the patients died before angiography could be performed. An aneurysm was confirmed as the origin of the bleeding in 76% of the patients (aSAH), while in 19% of the patients no lesion was found in the angiographic studies and were thus classified as idiopathic subarachnoid hemorrhage (ISAH). Of those patients with aSAH, 47% were treated endovascularly, 39% surgically, 3% received a combined treatment and 11% did not receive any treatment for their aneurysm because of early death. Regarding outcome, there is a 22% mortality in the series. Only 40% of the patients with aSAH reached a good outcome at discharge (GOS = 5). CONCLUSIONS: Spontaneous SAH continues to be a disease with high morbidity and mortality. This database can be an ideal instrument for improving the knowledge about this disease in our environment and to achieve better results. It would be desirable that this database could in the future be the origin of a national registry of spontaneous SAH.

Telemonitoring systems interoperability challenge: an updated review of the applicability of ISO/IEEE 11073 standards for interoperability in telemonitoring.

Advances in Information and Communication Technologies, ICT, are bringing new opportunities and use cases in the field of systems and Personal Health Devices used for the telemonitoring of citizens in Home or Mobile scenarios. At a time of such challenges, this review arises from the need to identify robust technical telemonitoring solutions that are both open and interoperable. These systems demand standardized solutions to be cost effective and to take advantage of standardized operation and interoperability. Thus, the fundamental challenge is to design plug-&-play devices that, either as individual elements or as components, can be incorporated in a simple way into different Telecare systems, perhaps configuring a personal user network. Moreover, there is an increasing market pressure from companies not traditionally involved in medical markets, asking for a standard for Personal Health Devices, which foresee a vast demand for telemonitoring, wellness, Ambient Assisted Living (AAL) and e-health applications. However, the newly emerging situations imply very strict requirements for the protocols involved in the communication. The ISO/IEEE 11073 family of standards is adapting and moving in order to face the challenge and might appear the best positioned international standards to reach this goal. This work presents an updated survey of these standards, trying to track the changes that are being fulfilled, and tries to serve as a starting-point for those who want to familiarize themselves with them.

Implementation experience of a patient monitoring solution based on end-to-end standards.

This paper presents a proof-of-concept design of a patient monitoring solution for Intensive Care Unit (ICU). It is end-to-end standards-based, using ISO/IEEE 11073 (X73) in the bedside environment and EN13606 to communicate the information to an Electronic Healthcare Record (EHR) server. At the bedside end a plug-and-play sensor network is implemented, which communicates with a gateway that collects the medical information and sends it to a monitoring server. At this point the server transforms the data frame into an EN13606 extract, to be stored on the EHR server. The presented system has been tested in a laboratory environment to demonstrate the feasibility of this end-to-end standards-based solution.

Proposal of an ISO/IEEE11073 platform for healthcare telemonitoring: plug-and-play solution with new use cases.

Remote patient monitoring in e-Health is everyday closer to be a mature technology / service. However, there is still a lack of development in areas such as standardization of the sensor's communication interface, integration into Electronic Healthcare Record systems or incorporation in ambient-intelligent scenarios. This work identifies a set of use cases involved in the personal monitoring scenario and highlights the related features and functionalities, as well as the integration and implementation difficulties found when these are to be implemented in a system based on the ISO/IEEE11073 (X73) standard. It is part of a cooperative research effort devoted to the development of an end-to-end standards-based telemonitoring solution. Standardization committees are working towards adapting the X73 standard to this emerging personal health devices market and use case identification is essential to direct these revisions.

Integrated care prevents hospitalisations for exacerbations in COPD patients.

Hospital admissions due to chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on the disease evolution and costs. The current authors postulated that a simple and well-standardised, low-intensity integrated care intervention can be effective to prevent such hospitalisations. Therefore, 155 exacerbated COPD patients (17% females) were recruited after hospital discharge from centres in Barcelona (Spain) and Leuven (Belgium). They were randomly assigned to either integrated care (IC; n = 65; age mean+/-sd 70+/-9 yrs; forced expiratory volume in one second (FEV(1)) 1.1+/-0.5 L, 43% predicted) or usual care (UC; n = 90; age 72+/-9 yrs; FEV(1) 1.1+/-0.05 L, 41% pred). The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team, as well as accessibility to a specialised nurse case manager through a web-based call centre. After 12 months' follow-up, IC showed a lower hospitalisation rate (1.5+/-2.6 versus 2.1+/-3.1) and a higher percentage of patients without re-admissions (49 versus 31%) than UC without differences in mortality (19 versus 16%, respectively). In conclusion, this trial demonstrates that a standardised integrated care intervention, based on shared care arrangements among different levels of the system with support of information technologies, effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients.

Towards e-Health device interoperability: the Spanish experience in the telemedicine research network.

The expansion of e-Health solutions is hindered by the high costs and low flexibility of home and mobile telemonitoring systems. This situation may be improved by the use of standards to design open, plug-and-play and interoperable devices. This work describes the joint efforts of three research groups in Spain towards the interoperability of their telemonitoring solutions based on the ISO11073/IEEE1073 family of standards.

Interoperability of a mobile health care solution with electronic healthcare record systems.

Mobile health care solutions involving patient monitoring are an increasingly accepted element in chronic disease management strategies. When used in healthcare systems with different providers, it is essential that the information gathered from the patient is available at each of these providers information repositories. This paper describes the design of a connectivity interface based on the HL7 standard that allows the MOTOHEALTH mobile health care solution to communicate with external electronic healthcare record systems supporting HL7.