sábado, 21 de mayo de 2011

The Five Steps of Social Media Grieving


The Five Steps of Social Media Grieving (for Hospital Execs)


While many hospital marketers have already accepted and/or embraced the use of social media, there continue to be holdouts in the “C-suite” who struggle to accept social media as a valid strategic tool. Why this reluctance? I have a theory…
By now most of us are familiar with the “five stages of grief” identified by psychologist Elisabeth Kübler-Ross. I suspect that as modern marketers struggle with the “death” of outdated marketing strategies, the same five stages can be applied to their reluctance to embrace the new medium of social media.
Stage 1: Denial
At first, hospital leadership has a tendency to deny the very fact that social media greatly impacts how people search online for healthcare information. Rather than accept that
  • YouTube comprises 25% of all Google searches
  • Facebook is a valid source for millions of online healthcare searchers
  • Twitter has become an acceptable and trusted form of communication
…hospital leaders continue to reject the mainstream use of social media.
Examples: ”No one uses social media to look for health problems.” . . . “Why would anyone look at YouTube for hospitals? It’s preposterous!!” . . . “Twitter is only for leaking unverified news stories and facilitating revolutions in the Middle East – not for healthcare!”
Stage 2: Anger
Once they start to see past this denial, the next phase reluctant hospital executives face is extreme anger at the very existence of social media. At this stage, there is a tendency to react with irrational behavior, outrageous litigation and general discontent with the web (as a marketing vehicle) itself.
Examples: ”How could someone write all this stuff about my hospital? What right do they have?” . . . “I’m going to stop patients from having any opinion about me online by having them sign this gag order! Then, I’ll sue!” . . . “I won’t let any of my employees on social media sites — I’ll have our IT department block YouTube and Facebook.”
Stage 3: Bargaining
At this stage, reluctant hospital leaders start to see that social media is not a fad, and so they reluctantly begin to bargain to make the (perceived) negative impact less severe. Often they try to compromise the openness of social media by forcing it to act more like traditional marketing.
Examples: ”Well, OK, I’ll create a YouTube channel, but I am going to turn off all comments.” . . . “I’ll guess I have to get a Twitter account, but I won’t follow anyone and I will rarely post a ‘tweet’.” . . .  ”Maybe I’ll just look over my daughter’s shoulder the next time she’s on Facebook, to see what it’s all about.”
Stage 4: Depression
After attempting to tiptoe their way into social media, reluctant hospital execs then reach a period of deep malaise and sadness. They are gripped by fears that the tide of social media (and user-generated content) will wash away all their expensive branding efforts. Numbness, anger and sadness may also remain.
Examples: ”There is no way to respond to blog posts about my hospital — why should we even bother?” . . . “What’s the point of looking for what people say about us on Facebook — I can’t control anything they say.” . . . “I long for the good old days when all I had to do was create a few nice billboard and newspaper ads to define my hospital brand.”
Stage 5: Acceptance
The last stage encountered by reluctant hospital leaders is acceptance. At this point, the anger and sadness has worn off, and they start to accept that social media is here to stay. Soon, they are on the path to learning how these tools can augment and enhance their existing branding and communication efforts — and actually bear out positive successes.
Examples: ”You know, Facebook really isn’t a bad way to increase awareness of my hospital’s foundation.” . . . “Actually, my traditional marketing techniques are really not as effective as they once were — maybe there is something to this social media stuff.” . . . “I can’t fight it, so I may as well learn how to use social media effectively.”
In keeping with Kübler-Ross’s original theory, the above steps do not necessarily occur in the order noted above; nor are all steps experienced by all hospital leaders. But I’ve found that most hospital execs seem to experience at least two of the above stages.
Ask yourself honestly – are you going through any of these stages? If so, don’t worry — and try not to force the process. To quote Wikipedia’s article on the Five Stages of Grieving:
“Don’t rely on others saying “you should be over this by now”; “you’re taking too long”, or, “you haven’t waited long enough”. The process is highly personal and should not be rushed, nor lengthened, on the basis of another’s imposed timeframe or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of “Acceptance” will be reached.”
Chris Boyer is a member of the Advisory Board for the Mayo Clinic Center for Social Media. He also will be presenting at our third annual Social Media Summit Oct. 17-19 in Rochester, Minn. See this post for details on how to register.
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Redes sociales para la educación

Nutricion en Enfermedades Respiratorias

Reversión urgente de la terapia antagonista de vitamina K.


Reversión urgente de la terapia antagonista de vitamina K.
Urgent reversal of vitamin K antagonist therapy.
VANG, M. L., HVAS, A. M. and RAVN, H. B.
Acta Anaesthesiologica Scandinavica 2011: 55: 507-516.
doi: 10.1111/j.1399-6576.2011.02414.x
In the developed world, an increasing number of patients receive therapy with vitamin K antagonists (VKA). This group of patients poses an additional challenge in the perioperative management of emergency surgery and trauma. The present review offers a detailed description of some treatment options for reversal of VKA therapy. Optimal treatment of the anticoagulated patient requires a well-balanced intervention securing a reduced risk of haemorrhagic surgical complications as well as optimal anticoagulation post-operatively without exposing the patient to an increased risk of thromboembolic complications. The following factors must be considered in VKA-treated patients scheduled for emergency surgery: (1) the indication for VKA therapy, including the risk of thromboembolic events when the International normalized ratio (INR) is reduced, (2) type of surgery, including the risk of haemorrhagic complications and (3) the pharmacodynamic/-kinetic profile of the therapy used to revert the VKA therapy. Therapeutic options for acute reversal of VKA therapy include: vitamin K, fresh frozen plasma (FFP), prothrombin complex concentrate (PCC) and perhaps activated recombinant factor VII. PCC is a relatively new drug in some European countries and clinical experience is limited compared with the use of FFP. Reversal of VKA anticoagulation with PCC is faster and more efficient compared with FFP, but there are currently no randomized studies demonstrating an improved clinical outcome.

http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02414.x/pdf

 
Atentamente
Dr. Juan Carlos Flores-Carrillo 
Anestesiología y Medicina del Dolor

En este día...


ON THIS DAY

On This Day: May 21

On May 21, 1927, Charles A. Lindbergh landed his Spirit of St. Louis near Paris, completing the first solo airplane flight across the Atlantic Ocean
On May 21, 1921, Andrei Sakharov, the Nobel Peace Prize-winning Soviet scientist and dissident, was born. Following his death on Dec. 14, 1989, his obituary appeared in The Times.

On This Date

1832The first Democratic National Convention got under way, in Baltimore.
1840New Zealand was declared a British colony.
1881Clara Barton founded the American Red Cross.
1892The opera "I Pagliacci" by Ruggiero Leoncavallo was first performed, in Milan, Italy.
1924Nathan Leopold Jr. and Richard Loeb, two students at the University of Chicago, killed a 14-year-old boy in a "thrill killing."
1956The United States exploded the first airborne hydrogen bomb, over Bikini Atoll in the Pacific.
1959The musical "Gypsy" starring Ethel Merman opened on Broadway.
1979Former San Francisco City Supervisor Dan White was convicted of voluntary manslaughter in the shooting deaths of Mayor George Moscone and Supervisor Harvey Milk.
1991Former Indian Prime Minister Rajiv Gandhi was assassinated by a suicide bomber.
1999Susan Lucci, star of the ABC soap opera "All My Children," won her first Daytime Emmy Award for best actress in the 19th straight year she was nominated.
2008David Cook won the seventh season of "American Idol."

Current Birthdays

Lisa Edelstein, Actress (“House M.D.”)
Actress Lisa Edelstein ("House M.D.") turns 45 years old today.
AP Photo/Evan Agostini
Al Franken, U.S. senator, D-Minn.
Sen. Al Franken, D-Minn., turns 60 years old today.
AP Photo/J. Scott Applewhite
1941Ron Isley, R&B singer (The Isley Brothers), turns 70
1948Leo Sayer, Singer, turns 63
1952Mr. T, Actor ("The A Team"), turns 59
1957Judge Reinhold, Actor ("Beverly Hills cop" movies), turns 54
1959Nick Cassavetes, Actor, director, turns 52
1977Ricky Williams, Football player, turns 34
1981Josh Hamilton, Baseball player, turns 30
1991Sarah Ramos, Actress ("Parenthood"), turns 20

Historic Birthdays

56Alexander Pope 5/21/1688 - 5/30/1744
English poet and satirist
65Elizabeth Fry 5/21/1780 - 10/12/1845
English philanthropist and social reformer
47Edwin Christy 5/21/1815 - 5/21/1862
American minstrel show performer
66Henri Rousseau 5/21/1844 - 9/2/1910
French painter
85Gustav Lindenthal 5/21/1850 - 7/31/1935
Austrian-born American civil engineer; designed the Hell Gate Bridge
74Leon Bourgeois 5/21/1851 - 9/29/1925
French statesman and promoter of the League of Nations; awared Nobel Prize for Peace (1920)
58Grace Hoadley Dodge 5/21/1856 - 12/27/1914
American philanthropist
67Willem Einthoven 5/21/1860 - 9/29/1927
Dutch physiologist and developer of the electrocardiograph; won Nobel Prize (1924)
52Glenn Curtiss 5/21/1878 - 7/23/1930
American aviation pioneer
79Marcel Breuer 5/21/1902 - 7/1/1981
Hungarian-born American architect
39Fats Waller 5/21/1904 - 12/15/1943
American pianist and composer

las cesáreas y sus potenciales repercusiones sobre el niño y la propia madre

Hola a tod@s

Os ofrecemos, por si resultan de vuestro interés, diversos artículos publicados en "Evidencias en Pediatría"http://www.evidenciasenpediatria.es sobre las cesáreas y sus potenciales repercusiones sobre el niño y la propia madre:

El parto por cesárea conlleva un aumento de la morbilidad materna. ¿Compensa el riesgo? Evid Pediatr. 2008;4:16.  http://goo.gl/cdLbl

Influencia de la atención al parto y al nacimiento sobre la lactancia, con especial atención a las cesáreas. Evid Pediatr. 2011;7:2. http://goo.gl/QN8ma

Los niños nacidos por cesárea toman menos lactancia materna. Evid Pediatr. 2011;7:15.    http://goo.gl/H5Hgn

Feliz fin de semana:

Cristóbal Buñuel
Girona (España)
Codirector de "Evidencias en Pediatría"
http://www.evidenciasenpediatria.es

Utilidad del cribado electrocardiográfico en población neonatal


Utilidad del cribado electrocardiográfico en población neonatal

Publicado en An Pediatr (Barc). 2011;74:303-8. - vol.74 núm 05
Leer en: English
Descargar en: Español

Introducción
El síndrome de QT largo congénito es una entidad poco frecuente y sin embargo causante de cerca del 10% de las muertes súbitas del lactante. Se caracteriza por un intervalo QT prolongado en el electrocardiograma (ECG) basal que asocia episodios de arritmias potencialmente mortales, en general en pacientes previamente asintomáticos, que son prevenibles con un tratamiento adecuado.
Objetivos
Estudiar el impacto de la implementación de un screening electrocardiográfico en neonatos y obtener los valores de referencia en nuestra población.
Material y métodos
Se realizó un ECG de 12 derivaciones. Medidas: intervalos RR, PR, QT y QT corregido; amplitud de R (V1, AVR y AVL), de Q (I y aVL), amplitud y duración de la onda P; morfología de bloqueo de rama derecha con elevación del ST (patrón Brugada); onda delta. Se consideraron patológicos: QT corregido > 0,44 o < 0,30 segundos; R en V1 > 12 y en aVR > 8mm; R en aVL > 7,5mm; Q > 25% QRS (I y aVL), patrón Brugada y onda delta.
Resultados
Nacieron 1.061 niños sanos en nuestro hospital entre el 29 de mayo de 2007 y el 12 de diciembre de 2008, 50,3% varones. Se realizó ECG a 1.006 (asistencia del 94,8%). Cinco fueron patológicos (0,5%): 2 QT largos (no confirmados en estudio posterior), 2 Wolf-Parkinson-White y 1 onda Q patológica. No se encontró cardiopatía estructural en ninguno de ellos.
Conclusiones
El cribado electrocardiográfico en neonatos es una prueba inocua, económica y bien aceptada por los padres que permite diagnosticar patología cardíaca asintomática pero potencialmente mortal, y se obtienen con dicho cribado las principales medidas electrocardiográficas en nuestra población.
Palabras clave Síndrome QT largo. Muerte súbita. Electrocardiograma.

Pubertad precoz central: aspectos epidemiológicos, etiológicos y diagnóstico-terapéuticos


Pubertad precoz central: aspectos epidemiológicos, etiológicos y diagnóstico-terapéuticos

Publicado en An Pediatr (Barc). 2011;74:336.e1-e13. - vol.74 núm 05
Leer en: English
Descargar en: Español
Resumen
La pubertad precoz central (PPC) es una enfermedad rara, de claro predominio femenino y con mayor incidencia entre individuos adoptados. De etiología idiopática en la mayoría de ocasiones, en los últimos 2 años se han descrito las primeras mutaciones causantes de PPC. La prevalencia de patología orgánica es notablemente inferior entre las niñas con PPC; sin embargo, no se han descrito variables predictoras lo suficientemente seguras como para seleccionar a qué tipo de niñas se les debe realizar una prueba de imagen. Aunque con las nuevas técnicas disponibles se ha conseguido mejorar la sensibilidad de la determinación de LH basal como marcador de PPC, a día de hoy la prueba más relevante sigue siendo el pico de LH tras test de estimulación con LHRH. Finalmente, la utilización de los análogos de GnRH se ha mostrado principalmente eficaz en el tratamiento de PPC de menores de 6 años.
Palabras clave Pubertad precoz central.

Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre diagnóstico y tratamiento de la candidiasis invasiva


Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre diagnóstico y tratamiento de la candidiasis invasiva

Publicado en An Pediatr (Barc). 2011;74:337.e1-e17. - vol.74 núm 05

Leer en: English
Descargar en: Español
Resumen
Las levaduras del género Candida son comensales ubicuos, que pueden causar infección oportunista en cualquier localización del organismo; la fuente de infección puede ser tanto endógena como exógena. La candidiasis invasiva engloba entidades distintas que van desde la candidemia o invasión limitada al torrente circulatorio a la candidiasis diseminada o infección multiorgánica. La candidemia constituye la tercera causa de infección del torrente circulatorio en la IN y la cuarta de todas las infecciones. También constituye la IFI más frecuente en el paciente crítico no neutropénico, habiendo sufrido un incremento muy notable en los últimos 20 años, debido tanto a una mayor supervivencia de los pacientes críticamente enfermos como a una mayor complejidad de los procedimientos diagnóstico-terapéuticos y quirúrgicos. Su incidencia en lactantes, según revisiones recientes, se sitúa en 38,8 casos/100.000 menores de 1 año. La especie más frecuentemente implicada en infecciones invasoras sigue siendoCandida albicans, aunque en los últimos años existe un incremento de infecciones causadas por especies distintas: es relevante la aparición de Candida krusei y Candida glabrata y el incremento de candidemia por Candida parapsilosisasociada principalmente al manejo de catéteres intravenosos centrales, especialmente en unidades neonatales.
La mortalidad global de la candidiasis invasiva es elevada, llegando a cifras del 20 al 44% a los 30 días en determinadas series que incluyen a pacientes pediátricos.
Este documento recoge una revisión actualizada sobre incidencia, epidemiología, diagnóstico, tratamiento y evolución, de la infección invasiva por Candida spp. en el paciente pediátrico.
Palabras clave Candidiasis invasiva. Candida. Tratamiento. Diagnóstico. Pediatría