domingo, 17 de julio de 2011

El por qué de Facebook en una clínica o un hospital


Las marcas tienen que estar al lado de la gente. Las clínicas y hospitales tienen que estar donde están sus usuarios.

Hoy las personas están en las redes sociales. Por tanto, los centros sanitarios tienen que estar en ellas.
Tenemos que replantearnos como nos comunicamos con nuestros pacientes. El usuario es un consumidor social. Por lo que pregunta, investiga y busca recomendaciones de sus conocidos a través de las redes sociales.
Para ello tenemos que escuchar a nuestro público. No se trata de vender, se trata de fortalecer relaciones, que luego nos generarán beneficios. Debemos convertir a nuestros seguidores en clientes.
No es bueno dejarse llevar por la retórica del momento, ni por la propia del consultor de turno, De la misma forma, no es bueno dejarse llevar por los prejuicios acerca de determinado tipo de servicios y/o herramientas. Los centros sanitarios tienen que estar dispuestos y preparados para emprender el nuevo camino de las redes sociales.
Un caso de estudio es la Clínica Mayo, la prestigiosa institución sanitaria que desde principios del siglo XX mantiene los más altos estándares de atención a sus pacientes.
La misma comenta: “El 90% de nuestros pacientes hablaba cosas buenas de la clínica a sus amigos. Así que decidimos crear una serie de canales para amplificar estas opiniones”.
La lista de estos canales que, a día de hoy, mantiene la clínica Mayo, incluyen una cuenta en Twitter, un canal en YouTube, una página en Facebook y, sobre todo, la posibilidad de compartir cualquiera de los artículos que encontremos sobre la Clínica en cualquier red social.
Es famoso el caso del popular vídeo de Marlow y Fran Cowan, una pareja de octogenarios que fueron filmados, mientras tocaban el piano en uno de los edificios de la Clínica Mayo por otra paciente. La hija de esta paciente encontró el vídeo tan divertido, que decidió subirlo por su cuenta a YouTube, donde obtuvo poco más de 1.000 visionados en seis meses. Fue entonces cuando pidieron autorización para utilizar el vídeo dentro de los canales de la clínica Mayo. Dicho y hecho se colgó en la página de Facebook y se escribió en Twitter sobre él. El vídeo se convirtió en poco tiempo en un fenómeno viral del que todo el mundo hablaba, siendo visto casi 4 millones de veces y mencionado en numerosos medios online y programas de televisión, incluyendo el famoso late night de Jay Leno.
Y cuando se les pregunta a la clínica Mayo sobre qué consejos darían a otra organización a la hora de “introducirse” en el mundo del Social Media Marketing, su respuesta es muy clara:
“No es algo que se pueda hacer de la noche a la mañana. Empieza escuchando, ya tendrás el tiempo suficiente para poder generar resultados”,
También puedes leer:
Si eres profesional de la salud, paciente, familiar o te parece interesante, compártelo con tus conocidos.
Esta entrada fue publicada en Social Media Marketing y etiquetada ,. Guarda el enlace permanente.

Del e-patient al p-patient... o el periplo del error de foco



El p-patient (poor-patient) es un tipo de paciente muy frecuente en nuestras consultas del centro de salud y hospitales, pero lo será mucho más en los próximos años. El tipo de consultas más frecuentes en el p-patient suelen estar relacionadas con afecciones cardiovasculares, trastornos por somatización y consultas encuadrables dentro del ámbito de lo psicosocial.

El p-patient no demanda relacionarse con su médico por correo electrónico ni que la consejería de salud de su comunidad autónoma se gaste chorrocientos mil euros en redes sociales de pacientes o plataformas virtuales que lo empoderen. En realidad el p-patient en muchas ocasiones no sabrá siquiera deletrear la palabra “empoderar”.

Al p-patient no se le organizan congresos o jornadas, no se le escriben libros y ninguno de ellos se convertirá en un conferenciante de éxito. Lo más que logrará algún p-patient será encontrar un médico que entienda qué es lo que se esconde detrás de sus dolencias (e incluso delante). Lo más que se logrará para los p-patients será bajar la tasa de paro, remodelar edificios de 8 plantas sin ascensor o subir el salario mínimo interprofesional.

¿Que hay que prestarle atención también al e-patient (paciente que usa internet)? No me cabe duda, pero las diferentes atenciones que se le prestan a unos pacientes (e-patients) y a otros (p-patients) me hacen ver que seguimos fomentando un modelo de sistema sanitario que tapa más a quien menos frío tiene.

Mascarilla laríngea y embarazo


La mascarilla laríngea es efectiva (y probablemente segura) en parturientas sanas seleccionadas para cesárea electiva: estudio prospectivo de 1067 casos
.
The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067 cases
Tae-Hyung Han MD PhD FAAFP, Joseph Brimacombe MB CHB FRCAMD, Eun-Ju Lee MD,
Hong-Seuk Yang MD PhD
CAN J ANESTH 2001 / 48: 11 / pp 1117-1121
Purpose: To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia. Methods: Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N2O and 50% O2 and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO2 <94%, or end-tidal CO2 >45 mmHg. Postdelivery, vecuronium and fentanyl were administered. Results: An effective airway was obtained in 1060 (99%) patients,
1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO2 <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were $7 after five minutes. Conclusion: We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users.

http://anesthesiology.med.miami.edu/documents/mm_articles/54.pdf
 
Intubación traqueal fallida obstétrica y soporte respiratorio con mascarilla laríngea ProSeal
Failed obstetric tracheal intubation and postoperative respiratory support with the ProSeal laryngeal mask airway.
Keller C, Brimacombe J, Lirk P, Pühringer F.
Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria.
Anesth Analg. 2004 May;98(5):1467-70
Abstract
The ProSeal laryngeal mask airway (ProSeal LMA) provides a better seal and probably better airway protection than the classic laryngeal mask airway (classic LMA). We report the use of the ProSeal LMA in a 26-yr-old female with HELLP syndrome for failed obstetric intubation and postoperative respiratory support. Both laryngoscope-guided tracheal intubation and face mask ventilation failed, but a size 4 ProSeal LMA was easily inserted and high tidal volumes obtained. A gastric tube was inserted through the ProSeal LMA drain tube and 300 mL of clear fluid was removed from the stomach. There were no hemodynamic changes during ProSeal LMA insertion. Postoperatively, the patient was transferred to the intensive care unit, where she was ventilated via the ProSeal LMA for 8 h until the platelet count had increased and she was hemodynamically stable. Weaning and ProSeal LMA removal were uneventful. There is anecdotal evidence supporting the use of the LMA devices for failed obstetric intubation (19 cases) and for postoperative respiratory support (8 cases). In principle, the ProSeal LMA may offer some advantages over the classic LMA in both these situations. IMPLICATIONS: We report the successful use of the ProSeal laryngeal mask airway for failed obstetric intubation and postoperative respiratory support in a patient with HELLP syndrome.

http://www.anesthesia-analgesia.org/content/98/5/1467.full.pdf+html  
Uso de la mascarilla laríngea ProSeal para el mantenimiento durante cesárea urgente después de intubación traqueal fallida
Use of a ProSeal laryngeal mask airway for airway maintenance during emergency Caesarean section after failed tracheal intubation.
Awan R, Nolan JP, Cook TM.
Royal United Hospital, Combe Park, Bath BA1 3NG, UK.timcook@ukgateway.net
Br J Anaesth. 2004 Jan;92(1):144-6.
Abstract
We report the use of the ProSeal laryngeal mask airway to establish and maintain the airway during emergency Caesarean section when tracheal intubation had failed with conventional laryngoscopy and mask ventilation was difficult. The ProSeal laryngeal mask allowed controlled ventilation without gas leak and facilitated drainage of the stomach.

http://bja.oxfordjournals.org/content/92/1/144.full.pdf+html 

Vía aérea difícil en anestesia obstétrica
Difficult Airway in Obstetric Anesthesia
Sonia J. Vaida
TMJ 2006, Vol. 56, No. 2-3
ABSTRACT
The difficult airway in obstetric anesthesia represents an important problem, the incidence being eight times higher than in the non-pregnant population and the morbidity thirteen times higher. In these conditions, the trend in anesthesia for cesarian section is to avoid as much as possible general anesthesia and this trend can determinate a relative inexperience with the obstetric airway. In this review we will present the causes for difficult intubation in pregnant patients, the risks associated with this condition and the management of the difficult airway in a decision making protocol. We will also make a description of the supraglotic airway devices, with there indications, contraindications and limits.

http://www.tmj.ro/pdf/2006_number_2_3_6979794659124497.pdf 
 
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor


Google +, primera revisión crítica (y un truco)

 | Sunday, July 17th, 2011 | 2 Comentarios / Referencias »

Llevamos ya varios días probando, leyendo todo tipo de informaciones acerca de Google Plus, así que toca ya plantearse, después de haber profundizado en sus Círculos desde un punto de vista macrosocial, una primera valoración como usuarios. Dejo algunos puntos para la reflexión:
-Si la observación, la monitorización, junto a la flexibilidad para cambiar, son clave en la web, en el caso de Google Plus tiene todas las de ganar si aprovecha que además, parece que esa mayoría de público geek que lo habitamos, a quienes también podemos llamar “usuarios maduros” de la web, tenemos ganas, muchas ganas de opinar, de sugerir, de aportar ideas nuevas. Si echáis un vistazo al timeline de vuestro Plus veréis cómo tiende, de forma espectacular, a hablar de sí mismo.
En algún blog ya listan las novedades que Google anuncia para la semana que viene:
  • Poder enviar mensajes privados como en Twitter y Facebook
  • Poder crear sub-círculos
  • Posibilidad de silenciar las notificaciones en las que hemos comentado
  • Inclusión de juegos (Google Game)
  • Poder editar quien puede ver un post una vez que haya sido publicado
  • Posibilidad de seguir a más de 5000 personas
  • Compartir Docs y Calendar con nuestros círculos
  • Posibilidad de compartir algo excepto con x persona
google plus facebook

-Google Plus tiene todo el potencial del mundo para convertirse en la primera red social, monopolizando prácticamente todo lo que hacemos en la web pero no sé si está a tiempo. Los usuarios hard de Facebook opinan que es una burda copia del primero, que no por bueno ni respetuoso pero sí por antiguo, tiene ya el poder de nuestro grafo social.
Aún así, genera curiosidad…. y cuenta con la pasión y defensa acérrima por parte de los muchos que llevamos tiempo denunciando a FB por vulnerar múltiples derechos como usuarios de la web social.
TIP: Descubría anoche una forma de importar nuestros contactos casi “legalmente” desde FB a Plus. Desde Yahoo mail podemos importarlos desde Facebook. Después, desde Circles podremos importar los contactos de Yahoo.

-Está verde, bastante verde (trabajar con grupos de 1000 contactos es casi imposible, la aplicación se cuelga) y las aplicaciones que van surgiendo, en su mayoría extensiones del navegador, son igualmente deficitarias. Es probable, además, que en muchos casos, futuras actualizaciones de Plus las hagan inservibles. No le veo demasiado sentido a probarlas aún…

-No hay API para desarrolladores, lo cual dificulta su integración con Twitter y otros muchos temas. Es cierto, como comenta Antonio en Blogpocket, que el tema podría convertir Plus, como Buzz, en un repositorio – copia de lo que cargamos en la red social de elección. Por mi parte tampoco le veo mayor probema en utilizarla en un primer momento de esta forma. De hecho, creo que muchos/as estamos trasladando manualmente algunas de las cosas que decimos en twitter a Google +, valorando sus ventajas. En mi caso ya puedo decir que me atraen tanto el potencial de difusión que supone como lo bien que, en mi opinión, maneja la conversación.

-Como decíamos, excelente manejo de la conversación, aunque espero que surja pronto la posibilidad de integrarla en blogs, al estilo Disqus, Intense Debate, etc. Un buen ejemplo es la que generaba el último post en El caparazón, de una calidad excelente y fácil de seguir a través del enlace a ¿Está Google sustituyendo nuestra memoria? en gplus.

-Gran parte de su potencial vendrá de los Perfiles corporativos, que parece que llegarán pronto y que le harán aún más protagonista en el ámbito Social Media.

-Poca claridad en las recomendaciones. No he profundizado en el tema (se admiten correcciones) pero coincido con la observación leída en varios blogs internacionales sobre que parece que la nueva red social de Google está promocionando a los de siempre. Mezclando relaciones naturales, derivadas de las interacciones que en el pasado hayamos mantenido, con “featured users” disimulados que son los ya habituales en los top ranking.  Refuerzan así la conocida Ley de Pareto según la cual es el 20% el que capta la atención del 80 restante, perpetuando en cierto modo las desigualdades que arrastramos.

-Creo que lo mismo puede aplicarse a los “Sparks” (Intereses en plain spanish), interesantes si pensamos en curación de contenidos pero que como en el caso de las cuentas recomendadas, es probable que sigan favoreciendo a unos pocos más que proporcionar posibilidades reales de exploración o acercarse de verdad a nuestros intereses.

Esperemos que todo mejore y poder dejar ya en el olvido aquella idea de que Google es de ingenieros y no de expertos sociales para lograr de verdad una red social inclusiva, abierta y justa.

Allí estamos de momento, os dejo enlace a mi perfil en Google +.  Allí compartimos también.

Dangers of Smoking
'smoking health risks'



A piece about the dangers of smoking must form the first page in this section about self hypnosis for smoking, and if you’re a smoker, I’m sure this won’t surprise you! I’m sure you’ve been told innumerable times about the dangers of smoking, all the smoking health risks – ranging from bad breath to a quick and painful death from lung cancer, and you have a reminder each time you take a cigarette out of its packet, when you read the warning: ‘Smoking Kills’!
But you still smoke! Despite all that you have been told about the serious effects of smoking, you still smoke! Despite all you know about the smoking health risks, you still smoke! You continue to poison yourself even though you know (and it doesn’t matter how often you try to convince yourself that none of the bed effects of smoking will ever happen to you – deep down you know) that smoking is doing serious harm to you.
It may be that you have landed on this page because you are trying to stop smoking, in which case I recommend that you continue to read through this entire page to reinforce all the reasons you have given yourself for deciding to quit smoking.



All tobacco is bad
Just in case you have the thought that smoking cigars or smoking a pipe is less harmful than smoking cigarettes, (“I don’t inhale, so I’m safe from all the dangers of smoking”) I’m going to be as tough and clear in telling you of the smoking dangers associated with pipes and cigars. The dangers of smoking don’t just relate to cigarettes. The smoking health risks actually apply to all tobacco use.
Alongside this section is an old photograph of Sigmund Freud. You will note the cigar in his right hand. You may know a bit about Freud and his work and theories. What you probably don’t know is that he died of cancer of the mouth caused by his heavy cigar smoking. (If I’m honest, that’s not strictly correct! Freud was helped to commit suicide, being given repeated injections of the morphine that had been prescribed to control the pain from his mouth cancer, and dying on 23rd September 1939 after a 17 year battle with mouth cancer.)
So-called ‘smokeless tobacco’ (chewing tobacco and snuff) are also responsible for some serious health problems: oral cancer (mouth cancer, which includes cancer of the salivary glands); oesophageal cancer (cancer of the gullet); cancer of the pancreas. The former baseball player, Rick Bender had surgery to remove part of his tongue and jaw to treat the oral cancer caused by his chewing tobacco habit (diagnosed when he was only 26 years old!).
So don’t run away with the idea that your personal tobacco habit is less harmful than other people’s habit, that the dangers of smoking only apply to other people:
all tobacco use is harmful


Tobacco smoke is known to contain more than 4,000 different chemicals. More than 400 of these chemicals are known to be harmful, and more than 50 of them are known to cause cancer in humans. Here are a few examples of the most dangerous chemicals you take into your body when you use tobacco:
Ammonia – used also as a toilet cleaner and dry-cleaning agent;
Benzene – used as a petrol additive, and known to cause cancer;
Formaldehyde (formalin) – used as an embalming fluid to preserve dead bodies (but not to preserve living bodies!);
Carbon monoxide – the same gas that comes out of car exhausts;
Arsenic;
Hydrogen cyanide (the same gas that’s used in execution gas chambers).
When you smoke, initially the smoke passes through your mouth and then down into your lungs. In the mouth, some of the chemicals get mixed with saliva and pass down your gullet into your stomach, and then into your small intestine, and then into your large intestine. Some of the chemicals are absorbed in the mouth and stomach and pass to the liver, where they are metabolised and passed back into the blood stream for removal by the kidneys, where they pass into the bladder before being finally being passed out of your body in your urine. That’s quite a journey through your body, and many parts of your body are exposed to the harmful chemicals in tobacco.
Smoking has also been shown to increase cholesterol levels. Smoking decreases the amount of oxygen getting into the lungs and into the blood, thus sparking a physical reaction that leads to an increase in blood pressure and heart rate, which damages small blood vessels (especially in the brain and kidneys). The tar in tobacco gets deposited in the lungs, blocking the air passages, making breathing increasingly difficult.
So, as you can see, the physical dangers of smoking affect many different parts of your body, and all are very good reasons for you to stop smoking.
What diseases are caused by tobacco use?
In view of the journey through your body that tobacco’s harmful chemicals take, it should come as no surprise that tobacco use causes a number of serious illnesses affecting many parts of the body. It’s true that the most serious dangers of smoking are the dangers posed to your health.
Here is a list of the illnesses that have tobacco as a cause:
Lung cancer;
Mouth cancers;
Oesophageal cancer;
Stomach cancer;
Liver cancer;
Bladder cancer;
Coronary heart disease;
Stroke (cerebrovascular disease);
Damage to the smaller arteries in the legs (peripheral vascular disease, such as ‘intermittent claudication’ and Buerger’s disease, which often leads to leg amputation);
Chronic lung diseases such as emphysema, obstructive pulmonary disease (COPD). Smoking also makes asthma much worse;
Gum disease in the mouth, and halitosis (bad breath);
Impotence (due to damage to the small blood vessels that supply the penis with blood).
This is a long and scary list of disease that can be caused by smoking – all very good reasons to stop smoking!
Harm to others
The dangers of smoking are not just confined to people who use tobacco, but are also experienced by people second-hand – by those who are near smokers, or who live or work with smokers.
Second-hand smoke (passive smoking) happens in two ways: the smoke released from the burning end of a cigarette; the smoke exhaled by the smoker. So the dangers of smoking are experienced by those people who are near smokers as they smoke.
A 2007 report by the Office of the Surgeon General in the USA showed that there are over 250 chemicals in second-hand smoke that are known to be toxic or carcinogenic including: hydrogen cyanide; carbon monoxide; butane; benzene; ammonia; toluene; arsenic; cadmium; chromium; lead; polonium 201.
These chemicals can cause harm to the passive smoker in exactly the same way as they do to the active smoker. As a result, the effects of smoking can be as harmful to the passive smoker as they are to the active smoker. (The British entertainer, Roy Castle, who never smoked in his life died of lung cancer in 1994, having contracted his illness through years of playing trumpet in smoky jazz clubs.)
Clearly, these smoking dangers are more reasons for you to quit smoking!
Health problems are not the only smoking dangers
Your health is not the only thing that suffers from your smoking habit – there are two other important dangers of smoking: damage to your money; damage to your relationships.
I’d like you to stop reading this section for a few moments in order to carry out the following task:
Take a pen and a piece of paper;
Write down how often you purchase tobacco;
Write down how much you spend each time you purchase tobacco;
Multiply that number to work out how much money you spend on tobacco each year.
Remember, if you add any elicit substances to the tobacco (e.g. cannabis), then you must add the cost of the drug to the tobacco to find the overall financial cost of your smoking.
Now think of some of the things you could do with that money. Take your time – try to imagine those things being real – try to imagine your pleasure in experiencing them.
There are other problems that are cause by your smoking: your breath smells very bad; your clothes smell very bad; your hair and skin smell very bad. Your home also suffers from your smoking: the furnishings smell of stale tobacco; the walls and ceilings become stained by the tobacco smoke.
Your relationships may also suffer from your smoking habit. I’m sure you know that many people find smoking a truly disgusting and offensive habit. So, if you are trying to find a partner, it’s worth bearing in mind that many potential partners will be put off by the smell of tobacco on your breath, on your hair, and on your clothes, and in your car, and in your home. (You wouldn’t try to eat the contents of an ashtray, so why should you expect anyone to kiss you when you stink of tobacco?)
So, the dangers of smoking are more than physical. When you think of the harm that your smoking habit is doing to you, remember the damage it is doing to your finances, and your relationships. 




The big lesson from this page is that the dangers of smoking are many and extreme! If you didn’t already know, or if you still believe that your tobacco habit is not harmful, let me put it clearly:
TOBACCO IS BAD FOR YOU AND EVERYONE AROUND YOU
If you smoke, it is time for you to quit smoking! There are a number of stop smoking programs. I would recommend hypnosis and self hypnosis as the most effective way.