miércoles, 30 de noviembre de 2016

Turismo médico / Medical turism

Noviembre 30, 2016. No. 2524






Buscando un cuidado médico en el extranjero: Un reto para la empatía.
Seeking medical care abroad: A challenge to empathy.
Zein NN1,2,3.
Cleve Clin J Med. 2016 Nov;83(11):801-803. doi: 10.3949/ccjm.83a.16097.
On an otherwise pleasant evening during the first week of July 2016, a businessman who was a citizen of the United Arab Emirates visiting Cleveland for medical treatment was falsely accused of links to a terror organization. Officers stormed his hotel with assault rifles and handcuffed and arrested him-all this, apparently, because the man was dressed in traditional Emirati clothing.
Turismo médico: ¿Costo o beneficio para el NHS?
Medical tourism: a cost or benefit to the NHS?
PLoS One. 2013 Oct 24;8(10):e70406. doi: 10.1371/journal.pone.0070406. eCollection 2013.
Abstract
'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.
"Ni siquiera sabía lo que estaba buscando": Un estudio cualitativo de los procesos de toma de decisiones de los turistas médicos canadienses.
"I didn't even know what I was looking for": A qualitative study of the decision-making processes of Canadian medical tourists.
Global Health. 2012 Jul 7;8:23. doi: 10.1186/1744-8603-8-23.
Abstract
BACKGROUND: Medical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists' decision-making processes. METHODS: Semi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed. RESULTS: Three overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites. CONCLUSIONS: While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients' private international medical travel.
Manejo perioperatorio de los turistas-pacientes
Perioperative Care of Tourist-Patients
Whizar-Lugo V, Flores-Carrillo JC, Campos-León J, Parra-Beltrán P, Azamar-Llamas D.
J Anesth Crit Care Open Access 2015;3(4):00119.
Abstract
Medical tourism is an ancient activity that was recently reactivated. It is a multidisciplinary complex matter that involves governments and private health care as well as lay people interested in facilitating this activity. The beginning of the XXI century has enabled this phenomenon and medical tourists intentionally travel from their hometown to a different countries to receive medical care. This growing international phenomenon has multiple legal, ethical, political, economic and medical facets. Minimal literature exists on this topic, including legal, ethics, cost, quality, postoperative care and complications for medical tourists. Anesthesia in these patients is a challenge that has not been properly investigated; it has many important aspects such as suitable pre-anesthetic communication, characteristics of other races with a wide range of illness and pharmacological response, physiological changes during prolonged trips like DVT/PE, the possibility of surgical-anesthesia complications and many more. Numerous questions remain unanswered and there is a need to review our anesthesia techniques. Keywords: Medical-tourists; Anesthesia care;
Turismo Médico: Tratamientos, Mercados e Implicaciones del Sistema de Salud: Una revisión de alcance
Medical Tourism: Treatments, Markets and Health System Implications: A scoping review
Neil Lunt, Richard Smith, Mark Exworthy, Stephen T. Green, Daniel Horsfall and Russell Mannion
Segundo Curso-Taller de Anestesia y Dolor
Zapopan Jalisco, México
Dic 1-2, 2016
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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Anestesiología y Medicina del Dolor

52 664 6848905

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martes, 29 de noviembre de 2016

Manejo del Trauma de la columna Toracolumbar

Manejo del Trauma de la columna Toracolumbar



Manejo del Trauma de la columna Toracolumbar Management of Thoracolumbar Spine Trauma
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Ketamina / Ketamine

Noviembre 29, 2016. No. 2523






¿La profilaxis con haloperidol reduce el delirio inducido por ketamina en los niños?
Does haloperidol prophylaxis reduce ketamine-induced emergence delirium in children?
Sultan Qaboos Univ Med J. 2013 May;13(2):256-62. Epub 2013 May 9.Abstract
OBJECTIVES: Ketamine is a non-barbiturate agent with rapid action onset that induces profound sedation; however, some emergency physicians tend not to use ketamine because of the risk of emergence delirium (ED). This study aimed to evaluate the effectiveness of haloperidol prophylaxis in postoperative ketamine delirium in children. METHODS: Prospective data relating to any emergence dreams, delirium, hallucinations, agitation, crying, altered perceptions, and necessary interventions were recorded in consecutive cases of ketamine delirium in patients attending Mansoura University Hospital, Egypt, from June 2010 to May 2011. RESULTS: A total of 537 records were available for analysis. Of those, 267 received prophylactic haloperidol (49.7%). There were significant differences between the two groups regarding post-anaesthetic care unit behaviour. The ketamine-haloperidol groups included more patients who were sleepy, calm (P ≤0.01) and less irritable (P ≤0.01), with a lower incidence of crying (P ≤0.01) and disorientation (P ≤0.01). CONCLUSION: We found that preoperative administration of haloperidol decreases the incidence of postoperative delirium in a sample of Egyptian children undergoing minor surgery. This is congruent with earlier work conducted in adults. This work carries great hope to decrease and even prevent ED in hospitalised, non-surgical patients.
KEYWORDS: Anesthesia; Children; Delirium; Egypt; Haloperidol; Ketamine
Ketamina en dolor crónico. Riesgos y beneficios
Ketamine for chronic pain: risks and benefits.
Br J Clin Pharmacol. 2014 Feb;77(2):357-67. doi: 10.1111/bcp.12094.
Abstract
The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamineis increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain.
Epidemiología y patrones de la toxicidad crónica y aguda asociados al uso recreacional de ketamina
The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use.
Emerg Health Threats J. 2011 Apr 15;4:7107. doi: 10.3402/ehtj.v4i0.7107.
Abstract
Ketamine was originally synthesised for use as a dissociative anaesthetic, and it remains widely used legitimately for this indication. However, there is increasing evidence of non-medical recreational use of ketamine, particularly in individuals who frequent the night-time economy. The population-level and sub-population (clubbers) prevalence of recreational use of ketamine is not known but is likely to be similar, or slightly lower than, that of other recreational drugs such as cocaine, MDMA, and amphetamine. The predominant features of acute toxicity associated with the recreational use of ketamine are neuro-behavioural abnormalities such as agitation, hallucinations, anxiety, and psychosis. Secondary to these, individuals put themselves at greater risk of physical harm/trauma. Cardiovascular features (hypertension and tachycardia) occur less frequently and the risk of death from recreational use is low and is predominately due to the physical harm/trauma. Long-term recreational use of ketamine can be associated with the development of psychological dependence and tolerance. There are reports of gastro-intestinal toxicity, particularly abdominal pain and abnormal liver function tests, and of neuropsychiatric disorders, typically a schizophrenia-like syndrome, in long-term users. Finally, there are increasing reports of urological disorders, particularly haemorrhagic cystitis, associated with long-term use. The management of these problems associated with the long-term use of ketamine is largely supportive and abstinence from ongoing exposure to ketamine. In this review we will collate the available information on the epidemiology of recreational use of ketamine and describe the patterns of acute and chronic toxicity associated with its recreational use and the management of this toxicity.
KEYWORDS: 2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone; acute toxicity; chronic toxicity; dependence; epidemiology; haemorrhagic cystitis; ketamine; recreational drugs
Segundo Curso-Taller de Anestesia y Dolor
Zapopan Jalisco, México
Dic 1-2, 2016
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905