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ioan

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  1. Aκτινοθεραπείες με... ληγμένα μηχανήματα ΔΕΣΠΟΙΝΑ ΚΟΥΚΛΑΚΗ Το ραντεβού της ήταν προγραμματισμένο για τα τέλη Ιουνίου, αλλά λίγο καιρό πριν την ειδοποίησαν πως έπρεπε να ψάξει για άλλο νοσοκομείο αφού το μηχάνημα στο Αλεξάνδρα τέθηκε εκτός λειτουργίας! «Ξαφνικά έμεινα ξεκρέμαστη. Ενώ ήταν όλα κανονισμένα, έπρεπε να ψάξω πάλι από την αρχή. Γύρισα όλα τα νοσοκομεία. Απευθύνθηκα ακόμη και στον ιδιωτικό τομέα όπου μου ζήτησαν πάνω από 3.000 ευρώ για την ακτινοθεραπεία», λέει στα «NEA» η κ. Κοτσιώρη που προσβλήθηκε πρόσφατα από καρκίνο του μαστού. Τελικά, πήρε θετική απάντηση για να αρχίσει ακτινοβολίες στο Αρεταίειο Νοσοκομείο. Διαφορετικά, όπως λέει, θα στριμωχνόταν πολύ οικονομικά για να πληρώσει τη θεραπεία σε ιδιωτικό θεραπευτήριο. Στη θέση της βρέθηκαν τους τελευταίους μήνες δεκάδες καρκινοπαθείς που επρόκειτο να υποβληθούν σε ακτινοθεραπεία στο Αλεξάνδρα. Ο γραμμικός επιταχυντής - το βασικό μηχάνημα για την ακτινοθεραπεία των ασθενών με καρκίνο - είναι εκτός λειτουργίας λόγω παλαιότητας! Παρωχημένης τεχνολογίας είναι τα ακτινοθεραπευτικά μηχανήματα και σε πολλά άλλα νοσοκομεία, με αποτέλεσμα οι γιατροί να ομολογούν ότι γίνονται... μεσίτες των ασθενών στον δρόμο για τον ιδιωτικό τομέα. «Εδώ και τρεισήμισι μήνες, ο επιταχυντής δεν λειτουργεί και οι ασθενείς που επρόκειτο να αρχίσουν θεραπεία διοχετεύονται σε άλλα νοσοκομεία. Πολλοί από αυτούς στρέφονται αναγκαστικά στον ιδιωτικό τομέα πληρώνοντας από την τσέπη τους αρκετές χιλιάδες ευρώ, αφού ο χρόνος αναμονής στα δημόσια νοσοκομεία είναι μεγάλος. Και να σκεφθεί κανείς ότι το συγκεκριμένο μηχάνημα εξυπηρετούσε 20 - 25 ασθενείς καθημερινά», ανέφερε στα «NEA» ο κ. Γιώργος Πισσάκας, διευθυντής του ακτινοθεραπευτικού τμήματος στο Αλεξάνδρα. Ούτε ανταλλακτικά Ο γραμμικός επιταχυντής του νοσοκομείου έκλεισε 26 χρόνια ζωής και τα ανταλλακτικά του... έπαψαν να κυκλοφορούν: «Πριν από τρεισήμισι μήνες χρειάστηκε να αντικατασταθεί μια μικρή πλακέτα, η οποία δεν βρέθηκε. Πριν από αρκετό καιρό το νοσοκομείο είχε ενημερωθεί για την μη ύπαρξη ανταλλακτικών, ενώ πρόσφατα μας κοινοποιήθηκε από τη διοίκηση ότι έχει παρέλθει ο χρόνος ζωής του μηχανήματος», δηλώνει. Στο νοσοκομείο λειτουργεί μόνο μία μονάδα κοβαλτίου - σύστημα ακτινοθεραπείας που δεν είναι κατάλληλο για όλους τους καρκινοπαθείς. Το τμήμα έχει ζητήσει δύο νέους γραμμικούς επιταχυντές και έχει τη σύμφωνη γνώμη της διοίκησης. Και σήμερα να γίνει η παραγγελία, όμως, θα περάσουν τουλάχιστον 15 μήνες για να αρχίσουν να λειτουργούν. Από τους 24 γραμμικούς επιταχυντές που είναι εγκατεστημένοι σε δημόσια και πανεπιστημιακά νοσοκομεία της χώρας, οι μισοί είναι από 9 μέχρι και 20 ετών. «Ουσιαστικά είμαστε σε ένα σημείο όπου γινόμαστε... μεσίτες του ιδιωτικού τομέα! Με παλιά μηχανήματα και μεγάλη αναμονή, οι ασθενείς έχουν ως μόνη λύση τα ιδιωτικά νοσοκομεία όπου μπορούν να αρχίσουν θεραπεία την επόμενη ημέρα», αναφέρει ο πρόεδρος της Ελληνικής Εταιρείας Ακτινοθεραπευτικής Ογκολογίας Παναγιώτης Παντελάκος. H ακτινοθεραπεία στον ιδιωτικό τομέα κοστίζει κατά μέσο όρο 4.500 - 5.000 ευρώ, μαζί με την αμοιβή του γιατρού. Δεν υπάρχουν ούτε γιατροί OYTE οι γιατροί περισσεύουν στα ακτινοθεραπευτικά τμήματα του ΕΣΥ. Σύμφωνα με τον Παναγιώτη Παντελάκο, πρόεδρο της Ελληνικής Εταιρείας Ακτινοθεραπευτικής Ογκολογίας, μόνο ένας ακτινοφυσικός στελεχώνει το τμήμα στο Νοσοκομείο Μεταξά του Πειραιά, ενώ στο Αττικό υπηρετούν δύο εκ των οποίων ο ένας με απόσπαση. Στο ίδιο νοσοκομείο υπηρετούν δύο από τους πέντε τεχνολόγους που προβλέπονται, ενώ τα δέκα κρεβάτια νοσηλείας στο ακτινοθεραπευτικό μένουν κλειστά λόγω έλλειψης προσωπικού. Κι ενώ τα τελευταία δυόμισι χρόνια έχουν προσληφθεί τουλάχιστον 300 επικουρικοί ιατροί διαφόρων ειδικοτήτων, οι ακτινοθεραπευτές που είχαν γραφτεί στον σχετικό κατάλογο ήταν μόλις 18. Δεν διορίστηκε κανείς... ΤΑ ΝΕΑ , 29/08/2006
  2. Πήγε για τον κάλο του έκοψαν το πόδι ΚΑΡΔΙΤΣΑ Μια συνήθης αφαίρεση ενός κάλου κατέληξε σε αφαίρεση ενός ποδιού. Το πρωτοφανές περιστατικό, όπως υποστηρίζει ο 67χρονος Ηλίας Σιόκης, συνέβη στον ίδιο πέντε χρόνια νωρίτερα, όταν πήγε στο νοσοκομείο Καρδίτσας για επέμβαση αφαίρεσης κάλου, αλλά καθώς ήταν διαβητικός, οι γιατροί δεν πρόσεξαν και αργότερα χρειάστηκε να του κόψουν το πόδι. Ο κ. Σιόκης υποστήριξε ότι ο ακρωτηριασμός και η ταλαιπωρία που πέρασε θα μπορούσε να είχε αποφευχθεί και κατήγγειλε τους γιατρούς του νοσοκομείου της Καρδίτσας ότι δεν έδωσαν τη δέουσα προσοχή στο πρόβλημά του, με αποτέλεσμα να κινδυνέψει ακόμη και η ζωή του. Από το περιβάλλον των γιατρών υπήρξε ο ισχυρισμός ότι ο ασθενής, μολονότι γνώριζε το πρόβλημά του, δεν είχε ενημερώσει πως ήταν διαβητικός. Ο διοικητής του νοσοκομείου Καρδίτσας Σωτήριος Μαλτές, που ενημερώθηκε από την τηλεόραση για το περιστατικό, διέταξε τη διενέργεια προκαταρκτικής εξέτασης. Για το θέμα του κ. Σιόκη ενημερώθηκε και ο υπουργός Υγείας Δημήτρης Αβραμόπουλος, ο οποίος ζήτησε να διερευνηθεί σε βάθος η καταγγελία. ΕΛΕΥΘΕΡΟΤΥΠΙΑ - 29/08/2006
  3. Medical Errors? Patients May Be the Last to Know By NICHOLAS BAKALAR A survey of more than 2,600 surgeons and medical specialists reveals wide variations in doctors’ willingness to disclose errors and in the ways they would present the details to patients. The authors of the survey presented hypothetical but clinically realistic medical errors to the doctors to determine how they would disclose the mistake, whether disclosure was different if the error was less apparent to a patient and what factors were associated with disclosure. The survey results were published Aug. 14 in The Archives of Internal Medicine. The hypothetical errors were all mistakes that would cause some degree of serious injury. Some were apparent — like leaving a sponge in a surgical patient — and some were less so, like misreading chart data. When the error was obvious, like an improperly written prescription that led to an overdose, 81 percent of doctors said they would definitely disclose the error to a patient. But when presented with an error less apparent, only 50 percent thought it was worth mentioning. One example was a blood chemistry reading that had been overlooked. If it had been noticed, a serious complication would have been prevented. “It isn’t that doctors routinely make a conscious decision to conceal errors,” said Dr. Thomas H. Gallagher, the study’s lead author and an associate professor of medicine at the University of Washington. But when an error is less obvious, he continued, “the doctor is thinking about what the patient really needs to know to understand what happened.” “Doctors worry about telling patients too much, scaring them unnecessarily,” Dr. Gallagher said. Surgeons were more likely than other medical specialists to believe that an error would result in a lawsuit, but they were also more likely to report that they would definitely disclose an error. At the same time, they would disclose less information than medical specialists, and they were less inclined to use the word “error.” Over all, 56 percent of doctors would mention the problem, but only 42 percent would disclose that the problem had been caused by an error. Doctors had a spectrum of opinions about how much information to disclose and how specific that information should be. Half of them said they would disclose specific information about what the error was, while 37 percent would offer only a partial explanation. The remaining 13 percent would reveal no details at all unless the patient asked. When presented with just the errors that were less apparent, almost one-fifth would volunteer no information at all. Only 8 percent would be silent about more obvious mistakes. Almost all doctors surveyed said they would apologize, but only about one-third chose an explicit apology (“I am so sorry that you were harmed by this error”) while two-thirds would offer a general expression of regret (“I’m sorry about what happened”). According to the authors, some malpractice insurers encourage doctors to apologize in the belief that this may help prevent lawsuits or encourage smaller settlements when suits are filed. One problem physicians face, Dr. Gallagher said, is that patients may fail to distinguish errors from unavoidable medical problems. “I think that often patients assume that any adverse event is due to error,” he said. “That’s not so. A vast majority of such events are not errors and not preventable.” The authors write that their results reveal a significant lack of consensus among doctors about whether to disclose medical errors and how to discuss them. This pattern, they say, increases the likelihood that patients’ expectations will not be met. “People have suggested that, well, you just tell the truth, tell what happened,” Dr. Gallagher said. “But when you dig below the surface, there are all sorts of different components to the truth or to what happened. And this is where there isn’t much consensus about how much information is helpful. “Doctors and patients need to get better at having these conversations.”
  4. The Beep of the Sensor, the Thrill of Control By DAN HURLEY On Cape Cod for a two-week vacation last August, I went to sleep one night and almost never woke up. An insulin-dependent diabetic, I had developed such a severe low-blood-sugar level that my 9-year-old daughter, Annie, found me unresponsive and soaked in sweat in the morning. With my wife in New Jersey for a couple of days to attend a meeting, Annie managed to dribble some grape soda into my mouth, followed by a few spoonfuls of Marshmallow Fluff. Fifteen minutes later, my blood sugar rising, I came to my senses enough to think, “Not again!” No, I’m not one of those out-of-control diabetics who refuse to follow their doctors’ advice. I knew a guy like that once. When I told him I tested my blood sugar seven or eight times a day, he told me, “I’d rather die than do that.” And then he did die, a couple of years later, from severe low blood sugar. I’m at the other extreme, always testing, then taking a little insulin to bring down a high or having a snack to avoid a low. The crazy thing, though, is that by carefully following my doctor’s advice to keep my blood-sugar levels as close to normal as possible (which, studies have shown, greatly reduces the risk of long-term complications), I always live on the edge, a cupcake away from a coma. Every day or two, I get a brief, mild low that leaves me feeling muddle-headed and cranky for half an hour. Not the end of the world, but a definite annoyance. And in the 30 years since developing diabetes during my freshman year of college, I’ve had seven or eight awful lows like the one last August. So imagine my enthusiasm when I learned last fall that the Food and Drug Administration had finally approved the first implantable sensor to continuously measure glucose, beeping or vibrating a warning whenever levels head too high or too low. On Monday, June 12, I took the train down to Washington to be hooked up while the annual meeting of the American Diabetes Association was in town. The device, made by Medtronic MiniMed, is called the Paradigm Real-Time, a combination insulin pump and continuous glucose sensor. The sensor doesn’t control the pump but allows a diabetic to make quicker, presumably better decisions. I’d already been on a stand-alone MiniMed pump for a few years, but I found it only an incremental improvement over taking insulin by injection. Like the pump, the sensor requires injecting a tiny catheter (less than an inch long) into the midsection of the body, and changing it every three days to avoid infection. The sensor has a coated tip that measures the electrical conductivity of the interstitial fluid, the juice floating between fat cells right under the skin. As luck would have it, the conductivity is directly proportional to how much glucose is floating around in the juice. Even with the help of an expert trainer from MiniMed, I found that injecting the catheter took much more dexterity than injecting one for a pump. It has to be placed above the hip or the buttocks, which makes reaching it awkward, and then the wire leading from the sensor has to be connected to a transmitter that wirelessly sends the information to the pump. When everything was in, I had two catheters and the transmitter all taped to my body, plus the pump hanging on my belt. Kind of weird, but kind of cool, in a sci-fi way, and I remained thrilled at the prospect of seeing my first glucose reading. Then the waiting began. The sensor needs three hours to settle in before it can begin transmitting data. By late afternoon, when it was supposed to start, I got an error message instead. When I tried to recalibrate it a half-hour later, it still wasn’t working right, so I had to remove it and inject a second one. It was after 9 p.m. before the second one finally began working. At first, I was transfixed by the numbers as they were updated every five minutes. That night, however, the sensor kept beeping me awake, nearly every hour, warning that my glucose level was too high. I kept following the recommendations of the embedded calculator, taking only very small amounts of insulin to bring my sugar level down. But by morning, I was still high, so I followed my own usual guesstimate and took much more. Two hours later, while attending a session at the diabetes association meetings, in which four experts talked about the new sensors, I heard mine beep again, this time warning me that my glucose level was plummeting. I quickly drank a juice box, and within minutes my numbers started leveling off. I had avoided my first low. All the hassles of the past 24 hours were forgiven. This bionic diabetic was in rapture. Over the next six weeks of testing, I came down to earth as I realized that while the sensor enabled me to drastically cut my usual number of lows, it did not eliminate them. The main problem was that the sensor was simply not as accurate as a blood-glucose tester. MiniMed’s studies show the sensor’s accuracy can be off by as much as 18 percent. Another sensor, just approved by the F.D.A. and made by DexCom, is said by some researchers to be a bit more accurate, as is a third device, from Abbot, which has not yet been approved. But none are as accurate as a standard blood-sugar test. I also had three sensor catheters slip out and require early replacement, which would be especially annoying to anyone paying the $35 that each sensor costs; I wasn’t, because MiniMed had supplied everything free for testing, but everybody else will, since the sensors are not yet covered by insurance. With each catheter intended to last just three days, the bill comes to $350 a month. But the bottom line is that over the entire six weeks I had only a few lows that left me feeling woozy, the kind I used to put up with two or three times a week. On July 24, my test period over, I felt like Mr. Magoo without his glasses. I made it through our annual Cape Cod vacation without incident, but Annie kept a wary eye on me. I think I owe it to her to start shelling out that $350 per month, at least until the insurance companies figure out what a lifesaver this transformative new technology can be.
  5. Επειδή η Ιταλία δεν είναι Ρουμανία, ούτε Βουλγαρία, μα και ούτε άλλη χώρα έξω από EU... όποιος έρχεται με πτυχίο ιατρικής από εκεί (έξω από EU) πρέπει πρώτα να κάνει την αναγνώριση του πτυχίου του, δίνοντας εξετάσεις του 5ου και του 6ου έτους ιατρικής (όχι όλα τα μαθήματα, μα ανάλογα από πού προέρχεται), κάνοντας και τις υποχρεωτικές παρουσίες σε κλινικές. Μετά δίνει τις πρακτικές και γραπτές εξετάσεις για την άδεια άσκησης ιατρικού επαγγέλματος, οι οποίες γίνονται δύο φορές το χρόνο (3 μήνες είναι το πρακτικό τμήμα). Η όλη αυτή ιστορία τρώει γύρω στα 3 χρόνια. Η γλώσσα είναι βεβαίως τα ιταλικά. Όποιος δεν τα μιλάει τρώει σούτ. Δεν είναι δυνατόν να ασκεί το ιατρικό επάγγελμα χωρίς άδεια άσκησης. Δίδακτρα για το πανεπιστήμιο και για την άδεια άσκησης υπάρχουν; δεν είναι πολλά, μα δεν είναι τσάμπα. Έρχονται πάρα πολλοί Ρουμάνοι, Βούλγαροι, Ουκρανοί και Ρώσοι... νομίζουν πως είναι απλό πράγμα, μέχρι που να καταλάβουν τί σημαίνει η όλη αυτή διαδικασία. Όπως πάντα οι περισσότεροι χάνονται στο δρόμο. Αυτά ισχύουν όχι μόνο από το πρώην ανατολικό μπλόκ, μα και για όσους έρχονται από Βραζιλία, Κούβα, Μεξικό, Αργεντινή, Χιλή, Κολομβία... Έχω γνωρίσει έναν από κάθε περίπτωση (σχεδόν), μιάς που περνούν από το πανεπιστημιακό που είμαι. Δεν είναι απλό πράγμα. Αν τώρα νομίζει κανείς πως η Ιταλία είναι η εύκολη λύση, ας έρθει να το διαπιστώσει από πρώτο χέρι. Σημείωση... η ειδικότητα είναι άλλο θέμα και είναι τελείως άσχετο από την αναγνώριση του πτυχίου και την άδεια άσκησης.
  6. In Philadelphia 30 Years Ago, an Eruption of Illness and Fear By LAWRENCE K. ALTMAN In late July 1976, American Legionnaires returning from a state convention in Philadelphia began to fall ill with mysterious symptoms: pneumonia and fevers topping 107 degrees. By early August, news organizations across the country were reporting that 6 to 14 of the men in Pennsylvania had died. Others were in hospitals fighting for their lives. No laboratory tests could determine the cause of their illness, which quickly became known as Legionnaires’ disease. No one knew the health status of the 10,000 other convention participants. As the news began to break, 30 years ago this week, Americans were primed for the threat of an epidemic. The Ford administration was making plans to vaccinate every American against a new strain of influenza, known as swine flu, after repeated warnings from government officials that a devastating epidemic could strike without warning. Michael Crichton’s “Andromeda Strain” had become a best seller. And some scientists were calling for a moratorium on laboratory efforts to genetically engineer microbes for fear they might create a monster germ. These factors made the unexpected attack on American veterans, which occurred shortly after the country’s bicentennial celebration, front-page news. When I first heard about the mysterious cases from news agency bulletins on Aug. 2, I initially viewed them with some skepticism. A few months earlier, Dr. Leonard Bachman, the Pennsylvania health secretary, issued a news release saying that a staff member, Dr. Buford S. Washington, had discovered an often fatal new disease, pantosomatitis, that was spreading throughout the eastern United States. Looking into the claim, I found there was no documented case and no such disease. Disease outbreaks were familiar territory for me. Before coming to The New York Times, I’d been an Epidemic Intelligence Service officer at the Communicable Disease Center, now the Centers for Disease Control and Prevention, in Atlanta. If the Legionnaires’ outbreak had occurred a decade sooner, I might have been one of the investigators sent to Pennsylvania. Health officials there urged the public not to panic, and some initially denied that the cluster of cases was an outbreak of an infectious disease. But behind the scenes, the same officials were bracing themselves for a medical catastrophe. “We thought we might be faced with an unprecedented condition in modern medicine, one for which we had no really effective antibiotics, drugs or therapy,” Dr. Bachman told me in 1976. Because there was no way to predict how many more Legionnaires would fall ill, Dr. Bachman said he had contemplated seizing control of all hospitals in the state and imposing quarantines. It took six months to determine that the illness had been caused by a bacterium, Legionella pneumophilia, which we now know usually succumbs to the timely prescription of proper antibiotics. The bacterium, which in this case was apparently spread from the hotel’s air-conditioning system, is a cause of pneumonia and other illnesses worldwide. The investigation that solved the mystery took an array of surprising twists and turns. It revealed the strengths and weaknesses of the nation’s health system in response to an outbreak from an unknown agent. Some lessons learned from the outbreak improved investigations of later outbreaks like avian flu, SARS and the deliberate release of anthrax spores in the postal system shortly after the Sept. 11 attacks. But many authorities have not learned other important lessons, like the need for more effective communication. Intense news coverage of the Legionnaires’ outbreak continued for weeks, providing one of the rare opportunities for the public to see how medical detectives work and how scientists make discoveries. The epic challenged the widespread notion that medicine was all-knowing, able to lick almost any problem, and that antibiotics and vaccines had turned once lethal infectious diseases into minor threats. The news coverage also marked a turning point in journalism’s efforts to hold officials accountable for their response to epidemics that can threaten the lives of thousands of people, as well as tourism, international trade and world economies. News about the outbreak led to the temporary closing of the Bellevue-Stratford Hotel, a Philadelphia landmark that was the headquarters of the American Legion convention and a focus of suspicion about the spread of the bacterium. The C.D.C. sent 20 epidemiologists — the largest squad of medical detectives to investigate an outbreak in the federal agency’s history — to Pennsylvania where they joined scores of state health workers. The sleuths fanned across the state to review the medical records of all the ill Legionnaires and to study the autopsy findings in the fatal cases. Epidemiologists also checked every hospital to identify new cases and interview patients’ families and doctors, in part to determine whether one or more Legionnaires might have taken the illness to Philadelphia. On Aug. 2, when news agencies began issuing dispatches, a quick look convinced me that the Legionnaires’ cases were real, not another false alarm. Late that evening, I finished my first article about the still-unnamed mysterious disease. Then I drove to Harrisburg, listening to the radio to keep me awake but unable to escape the repetitious news accounts about the outbreak, the speculation that the illness was swine flu and the safety concerns about visiting Philadelphia. The Times handled the story more cautiously than radio and television. My article, on Page 12, was not even included in the news summary. Over the next few days, the toll of the illness rose. The final count was 221 cases, including 34 deaths. As a physician, I wanted to see the patients who were recovering or fighting to stay alive and to learn what leads were being developed from the interviews. In Chambersburg, Pa., I joined Dr. Stephen B. Thacker, then a rookie in the C.D.C. epidemiology program. We interviewed a Legionnaire, Thomas A. Payne, 48, whose temperature rose to 107.4 degrees before he was put in a cooling blanket. We felt safe entering his room because we followed standard precautions, wearing yellow masks, white gowns and gloves. In introducing us, Dr. Thacker told Mr. Payne that he “was part of the medical team investigating this weird disease.” Dr. Thacker, who later became the head of the epidemiology program, asked Mr. Payne a number of questions related to the onset of his illness, how he had felt since, where he had stayed in Philadelphia and what convention events he had attended. Then Dr. Thacker sent the information to colleagues in Harrisburg. Two weeks later, I interviewed another hospital patient who had driven with four Legionnaires from their home in Saltillo, Pa., to Philadelphia where they had stayed at the same hotel and were together for nearly all the convention events. But no one could figure out why only that patient had developed the disease. The anecdote illustrates the kinds of dead ends that epidemiologists, like criminal detectives, encounter and that scientific journals rarely publish. They and other factors create a false impression that investigations and discoveries are simpler than they really are. A week into the investigation, health officials were relieved as a second outbreak failed to develop among those attending an international religious meeting in Philadelphia and no spread of the ailment occurred from Legionnaires’ patients to their families and friends. Tests also excluded all forms of influenza as a cause of the outbreak. “All of us can breathe a sigh of relief it was not the flu,” said Dr. David J. Sencer, then the C.D.C. director. If not influenza, what was the illness? Earlier tests had ruled out poisoning from 17 metals. But experts in a variety of specialties who were not connected with the outbreak had called or written to me and health officials to suggest a number of toxins. Stumped, health officials re-examined the possibility of other toxins or poison gases. One poison, nickel carbonyl, was a long shot that health officials took seriously, only to be embarrassed by flaws in the collection of the tissues for testing. The initial nickel findings were ruled invalid because of probable contamination from the use of metal instruments in autopsies. Pathologists were then ordered to use plastic knives. Reports of the lapses in investigation technique jarred public confidence about the ability of health departments to detect outbreaks from hazardous chemicals. The flaws also led to a Congressional hearing in the fall on the medical investigation, causing federal and state health officials further embarrassment. By winter, many of the authorities said the outbreak’s cause was definitely not a bacterium and that it would never be known. But the doubters overlooked the importance that human factors like compulsiveness, embarrassment and public pressure can play in solving scientific riddles and making discoveries. At Christmastime in 1976, Dr. Joseph McDade, a C.D.C. laboratory scientist who had tested specimens from the outbreak, was harshly criticized at a party for his agency’s failure to solve the mystery. Dr. McDade said his usual custom at that time of year was to “tidy up loose ends,” so when he went to his laboratory “to put to rest some hunches about something” he had seen in the specimens, the insult lurked in the background. Within a month, Dr. McDade had identified the culprit and showed that Legionnaires’ was a newly recognized old disease. The bacterium had been isolated at least twice before by different groups of researchers at the Walter Reed Army Institute of Research in Washington starting in 1947. Each group believed it was dealing with a bacterium that affected animals, not humans. Dr. McDade’s discovery quickly led scientists to document a number of earlier outbreaks in Pontiac, Mich.; Washington; and elsewhere. Legionnaires’ disease now accounts for an estimated 18,000 hospital admissions in this country each year, and C.D.C. scientists have said that doctors miss the diagnosis in many more patients. Most outbreaks and cases have been traced to contaminated water in places like shower heads, air-conditioning systems and medical respiratory devices. The largest outbreak, in Spain in 2001, affected nearly 700 people. The Legionnaire bacterium can produce two forms of illness that begin with flulike symptoms. One, Legionnaires’ disease, goes on to produce pneumonia and systemic illness. The other, Pontiac fever, produces only a mild illness. Why the same bacterium causes two distinct illness patterns is not known. Seamless teamwork between epidemiologists and laboratory scientists can be a potent weapon in solving disease outbreaks caused by known and unknown agents. But the teamwork in the Pennsylvania outbreak was porous, as lapses in investigation technique showed. From the start, the investigation encountered a number of problems, some beyond their control. One was that the American Legion had no registration list of conventioneers, leaving no easy way to contact attendees to check on their health. In investigating outbreaks, epidemiologists often develop questionnaires, in part to make statistical comparisons between those who become ill and those who do not. Another aim is to determine the priority in performing laboratory tests to determine the cause of an illness. But the longer the delay in starting this medical sleuthing, the fuzzier people’s recall of events becomes. A problem was that health officials could have learned of the outbreak earlier than they did. For example, a physician in Pennsylvania called health officials on July 30, a Friday afternoon, to report a Legionnaire with possible typhoid fever. It was too late in the day, call back on Monday, a nurse said. The episode illustrated that many health departments did not provide the type of 24/7 coverage for calls and emergencies that hospitals and doctors did. Now more health departments provide such coverage. Still another problem was that Philadelphia health officials learned belatedly about an earlier outbreak of 19 cases of an illness similar to Legionnaires’ disease, including three deaths. It affected members of the Independent Order of Odd Fellows in 1974 after they had visited the Bellevue-Stratford. The cluster was not reported until after news of the Legionnaires’ outbreak in 1976. However, there were widespread complaints about a number of issues over which health officials had some control. One was the lack of coordination between investigators from federal, state and local health departments and determining which was in charge. Doctors who cooperated in providing information and specimens from Legionnaires’ patients said they had received little feedback from health officials. For example, some doctors said antibiotics were effective in their patients and urged wider use of them in the outbreak. But health officials gave no advice, largely because they could not scientifically evaluate the effectiveness of the antibiotics among the patients quickly enough. The issue of providing such evaluations of therapy during an outbreak remains an important problem; many doctors and others lodged the same complaint against the C.D.C. in the anthrax outbreak in 2001. Some critics said they learned more about the outbreak from news organizations than from the agency. In the case of Legionnaires’, persistent pressure from the news media, a number of health officials said later, helped hold them accountable and to spur scientists to do what they rarely had done in other unsolved cases and outbreaks — taking a crucial second look that solved the Legionnaires’ outbreak.
  7. Dr. Good Has Left the Building By ABIGAIL ZUGER, MD When people ask me to recommend a doctor for them, half a dozen spring to mind immediately. They are all intelligent, kind and committed, intellectually imposing but down to earth, practical but visionary, and leavened with a good sense of humor. You couldn’t ask for a better person to oversee your health than one of them. There’s only one problem: not one of them sees patients anymore. No, they haven’t retired. They have simply moved onward and upward into the medical stratosphere. They have arrived at positions of power and influence; they do groundbreaking research, set policy, write guidelines and generally shape the health of the planet. As for figuring out why you can’t stop coughing, forget it. They don’t do that kind of thing anymore. Doctors without patients: can such creatures really exist? Or do they automatically negate themselves into some other sphere of existence, a cloudy existential plane where teachers without students and merchants without customers all wander around in search of a new identity? It is a purely rhetorical question, because not only do doctors without patients exist, they thrive. They top most heaps: they are the administrators, the professors, the chairmen, the directors and the chief executives. In fact, if truth be told, little baby doctors often go to bed at night thinking, I want to be just like them. In the memoir “Teacher Man,” Frank McCourt described “the situation in the public schools of America: the farther you travel from the classroom, the greater your financial and professional rewards.” The situation in the health care arenas of America may not be identical, but there are certainly parallels. Like the blackboard, the examining table is where the grunt work is done. Brilliant career paths often lead in the opposite direction. Some medical movers and shakers head off without a backward look: they never liked that “say ahhh; where does it hurt?” business to begin with. Some wax nostalgic: “If I only had the time,” they say, gesturing at the toppling piles of papers on their desks. “I miss patient care.” But they never quite make it back to that buffer-free zone of the examining room, to that lonely hot seat where the decisions are all theirs, and the fallout is too. Instead, their horizons expand, and in some sense, so do their patient loads. After all, to write an article establishing that one treatment is better than another is effectively to participate in the health care of millions. So is taking a new chemotherapy from test tube to pharmacy, or configuring an insurance company’s preferred drug formulary. And should something go wrong, the seat still gets plenty hot. But the work is not quite the same. Most of medicine these days is based on the big picture — trends set by thousands of research subjects (or hospital admissions or insured lives) moving in synchronies visible only to high-speed computers. The patterns can look very different writ small. In other words, a giant study may show that two pain relievers work about the same. But if only one helps Mrs. Jones (the gallant, delightful, terminally ill and utterly impoverished Mrs. Jones) and her insurer pays only for the other one, Mrs. Jones’s physician will quickly come to realize that they are not the same after all. Doctors who never get to know Mrs. Jones seldom learn this lesson. In fact, after enough years away from the examining table, it is easy to forget that people like Mrs. Jones exist at all. Some say that’s for the best. Many years ago, a famous professor and researcher interviewing me for a job remarked, in the tones of one imparting a secret of the universe, “Any idiot can make a patient feel better.” Research was the key to medicine, he continued, to really making a difference. Otherwise, wishes and hopes and idiosyncrasies, both yours and those of your patients, would tangle you up so completely that you would never break free. At least, I think that’s what he was trying to say. I actually never saw him again, deciding to take a job elsewhere, with a somewhat less famous man who still saw his own patients, one of the few graying heads in a sea of young medical grunts. “Keeps you honest,” he said.
  8. Τα πάνω δεν έχουν καμία σχέση με το θέμα του αγροτικού... αφορούν την ανταλλαγή πληροφοριών για την εισαγωγή στις ειδικότητες στην Ιταλία (ραδιοδιαγνωστική, όπου και μπήκε ο ένας, εσωτερική παθολογία, όπου και δεν μπήκε ο άλλος). Είναι Off Topic. Οπότε αν κάποιος mod θέλει να τα σβήσει από εδώ, δε θα είχε άδικο. Δεν είναι σωστό να χρησιμοποιεί κανείς μιά γλώσσα που η πλειοψηφία των μελών του forum δεν γνωρίζει. Χάνεται η επικοινωνία έτσι.
  9. Fred J. Epstein, 68, Pediatric Neurosurgeon, Dies By DOUGLAS MARTIN Dr. Fred J. Epstein, a pediatric neurosurgeon who devised new ways to operate on slow-growing tumors intertwined with brain stems and spinal cords, died on Sunday at his home in Greenwich, Conn. He was 68. The cause was melanoma, his wife, Kathy, said. Dr. Epstein performed more than 2,500 operations as he pioneered in using new technology, including lasers, ultrasound and huge microscopes, to remove mainly noncancerous tumors that were once thought to be incurable because of their location. He sought and achieved a prominence beyond the medical world, in part to raise money for the expensive equipment he required. He wrote two books for general readers and was the subject of three segments of “20/20” on ABC television and a Reader’s Digest feature article. The license plate on his Ferrari read, “PED-NS1,” short for “pediatric neurosurgeon 1.” In an interview with The Los Angeles Times in 1993, Dr. David McLone, a past president of the American Society of Pediatric Neurosurgery, said brain-stem tumors were “regarded by most people as inoperable until Fred developed the technique, did them and showed other people how to do this.” Dr. A. Leland Albright, chief of pediatric neurosurgery at Children’s Hospital in Pittsburgh, said in an interview with Newsday in 1993: “Over the years, he has operated on some patients that very few people will. But it has been with the hope of identifying the limits of surgery. And I think he has pretty well done that.” Dr. Epstein founded the division of pediatric neurosurgery at New York University Medical Center, then moved his unit to Beth Israel Medical Center, where he founded the Hyman-Newman Institute for Neurology and Neurosurgery. About 108 people followed him from job to job. Dr. Epstein was president of the International Society of Pediatric Neurosurgery and the American Society of Pediatric Neurosurgery. He published more than 175 scholarly papers and was editor in chief of The Journal of Pediatric Neurosurgery. In 2001, the American Association of Neurological Surgeons awarded him its Lifetime Achievement Award. Dr. Epstein made news by operating on the son of the Yankee pitcher Tommy John and on a Tibetan monk for whom the Dalai Lama prayed at Dr. Epstein’s institute. In 1997, he operated on a millionaire’s pug in exchange for a donation to help pay for surgery that Dr. Epstein then performed on a 5-year-old boy from rural Pennsylvania. He was a connoisseur of fine cowboy boots, and he often invited journalists and video crews into his operating room. In September 2001, Dr. Epstein suffered severe brain damage when he fell off his bicycle, splitting his helmet. He was in a coma for 26 days and in the hospital for nine months. “It’s hard to give up taking care of patients,” he said in an interview with Greenwich Time in 2003. In recent months, he had consulted on neurological matters with the Miami Children’s Hospital. Fred Jacob Epstein, the second of three children of a psychiatrist and a social worker, was born in Yonkers on July 26, 1937. He was president of his senior class at a private high school in Yonkers that became the Halsted School and the student council. He was also captain of the football and baseball teams. For all his popularity, Dr. Epstein as a boy suffered what he later characterized as learning disabilities. He told Greenwich Time that he read slowly, had trouble making sense of numbers and wrote the letter “e” backward. “I was told that I couldn’t go to medical school, that I couldn’t be a doctor,” he said. But he said he studied many more hours than other students and graduated from New York University and New York Medical College. He did his internship and surgical residency at Montefiore Medical Center in the Bronx. He did his neurosurgical residency at New York University-Bellevue Medical Center, while serving in the Army reserves. In 1983, he was named professor of neurosurgery at N.Y.U. and two years later director of the division of pediatric neurosurgery. It was there that he saw the resemblance of operable tumors in the cerebellum and, until then, inoperable ones in the brain stem. He likened the technique he developed to removing lead from a pencil, the pencil being the spinal cord. Dr. Epstein is survived by his wife of 41 years, the former Kathy Candel; his daughters Samara Epstein Cohen of Manhattan and Greenwich and Ilana Epstein Grady of Greenwich; his sons, Jason, of Scarsdale, N.Y., Joseph, of Greenwich, and Benjamin, of Greenwich; his brothers Simon, of Stamford, Conn., and Abram, of Manhattan; and three granddaughters.
  10. Could you explain HOW you managed to do it? It seems impossible without recommendations.
  11. Mute 19 Years, He Helps Reveal Brain's Mysteries By BENEDICT CAREY HARRIET, Ark., July 2 — Terry Wallis spends almost all of his waking hours in bed, listening to country-western music in a cramped, two-room bungalow down a gravel road off State Highway 263. Mr. Wallis, 42, wears an open, curious expression and speaks in a slurred but coherent voice. He volleys a visitor's pleased-to-meet-you with, "Glad to be met," and can speak haltingly of his family's plans to light fireworks at his brother's house nearby. For his family, each word is a miracle. For 19 years — until June 11, 2003 — Mr. Wallis lay mute and virtually unresponsive in a state of minimal consciousness, the result of a head injury suffered in a traffic accident. Since his abrupt recovery — his first word was "Mom," uttered at the sight of his mother — he has continued to improve, speaking more, remembering more. But Mr. Wallis' return to the world, and the progress he has made, have also been a kind of miracle for scientists: an unprecedented opportunity to study, using advanced scanning technology, how the human brain can suddenly recover from such severe, long-lasting injury. In a paper being published Monday, researchers are reporting that they have found strong evidence that Mr. Wallis's brain is healing itself by forming new neural connections since 2003. The paper, appearing in The Journal of Clinical Investigation, includes a series of images of Mr. Wallis's brain, the first such pictures ever taken from a late-recovering patient. The new findings raise the hope that doctors will eventually have the ability to determine which patients with severe brain damage have the best chance of recovering. They might also help settle disputes in cases like that of Terri Schiavo, the Florida woman who was removed from life support and died last year after a bitter national debate over patients' rights. Ms. Schiavo suffered more profound brain damage than Mr. Wallis and did not show signs of responsive awareness, according to neurologists who examined her. "We read about these widely publicized cases of miraculous recovery every few years, but none of them — not one — has ever been followed up scientifically until now," said Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College in Manhattan and the senior author of the new imaging study. An estimated 100,000 to 200,000 Americans subsist in states of partial or minimal consciousness, cut off from those around them. On Saturday, Mr. Wallis said he felt good, but he showed no memory of the study. After prompting from his mother, he did remember the trip back from the researchers' laboratory in New York. "Gasoline," he said, referring to a stop the airplane made to refuel. "We stopped for gasoline." His mother, Angilee Wallis, said: "He is starting to learn things now. That right there is new." In recent weeks, she said, he has also shown hints of self-awareness, alluding to his disabled condition for the first time. Mrs. Wallis, 58, and her husband Jerry, 62, live with and care for their son in a white clapboard cabin, with a small concrete porch surrounded on all sides by acres of trees. Their house, between Harriet and Big Flat, is among a scattering of such hidden homes, sheds and dirt roads a couple of miles from a highway intersection anchored by two liquor stores. The nearest decent grocery store is 30 minutes away, in Mountain View, Ark. For the Wallis family, Terry's accident, his long years of mental absence and his return have been a story of celebrity as well as recovery, of how media attention can strike like a flash flood and just as quickly dry up, leaving families to figure out what all the attention meant, if anything — and whether it was worth it. He was a lanky 19-year-old in 1984, with a gift for elaborate pranks and engine work, when he and two friends skidded off a small bridge in a pickup, landing upside down in a dry riverbed. The family never figured out exactly what happened. The crash left their son unresponsive, breathing but immobilized, there but not there, said his father. Terry Wallis showed no improvement in the first year, and doctors soon pronounced him to be in a persistent vegetative state, and gave him virtually no chance of recovery, his parents said. About 52 percent of people with traumatic wounds to the head, most often from car accidents, recover some awareness in the first year after the injury, studies find; very few do so afterward. Only 15 percent of people who suffer brain damage from oxygen deprivation — like Terri Schiavo, whose heart stopped temporarily — recover some awareness within the first three months. A 1994 review of more than 700 vegetative patients found that none had done so after two years. But at some point after his accident, probably within months, Mr. Wallis, a mechanic before his injury, entered what is called a minimally conscious state, Dr. Schiff said. The diagnosis, established formally in 2002, is given to people who are severely brain damaged but occasionally responsive. In their good moments, they can track objects with their eyes, respond to commands by blinking, grunting or making small movements. They may spend the rest of their lives in this condition, but it is a necessary intermediate step if they are ever to regain some awareness, neurologists say. Mr. Wallis spent the second 19 years of his life at a nursing home in Mountain View, and family members who visited said they saw plenty of hints of awareness along the way. He seemed to brighten when they walked in his room. Something in his face would tighten when he was impatient or hungry. None of which made the day he said "Mom" any less thrilling. Ms. Wallis, her voice unsteady, quickly put out the word to the extended family. Later, the patient had another visitor, a striking blonde woman: his 19-year-old daughter, Amber, who had been 6 weeks old at the time of his accident. "I was so nervous driving over there," she said. "I was looking in the rearview mirror to check my hair, I swear, I was so worried he wouldn't recognize me." When finally he did, she said, the first sentence he uttered was, " 'You're beautiful,' and he told me he loved me." He was suddenly speaking; it was a transformation. He was still disabled, barely able to move or speak, but he was recognizable as Terry. The months that followed brought a swarm of other emotions. Mr. Wallis, now considered clinically recovered but still in need of around-the-clock attention, was moved into his parents' home, shifting much of the financial burden of his care from Medicaid to them. And the world came knocking. A camera crew from Japan arrived and spent two weeks doing daily interviews and filming. Another crew visited from England. There were talk show appearances, agents, documentary makers, forcing Mrs. Wallis to take time away from her job at a local shirt factory to help her husband, a mechanic and farmer, play host. But the attention soon dissipated, and a fund his parents established for their son's care — the Terry Wallis Special Needs Trust — attracted few substantial contributions, they said. Their son still needed to be fed, washed, exercised and turned in his bed every two hours, night and day. His daughter took two regular shifts a day to tend to him, and another aide began working with the family. But in some ways it was like living with a child who never grows up or leaves home: there, out back in the trees, was his old gray Ford van, untouched since 1984; out front was an aluminum boat his father had bought for him, overturned, unused. In 2004, Dr. Schiff contacted the family, asking if they would allow their son to be studied. He helped arrange to have the Wallises flown to New York in April of that year, and again 18 months later, for brain scanning. A research team from New York, New Jersey and New Zealand spent more than a year analyzing the results, comparing them to images from healthy brains and from another minimally conscious patient who had not recovered. Using a novel technique, they saw evidence of new growth in the midline cerebellum, an area involved in motor control, as Mr. Wallis gained strength and range in his limbs. Another area of new growth, located along the back of the brain, is believed by some experts to be a central switching center for conscious awareness. The daily exercises, the interactions with his parents, his regular dose of antidepressant medication: any or all of these might have spurred brain cells to grow more connections, the researchers said. "The big missed opportunity is that we didn't know this guy would spontaneously emerge, and we didn't get to monitor him before then" to find out what preceded it, Dr. Schiff said. To answer that kind of question in a systematic way, researchers will need to follow more minimally conscious patients for longer periods, experts say. But there is no national system to track such patients, they say, no central database like that which exists for other diseases. "We don't see these people. They exist outside of our gaze. We don't even know where they live," said Dr. Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital-Weill Cornell Medical Center. Mr. Wallis, it was clear over the weekend, continues to live for the day. He has a granddaughter now, Amber's child, Victoria, and the 2-year-old does not seem bothered by the pale man with the dark mustache and the inward-turned arms. He does not feel any physical pain, he told his parents, and he has no real sense of time. He also said recently that he was "proud" to be alive. "It is good to know all that," said his father, sitting on the porch on Saturday evening. "It's good to hear him say that, because if he didn't say so, you'd just have no way to know."
  12. The Claim: Reading in the Dark Will Damage Your Eyes By ANAHAD O'CONNOR THE FACTS Everyone who has ever held a flashlight to a book at night has probably heard the dire warnings about reading in the dark. It will weaken your eyes. It can ruin your vision. But according to most ophthalmologists, while reading in the dark might strain your eyes and give you a headache, the notion that it can cause lasting damage is wrong. Most people can expect to experience some decline in their vision as they age, and genetic research shows that it is family history above all else that determines to what extent your vision will weaken. But some researchers argue that putting too much strain on your eyes as a child or young adult, like the kind caused by reading in the dark, or simply reading for prolonged periods in general, might contribute to the decline of your eyesight later in life. Population studies in the United States and other countries have shown, for example, that the rates and severity of myopia are always greatest among people who attain the highest levels of education, as well as those whose occupations require them to do a great deal of reading, like lawyers, editors and doctors. But most of those studies have not taken into account economic factors like limited access to eye doctors. One ophthalmologist who has studied the claim, Dr. Robert Cykiert at New York University Medical Center, is adamant that the strain reading puts on your eyes — in poor light or not — is safe. "It may create fatigue," he said, "but it cannot hurt your eyes in any way." THE BOTTOM LINE Most experts say reading in the dark is safe, despite circumstantial evidence that constantly straining your eyes can weaken your vision.
  13. When bleeding was a treatment Elena Conis For thousands of years, physicians relied heavily on a single treatment for hysteria, heart disease and just about every other malady: bloodletting. The theory behind the practice changed often over time, but the practice itself remained much the same — with doctors often bleeding patients until they were weak, pale and, sometimes, unconscious. In the beginning in Asia and the Mideast, patients were bled to release demons and bad energy. Later, in ancient Greece, they were bled to restore the body's balance of fluids, and even later, in medieval and Renaissance Europe, they were bled to reduce inflammation — by then thought to be at the root of all disease. In ancient times, leeches were sometimes used, but more often people used thorns or sharpened sticks, bones or shells to cut open a vein (a process known as venesection) or to make small incisions in capillaries just below the skin (known as scarification). Their successors used lancets and fleams — small double-edged blades that came with pocket-sized, often tortoiseshell carrying cases. They used vacuum cups of varying dimensions to draw blood to the surface of the skin and bleeding bowls to catch the fluid, released in amounts from a few ounces to a quart at a time. By the time of the Renaissance, blood-letters (often barbers in Europe), had the practice down to a science of sorts. Zodiac charts determined the best times of year for letting blood from different parts of the body. Medical tomes distinguished between diverting blood flow (bleeding the right arm to staunch a bloody left nostril, for example) and encouraging it (bleeding the foot to draw menstrual blood down). Practitioners throughout Europe routinely bled patients who could afford it in efforts to prevent sickness brought on by excess food, weather changes and wounds. By the late 1700s, bloodletting was the treatment of choice in America too — thanks to the efforts of Declaration of Independence signer and physician Benjamin Rush. Rush, who believed that tension in blood vessels was at the root of disease, turned to bloodletting to treat victims of Philadelphia's devastating yellow fever outbreak in 1793. He favored a quart at a time, repeated several times over several days, and claimed the treatment sped his recovery when he contracted the disease. Later that same decade, George Washington fell ill with laryngitis, and his physicians bled him heavily, one after the other. The president gave up more than two liters of blood during the procedures and died a day later. Historians dispute whether it was the loss of blood or other complications that actually killed him. In the decades that followed, physicians began to realize that germs — not an imbalance of fluids — were at the root of cholera, flu and other illnesses. But bloodletting retained a few adherents into the 20th century, and even today some of its wisdom, however faint, is coming to light: Leeches are used to improve circulation and prevent clotting in some surgical patients. In 2004, University of Chicago researchers found that some bacteria rely on iron in blood cells to survive — leading some researchers to conclude that as an attempt to kill bacteria, letting blood out of the body may not have been such a bad idea after all.
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    The statistics of the greek medical population are based on the active members of TSAY... on their first year of activation... activated once, remain till the end
  15. Screening: Women Often Hide Domestic Abuse From Doctors By ERIC NAGOURNEY Women are often reluctant to volunteer to doctors that they are victims of domestic abuse, and doctors shy away from the subject. "The end result," a new study says, "is silence between patients and health care providers." But when the women are screened for the problem using a computer, the study finds, they are much more likely to disclose it. In the current Archives of Internal Medicine, researchers write that screening may be valuable in emergency department waiting rooms. The study was led by Dr. Karin V. Rhodes, now of the University of Pennsylvania, when she was at the University of Chicago. The researchers set up computers at two emergency rooms, one in an urban area that served a mainly black population, and one in a suburban area that served mainly wealthier white patients. In all, 781 women who came in were randomly assigned to be screened. The idea is that patients are often more willing to answer certain questions when they are not dealing with a person. The screening included eight questions intended to uncover a risk of abuse, like "Does your partner try to keep you away from your family or friends?" If a woman said yes to any question, a note on her chart alerted the doctor. About 26 percent of the women at the urban hospital indicated that they were at risk, as did 21 percent of the suburban patients. The women who were screened at the urban hospital were much more likely to discuss domestic violence with their doctors, more likely to disclose that they had problems and somewhat more likely to get referrals for help. Among the suburban women, little difference was seen between those who were screened and those who were not. Domestic violence "was still grossly underaddressed" in emergency rooms. It was discussed in just under half the visits when patients had indicated a risk.
  16. Vaccine Prevents Cervical Cancer. So, What's the Down Side? By BEN DAITZ, M.D. "Someone please help me with my daughter!" the middle-aged woman announced in the waiting room of our clinic. "She's in the back of the car and I can't carry her." I followed the woman to her car. Her daughter, in her late 20's, lay huddled under a blanket in the back seat. Her face was ashen and her body cadaveric, and when I picked her up, she stared at me with hollow, dull eyes as her bones rubbed against my arms. Her mother told me that she'd brought her daughter back on a plane from New York City, where she'd been a ballerina. I had never seen an adult patient so thin, so emaciated. My patient said she had pain in her abdomen and pelvis, and when I did a pelvic exam, I did not know what I was feeling. I only knew it was very bad. That was almost 30 years ago, and I was feeling the contours of a cauliflowerlike mass, a so-called fungating carcinoma of the cervix, a cancer every bit as bad as it sounds. It caused my young patient's death several weeks later. If the Food and Drug Administration rules as expected on a new vaccine next month, cancer of the cervix could be prevented by a vaccine. Last week, an F.D.A. advisory board unanimously endorsed the vaccine, which protects against infection with human papillomavirus or HPV. There have been only a few times in my life as a physician when I've been able to say (at least to myself), "This is truly big news." My colleagues are saying the same thing. But they are also asking how this promising new treatment will be made available to women and girls worldwide. In the 30 years since I saw my patient, HPV has been demonstrated to be the most common sexually transmitted disease in the world and the cause of almost all cervical cancers. That knowledge spurred a widespread screening effort in the United States and other medically sophisticated countries. The increased use of Pap tests to detect cancer, and specific HPV testing along with improved diagnostic and treatment options, has resulted in a sharp decrease in the incidence of cervical cancer in the United States. "When we first started looking for HPV in the 80's, I said, 'Oh my God! Everyone's infected!' Half of the women at the student health center had HPV," Dr. Cosette M. Wheeler told me. Dr. Wheeler is professor of medical genetics and ob-gyn at the University of New Mexico Health Sciences Center and one of the lead investigators in the vaccine trials. "Now we can say that the vaccine is 100 percent effective against HPV Types 16 and 18, which are responsible for the majority of the cancers," Dr. Wheeler said. In the United States, cervical cancer has slipped to eighth in the rankings of the incidence of cancers among women, but in the developing world, it ranks second. A study by public health investigators in Mexico reported that an average of 12 women died of cervical cancer there each day. Increasingly, cervical cancer will become a disease of poor women who have limited or no access to basic health care, much less vaccines expected to cost $300 to $500 for a series of three shots. Unfortunately, the prospect of the first preventive vaccines for a devastating cancer come with side effects other than just the high cost. The physical side effects of the vaccines themselves are reported as minor, but the immunizations' implications for public health and health policy, for moral and ethical decisions, for religious convictions and ultimately for sexual politics, nationally and globally will be major. Dr. Wheeler and most other public health specialists argue that vaccinating young girls and eventually, boys, before they become sexually active is the best overall prevention strategy and the most effective way to continue to research the vaccines' efficacy (although no effectiveness studies have yet been done in males). But some conservative Christians oppose mandatory vaccination, and have argued that the vaccine would promote promiscuity and detract from their, and the Bush administration's, abstinence messages in the United States and abroad. The present cost of screening-prevention methods like Pap smears and colposcopy approaches $6 billion a year in the United States. Those costs will continue in addition to the vaccine expense. Who will pay for cervical cancer prevention for the neediest women and girls? The scientists and researchers who made and tested these incredibly promising vaccines will probably not be deciding the best way to educate men and women about cervical cancer, or how to plan for affordable global distribution that is now, more than ever, the right thing to do. Regrettably, some of those decisions have already been made — in pharmaceutical company boardrooms — and we can now see the opening act of another sophisticated "ask your doctor" advertising campaign on the evening news. This one begins with a well-dressed, hip young woman who reflects, while contemplating the middle distance: "There's a common virus that can cause cancer? I didn't know that!" Maybe she didn't. But here, where public health was born, and where the knowledge that HPV causes cancer has been around for almost two decades, it's a crying shame she has to learn it from a drug company.
  17. Patterns: Exploring Women's Health and Double Duty By NICHOLAS BAKALAR For women, combining work and family may be a healthier choice than staying home, recent research in Britain suggests. The researchers studied 1,171 women born in 1946, interviewing them in each decade from their 20's on to collect information about their health, work, marriage and children. They then had the women report their state of health at 54. The study found that women who had taken on multiple roles as mothers, wives, and employees over those years were significantly healthier than those who had not. "Our question," said Anne McMunn, the lead author of the findings, "was whether women were working and having families because of their good health or whether their health was relatively good because of multiple role occupation." The answer, the study found, is that taking on extra roles was itself associated with good health, and that initial good health was not a predictor of taking on extra roles. Dr. McMunn is a senior research fellow in the department of epidemiology and public health at University College London. According to background information in the paper, which appears in the June issue of The Journal of Epidemiology and Community Health, it has been well known for some time that women who both work and maintain families are healthier than those who do not. But it had not been clear that that was not simply because healthier women were inclined to take on both work and other roles. The authors acknowledged the difficulty of generalizing beyond the specific group of British women included in the study. Examining other populations may produce different findings. Nevertheless, they concluded, "Our results suggest that good health is more likely to be the result, rather than the cause" of taking on work along with family and child-rearing obligations.
  18. Motivation: For Patients, There's Beauty in the Ugly Truth By NICHOLAS BAKALAR Seeing is believing for heart patients. A new study suggests that when patients see a scan showing plaque accumulation in their own arteries, their adherence to a lipid-lowering drug regimen increases significantly. Researchers studied 505 asymptomatic patients on statin therapy who had their arteries examined by electron beam tomography, which produces a picture of arterial plaque. Each patient looked at the actual scan, which clearly showed the artery-blocking plaque as bright white spots. The patients were informed of the severity of blockage, and the researchers explained the consequences related to heart disease. After controlling for age, sex, hypertension, diabetes, tobacco use and family history, the amount of plaque seen on the scan at the outset of the study remained an independent predictor that a patient would stay on a prescribed lipid-lowering medicine. The more severe the plaque accumulation, the more likely the patients were to stay on their medicine. Among the 25 percent of the participants with the least severe buildup, 53 percent were still on their regimens when researchers followed up an average of three and a half years later. By contrast, among the 25 percent with the most severe accumulation, 92 percent were still taking their drugs. "I'm not saying that everyone should get this test," said Dr. Matthew Budoff, the lead author on the study and an associate professor of medicine at the University of California, Los Angeles. "But I think this is a very useful tool for patients who are prone to stop taking their medicine." "For certain patients, the test will definitely increase adherence, and those patients should get it," Dr. Budoff said. The findings appeared last month in the journal Atherosclerosis.
  19. Πολυπτυχιούχοι με μηνιαία αμοιβή μόνο χίλια ευρώ Γενιά τριαντάρηδων με προσόντα αζήτητα στην Ελλάδα και την Ε.Ε. Αυτό που προβληματίζει σήμερα τους νέους εργαζόμενους και προκαλεί σαρωτικό κύμα ανησυχίας στη γενιά τους, σε Ελλάδα και εξωτερικό, είναι ότι, παρ' όλα τα πτυχία και τις ξένες γλώσσες, τα βαριά ωράρια και το αστείρευτο μεράκι για δουλειά δεν έχουν καταφέρει -και δεν θα το καταφέρουν άμεσα- να αμείβονται με έναν αξιοπρεπή μισθό. Εχουν δρασκελίσει τα τριάντα και ζουν ακόμη στο πατρικό. Αλλοι, για να βγάλουν το νοίκι και τα πάγια, «φορτώνουν» τις κάρτες και καταφεύγουν σε καταναλωτικά. Στην Ευρώπη τους έχουν δώσει ήδη όνομα: η «γενιά των 1.000 ευρώ». Νέοι επιστήμονες, γιατροί, καθηγητές, μηχανικοί, δικηγόροι, διαφημιστές, έχουν σε Ελλάδα, Ιταλία, Γαλλία, Ισπανία, ένα κοινό πρόβλημα: «υπερβολικά» προσόντα για την αγορά εργασίας, που θέλει στρατιές εργαζομένων με αμοιβές για χρόνια καθηλωμένες στα 1.000 ευρώ. Η «Κ» μίλησε με εκπροσώπους της γενιάς -στη χώρα μας- των «900 ευρώ» και αποτυπώνει την ανασφάλεια, αυτήν τη φορά όχι άνεργων αλλά εργαζόμενων νέων, οι οποίοι δεν καταφέρνουν να είναι οικονομικά ανεξάρτητοι. Hμερομηνία : 14-05-06 http://www.kathimerini.gr
  20. Την υγειά τους να 'χουν, να περιμένουν Πόσα χρόνια χρειάζεται για να σπουδάσει ένας γιατρός στην Ελλάδα; Περίπου 25 (!). Γιατί; Εξι χρόνια η απόκτηση του πτυχίου και άλλα 5-6 χρόνια η ειδικότητα. Κι άλλα τόσα χρόνια η αναμονή για να πάρει την ειδικότητα. Σύνολο 25. *Ο αριθμός των γιατρών που περιμένουν αυτή τη στιγμή να πάρουν ειδικότητα είναι περίπου 3 με 5 χιλιάδες. Το σχέδιο νόμου, όμως, που θα άλλαζε τον τρόπο εισαγωγής στην ειδικότητα παραμένει στα χαρτιά. Το Κεντρικό Συμβούλιο Υγείας ακόμη το μελετά για να κάνει τις προτάσεις στο υπουργείο. Οσο για τις προεκλογικές δεσμεύσεις της κυβέρνησης, μία από αυτές που έχουν μείνει στα χαρτιά είναι η αναβάθμιση της ιατρικής εκπαίδευσης. *Τα στοιχεία της Πανελλήνιας Ιατρικής Εταιρείας Διευθυντών του ΕΣΥ δίνουν μια εικόνα της κατάστασης: από τον συνολικό αριθμό των γιατρών που ειδικεύονται, που είναι περίπου 7 χιλιάδες, με μέση διάρκεια ειδίκευσης 5,2 χρόνια, υπολογίζεται ότι κάθε χρόνο βγαίνουν στην αγορά περίπου 1.600 ειδικευμένοι γιατροί! Οι ειδικότητες με τους περισσότερους γιατρούς και επομένως με μεγάλη αναμονή είναι: η παθολογία (12% των γιατρών), η παιδιατρική (8%), η γυναικολογία (8%), η καρδιολογία (7%) και η χειρουργική (7%). *Ο Γ. Πατούλης, πρόεδρος των ελευθεροεπαγγελματιών γιατρών Αττικής και επί χρόνια εκπρόσωπος των ειδικευομένων της χώρας, λέει: «Αυτή τη στιγμή, η μέση αναμονή στην Αθήνα είναι 5-10 χρόνια, στη Θεσσαλονίκη 5-8 και στην υπόλοιπη περιφέρεια 2-5 χρόνια. Στις πανεπιστημιακές κλινικές που η ζήτηση είναι μεγαλύτερη, η αναμονή είναι σχεδόν διπλάσια από τον μέσο όρο». Για παράδειγμα, μια πρόσφατη καταγραφή έδειξε ότι για να ειδικευτεί κάποιος στην οφθαλμολογία στο Γενικό Κρατικό Αθηνών χρειάζεται να περιμένει σχεδόν 10 χρόνια, στην παιδιατρική στα νοσοκομεία Παίδων «Αγία Σοφία» και «Αγλαΐα Κυριακού» έξι χρόνια και στην παθολογική ογκολογία στο πανεπιστημιακό Ιωαννίνων εννιά χρόνια. Οπως εξηγεί ο Γ. Πατούλης, «πολλοί γιατροί αναγκάζονται να μείνουν άνεργοι και μακριά από την ιατρική πράξη για χρόνια και όταν έρθει η ώρα να ξεκινήσουν επιτέλους την ειδικότητα, έχουν ξεχάσει κι αυτά που ήξεραν». *Σήμερα πολύ χαμηλή, ακόμη και καθόλου αναμονή έχουν οι εργαστηριακές ειδικότητες, όπως η ακτινολογία. Αντίθετα, οι κλινικές ειδικότητες οι οποίες συνήθως αποφέρουν μεγάλα κέρδη στους γιατρούς που θα επιλέξουν το δρόμο του ιδιωτικού ιατρείου, για παράδειγμα η οφθαλμολογία, η ενδοκρινολογία και η παιδιατρική, έχουν αναμονή 8-10 χρόνια. Μ. Π. ΚΥΡΙΑΚΑΤΙΚΗ - 14/05/2006
  21. Maybe Brain Surgeons Aren't as Smart as You Thought By WILLIAM GRIMES "It's not brain surgery." In casual English, that means the task at hand is not complicated. Brain surgeons, like rocket scientists, are presumed to be at the top rung of the intellectual ladder, solving problems of Einsteinian complexity. Think again. Katrina Firlik, a neurosurgeon practicing in Connecticut, deflates that myth right off the bat in "Another Day in the Frontal Lobe," her engaging tour of human brains and the doctors who cut into them. It's neurologists or psychiatrists who are more likely to ponder the deep questions of mind and consciousness. Neurosurgeons, whom Dr. Firlik describes as "part scientist, part mechanic," do manual labor, the hands-on work of opening the skull and cutting out tumors or cysts. Sometimes the work calls for exquisite delicacy. Other times, they're reaching for a mallet and chisel. Good neurosurgeons (who, by the way, spend more time operating on spines than they do on brains) like to keep things simple. Case No. 1 in Dr. Firlik's file is a construction worker who has been shot in the head with a nail gun by his partner and has a two-inch nail in his frontal lobe. The victim is alert and mentally sharp. He feels no pain. In the operating room Dr. Firlik, rolling up her sleeves, drills a circular hole in the skull around the nail head and gently pulls it out along with the nail. After pounding the nail out, she fastens the disc of bone back to his head with titanium plates and screws. Within 24 hours the patient is sent on his way. No harm done. Mr. Nailhead makes a good demonstration model. Dr. Firlik uses his case, and others from her long years of medical training, to explain how neurosurgeons think, how they develop their skills and what they encounter from day to day. It is a report on the profession, and an autobiography as well. She describes her childhood in a Cleveland suburb, where her father was a doctor, the influences that led her to choose neurosurgery as a profession (a neat freak, she once dreamed of becoming a cleaning woman) and the long, slow slog through medical school. Dr. Firlik is not always sure which book she is writing, and readers keen to get to the next case study may fret as the author discusses, say, her philosophy about the afterlife or the artwork of Andy Goldsworthy, introduced because it deals with the way nature fragments over time, just as the brain does. Dr. Firlik is a bit obsessive about her career, and in her more self-indulgent moments she puts it on display, like an art object, for general admiration. Fortunately she has a sharp sense of humor, and a lively sense of the small absurdities of her profession. She looks on with amusement at the brain squeeze toys that medical manufacturers like to give away, and at the book "Gifted Hands," which a neurosurgeon writes about himself. On occasion, as one might expect, the humor is black. "If the patient isn't crying by the time you're done going over the consent for surgery, then you haven't done your job," she writes. As a guide to the winding hallways of a hospital, and the terrifying mysteries of the operating room, Dr. Firlik excels. She starts with the brain itself and what it feels like, which is tofu, "the soft variety, if you know tofu." Because it is soft, the brain, it turns out, is a forgiving, flexible organ. In the large frontal lobes, tumors can grow to "impressive citrus fruit proportions" before patients even notice something amiss. Who operates on what, and what with, turns out to be fascinating. Some neurosurgeons specialize in aneurysms, others in movement disorders like Parkinson's. Skull-base neurosurgeons, who deal with tumors at the base of the brain, are known for operations that can take so long they work in teams, one replacing the other at the end of a shift. The equipment can be as simple as a drill, or as complex as a three-dimensional image guidance system, bearing the brand name Stealth or BrainLab, which allows surgeons to pinpoint the contours of a tumor in the brain. But even drilling has its subtleties. Neurosurgeons learn early to recognize the sound that a drill makes as it passes through each layer of the skull. And it is reassuring to know that doctors can overrule computers. In one of the book's highlights, a senior neurologist, ignoring the ambiguous information coming from a computer guidance system in the operating room, locates a tumor by running his finger over the surface of the baby patient's brain. As the tofu comparison suggests, Dr. Firlik likes vivid examples, and she has a gift for translating medical issues into everyday terms, like the near-impossibility of cutting out glioblastoma multiforme, the worst kind of brain tumor. Imagine quickly ripping open a bag of unpopped popcorn in the kitchen, Dr. Firlik suggests. Most of the kernels land in a pile nearby, but over the next few days stray kernels keep turning up, some as far off as the living room. "That's what a glioblastoma is like," she writes. "You can clean up the focused mess, but you know there are cells you can't see at first, far removed from the obvious focus." Neurosurgeons solve problems, which makes their profession a lot less depressing than it might seem, but some of the cases Dr. Firlik deals with are grim. One in particular, is worth the price of the book. Without going into detail, suffice it to say that if you see a small growth on your face, you really should have a doctor look at it as soon as possible.
  22. Behavior: Surgical Teams Found Lacking, in Teamwork By ERIC NAGOURNEY They call it a surgical team, but there may be a lot of teamwork left to be desired, a new study finds. The researchers surveyed more than 2,100 surgeons, anesthesiologists and nurses about operating room communications. Their views — and the divergence among them — may shed light on how some surgical mistakes happen. When the participants were asked to "describe the quality of communication and collaboration you have experienced" with other members of operating teams, surgeons were given the lowest rating for teamwork. Their worst assessment was from nurses, the group that got the highest rating. "The study is somewhat humbling to me," said the lead author of the study, Dr. Martin A. Makary, a surgeon at Johns Hopkins who has been advocating a new approach to operating room communication. "There's a lot of pride in the surgical community. We need to balance out the captain-of-the-ship doctrine." For the study, described in the current issues Annals of Surgery and The Journal of the American College of Surgeons, the researchers surveyed medical workers at 60 hospitals in 16 states. The survey was based on the Safety Attitudes Questionnaire that airlines use to improve cockpit management. The goal is to make sure all members of a team feel free to speak out if they feel a mistake is being made. Many operating room mistakes, like sponges left in patients or the wrong body part being operated on, could be avoided through better communication, the researchers said. But this can mean getting over barriers of class, race, gender and even general outlook. Afterward, the researchers spoke with participants and found that "nurses often describe good collaboration as having their input respected, and physicians often describe good collaboration as having nurses who anticipate their needs and follow instructions."
  23. ioan

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  24. Do you know what is this? How is it used? I know... but I promise not to tell
  25. Υψηλό το κόστος για ασθενείς αλλά και υγιείς «H Eλλάδα και η Iταλία θα αντιμετωπίσουν περί το 2030 το μεγαλύτερο πρόβλημα γήρανσης του πληθυσμού στην Eυρώπη, λόγω της υπογεννητικότητας», αναφέρει στην «K» ο κ. Aντώνης Kαρόκης, οικονομολόγος της υγείας. «Eως τότε», επισημαίνει, «είναι δεδομένη η αύξηση των δαπανών για περίθαλψη και υπηρεσίες υγείας και λόγω της γήρανσης και λόγω των νέων τεχνολογιών». «Παλαιότερα θεωρούσαμε ότι αυτός που εισέρχεται υγιής στην τρίτη ηλικία θα ξοδέψει λιγότερα για την υγεία του. Tελικά, αυτό δεν είναι αλήθεια, η διαφορά δεν είναι σημαντική. Στο πλαίσιο της μελέτης έγινε σύγκριση υγιών και μη, ηλικιωμένων και διαπιστώθηκε ότι η διαφορά της δαπάνης στη μία και την άλλη περίπτωση δεν ξεπερνάει το 10% κατ’ άτομο. Oι ασθενείς έχουν αυξημένες δαπάνες περίθαλψης κυρίως τον πρώτο χρόνο από τη διάγνωση, αλλά μικρότερο προσδόκιμο επιβίωσης. Oι υγιείς ζουν περισσότερο και προϊόντος του χρόνου εκδηλώνουν χρόνιες παθήσεις που απαιτούν και άλλες υπηρεσίες, φυσικοθεραπεία, κατ’ οίκον νοσηλεία και άλλες κοινωνικές παροχές. Oσα περισσότερα χρόνια νοσήματα εμφανίζει ο ηλικιωμένος τόσο αυξάνει το κόστος και χειροτερεύει η ποιότητα της ζωής του». «Kατόπιν αυτών», καταλήγει ο κ. Kαρόκης, «θα μπορούσε κανείς να θέσει ένα υποθετικό ερώτημα. Aξίζει όλη αυτή η προσπάθεια που καταβάλλεται για τη μείωση των παραγόντων κινδύνου, που είναι το κάπνισμα, η παχυσαρκία, η υπέρταση, ο σακχαρώδης διαβήτης; Θα έλεγα ότι δεν έχει ιδιαίτερο ενδιαφέρον όσον αφορά τα οικονομικά της υγείας. Eίναι αναγκαία, γιατί συμβάλλει στην καλύτερη υγεία και τη βελτίωση της ποιότητας της ζωής μας κυρίως σε μεγάλη ηλικία. Tο ερώτημα δεν είναι αν θα ξοδέψουμε χρήματα, αυτό όπως είπαμε είναι δεδομένο, αλλά πού θα τα ξοδέψουμε. Σε αρρώστους που πεθαίνουν γρήγορα ή σε υγιείς που ζουν καλύτερα και περισσότερο;». http://www.kathimerini.gr
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