Hidradenitis Suppurative: Our Experience with a Surgical Case Management Team. / Comité quirúrgico para la hidradenitis supurativa: nuestra experiencia.

BACKGROUND AND OBJECTIVES: The complexity of hidradenitis suppurativa (HS) treatment calls for a multidisciplinary approach. We therefore created a multidisciplinary team to manage surgical care. This study aimed to describe the clinical characteristics of the patients we evaluated and the outcomes of the surgical techniques used. MATERIAL AND METHODS: Descriptive cross-sectional study of 104 patients evaluated by our surgical case management team between September 2015 and July 2018. RESULTS: Surgery was used to treat 46% of the patients with HS who were evaluated. Most were men (73%) with no family history of HS (63%) and smokers or former smokers (76%). Gluteal HS comprised the largest phenotype group (41%) and the majority of cases were serious (Hurley stage II, 36%; stage III, 46%). The anatomical regions with the largest number of lesions were the axillae (51.9%) and the groin (41.3%). Surgery was most often performed in the axilla (38.3%), followed by the gluteus (23.4%). The most common drug treatment was a combination of rifampicin and clindamycin, Deroofing was the technique used most often (in 48% of the patients who underwent surgery). Postoperative outcomes were assessed as satisfactory overall in 63.4% of the cases. The HS lesion recurred in 20% and 12% developed wound dehiscence. CONCLUSIONS: Our experience leads us to recommend forming multidisciplinary teams to improve communication between specialists, provide tailored treatment for the patient with HS, and improve follow-up.

[Cystic adenoid carcinoma. Apropos of a case with very prolonged survival]. / Carcinoma adenoide quístico. A propósito de un caso con supervivencia muy prolongada.

Adenoid cystic carcinoma is an infrequent tumor, but not a rare one. Its primary location is most often the salivary glands, although it can be found in many other organs, including the lung, which is the most frequent site of remote metastasis. The tumor's two main features, which indicate a need for long-term monitoring, are 1) its high level of local aggressivity and rate of recidivism in spite of radical excision, with recurrence sometimes taking place long after the primary tumor appears, and 2) its slow natural history even when disseminated disease is present. Type of tumoral tissue is an important prognostic factor.

Interoperable and standard e-Health solution over Bluetooth.

The new paradigm of e-Health demands open sensors and middleware components that permit transparent integration and end-to-end interoperability of new personal health devices. The use of standards seems to be the internationally adopted way to solve these problems. This paper presents the implementation of an end-to-end standards-based e-Health solution. This includes ISO/IEEE11073 standard for the interoperability of the medical devices in the patient environment and EN13606 standard for the interoperable exchange of the Electronic Healthcare Record. The design strictly fulfills all the technical features of the most recent versions of both standards. The implemented prototype has been tested in a laboratory environment to demonstrate its feasibility for its further transfer to the healthcare system.

Integration proposal through standard-based design of an end-to-end platform for p-Health environments.

Interoperability among medical devices and compute engines in the personal environment of the patient, and with healthcare information systems in the remote monitoring and management process is a key need that requires developments supported on standard-based design. Even though there have been some international initiatives to combine different standards, the vision of an entire end-to-end standard-based system is the next challenge. This paper presents the implementation guidelines of a ubiquitous platform for Personal Health (p-Health). It is standard-based using the two main medical norms in this context: ISO/IEEE11073 in the patient environment for medical device interoperability, and EN13606 to allow the interoperable communication of the Electronic Healthcare Record of the patient. Furthermore, the proposal of a new protocol for End-to-End Standard Harmonization (E2ESHP) is presented in order to make possible the end-to-end standard integration. The platform has been designed to comply with the last ISO/IEEE11073 and EN13606 available versions, and tested in a laboratory environment as a proof-of-concept to illustrate its feasibility as an end-to-end standard-based solution.

Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments.

Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

Implementing ISO/IEEE 11073: proposal of two different strategic approaches.

This paper explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. In this way a framework for MDs can be obtained. Second one is focused on more powerful machines such as data loggers or gateways (aka. computer engines (CE)), which do not have the MDs' memory and processor usage constraints. For CEs a more intelligent and adaptative Plug&Play (P&P) solution is provided. It consists on a general platform that can access to any device supported by the standard. Combining both strategies will cut developing time for applications based on ISO/EEE 11073.

Optimization proposal of a standard-based patient monitoring platform for ubiquitous environments.

This article describes the optimization of a patient telemonitoring platform based on the ISO/IEEE11073 (X73) standard to enable medical device interoperability. In order to achieve this, principal advantages and remaining improvements are evaluated to include in further upgrades towards the new profile evolution, oriented to ubiquitous environments and wearable devices (Personal Health Devices, X73-PHD), and opened to additional plug-and-play features and remote management. After evaluating the possibilities, we describe the platform porting process, a required step to adapt it to the new functionalities and allowing the development of end-to-end standard based systems. The paper details the implementation of the agent-manager architecture, particularized on the X73-PHD communication protocol between a Medical Device (MD) and a central gateway (Compute Engine, CE). Lastly, the obtained results are evaluated, oriented to constitute an X73-PHD tester to prove the challenges currently under discussion in the European Standardization Committee (CEN).

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

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

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

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

[The approach to the quality of life in the chronic respiratory patient]. / Aproximación a la calidad de vida en el enfermo respiratorio crónico.

Due to the fact that the treatment in chronic respiratory patients is almost completely palliative, it is important to find some kind of scale which can yield precise information on the limitations which the subject has to face on his/her day-to-day life. Respiratory function tests and dyspnea scales are not appropriately enough systems for such purpose, therefore during the last few years several CV tests have been applied, general or specific, standardized or not. The method which currently seems more useful is CRQ, even tough SGRQ seems to be the more promising, due to the fact that it has been fully standardized and allows interindividual as well as and in interpopulation comparisons.