Analysing the attributes of Comprehensive Cancer Centres and Cancer Centres across Europe to identify key hallmarks.

There is a persistent variation in cancer outcomes among and within European countries suggesting (among other causes) inequalities in access to or delivery of high-quality cancer care. European policy (EU Cancer Mission and Europe's Beating Cancer Plan) is currently moving towards a mission-oriented approach addressing these inequalities. In this study, we used the quantitative and qualitative data of the Organisation of European Cancer Institutes' Accreditation and Designation Programme, relating to 40 large European cancer centres, to describe their current compliance with quality standards, to identify the hallmarks common to all centres and to show the distinctive features of Comprehensive Cancer Centres. All Comprehensive Cancer Centres and Cancer Centres accredited by the Organisation of European Cancer Institutes show good compliance with quality standards related to care, multidisciplinarity and patient centredness. However, Comprehensive Cancer Centres on average showed significantly better scores on indicators related to the volume, quality and integration of translational research, such as high-impact publications, clinical trial activity (especially in phase I and phase IIa trials) and filing more patents as early indicators of innovation. However, irrespective of their size, centres show significant variability regarding effective governance when functioning as entities within larger hospitals.

[Linear accelerator-based stereotactic radiosurgery for the treatment of trigeminal neuralgia. Nine years' experience in a single institution]. / Radiocirugia estereotactica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institucion.

INTRODUCTION. Pharmacological treatment is the first therapeutic step towards controlling pain in trigeminal neuralgia, but 25-50% of patients become medication resistant. There are currently several surgical alternatives for treating these patients. AIM. To evaluate the effectiveness and safety of stereotactic radiosurgery for the treatment of patients with trigeminal neuralgia. PATIENTS AND METHODS. A follow-up study was conducted on 30 patients who underwent radiosurgery using a Novalis linear accelerator. Eighty per cent of the dosage was calculated at the isocentre, the entry zone of the root of the trigeminal nerve. The mean follow-up time was 27.5 months (range: 1-65 months). RESULTS. The mean age was 66 years (range: 36-87 years), with a time to progression of 7.1 years (range: 4-27 years). The distribution of the pain was from the right side (63.3%). Of the 30 patients, 27 experienced an improvement (90%) 1.6 months (range: 1 week-4 months) after the treatment; 10 patients (33.3%) scored grade I, and 17 patients (56.6%) obtained a score of grade II. During the follow-up, four patients (14.2%) suffered a relapse; two underwent re-irradiation. Time without recurrence was 62.7 months (range: 54.6-70.8 months). The rate of side effects was 76.7% and only three patients developed facial anaesthesia with loss of the corneal reflex. CONCLUSIONS. The use of the linear accelerator is an effective therapeutic option in the treatment of trigeminal neuralgia, since it provides adequate long-term control of the pain, reduces the use of medication and improves the quality of life.

TITLE: Radiocirugia estereotactica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institucion.Introduccion. El tratamiento farmacologico constituye el primer escalon terapeutico para el control del dolor en la neuralgia del trigemino, pero entre el 25-50% de los pacientes se hace farmacorresistente. Actualmente existen varias alternativas quirurgicas para tratar a estos pacientes. Objetivo. Evaluar la efectividad y seguridad de la radiocirugia estereotactica para el tratamiento de pacientes con neuralgia del trigemino. Pacientes y metodos. Se dio seguimiento a 30 pacientes que se sometieron a radiocirugia con acelerador lineal Novalis. Se calculo el 80% de la dosis en el isocentro, la zona de raiz de entrada del nervio trigemino. El tiempo medio de seguimiento fue de 27,5 meses (rango: 1-65 meses). Resultados. La edad media fue de 66 años (rango: 36-87 años), con un tiempo de evolucion de 7,1 años (rango: 4-27 años). La distribucion del dolor fue del lado derecho (63,3%). De los 30 pacientes, 27 tuvieron mejoria (90%) 1,6 meses (rango: 1 semana-4 meses) despues del tratamiento; 10 pacientes (33,3%) tuvieron una valoracion de grado I y 17 pacientes (56,6%) una valoracion de grado II. Durante el seguimiento, cuatro pacientes (14,2%) tuvieron recidiva; dos se sometieron a reirradiacion. El tiempo sin recurrencia fue de 62,7 meses (rango: 54,6-70,8 meses). La tasa de efectos secundarios fue del 76,7%, y solo tres pacientes desarrollaron anestesia facial con perdida del reflejo corneal. Conclusiones. El uso del acelerador lineal es una opcion terapeutica efectiva en el tratamiento de la neuralgia del trigemino, proporciona a largo plazo adecuado control del dolor, reduce el uso de medicamentos y mejora la calidad de vida.

[Present situation of science and technology of traditional Chinese medicine in China].

This paper explains the status of science and technology of traditional Chinese medicine in China. Basic conclusions are as follows: policy environment is improved step by step, R&D funds and R&D personnel in traditional Chinese medicine field are increased continuously, and a lot of achievements have been got in traditional Chinese medicine field.

Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey.

OBJECTIVE: To assess the current state of electronic health record (EHR) use by ophthalmologists, including adoption rate, user satisfaction, functionality, benefits, barriers, and knowledge of meaningful use criteria. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 492 members of the American Academy of Ophthalmology (AAO). METHODS: A random sample of 1500 AAO members were selected on the basis of their practice location and solicited to participate in a study of EHR use, practice management, and image management system use. Participants completed the survey via the Internet, phone, or fax. The survey included questions about the adoption of EHRs, available functionality, benefits, barriers, satisfaction, and understanding of meaningful use criteria and health information technology concepts. MAIN OUTCOME MEASURES: Current adoption rate of EHRs, user satisfaction, benefits and barriers, and availability of EHR functionality. RESULTS: Overall, 32% of the practices surveyed had already implemented an EHR, 15% had implemented an EHR for some of their physicians or were in the process of implementation, and another 31% had plans to do so within 2 years. Among those with an EHR in their practice, 49% were satisfied or extremely satisfied with their system, 42% reported increased or stable overall productivity, 19% reported decreased or stable overall costs, and 55% would recommend an EHR to a fellow ophthalmologist. For those with an electronic image management system, only 15% had all devices integrated, 33% had images directly uploaded into their system, and 12% had electronic association of patient demographics with the image. CONCLUSIONS: The adoption of EHRs by ophthalmology practices more than doubled from 2007 to 2011. The satisfaction of ophthalmologists with their EHR and their perception of beneficial effects on productivity and costs were all lower in 2011 than in 2007. Knowledge about meaningful use is high, but the percentage of physicians actually receiving incentive payments is relatively low. Given the importance of imaging in ophthalmology, the shortcomings in current image management systems need to be addressed. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Bell's palsy. A prospective, longitudinal, descriptive, and observational analysis of prognosis factors for recovery in Mexican patients.

OBJECTIVE: To determine the prognosis factors in Mexican patients with Bell's palsy. DESIGN: We designed a prospective, longitudinal, descriptive, and observational analysis. Two hundred and fifty one patients diagnosed with Bell's palsy at the National Institute of Rehabilitation were included. We studied the sociodemographic characteristics, seasonal occurrence, sidedness, symptoms, and therapeutic options to determine the prognostic factors for their recovery. RESULTS: Thirty-nine percent of patients had a complete recovery and 41.5% had an incomplete recovery. Marital status, gender, etiology, symptoms, sidedness, House-Brackmann grade, and treatments did not represent significant prognostic factors for recovery. Age > 40 years (OR = 2.4, IC 95% 1.3-4.3, p = 0.002) and lack of physical therapy (OR = 6.4, IC 95% 1.4-29.6, p = 0.006) were significant prognostic factors for incomplete recovery. Familial palsy resulted to be a protective prognostic factor against an incomplete recovery (OR = 0.54, IC 95% 0.28-1.01, p = 0.039). This protection factor was only significant in female patients (OR = 0.41, p = 0.22) but not in male patients (OR = 1.0, p = 0.61). CONCLUSIONS: The proportion of cases with incomplete recovery was high. The age > 40 years and lack of physical therapy were the only significant prognostic factors for an incomplete recovery.

Análise crítica do desempenho evolutivo da visão subnormal no Instituto Benjamin Constant / Critical analysis of the progressive performance of low vision in Benjamin Constant Institute

OBJETIVO: Avaliar a efetividade do setor de Visão Subnormal no Instituto Benjamin Constant (IBC) e comprovar a real necessidade de um Instituto nos moldes do Instituto Benjamin Constant na atual política de inclusão. MÉTODOS: Estudo ecológico, realizado de 1° de outubro de 1990 a 20 de dezembro de 2002, analisando três períodos de atendimento no setor de Visão Subnormal no Instituto Benjamin Constant: a) 1991 - início do atendimento; b) 1995 - integração médico-pedagógica; c) 2002 - estágio atual. Nesta análise foram estudados os seguintes indicadores: I - número de atendimentos no setor de Visão Subnormal; II - condições do setor de Visão Subnormal no Instituto Benjamin Constant e III - associados. RESULTADOS: Observou-se aumento do atendimento, que passou a ser mais abrangente após a integração médico-pedagógica. Outros indicadores, como a capacitação de profissionais médicos, a participação em cursos de capacitação no Instituto Benjamin Constant, o aumento do número de convênios e encaminhamentos para o Instituto Benjamin Constant, além da Reabilitação, também confirmam a efetividade do setor de Visão Subnormal no Instituto Benjamin Constant. CONCLUSÕES: O setor de Visão Subnormal mostrou ser a interface entre o serviço médico e o serviço pedagógico, passando a interagir posteriormente com a Reabilitação e a Coordenação de Educação Física. Isto acarretou mudança de postura de diferentes setores do Instituto Benjamin Constant com relação ao paciente portador de visão subnormal, desde o educando até o paciente da comunidade. Desse modo, o Instituto Benjamin Constant mostrou a sua utilidade no tocante à política de inclusão.

[Critical analysis of the progressive performance of low vision in Benjamin Constant Institute]. / Análise crítica do desempenho evolutivo da visão subnormal no Instituto Benjamin Constant.

PURPOSE: To evaluate effectiveness of the Low Vision the Benjamin Constant Institute (BCI) and confirm the real necessity of an Institute like BCI in the present inclusion policy. METHODS: Ecological study, analyzing 3 periods of Low Vision Assistance at the Benjamin Constant Institute from October 1, 1990 to December 20, 2002: a) 1991--starting assistance; b) 1995--medical pedagogic integration; c) 2002--present-day situation. We considered in this analysis as indicators: I--Low Vision Assistance, II--Low Vision sector in the Benjamin Constant Institute, III--Associates. RESULTS: This study demonstrated an increase in assistance, reaching a wider spectrum of patients after medical-pedagogic integration. Other indicators, such as physician capacitation, participation in Benjamin Constant Capacitation Courses, increase in orientation to institutions, schools and others and referrals to the Benjamin Constant Institute, and Rehabilitation also attest the effectiveness of the Low Vision sector of the Benjamin Constant Institute. CONCLUSIONS: The Low Vision sector proved to be the interface between the Medical and Pedagogic Departments, and later on the Rehabilitation and Physical Education Coordination sectors. This has implied alterations in the way to manage the low-vision patient, not only regarding the regular Benjamin Constant Institute student as well as any other patient in the community. The Benjamin Constant Institute proved its importance as regards inclusion policy.

[Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán]. / Tratamiento quirúrgico de la hemorragia del tubo digestivo bajo. Experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. RESULTS: There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors. CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.

Pediatric oncology in Slovenia.

Slovenia, a new country and formerly a part of Yugoslavia, has had its Childrens Hospital in Ljubljana since 1865. This became a part of the University Hospital in 1945, and in the early 1960s the Department of Pediatric Hematology-Oncology was established. The Oncological Institute of Slovenia was established in 1938 and has developed into a modern facility for comprehensive cancer care, research, and teaching. In close cooperation, established in the 1960s, a team from these two institutions takes care of the approximately 60 children per year who develop cancer in Slovenia. Consisting of pediatricians, radiation oncologists, pathologists, cytologists, surgeons, and other ad hoc specialists, the team meets at least twice weekly to plan treatment, follow the patients, discuss the results, and teach. All patients are subject to regular follow-up indefinitely. A separate team has been formed to study the late effects of cancer treatment on survivors, who by now are mostly adults.