La Interoperabilidad como base de la Historia Clínica Digital en el Sistema Nacional de Salud / Interoperability as the basis of digital medical records in the National Health System

La utilización de las Tecnologías de la Información y las Comunicaciones (TIC) en nuestras organizaciones sanitarias ha sido muy notoria en la última década. Ello ha sido especialmente relevante en e tratamiento de la Historia Clínica dando lugar en el Sistema Nacional de Salud (SNS) a la implantanción de soluciones e Historia Clínica Electrónica (HCE) distintas en los diferentes servicios de salu, tanto en lo funcional, como en lo tecnológico. La movilidad de lso ciudadanos, impne la necesidad de que estas diferentes soluciones operen entre si transmitiéndose información resecto del mismo paciente y, en este momento, la tecnología está madura para hacerl y ya existen instrumentos semánticos para poder trabajar en su desarrollo. El Sistema Nacional de Salu bajo a coordinación del Ministerio de Sanidad y Consumo, junto a todas las Comunidades Autónomas y las Ciudades Autónomas del territorio español está desarrollando las estrategias que hagan posible la interoperabilidad técnica, semántica y organizacional de las historias clínicas de los pacientes (AU)

This paper aims to describe certain strategies, outlining the background, working methods, advances achieved and future projection within the National Health System (AU)

Retrospective analysis of the serologic response to the treatment of syphilis during pregnancy.

OBJECTIVE: The purpose of this study was to assess the effect of several maternal variables on the serologic response following the treatment of syphilis in pregnancy. METHODS: A 5-year chart review identified 95 patients coded with syphilis at Hermann Hospital. Inclusion criteria were 1) serologically confirmed syphilis infection during the index pregnancy, 2) complete treatment during the index pregnancy, and 3) minimum of one follow-up rapid plasma reagin (RPR) titer. Forty-nine of 95 patients met the inclusion criteria. Treatment response was evaluated by comparing each post-treatment titer of a patient to her pretreatment titer. Each comparison was considered an "observation." Each observation was classified as either a positive response (>/=4-fold titer decline) or a negative response (<4-fold titer decline). Maternal variables assessed included 1) prior history of syphilis untreated or incompletely treated prior to the index pregnancy, 2) gestational age, 3) titer level, 4) unknown duration, 5) positive response at 1 month, 6) positive response at 2 months, 7) positive response at >3 months, and 8) race. RESULTS: A positive response following treatment was significantly more likely if there was no prior history of syphilis or if there was a high initial RPR titer (>32). Only 33/54 (61%) observations at or greater than 3 months had a positive response. CONCLUSIONS: Our study suggests that an absence of a history of syphilis and an initial high RPR titer are predictive of a positive response following appropriate treatment. Given the low percentage of observations with a positive response at 3 months, we speculate that we may be undertreating our pregnant patients with syphilis infection.

Soluble interleukin-2 receptors in children with Kawasaki syndrome.

We studied levels of soluble interleukin-2 receptors (IL-2R) in serial serum samples obtained from 93 patients with Kawasaki syndrome, using a double-antibody "sandwich" enzyme-linked immunosorbent assay technique. Concentrations of soluble IL-2R were significantly increased in Kawasaki syndrome patients in the first 4 weeks of illness when compared with either healthy adult or pediatric controls (P less than 0.02), and in the first 2 weeks of illness when compared with a group of children with measles (P less than 0.0001). Furthermore, in the second week of illness, levels of soluble IL-2R were significantly greater in children who subsequently developed coronary artery aneurysms than in patients with normal appearing coronary arteries. Serum concentration of soluble IL-2R is a useful marker for detecting early Kawasaki syndrome and identifies those patients who are at greater risk of developing coronary artery aneurysms.

Abnormalities of immunoregulation in juvenile rheumatoid arthritis.

Immunoregulatory imbalances are thought to be involved in the pathogenesis of juvenile rheumatoid arthritis (JRA). We have found that a subset of patients with JRA demonstrate a marked expansion of B cells without an alteration in B cell subset distribution. However, there was actually decreased in vitro immunoglobulin production in response to stimulation with either pokeweed mitogen or hydrocortisone. These B cell abnormalities were found to correlate with a marked increase in the percentage of CD4 + CD45R + T cells, a T cell subset thought to be responsible for inducing suppression. In addition, there was a significant decrease in the percentage of CD4 + CD29 + T cells, a T cell subset thought to be responsible for inducing B cell immunoglobulin production. Our results suggest that the B cell abnormalities seen in JRA may be related to defects in T cell immunoregulation.