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I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.
I would like to share the experience in our country. Singapore is a country in Sout...
I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.
I would like to share the experience in our country. Singapore is a country in South-East Asia. All public hospital junior staff communicate via mobile technology. There are no bleeps. Mobile technology is an essential communication tool. A majority of junior doctors, housemen and medical officer grades are employed by a government-linked company, which gives out monthly mobile phone subscription fee subsidies. Mobile phone numbers of doctors are published on the hospital intranets. As the mobile phones are always with the doctors, each doctor is more easily accessible and can attend to patients in a swifter manner, potentially improving patient care. Consequently, many doctors carry two mobile phones around - a personal phone and a work phone. The same work mobile phone with an internet subscription allows the doctor to access journals, articles and databases literally at his finger tips.
There is potential in mobile technology and I urge interested parties to embrace it.
I read with interest the manuscipt by Jeyaruban and colleagues.
However I am disappointed that a major issue identified was a "Failure of
adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically
relevant impact on gout management.
Surgical weight loss is one of the few non medication related
interventions that has a substantial impact on serum urate.
I read with interest the manuscipt by Jeyaruban and colleagues.
However I am disappointed that a major issue identified was a "Failure of
adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically
relevant impact on gout management.
Surgical weight loss is one of the few non medication related
interventions that has a substantial impact on serum urate.
The American College of Rheumatology recognised this in the 2012 ACR
Gout guidelines by saying "the TFP [Task Force Panel] recognized that diet
and lifestyle measures alone provide therapeutically insufficient serum
urate-lowering effects and/or gout attack prophylaxis for a large fraction
of individuals with gout".
One of the problems with lack of high quality gout care in Australia
in my opinion is the undue emphasis on non-evidence based interventions,
that, even if effective (which they have not shown to be yet), have a
small effect size. This is often to the detriment of emphasis on effective
evidence based therapies (all of which are currently medication based).
A focus on effective evidence based therapies would likely lead to a
better level of gout care by all involved with caring for these patients.
Conflict of Interest:
Menarini and AstraZeneca (Research Funding and Speaking)
We are living a new epoch all over the world. Also in clinical
medicine. As it is known, for example, the model of a single doctor
participating heavily at each step of treatment is giving way to expanded-
care teams.
Moreno-Rodriguez identified an universal crisis of the clinical
method, with dangerous consequences in the practice of medicine. Among its
main causes there are: a deteriora...
We are living a new epoch all over the world. Also in clinical
medicine. As it is known, for example, the model of a single doctor
participating heavily at each step of treatment is giving way to expanded-
care teams.
Moreno-Rodriguez identified an universal crisis of the clinical
method, with dangerous consequences in the practice of medicine. Among its
main causes there are: a deterioration in the doctor-patient relationship,
the undervaluation of clinics, the process of specialization, the
overvaluation of technology, and the indifference for general medicine.
(1)
Moreover, the rigid implementation of guidelines and protocols
adopted as an "standardized new medicine", tend to favor a person "non-
centered" medicine. (2) So, the doctor/patient relationship has been
diluted. These elements are more evident in the elderly patients, usually
with several chronic conditions, when they attend to Emergency
Departments,.
The case referred by John Launer in the Postgraduate Medical Journal
recently is common in the Casualty Departments of great general hospitals.
(3) In order to minimize these situations in our Hospital General
Universitario Dr. Gustavo Aldereguia Lima, daily emergency teams are
carefully planned with enough number of specialists in Internal Medicine,
Emergency Medicine, General Surgery, Traumatology, and the main
specialties of the center, all of them working at the same local of this
service, besides residents and internships. Specialists supervise -joined
with nurses- the continuous care of the patients that stay for abnormal
long periods in this department and in a beside Observation room, and
decide the final output of them: return to the community or admission to
the hospital wards.
No one system is perfect, but the knowledge of this new scenario in
clinical medicine, with the possibility to order different tests -many of
them unnecessary- particularly by the young doctors, (4) and the care
segmentation by different doctors of several specialties, is the first
step to avoid tortuous evolution in this new context.
As a BMJ Editor's choice several years ago expressed: "What is it
that doctors offer that other professionals cannot? Diagnosis, diagnosis,
diagnosis," so for good results the clinical gist in essential, (5)
including the indispensable humanitarianism of our profession.
Professor Alfredo D. Espinosa-Brito, MD, PhD,
Professor Angel J. Romero-Cabrera, MD, PhD,
Professor Alfredo A. Espinosa-Roca, MD, PhD
References:
1. Moreno-Rodriguez MA. Crisis del metodo clinico. Medisur
(Suplemento "El metodo clinico") 2010; 8(5):32-36.
2. Espinosa-Brito A. La medicina centrada en las personas y la medicina
personalizada. Medisur. 2015;13(6):920-924.
3. Launer J. Clinical gist. Postgrad Med J 2016;92:121 -122.
4. Nelson B. Waste: Unnecessary Overuse of Medical Care Causes Both Waste
and Harm. The Hospitalist 2015;19(6):23-27.
5. Editor's choice. Diagnosis, diagnosis, diagnosis. BMJ. 2002;324 (2
March). [accesed 11 Aug 2007]. Available in:
http://dx.doi.org/10.1136/bmj.324.7336.0/ghttp:/ BMJ 2002;324:g
Dear Editor,
I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.
I would like to share the experience in our country. Singapore is a country in Sout...
Author's Storify: https://storify.com/nephondemand/equal-work-for- unequal-pay-the-gender-reimbursemen
In response to articles:
American Council of Science and Health News: http://acsh.org/news/2016/08/17/medicare-supports-unequal-pay/
Twitter comments: https://twitter.com/Skepticscalpel/status/767785871500251136
Medscape: http://www.medscape.com/viewarticle/867652?src=rss
Co...
I read with interest the manuscipt by Jeyaruban and colleagues. However I am disappointed that a major issue identified was a "Failure of adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically relevant impact on gout management.
Surgical weight loss is one of the few non medication related interventions that has a substantial impact on serum urate.
...Dear Editor:
We are living a new epoch all over the world. Also in clinical medicine. As it is known, for example, the model of a single doctor participating heavily at each step of treatment is giving way to expanded- care teams.
Moreno-Rodriguez identified an universal crisis of the clinical method, with dangerous consequences in the practice of medicine. Among its main causes there are: a deteriora...
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