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Διαπίστευση JCI στο Ερρίκος Ντυνάν Hospital Center

Το Ερρίκος Ντυνάν Hospital Center έλαβε την κορυφαία διαπίστευση Joint Commission International, η οποία αποδεικνύει την απόλυτη συμμόρφωσή του προς τις απαιτήσεις του διεθνώς αναγνωρισμένου προτύπου διαπίστευσης υπηρεσιών υγείας. Η Χρυσή Σφραγίδα Έγκρισης (Gold Seal of Approval®) αποτελεί σύμβολο ποιότητας που αντανακλά τη δέσμευση του οργανισμού να παρέχει την πλέον ασφαλή και αποτελεσματική φροντίδα στους ασθενείς του και κατατάσσει το Ερρίκος Ντυνάν Hospital Center ανάμεσα στα 600 διαπιστευμένα νοσοκομεία στον κόσμο.

 Κατά τη διάρκεια της διεξοδικής επιθεώρησης, ομάδα έμπειρων επιθεωρητών (ιατροί, νοσηλευτές και διοικητικοί) του oργανισμού Joint Commission International αξιολόγησε τη συμμόρφωση του Ερρίκος Ντυνάν Hospital Center προς τα πρότυπα του JCI τα οποία περιλαμβάνουν ένα ευρύ φάσμα θεματικών ενοτήτων, όπως είναι οι Διεθνείς Στόχοι Ασφάλειας Ασθενών (International Patient Safety Goals), η ιατρονοσηλευτική εκτίμηση και φροντίδα των ασθενών, η αναισθησιολογική και χειρουργική φροντίδα, η διαχείριση των φαρμάκων, η βελτίωση της ποιότητας, η πρόληψη και ο έλεγχος των λοιμώξεων, η διοίκηση και η ηγεσία, η διαχείριση των εγκαταστάσεων, τα προσόντα και η εκπαίδευση του προσωπικού και η διαχείριση των πληροφοριών. Κατόπιν επιτυχούς ολοκλήρωσης της επιθεώρησης, το Ερρίκος Ντυνάν Hospital Center εντάχθηκε στην επίλεκτη κατηγορία οργανισμών υγείας, που έχουν λάβει παγκοσμίως τη διαπίστευση JCI. 

Τα πρότυπα και οι μέθοδοι αξιολόγησης του Joint Commission International σχεδιάστηκαν από ειδικούς εμπειρογνώμονες σε θέματα παροχής υπηρεσιών υγείας με πρωταρχικό στόχο τη διαρκή βελτίωση της ποιότητας και την αύξηση της ασφάλειας των ασθενών και των οικογενειών τους, μέσω της ελαχιστοποίησης των κινδύνων. Τα πρότυπα ενσωματώνουν την υιοθέτηση διεθνών πρακτικών, ιατρικών πρωτοκόλλων και κατευθυντήριων οδηγιών και την άποψη των εμπειρογνωμόνων, ώστε να βοηθούν τους οργανισμούς να μετρούν, να αξιολογούν και να βελτιώνουν διαρκώς την επίδοσή τους.

Η διαπίστευση κατά JCI αποτελεί ένα ισχυρό μήνυμα προς όλους τους ασθενείς, συνοδούς, επισκέπτες αλλά και εργαζόμενους, για τη δέσμευση του Ερρίκος Ντυνάν Hospital Center για συνεχή βελτίωση της ποιότητας και της ασφάλειας, βάσει διεθνώς αναγνωρισμένων προτύπων που καθιστούν τον ασθενή ως την απόλυτη προτεραιότητα.

Αναφερόμενος στη διεθνή διαπίστευση, ο Πρόεδρος και Διευθύνων Σύμβουλος του Ερρίκος Ντυνάν Hospital Center κ. Θέμος Χαραμής, δήλωσε: «Μετά από  συστηματική προετοιμασία και διεξοδικούς ελέγχους που ξεπέρασαν τα δύο χρόνια, το Ερρίκος Ντυνάν ανήκει στην επίλεκτη ομάδα που περιλαμβάνει μόνο 600 νοσοκομεία στον κόσμο, τα οποία έχουν λάβει τη Χρυσή Σφραγίδα Έγκρισης (Gold Seal of Approval®) από τον οργανισμό Joint Commission International. Είμαστε περήφανοι για αυτή την επιβράβευση, καθώς πρόκειται για την ισχυρότερη και εγκυρότερη διαπίστευση νοσοκομείων παγκοσμίως, αλλά και γιατί αποτελεί την έμπρακτη  αναγνώριση μιας ομαδικής προσπάθειας, που οδηγεί το Ερρίκος Ντυνάν σε μια νέα εποχή».

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Joint Commission International

O οργανισμός Joint Commission International (JCI) ιδρύθηκε το 1997 ως ένα τμήμα του Joint Commission Resources, Inc. (JCR) μια πλήρως ελεγχόμενη, μη κερδοσκοπική θυγατρική εταιρεία του The Joint Commission. Μέσω της διεθνούς πιστοποίησης, συμβουλευτικής, προγραμμάτων εκδόσεων και εκπαίδευσης, το JCI επεκτείνει  την αποστολή του The Joint Commission για τη βελτίωση της ποιότητας φροντίδας των ασθενών παγκοσμίως. Το JCI υποστηρίζει διεθνείς οργανώσεις παροχής ιατρικής φροντίδας, οργανισμούς δημόσιας υγείας, υπουργεία υγείας κλπ. σε πάνω από 100 χώρες.

https://www.dunant.gr/el/news/press-releases/press-releases-2020/diapistefsi-jci/

Λαπαροσκοπική αποκατάσταση κηλών

Στα πλαίσια της πληρέστερης ενημέρωσης των ασθενών είναι διαθέσιμες πλέον διαδικτυακά πληροφορίες που αφορούν τις συχνότερες κήλες του κοιλιακού τοιχώματος και την αποκατάσταση τους. Διαβάστε περισσότερα εδώ!

Λαπαροσκοπική χολοκυστεκτομή

Στα πλαίσια της πληρέστερης ενημέρωσης των ασθενών είναι διαθέσιμες πλέον διαδικτυακά πληροφορίες που αφορούν τις συχνότερες παθήσεις της χοληδόχου κύστης (χολολιθίαση, πολύποδες χοληδόχου κύστης) και τη λαπαροσκοπική χολοκυστεκτομή. Διαβάστε περισσότερα εδώ!

Μελάνωμα: Πώς θα το εντοπίσετε εγκαίρως στο δέρμα σας

Με το καλοκαίρι να πλησιάζει πρέπει να είμαστε υποψιασμένοι για μια ολοένα και συχνότερη μορφή καρκίνου του δέρματος. Η έγκαιρη αντιμετώπιση μπορεί να αποτελέσει και ίαση της νόσου.

melanoma

Διαβάστε ένα απλό και κατανοητό σχετικό άρθρο εδώ.

“Historic” Guidelines on Role of Bariatric Surgery in Diabetes

diabetes

Η βαριατρική χειρουργική κερδίζει έδαφος στην αντιμετώπιση του σακχαρώδους διαβήτη τύπου ΙΙ σε παχυσάρκους ασθενείς. Προτείνεται πλέον ως πιθανή θεραπευτική επιλογή ακόμα και σε τιμές Δείκτη Μάζας Σώματος (BMI) 30-35!

Metabolic surgery, or the use of bariatric surgery with the intent to treat type 2 diabetes and obesity, should be considered as a treatment option even in patients with mild obesity if their blood glucose levels are inadequately controlled, says a group of international experts, who are backed up by diabetes organizations.

In a statement that, for the first time, sets out a series of detailed recommendations on the use of surgery in type 2 diabetes, the experts from across the globe endorse metabolic surgery as an option in patients with a body mass index (BMI) of 30.0 to 34.9 kg/m2 with inadequately controlled hyperglycemia and as a recommended therapy in patients who are even more obese.

Noting that metabolic surgery is “potentially cost-effective” in obese patients with type 2 diabetes, they write: “The clinical community should work together with healthcare regulators to recognize metabolic surgery as an appropriate intervention for type 2 diabetes in people with obesity and to introduce appropriate reimbursement policies.”

Coauthor Philip R Schauer, MD, bariatric surgeon and director of Cleveland Clinic’s Bariatric & Metabolic Center, Ohio, toldMedscape Medical News that the guidelines are “historic.”

He said: “I’ve seen lots of guidelines on medical care in my career, for everything from colonoscopy to guidelines on aspirin and all kinds of things, but I’ve never seen guidelines that have been endorsed by 45 medical organizations.”

I’ve seen lots of guidelines on medical care in my career, for everything from colonoscopy to guidelines on aspirin…but I’ve never seen guidelines that have been endorsed by 45 medical organizations.

The statement is published in the June issue of Diabetes Care.

Despite recent growing evidence in its favor, bariatric surgery has been notably absent from treatment algorithms for type 2 diabetes.

Dr Schauer believes that that has hinged on previous interpretations of the robustness of the evidence. However, he said that in the past 2 or 3 years there has been an “accumulation of a number of very robust studies showing very consistently and predictably the effect of surgery on diabetes.”

The guidance also indicates that Roux-en-Y gastric bypass has the most favorable risk/benefit profile “for most patients with type 2 diabetes.”

GI Tract Is “Clinically Meaningful Target” for Treatment of Type 2 Diabetes

To develop a series of recommendations on the benefits and limitations of metabolic surgery, six international diabetes organizations, including the American Diabetes Association (ADA), the International Diabetes Federation (IDF) and Diabetes UK, convened the 2nd Diabetes Surgery Summit (DSS-II).

Ahead of the meeting, the DSS-II organizing committee tasked a multidisciplinary group of 48 international clinicians and/or scholars, of whom 75% were nonsurgeons, to conduct a MEDLINE search for studies published between 2005 and 2015 on the short- and long-term efficacy and safety of bariatric surgery in patients with type 2 diabetes.

A subsequent evidence appraisal was followed by three rounds of Delphi-like questionnaires, which measured the degree of consensus on 32 evidence-based conclusions.

In September 2015, these were then presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes in London and opened up for discussion and amended face-to-face by the expert committee.

At the time of going to press, as well as the ADA, IDF, and Diabetes UK, the recommendations had also been endorsed by the American Association of Clinical Endocrinologists, the American College of Surgeons, the European Association for the Study of Obesity, the European Association for the Study of Diabetes, and the US Endocrine Society, among others, as well as a range of national societies.

The final statement recommends that people who develop type 2 diabetes “should have access to all effective treatment options” and, given its role in metabolic regulation, the gastrointestinal tract is “a clinically and biologically meaningful target for the management of type 2 diabetes.”

Surgery an Option Even for BMI of 30 and Above

It goes to on state that there is “a substantial body of evidence” largely from short- and mid-term studies showing that metabolic surgery “can achieve excellent control of hyperglycemia and reduce cardiovascular risk factors.”

It acknowledges, however, that further studies are required to demonstrate long-term benefits of surgery.

Nevertheless, the experts agreed that metabolic surgery should be “a recommended option” to treat surgically suitable patients with class 3 obesity, defined as a BMI ≥40 kg/m2, “regardless of the level of glycemic control or complexity of glucose-lowering regimens.”

Dr Schauer emphasized that surgery “should play a more prominent role” in class 3 obesity, as “diabetes is so difficult to manage” in these patients and it is often accompanied by comorbidities such as sleep apnea, hypertension, dyslipidemia, fatty liver disease, and arthritic problems.

He added: “Class 3 obesity is very likely to respond well to surgery, and it’s not likely to respond well to anything else, in terms of medical therapy or even diet and exercise–type programs.”

The statement also recommends metabolic surgery in patients with class 2 obesity (BMI 35.0–39.9 kg/m2) who have inadequately controlled hyperglycemia, despite lifestyle and optimal medication therapy.

Dr Schauer also noted that, “for the first time ever,” the guidelines “have a place for surgery in patients with class 1 obesity.”

Specifically, the statement says that surgery should “be considered” as an option in class 1 obesity (BMI 30.0–34.9 kg/m2) among patients who have inadequately controlled hyperglycemia despite optimal medical treatment by either oral or injectable medications, including insulin.

In all cases, the BMI values should be reduced by 2.5 kg/m2 in patients of Asian descent, the statement says.

Bariatric Procedures Should Be Performed in High-Volume Centers

Another aspect that the guidelines emphasize is the need for multidisciplinary care in the provision of metabolic surgery and for the procedure to be performed in high-volume centers.

Dr Schauer observed that multidisciplinary care is common for type 2 diabetes patients, as they will often be being seen by an ophthalmologist, a cardiologist, and a psychologist or psychiatrist, alongside their primary medical doctor.

The multidisciplinary approach extends to those who need surgery at a bariatric center. “Patients who are going to be considered for surgery have to be evaluated by a psychologist, dietician, a medical doctor, and a surgeon and then followed long-term as well,” he explained.

“Ongoing and long-term monitoring of micronutrient status, nutritional supplementation, and support must be provided to patients after surgery according to guidelines for postoperative management of bariatric surgery,” the statement indicates.

Roux-en-Y Gastric Bypass Best for Most Type 2 Diabetes Patients

And with regard to the different types of bariatric procedures available, the experts give these verdicts.

For Roux-en-Y gastric bypass (RYGB), they say, “among the four accepted operations for metabolic surgery, it appears to have a more favorable risk/benefit profile in most patients with type 2 diabetes.”

For vertical-sleeve gastrectomy, they note that “longer-term studies” are needed, but current data suggest it is an effective procedure that results in excellent weight loss and major improvement of type 2 diabetes, at least in the short to medium term (1–3 years) in which outcomes have been measured in randomized controlled trials. “It could be a valuable operation to treat diabetes, especially in patients where concerns exist about the risk of operations that involve bowel diversion [such as gastric bypass].”

Laparoscopic adjustable gastric banding (LAGB) is “effective in improving glycemia” in patients with obesity and type 2 diabetes, but the procedure “is associated with greater risk for reoperation/revision compared with RYGB, due to failure or band-related complications (eg, slippage, erosion, etc).”

And finally, “although clinical evidence suggests biliopancreatic diversion may be the most effective procedure in terms of glycemic control and weight loss, the operation is associated with significant risk of nutritional deficiencies, making its risk/benefit profile less favorable than that of the other bariatric procedures for most patients.” This procedure “should be considered only in patients with extreme levels of obesity (eg, BMI >60 kg/m2),” it concludes.

The DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes 2015 were supported by the International Diabetes Surgery Task Force (a nonprofit organization), King’s College London, King’s College Hospital, Johnson & Johnson, Medtronic, Novo Nordisk, Fractyl, DIAMOND MetaCure, Gore, MedImmune, and NGM Biopharmaceuticals. None of the DSS-II codirectors, members of the organizing committee, or voting delegates received payment for their efforts. No other relevant financial relationships pertaining to this article were reported.

Diabetes Care. 2016;39:861-877. Article

New Risk-Stratification Guidelines for Thyroid Nodules

Thyroid-nodules

Στο άρθρο που ακολουθεί μπορείτε να διαβάσετε τις νέες κατευθυντήριες οδηγίες της “Αμερικανικής Ένωσης για το Θυρεοειδή” σχετικά με τους θυρεοειδικούς όζους. Ποιοι, πότε και γιατί χρειάζονται διερεύνηση;

The American Thyroid Association developed a new set of treatment guidelines for the evaluation and management of thyroid nodules.[1] As part of that treatment guideline, the stratification of nodules was established. This set of guidelines is different from previous iterations in that more of a pattern-based approach to thyroid nodules is utilized.

Nodules are stratified into one of five categories. Nodules in the first category have a simple cyst appearance and a very low risk for malignancy. These nodules do not require aspiration because of their low risk for malignancy regardless of their size. They may be aspirated for therapeutic purposes, however, if the patient has compressive symptoms.

Nodules in the next category are also cystic but have some solid component. These have a very low risk for malignancy—less than 3%—and may be aspirated when larger than 2 cm. These are typically spongiform nodules; when looked at in cross-section, they appear to have a sponge or honeycomb pattern.

The next category of nodules consists of low-risk nodules, which have a 5%-10% risk for malignancy. These nodules may be aspirated when they are larger than 1.5 cm. They are solid and iso- or hyperechoic compared with the surrounding thyroid tissue, meaning that they are brighter than or the same echogenicity as the surrounding thyroid tissue. Only 10%-15% of thyroid cancers follow this pattern. These nodules do not require aspiration until they are 1.5 cm.

The next category of intermediate-risk nodules carries a 10%-20% risk for malignancy. This category has the highest sensitivity for malignancy, at 60%-80%, but most nodules in this category are benign. They are solid and hypoechoic with well-defined borders. These lesions do not have any other suspicious sonographic features.

The final category consists of nodules that are highly suspicious. Both these and the intermediate-suspicion nodules should be aspirated when larger than 1 cm. The difference between the two groups, however, is that the highly suspicious lesions are hypoechoic and have one or more suspicious features, including extrathyroidal extension, microcalcifications, height greater than width, or a disrupted rim calcification. The identification of one of these types of nodules is associated with a very high risk for malignancy. These nodules should be aspirated when smaller than the nodules described before.

Nodules are very commonly seen in our population. They may be stratified so that we can further divert our resources to those nodules that have a higher risk for malignancy. The pattern-recognition system established by the American Thyroid Association allows us to stratify those nodules with higher-risk features to fine-needle aspiration at smaller size; nodules that have less aggressive features may be aspirated once they reach a larger-size threshold.

Πηγή: Medscape.com

Πασχαλινές ευχές με υγεία!

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