Surgery and the elderly

@varelalaf

More and more elderly people are being seen in the operating room, especially for large joint replacement interventions, for colorectal cancer resections or for vascular pathologies, to cite the most frequent casuistry. Many of these actions are aggressive and generate risks of postoperative complications, which often require catheters, serum, transfusions, intubations, etc. Therefore, a lot of clinical circumstances are generated that induce immobilization, a situation that adds a new chain of risks, especially thromboembolism, bedsores, infections, disorientation, delusions, malnutrition and dehydration.

Is my child hyperactive or is it simply that he is too small?

Pedro Rey

Parents are increasingly worried about their children being been diagnosed with attention deficit hyperactivity syndrome (ADHD). In fact, in the United States, the proportion of children between two and five years who were diagnosed with this syndrome increased by more than 50% from 2007 to 2012. It is estimated that in 2016 the worldwide prevalence of ADHD diagnosis in children under 18 years old was 5% and in the United States, for example, 5.2% of children of these ages take medication. Spain is one of the main consuming countries of methylphenidate, one of the medicines used to treat ADHD, whose consumption has multiplied by more than 30 in the last 15 years.

The topography of overuse

Andreu Segura

More and more voices warn about the damages associated with the excessive use of health services, although those who claim for the negative consequences attributable to precariousness and the cuts suffered by public health still prevail.

Of course, some protests as well maybe relevant since the health damages related to medical and health care are a consequence of both the action and the omission. And it isn't strange that both coexist because, for example, the abuse of imaging tests leads to an increase in the waiting list of patients who are candidates for exploration, so that the higher the proportion of superfluous prescriptions, the more they will be delayed those that are necessary, those whose result can modify the clinical decision for the benefit of the patient.

Medicine, values and communication

Salvador Casado

Modern medicine has achieved a spectacular development in the last century in parallel with the rest of society. Spurred on by science and technology it has managed to overcome ambitious goals and shines proudly on the basis of its achievements. Unfortunately, there is a long shadow that contains burdens and threats. Inequalities in health, overdiagnosis and overtreatment, iatrogeny, the progressive dependence of citizens on health systems are increasingly present realities.

Illustration by Paula Alvear, from the poems Arconte Enfurecido

On the other hand, private health systems and the enormous conglomerates of pharmaceutical and technological industries based on profit seek interests that are increasingly distant from the common good. In the face of these interests, public health systems are slowly collapsing due to under-funding, cutbacks and the chronic overloading of their professionals. Everyone agrees on the complexity of managing alternatives but no one dares to implement them. Meanwhile, the public health systems are melting like butter as services are outsourced, professionals working conditions get worse or units are reconverted and closed (Public Health and others).

The challenge of the 15 steps

Mònica Almiñana

They say that from outside the problems look different. How many times have we heard or said this phrase in our lives! Perhaps that is why different organizations, in recent years, have decided to take it literally and implement strategies to incorporate the external vision into the day-to-day work.

The National Health Service of the United Kingdom (NHS) presented at the end of 2017 "The challenge of 15 steps (15 Steps Challenge): quality from the patient's perspective".