tag:blogger.com,1999:blog-26762555522080259022024-03-13T18:45:15.456+01:00Oncología Radioterápica Huelva-SevillaA person who never made a mistake never tried anything new.
Este blog es para los interesados en la Oncología... y algo más.
David M Muñoz Carmona Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.comBlogger165125tag:blogger.com,1999:blog-2676255552208025902.post-6389559641747128052016-08-15T20:47:00.002+02:002016-08-15T20:47:40.120+02:00¿Cuándo se desaconseja la mastectomía contralateral profiláctica?<div class="MsoNormal" style="background: white; margin-right: 15.0pt; mso-outline-level: 1; text-align: justify; text-justify: inter-ideograph;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Cuándo se desaconseja la mastectomía
contralateral profiláctica<o:p></o:p></span></b></div>
<div style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">A
las mujeres con diagnóstico de cáncer de mama que tienen riesgo promedio se les
debe disuadir de que se sometan a una mastectomía contralateral profiláctica
pues la mayoría de ellas no obtendrán una ventaja oncológica, señala una nueva
declaración de consenso de la<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American Society of Breast Surgeons</span></em>.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">La<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American
Society of Breast Surgeons</span></em><span class="apple-converted-space"> </span>señala
que está apoyando una declaración previa emitida por la campaña "Selección
Prudente" del Consejo Estadounidense de Medicina Interna, la que afirma
que las mujeres con cáncer en una sola mama no se debieran someter a
mastectomía profiláctica, a menos que la mujer esté bien informada acerca de
los riesgos inherentes a la mastectomía contralateral profiláctica y tome su
decisión con base en hechos y no en el temor.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">La
declaración de consenso de la<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American Society of Breast Surgeons</span></em><span class="apple-converted-space"><i> </i></span>consta de dos partes. La<span class="apple-converted-space"> </span><a href="http://tinyurl.com/huk3fty"><span style="color: #5757a6; text-decoration: none; text-underline: none;">primera</span></a>
describe el efecto que la mastectomía contralateral profiláctica tiene sobre
resultados clínicos relevantes y que las pacientes podrían tener las
indicaciones apropiadas para la mastectomía contralateral profiláctica. La<span class="apple-converted-space"> </span><a href="http://tinyurl.com/hyrxoa4"><span style="color: #5757a6; text-decoration: none; text-underline: none;">segunda</span></a><span class="apple-converted-space"> </span>se refiere al sentir de las pacientes
en torno a la mastectomía contralateral profiláctica. Ambas declaraciones de
postura fueron publicadas el 28 de julio en la versión electrónica de <em><span style="font-family: Arial;">Annals of Surgical Oncology</span></em>.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">"Después
de charlar con muchas mujeres que a menudo desean asumir el control del mayor
número de aspectos de este proceso, como asociación queremos asegurarnos de que
las mujeres se percaten de que la mastectomía contralateral profiláctica no va
a mejorar su sobrevida, que su riesgo de presentar cáncer en la otra mama es
mucho más bajo que el que suponen y luego tratar de tranquilizarlas
explicándoles que muy probablemente serán objeto de seguimiento estrecho y que
si se detecta algo en la otra mama, se detectará en una etapa temprana",
dijo a<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">Medscape Noticias Médicas</span></em><span class="apple-converted-space"> </span>la Dra. Judy C. Boughey, profesora de
cirugía, de la Clínica Mayo, en Rochester, Minnesota, quien es la autora
principal del documento de postura de la<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American Society of Breast Surgeons</span></em>.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">"La
cuestión realmente decisiva que se ha de plantear es: "¿Por qué la
paciente piensa que requiere extirpación de la otra mama?' Y si dice, 'quiero
hacer esto para tratar mi cáncer', entonces es necesario reorientarla y
proporcionarle nueva información", añadió.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">Del
principal<span class="apple-converted-space"> </span><a href="http://tinyurl.com/hyrxoa4"><span style="color: #5757a6; text-decoration: none; text-underline: none;">artículo de postura</span></a><span class="apple-converted-space"> </span>de la<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American
Society of Breast Surgeons</span></em>, la recomendación fundamental es la
siguiente:<o:p></o:p></span></div>
<div style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l2 level1 lfo1; overflow: visible; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial; font-size: 12.0pt;">A las mujeres que tienen cáncer de mama unilateral con riesgo
promedio se les ha de disuadir de que se sometan a mastectomía contralateral
profiláctica.<o:p></o:p></span></div>
<div style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l2 level1 lfo1; overflow: visible; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial; font-size: 12.0pt;">Se ha de desalentar la mastectomía contralateral profiláctica en
mujeres con un cáncer primario avanzado, en mujeres con alto riesgo de
complicaciones quirúrgicas y en las que resultan negativas en las pruebas para
BRCA, pese a tener un familiar que sea positivo para BRCA.<o:p></o:p></span></div>
<div style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l2 level1 lfo1; overflow: visible; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial; font-size: 12.0pt;">A los hombres con cáncer de mama, independientemente de su
expresión de BRCA, también se les debe desalentar de someterse a la extirpación
de la mama contralateral.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<b><span style="color: #444444; font-family: Arial; font-size: 12.0pt;">Justificación para las recomendaciones de la<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American
Society of Breast Surgeons</span></em></span></b><span style="color: #444444; font-family: Arial; font-size: 12.0pt;"><o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">Ante
todo, el panel de consenso de la<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">American Society of Breast Surgeons</span></em><span class="apple-converted-space"><i> </i></span>recomienda que se utilice un
método conservador de la mama para quienes reúnen las indicaciones apropiadas y
que se tome en cuenta que el empleo de la terapia prequirúrgica u otros
enfoques aumenta las probabilidades de que una paciente se someta a mastectomía
parcial cuando es posible.<o:p></o:p></span></div>
<div style="-webkit-text-stroke-width: 0px; background: white; font-variant-caps: normal; font-variant-ligatures: normal; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; orphans: 2; overflow: visible; text-align: justify; text-justify: inter-ideograph; widows: 2; word-spacing: 0px;">
<span style="color: #444444; font-family: Arial; font-size: 12.0pt;">"La
mastectomía parcial es equivalente a la mastectomía radical en cuanto a la
sobrevida y ha sido el tratamiento preferido para el cáncer de mama desde la
declaración del<span class="apple-converted-space"> </span><em><span style="font-family: Arial;">National Cancer Institute</span></em><span class="apple-converted-space"> </span>en 1991", observa la Dra. Boughey
y sus colaboradores<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Y un incremento en el empleo de la mastectomía parcial puede
disminuir las tasas de mastectomía contralateral profiláctica", añaden.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Sin embargo, la cuestión de la mastectomía contralateral
profiláctica a menudo surge cuando las mujeres se deben someter o deben escoger
someterse a mastectomía para el tratamiento de su cáncer de mama. En tales
casos, la justificación de la mastectomía profiláctica depende del riesgo de
presentación de cáncer de mama contralateral que tenga cada paciente.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">La Dra. Boughey y sus colaboradores señalan que históricamente
el riesgo absoluto de que los pacientes presenten un cáncer de mama
contralateral fue aproximadamente 0,6% al año, pero la quimioterapia
posquirúrgica, el tamoxifeno y los inhibidores de aromatasa han reducido este
riesgo desde 0,2% hasta 0,5% por año.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Por otra parte, para los portadores conocidos de mutación en <i>BRCA1/BRCA2</i>,
el riesgo de presentar un cáncer de mama contralateral es hasta de 40% a 10
años y el riesgo parece incrementarse con el tiempo.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">En aquellas mujeres con diagnóstico de cáncer de mama a una edad
temprana, así como aquellas con un importante antecedente familiar de cáncer de
mama también tienen más riesgo de cáncer de mama contralateral, puntualizan los
miembros del panel de consenso.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Sin embargo, como lo observan los miembros del panel en su
documento de postura, en los estudios prospectivos no se ha evaluado la
mastectomía profiláctica contralateral en los criterios de valoración de cáncer
relevantes, de manera que se desconoce su efecto en la sobrevida.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Después de analizar la evidencia disponible, los miembros del
panel llegaron a la conclusión de que la mastectomía contralateral profiláctica
no parece mejorar la sobrevida, con la posible excepción de portadores de <i>BRCA</i>,
en quienes puede ser útil la mastectomía contralateral profiláctica.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">También es importante que la mastectomía contralateral
profiláctica no protege 100% contra la aparición de cáncer de mama contralateral,
un hecho que desvirtúa su propósito, añaden.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<b><span style="color: #444444; font-family: Arial;">Riesgos quirúrgicos con la mastectomía contralateral
profiláctica</span></b><span style="color: #444444; font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Las mujeres que consideren la mastectomía contralateral
profiláctica también deben tener presente que el procedimiento conlleva un
riesgo no insignificante de efectos adversos, entre ellos, la disminución
permanente de la sensibilidad de la piel en el tórax.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">"Se ha demostrado que la mastectomía contralateral
profiláctica incrementa al doble la tasa de complicaciones en comparación con
la mastectomía unilateral, independientemente de si se lleva o no a cabo la
reconstrucción, y ocurren complicaciones casi con la misma frecuencia en el
lado afectado que en el profiláctico", señalan la Dr. Boughey y sus
colaboradores.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">La mastectomía contralateral profiláctica también puede afectar
de manera adversa los desenlaces del cáncer en pacientes que nunca estuvieron
destinados a presentar un cáncer de mama contralateral, añade, y aquellas
pacientes que se someten a procedimientos de cirugía reconstructiva de ambas
mamas han informado que los resultados estéticos, la sensación reducida y la
sensación de hormigueo fueron peores que lo esperado.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Ha sido la experiencia personal de la Dra. Boughey que el deseo
por la simetría de las mamas reconstruidas es un factor clave que motiva a una
mujer a optar por la mastectomía contralateral profiláctica.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Explicó: "Sobre todo si las mujeres se van a someter a
reconstrucción, a menudo desean tener un par reconstruido"<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Esto depende del tamaño de la mama, de manera que si una mujer
tiene mamas caídas relativamente más grandes y se somete a mastectomía en el
lado del cáncer con una reconstrucción a base de implante, tendrá una mama
'erguida' en un lado y 'caída' en el otro, y entonces procurará someterse a una
mastopexia en el lado con ptosis, lo que significa que necesitará otra
intervención quirúrgica", añadió la Dra. Boughey.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #636363; font-family: Arial; mso-fareast-font-family: "Times New Roman";">Así que las mujeres dicen,'¿No sería
simplemente mejor extirparse ambas mamas y reconstruirlas, y tener un par que
concuerde?' </span><span style="color: #444444; font-family: Arial;">sobre todo
ahora que los cirujanos de mama están realizando cada vez más procedimientos
que conservan el pezón, de modo que las mujeres pueden mantener su propia piel
y conservar el complejo pezón-aréola en el lado profiláctico y, en algunos casos,
en los dos lados", dijo.</span><span style="color: #636363; font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">"Así que sienten que esta es una buena opción para
ellas", comenta la Dra. Boughey.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">"No estoy en una campaña para que las mujeres nunca se
extirpen la otra mama", hizo hincapié la Dra. Boughey.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">"La <i>American Society of Breast Surgeons</i> cree
firmemente en la toma de decisión compartida, y si una mujer dice: 'Me doy
cuenta que no tengo que hacerlo, que no es necesario desde el punto de vista
médico, sé que no tengo un alto riesgo de presentar cáncer en la otra mama,
pero he pensado muy bien esto y para mí, es la mejor cosa que puedo hacer',
entonces no voy a modificar la opinión de esa mujer", agregó.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #636363; font-family: Arial; mso-fareast-font-family: "Times New Roman";">Lo importante es proporcionar la información
más completa a la paciente y hacer una toma de decisiones compartida, esto es
lo que esperamos que logren estos artículos de postura<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.4pt; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
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<b><span style="color: #444444; font-family: Arial;">Perspectiva del riesgo</span></b><span style="color: #636363; font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: #444444; font-family: Arial;">Desde la perspectiva del riesgo, la mastectomía contralateral
profiláctica es apropiada sobre todo en quienes tienen más alto riesgo de
cáncer de mama contralateral, como las personas con una mutación en <i>BRCA1/BRCA2</i> o
un riesgo de por vida para cáncer de mama de más del 25%, principalmente debido
a un antecedente familiar o un antecedente de radiación en torax por linfoma
antes de los 30 años de edad.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Algunos pacientes también podrían considerarse para la
mastectomía contralateral profiláctica, aun cuando tengan menos riesgo de
cáncer de mama contralateral, añaden los miembros del panel. Estos pacientes
podrían ser, por ejemplo, los que son portadores de un gen diferente a la
mutación de <i>BRCA</i> que podría incrementar su riesgo de cáncer de
mama contralateral, aun cuando este riesgo en la actualidad no está bien
definido.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Otros motivos para considerar la mastectomía contralateral
profiláctica son los siguientes:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">Limitar las necesidades de vigilancia
de la mama contralateral<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">Controlar la aversión al riesgo<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">Tratar la ansiedad extrema<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<b><span style="color: #444444; font-family: Arial;">Consejos fundamentales para la asesoría</span></b><span style="color: #444444; font-family: Arial;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">En el segundo <a href="http://tinyurl.com/zt2tcru"><span style="color: #5757a6;">documento de postura,</span></a> que describe el
sentir de las mujeres en torno a la mastectomía contralateral profiláctica, los
miembros del grupo de consenso recopilaron un patrón de información que
recomiendan a los médicos utilizar en su charla con toda paciente con riesgo
promedio que esté considerando la mastectomía contralateral profiláctica.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; text-align: justify; text-justify: inter-ideograph;">
<span style="color: #444444; font-family: Arial;">Los consejos para asesoría fundamentales de estos miembros son
los siguientes:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">Para la mayoría de las mujeres, el
riesgo estimado de cáncer de mama contralateral es del 2% al 6% en los
siguientes 10 años. Esto significa que tienen una probabilidad del 94% a 98% de
no sufrir cáncer en la mama opuesta en los próximos 10 años o más.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral
profiláctica no protege 100% contra el cáncer que se forma en la mama
contralateral.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral
profiláctica no mejorará la tasa de curación del cáncer documentado.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral
profiláctica no reducirá el riesgo de que se vuelva a presentar cáncer en la
mama con cáncer documentado.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral
profiláctica no disminuirá la necesidad de otros tratamientos de cáncer para el
cáncer documentado (terapia posquirúrgica), si es necesario.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">El riesgo de complicaciones quirúrgicas
en la herida quirúrgica (como hemorragia, infección, complicaciones de la
cicatrización y dolor crónico) es aproximadamente el doble de alto cuando se
lleva a cabo la mastectomía contralateral profiláctica.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral
profiláctica da lugar a disminución permanente de sensibilidad de la piel de la
pared torácica (y del pezón, si se conserva).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral profiláctica
con reconstrucción dará lugar a un aumento en el número de operaciones.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">Las complicaciones por mastectomía
contralateral profiláctica pueden retrasar el tratamiento del cáncer
documentado, incluida la quimioterapia y la radioterapia que pueden recomendarse
después de la intervención quirúrgica.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">La mastectomía contralateral
profiláctica puede tener una repercusión negativa en el bienestar físico,
emocional y sexual. Aproximadamente 10% de las mujeres se arrepienten de su
decisión para someterse a mastectomía contralateral profiláctica.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 17.75pt; margin-bottom: 11.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 3.75pt; mso-list: l1 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt; text-justify: inter-ideograph;">
<!--[if !supportLists]--><span style="color: #444444; font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="color: #444444; font-family: Arial;">No será posible la lactancia materna
después de la mastectomía contralateral profiláctica.<o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com5tag:blogger.com,1999:blog-2676255552208025902.post-56175593064678788752016-06-12T10:24:00.001+02:002016-06-12T10:24:56.125+02:00Gender bias in individual radiosensitivity and the association with genetic polymorphic variations
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<span style="color: #0080ae; font-family: AdvGulliv;"><span style="font-size: large;">Radiotherapy and Oncology 119 (2016) 236–243</span></span><br />
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<i><span style="font-family: AdvGulliv;">Ghazi Alsbeih </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">a</span><span style="font-family: AdvGulliv; vertical-align: 5pt;">,</span><span style="color: #0080ae; font-family: AdvCORRESAST; vertical-align: 5pt;">⇑</span><span style="font-family: AdvGulliv;">, Rafa S. Al-Meer </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">b</span><span style="font-family: AdvGulliv;">, Najla Al-Harbi </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">a</span><span style="font-family: AdvGulliv;">, Sara Bin Judia </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">a</span><span style="font-family: AdvGulliv;">, Muneera Al-Buhairi </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">a</span><span style="font-family: AdvGulliv;">,
Nikki Q. Venturina </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">a</span><span style="font-family: AdvGulliv;">, Belal Moftah </span><span style="color: #0080ae; font-family: AdvGulliv; vertical-align: 5pt;">c
</span></i><br />
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<i><span style="font-family: AdvGulliv; vertical-align: 3pt;">a </span><span style="font-family: AdvGulliv;">Radiation Biology Section, King Faisal Specialist Hospital and Research Centre; </span><span style="font-family: AdvGulliv; vertical-align: 3pt;">b </span><span style="font-family: AdvGulliv;">Faculty of Science, King Saud University; and </span><span style="font-family: AdvGulliv; vertical-align: 3pt;">c </span><span style="font-family: AdvGulliv;">Biomedical Physics Department, KFSHRC, Riyadh, Saudi
Arabia</span><span style="color: #0080ae; font-family: AdvGulliv;"> </span></i><br />
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<a href="https://3.bp.blogspot.com/-wit00biq14Q/V10cO0hAEVI/AAAAAAAACcs/xt9i3JlTlicjRIt9y_gwf3YFUX9qOgFyACLcB/s1600/IMG-20160408-WA0007.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="189" src="https://3.bp.blogspot.com/-wit00biq14Q/V10cO0hAEVI/AAAAAAAACcs/xt9i3JlTlicjRIt9y_gwf3YFUX9qOgFyACLcB/s200/IMG-20160408-WA0007.jpg" width="200" /></a></div>
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<span style="font-family: AdvGulliv;"><b><br /></b></span></div>
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<span style="font-family: AdvGulliv;"><b>Purpose</b>: </span></div>
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<span style="font-family: AdvGulliv;">To assess the extent of variation in radiosensitivity between individuals, gender-related
dissimilarity and impact on the association with single nucleotide polymorphisms (SNPs).
</span></div>
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<span style="font-family: AdvGulliv;"><b>Materials and methods:</b> </span></div>
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<span style="font-family: AdvGulliv;">Survival curves of 152 fibroblast cell strains derived from both gender were
generated. Individual radiosensitivity was characterized by the surviving fraction at 2 Gy (SF2). SNPs in
10 radiation responsive genes were genotyped by direct sequencing.</span><b>Results</b>: </div>
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<span style="font-family: AdvGulliv;">The wide variation in SF2 (0.12–0.50; mean = 0.33) was significantly associated with 3 SNPs:
</span><span style="font-family: AdvGulliv;">TP53 </span><span style="font-family: AdvGulliv;">G72C (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">= 0.007), </span><span style="font-family: AdvGulliv;">XRCC1 </span><span style="font-family: AdvGulliv;">G399A (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">= 0.002) and </span><span style="font-family: AdvGulliv;">ATM </span><span style="font-family: AdvGulliv;">G1853A (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">= 0.01). Females and males differed
significantly in radiosensitivity (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">= 0.004) that impacted genetic association where only </span><span style="font-family: AdvGulliv;">XRCC1 </span><span style="font-family: AdvGulliv;">remained
significant in both gender (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">< 0.05). Meanwhile, discordant association was observed for </span><span style="font-family: AdvGulliv;">TP53 </span><span style="font-family: AdvGulliv;">that
was significant in females (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">= 0.012) and </span><span style="font-family: AdvGulliv;">ATM </span><span style="font-family: AdvGulliv;">that was significant in males (</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">= 0.0006). When
gender-specific SF2-mean (0.31 and 0.35 for females and males; respectively) was considered, further
discordance was observed where </span><span style="font-family: AdvGulliv;">XRCC1 </span><span style="font-family: AdvGulliv;">turned out not to be associated with radiosensitivity in males
(</span><span style="font-family: AdvGulliv;">P </span><span style="font-family: AdvGulliv;">> 0.05).
</span></div>
<div style="text-align: justify;">
<span style="font-family: AdvGulliv;"><b>Conclusions</b>: </span></div>
<div style="text-align: justify;">
<span style="font-family: AdvGulliv;">Although the variation in individual radiosensitivity was associated with certain SNPs,
gender bias for both endpoints was evident. Therefore, assessing the risk of radiation exposure in females
and males should be considered separately in order to achieve the ultimate goal of personalized radiation
medicine. </span></div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-45480354076241506282016-06-04T09:23:00.000+02:002016-06-04T09:23:30.183+02:00ASCO's New Guideline for Endocrine Therapy in Breast Cancer June 01, 2016<table border="0" cellpadding="0" cellspacing="0" class="inline_data_table" style="background-color: #cccccc; border-radius: 4px; border: 1px solid rgb(204, 204, 204); box-shadow: rgba(0, 0, 0, 0.298039) 0px 3px 4px, rgba(255, 255, 255, 0.498039) 0px 0px 1px inset; color: #444444; font-family: arial, sans-serif; font-size: 12.768px; line-height: 17.8752px; margin: 10px 0px; padding: 0px;"><tbody xmlns:dctm="http://www.documentum.com" xmlns:fmt="http://java.sun.com/jstl/fmt" xmlns:jsp="jsp" xmlns:xlink="http://www.w3.org/1999/xlink">
<tr><td colspan="2" style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"><b>Key Recommendations for Women With HR-Positive Metastatic Breast Cancer</b></td></tr>
<tr valign="top"><td colspan="2" style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Hormone therapy should be offered to patients whose tumors express any level of estrogen and/or progesterone receptors, and treatment recommendations should be based on factors such as the type of adjuvant treatment being administered, disease-free interval, and the extent of disease at the time of recurrence</td></tr>
<tr valign="top"><td colspan="2" style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Use of a specific agent can be repeated if recurrence happens more than 12 months after the last treatment</td></tr>
<tr valign="top"><td colspan="2" style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Endocrine therapy should be recommended as the initial treatment in this patient population, except in the case of immediate life-threatening disease or rapid disease recurrence during adjuvant endocrine therapy</td></tr>
<tr valign="top"><td colspan="2" style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">The use of combination endocrine therapy and chemotherapy is not recommended</td></tr>
<tr valign="top"><td colspan="2" style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"><b>For first-line therapy</b></td></tr>
<tr valign="top"><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Postmenopausal women should be offered aromatase inhibitors (AIs)</td></tr>
<tr valign="top"><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Combination hormone therapy with a nonsteroidal AI and fulvestrant (<em>Faslodex</em>, AstraZeneca) 500 mg and with a loading-dose schedule can be offered to patients who have not previously used endocrine therapy</td></tr>
<tr valign="top"><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Premenopausal women should be offered ovarian suppression or ablation and hormone therapy; current agents have only been studied in the postmenopausal population</td></tr>
<tr valign="top"><td colspan="2" style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"><b>For second-line therapy</b></td></tr>
<tr valign="top"><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Sequential hormone therapy should be offered except for those with rapid progression and organ dysfunction</td></tr>
<tr valign="top"><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">If fulvestrant is given, a 500 mg dose should be used, and with a loading schedule</td></tr>
<tr valign="top"><td colspan="2" style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"><b>For targeted therapy</b></td></tr>
<tr valign="top"><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Postmenopausal women can be offered a nonsteroidal AI and palbociclib (<em>Ibrance</em>, Pfizer)</td></tr>
<tr valign="top"><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Exemestane (<em>Aromasin</em>, Pfizer) and everolimus (<em>Afinitor</em>, Novartis) can be offered to postmenopausal women who progressed with nonsteroidal AIs, either before or after treatment with fulvestrant</td></tr>
<tr valign="top"><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Fulvestrant and palbociclib can be offered to patients who experienced progression with AIs, with or without prior chemotherapy</td></tr>
<tr valign="top"><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #f4f4f4; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Adding <em>HER2</em>-targeted therapy to first-line AIs should be offered to patients with HR-positive and <em>HER2</em>-positive disease if they are not candidates for chemotherapy</td></tr>
<tr valign="top"><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;"> </td><td style="background-color: #fefefe; border-color: rgb(204, 204, 204); border-style: solid; border-width: 1px 1px 0px 0px; font-size: 1.05em; padding: 6px 8px;">Genomic or expression profiling should not be used at this time to select treatment for metastatic HR-positive breast cancer</td></tr>
</tbody></table>
Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-36531030756122306642016-05-19T17:35:00.000+02:002016-05-19T17:35:16.686+02:00Amancio Ortega dona 40 millones de euros para la lucha contra el cáncer en Andalucía<header class="articulo-encabezado " id="articulo-encabezado" style="background-color: white; border: 0px; box-sizing: border-box; font-stretch: inherit; height: 231px; margin: 0px; padding: 0px; vertical-align: baseline;"><div class="articulo-titulares" id="articulo-titulares" style="border-image-outset: initial; border-image-repeat: initial; border-image-slice: initial; border-image-source: initial; border-image-width: initial; border: 0px; box-sizing: border-box; font-stretch: inherit; margin: 0px; padding: 0px 0px 10px; vertical-align: baseline;">
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<span style="color: #444444; font-size: 20px; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 27px;">La fundación del multimillonario costeará 25 equipos de última generación para radioterapia. </span></h1>
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<h2 class="articulo-subtitulo" itemprop="alternativeHeadline" style="border-image-outset: initial; border-image-repeat: initial; border-image-slice: initial; border-image-source: initial; border-image-width: initial; border: 0px; box-sizing: border-box; color: #444444; font-family: Majerit, serif; font-size: 20px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: 27px; margin: 0px 0px 4px; padding: 0px; vertical-align: baseline;">
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<span style="font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">La presidenta andaluza y la</span><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> vicepresidenta de la fundación y esposa del multimillonario, Flora Pérez, han firmado el acuerdo este jueves en el Palacio de San Telmo, sede del Gobierno andaluz. <span style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">En concreto, el convenio prevé la instalación de cuatro nuevos aceleradores, la sustitución de otros 17 con más de una década de antigüedad </span></span></div>
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<span style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">y la actualización tecnológica de otros cuatro equipos para incorporar la tecnología más avanzada. </span></span><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Hasta la fecha</span></span><span style="font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">, la sanidad pública andaluza disponía de 31 aceleradores.</span></div>
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Publicidad</div>
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<span style="font-family: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">El acuerdo también cubre las obras de construcción necesarias para la instalación de estos equipamientos. "Es de agradecer que por parte de la Fundación Amancio Ortega haya un compromiso de responsabilidad social con Andalucía apostando por nuestro sistema público de salud, que es una referencia y una garantía de la igualdad de oportunidades", ha dicho Díaz, quien ha resaltado su compromiso con la sostenibilidad del sistema. "Y hay que protegerlo y apostar por la investigación, que es la que va a hacer que el sistema sea sostenible", ha añadido. </span></div>
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<span style="font-family: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">El compromiso de la fundación con la sanidad andaluza se</span><a href="http://politica.elpais.com/politica/2015/10/22/actualidad/1445529300_703581.html" style="background-color: transparent; border-bottom-color: rgb(1, 108, 162); border-bottom-style: dotted; border-width: 0px 0px 1px; box-sizing: border-box; color: #016ca2; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">suma a los adquiridos en esta área y en educación en Galicia</a><span style="font-family: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">.</span><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Además de dos donaciones millonarias a la Xunta para guarderías,</span><span style="font-family: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;"> a finales del año pasado, la entidad firmó un acuerdo por 17 millones con el Gobierno de </span><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Alberto Núñez Feijóo</span><span style="font-family: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;"> para </span><span style="border: 0px; box-sizing: border-box; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">la renovación y mantenimiento de todos los aparatos de diagnóstico y tratamiento del cáncer durante los próximos ocho años.</span></div>
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<div class="titular" style="border-image-outset: initial; border-image-repeat: initial; border-image-slice: initial; border-image-source: initial; border-image-width: initial; border: 0px; box-sizing: border-box; color: #444444; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin-bottom: 35px; padding: 0px; text-align: justify; vertical-align: baseline;">
<span style="border: 0px; box-sizing: border-box; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">El acuerdo en Andalucía comenzará a materializarse el próximo año. Se comenzarán las obras para la instalación de </span>cuatro aceleradores que necesitan búnker en los hospitales Torrecárdenas de Almería, el Complejo Hospitalario de Jaén y el Virgen de la Victoria de Málaga (que sumará dos). Asimismo, se renovarán los equipos en el Área de Gestión Sanitaria Campo de Gibraltar-Jerez Norte, el Reina Sofía de Córdoba, el Virgen de las Nieves de Granada, el Juan Ramón Jiménez de Huelva, el Regional de Málaga y los Virgen del Rocío y Virgen Macarena de Sevilla. El protocolo también establece en 2017 la adquisición de un equipo para radioterapia intraoperatoria en el hospital cordobés. Esta tecnología permite administrar la dosis de la radiación durante la intervención quirúrgica directamente sobre la zona a tratar y no de forma externa. Además, se prevé la actualización de cuatro aceleradores para realizar radioterapia volumétrica con imagen guiada.</div>
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"La Fundación Amancio Ortega, además del desarrollo de programas propios en las áreas de educación y bienestar social, lleva a cabo colaboraciones con otras instituciones para desarrollar proyectos que contribuyan al avance de la sociedad en diferentes ámbitos", resalta el Gobierno andaluz. En el caso de Andalucía, la entidad ha participado en este protocolo tras conocer el análisis de la Consejería de Salud sobre las actuaciones necesarias para mejorar la atención a pacientes oncológicos, especialmente en la aplicación de radioterapia. Se estima que, al menos un 40% de todos los pacientes curados de cáncer ha recibido radioterapia como parte de su tratamiento y, en un 16% de los casos, la curación se debe exclusivamente a la radioterapia. En Andalucía, se prevé que anualmente se registren más de 32.000 casos nuevos de cáncer, de los que un 60% será candidato a recibir radioterapia, es decir, más de 19.000 pacientes cada año. </div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-31737881944204940082016-05-16T18:03:00.002+02:002016-05-16T18:03:46.738+02:00Recuerdos de Triana: "paseo en blanco y negro" <br />
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<a name='more'></a><a href="http://3.bp.blogspot.com/-BX34IEyBbGI/VznuvgCpeNI/AAAAAAAACZw/JMOgUHDHCss-J-GfdcsNW1Ph4Lj4KXGewCK4B/s1600/paraguas%2Bbyk.jpg" imageanchor="1"><img border="0" height="640" src="https://3.bp.blogspot.com/-BX34IEyBbGI/VznuvgCpeNI/AAAAAAAACZw/JMOgUHDHCss-J-GfdcsNW1Ph4Lj4KXGewCK4B/s640/paraguas%2Bbyk.jpg" width="404" /></a><br />Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-5437647502803956382016-05-14T12:12:00.003+02:002016-05-14T12:12:47.208+02:00Adjuvant RT Extends Survival in Elderly TNBC Patients<div class="panel-col-top panel-panel" style="border: 0px; font-family: Helvetica, Arial, Verdana, sans-serif; font-size: 12px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
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<span style="color: #888888; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">September 21, 2015</span><span class="article-info-divider" style="border: 0px; color: #888888; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 8px; vertical-align: baseline;"> | </span><a href="http://www.cancernetwork.com/asco-2015-breast-cancer-symposium" style="border: 0px; color: #888888; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">ASCO 2015 Breast Cancer Symposium</a><span style="color: #888888; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">,</span><span style="color: #888888; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;"> </span><a href="http://www.cancernetwork.com/breast-cancer" style="border: 0px; color: #888888; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Breast Cancer</a><span style="color: #888888; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;">,</span><span style="color: #888888; font-family: inherit; font-size: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit;"> </span><a href="http://www.cancernetwork.com/triple-negative-breast-cancer" style="border: 0px; color: #888888; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Triple-Negative Breast Cancer</a></h1>
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By <a href="http://www.cancernetwork.com/authors/mark-l-fuerst" rel="author" style="border: 0px; color: #a28976; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Mark L. Fuerst</a></div>
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Adjuvant radiation therapy after lumpectomy improves survival for elderly women with early-stage, triple-negative breast cancer (TNBC), according to a new study to be presented at the 2015 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in San Francisco (abstract 39).</div>
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Adjuvant radiation therapy may be omitted for elderly women with early-stage breast cancer who have favorable estrogen-receptor status. Some studies show that elderly women with TNBC have increased recurrence rates.</div>
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“Although the existing literature shows benefit from radiation, in the subgroup of elderly women with triple-negative breast cancer it does not provide a quantitative estimate on prolonged survival. Our study breaks ground by beginning to determine that exact amount,” lead author Sean Szeja, MD, radiation oncologist at the University of Texas Medical Branch at Galveston, Galveston, Texas, told <em style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Cancer Network</em>.</div>
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The researchers conducted a retrospective analysis of the effect of adjuvant radiation therapy on the survival of elderly women with early-stage TNBC who underwent lumpectomy. Using the Surveillance, Epidemiology, and End Result (SEER) database, they evaluated how the addition of adjuvant radiation affected the survival of women ages 70 and above with T1-2, N0, M0 TNBC.</div>
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From 2010-2011, SEER data showed 12,620 triple-negative cases. Of these, 6,980 (55%) had stage T1-2, N0, M0. Lumpectomy was used in 4,002 of these cases, including 974 lumpectomy cases of women aged 70 and above. Adjuvant radiation therapy was given in 662 (68%) cases.</div>
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After 23 months, lumpectomy plus radiation therapy led to a statistically significant improvement in overall survival (98.2%) as compared with lumpectomy alone (85.6%). Similarly, disease-specific survival improved significantly for the combination (99%) over lumpectomy only (94%). Cox regression showed radiation demonstrated improved overall survival and disease-specific survival.</div>
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Breast cancer–related deaths were more common in the lumpectomy-only group (6%) compared with the lumpectomy and radiation group (1%). “The applicability of this is broad, considering that the life expectancy of the average 70-year-old female is 16 years. Therefore, our results will enable future treatment decisions to be made with more information,” said Dr. Szeja.</div>
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When other factors were considered, such as age, tumor size, and other treatment descriptions, the use of adjuvant radiation was associated with an overall sixfold decrease in any death, as well as death from breast cancer.</div>
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The researchers note that the difference in survival observed between those who did and did not receive adjuvant radiation could be explained by other factors, such as use of adjuvant chemotherapy.</div>
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Also, with a potential for selection bias in the study, the researchers suggest that future prospective studies are needed to better define the management of early-stage TNBC in elderly patients.</div>
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Dr. Szeja said “the oncologist should consider the patients’ life expectancy outside of the setting of their cancer, as well as comorbidities, often associated with age, that may impact their benefits as well as toxicity from any treatment. The elderly are also at risk for social factors, such as limited family support, that may impede their ability to comply with treatment as well as recover from its toxicities.”</div>
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He recommended oncologists perform a comprehensive geriatric assessment to evaluate functional, cognitive, and nutritional status as well as polypharmacy risks.</div>
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<span style="font-family: Helvetica, Arial, Verdana, sans-serif; font-size: 12px; line-height: 18px;">- See more at: http://www.cancernetwork.com/asco-2015-breast-cancer-symposium/adjuvant-rt-extends-survival-elderly-tnbc-patients#sthash.kaZvmRUi.dpuf</span>Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-72514824624557348462016-04-18T21:58:00.000+02:002016-04-18T21:58:28.514+02:00Direct conversion from tramadol to tapentadol prolonged release for moderate to severe, chronic malignant tumour-related pain<h2 class="article_title" style="background-color: white; border: 0px; color: #333333; font-family: 'Helvetica Neue Light', Helvetica, Arial, sans-serif; font-size: 30px; font-weight: 300; line-height: 1.2; margin: 0px; padding: 20px 0px;">
<span style="color: #666666; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 1.5;">H G Kress, E D Koch, H Kosturski, A Steup, K Karcher, C Dogan, M Etropolski, M Eerdekens</span></h2>
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<em>European Journal of Pain: EJP 2016 April 7</em></div>
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<span class="b" style="font-weight: bold;">BACKGROUND:</span> A recent randomized-withdrawal, active- and placebo-controlled, double-blind phase 3 study showed that tapentadol prolonged release (PR) was effective and well tolerated for managing moderate to severe, chronic malignant tumour-related pain in patients who were opioid naive or dissatisfied with current treatment (Pain Physician, 2014, 17, 329-343). This post hoc, subgroup analysis evaluated the efficacy and tolerability of tapentadol PR in patients who previously received and were dissatisfied with tramadol for any reason and who had a pain intensity ≥5 (11-point numerical rating scale) before converting directly to tapentadol PR.</div>
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<span class="b" style="font-weight: bold;">METHODS:</span> In the original study, eligible patients had been randomized (2:1) and titrated to their optimal dose of tapentadol PR (100-250 mg bid) or morphine sulphate-controlled release (40-100 mg bid) over 2 weeks. The present report focuses on results during the titration period for a subgroup of patients randomized to tapentadol PR after having been on tramadol treatment prior to randomization in the study (n = 129). Results for this subgroup are compared with results for all 338 patients who received tapentadol PR during titration (overall tapentadol PR group).</div>
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<span class="b" style="font-weight: bold;">CONCLUSIONS:</span> Results of this subgroup analysis indicate that patients with cancer pain could safely switch from prior treatment with the weak centrally acting analgesic tramadol directly to the strong centrally acting analgesic tapentadol PR, for an improved analgesic therapy for severe pain. WHAT DOES THIS STUDY ADD?: Results of this post hoc analysis show that patients who had received prior tramadol therapy could switch directly to tapentadol PR, with the majority (˜70%) experiencing improved efficacy.</div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-34324737892183131122016-04-02T17:03:00.000+02:002016-04-02T17:03:28.695+02:00Corticosteroids compromise survival in glioblastoma <div class="panel-pane pane-highwire-article-citation" style="background-color: #fffffe; border: 0px; color: #030303; font-family: Helvetica, Arial, sans-serif; font-size: 14px; font-stretch: inherit; line-height: 21px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
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<div class="highwire-article-citation highwire-citation-type-highwire-article" data-apath="/brain/early/2016/03/26/brain.aww046.atom" data-node-nid="241766" data-pisa-master="brain;aww046" data-pisa="brain;aww046v1" id="node241766" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">
<cite class="highwire-cite highwire-cite-highwire-article highwire-citation-jnl-oup-article-one-line clearfix has-author-tooltip" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: normal; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; zoom: 1;"><div class="title-access-wrapper" style="border: 0px; clear: both; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 14px; outline: 0px; padding: 0px; vertical-align: baseline;">
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Corticosteroids compromise survival in glioblastoma</div>
</h2>
<span class="highwire-cite-access" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="highwire-citation-access highwire-citation-access-check" data-atom-uri="/brain/early/2016/03/26/brain.aww046.atom" data-pisa-id="brain;aww046" data-request-view="full" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><i class="highwire-access-icon highwire-access-icon-no-access no-access oup-restrictedaccess" style="background-image: url("/sites/all/themes/shared/jcore_oup/images/restricted.svg"); background-position: 0px 0px; background-repeat: no-repeat; background-size: contain; border: 0px; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; min-height: 16px; min-width: 16px; outline: 0px; padding: 0px; vertical-align: baseline;" title="Restricted access"></i></span></span></div>
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<span class="highwire-cite-authors add-author-link-processed" style="border: 0px; color: #666666; display: block; font-family: inherit; font-size: 11px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 9px; outline: 0px; overflow: hidden; padding: 0px; vertical-align: baseline;"><a class="" data-hide-link-title="0" data-icon-position="" href="https://brain.oxfordjournals.org/content/139/4" style="border: 0px; clear: left; color: #2c4ca3; float: left; font-family: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; margin-bottom: 1em; margin-right: 1em; margin-top: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;"><img alt="Brain: 139 (4)" src="https://d1gqps90bl2jsp.cloudfront.net/sites/default/files/styles/2_grid/public/highwire/brain/139/4.cover-source.jpg?itok=BAUxNdpV" style="border: 1px solid rgb(205, 205, 205); font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto; line-height: inherit; margin: 0px; max-width: 100px; outline: 0px; padding: 0px; vertical-align: bottom;" /></a><span class="highwire-citation-authors" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="highwire-citation-author first article-author-popup-processed has-tooltip" data-delta="0" rel="#hw-article-author-popups-node241766 .author-tooltip-0" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" title=""><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Kenneth L.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pitter</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="1" rel="#hw-article-author-popups-node241766 .author-tooltip-1" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ilaria</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Tamagno</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="2" rel="#hw-article-author-popups-node241766 .author-tooltip-2" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Kristina</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Alikhanyan</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="3" rel="#hw-article-author-popups-node241766 .author-tooltip-3" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Amira</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hosni-Ahmed</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="4" rel="#hw-article-author-popups-node241766 .author-tooltip-4" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Siobhan S.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pattwell</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="5" rel="#hw-article-author-popups-node241766 .author-tooltip-5" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Shannon</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Donnola</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="6" rel="#hw-article-author-popups-node241766 .author-tooltip-6" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Charles</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Dai</span></span>,<span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="7" rel="#hw-article-author-popups-node241766 .author-tooltip-7" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" title=""><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Tatsuya</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ozawa</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="8" rel="#hw-article-author-popups-node241766 .author-tooltip-8" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" title=""><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Maria</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Chang</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="9" rel="#hw-article-author-popups-node241766 .author-tooltip-9" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" title=""><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Timothy A.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Chan</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="10" rel="#hw-article-author-popups-node241766 .author-tooltip-10" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Kathryn</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Beal</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="11" rel="#hw-article-author-popups-node241766 .author-tooltip-11" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Andrew J.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Bishop</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="12" rel="#hw-article-author-popups-node241766 .author-tooltip-12" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Christopher A.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Barker</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="13" rel="#hw-article-author-popups-node241766 .author-tooltip-13" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Terreia S.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Jones</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="14" rel="#hw-article-author-popups-node241766 .author-tooltip-14" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" title=""><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Bettina</span><span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hentschel</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="15" rel="#hw-article-author-popups-node241766 .author-tooltip-15" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Thierry</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Gorlia</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="16" rel="#hw-article-author-popups-node241766 .author-tooltip-16" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Uwe</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Schlegel</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="17" rel="#hw-article-author-popups-node241766 .author-tooltip-17" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Roger</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Stupp</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="18" rel="#hw-article-author-popups-node241766 .author-tooltip-18" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;" title=""><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Michael</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Weller</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="19" rel="#hw-article-author-popups-node241766 .author-tooltip-19" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Eric C.</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Holland</span></span>, <span class="highwire-citation-author article-author-popup-processed has-tooltip" data-delta="20" rel="#hw-article-author-popups-node241766 .author-tooltip-20" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span class="nlm-given-names" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Dolores</span> <span class="nlm-surname" style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hambardzumyan</span></span></span></span></div>
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Glioblastoma is the most common and most aggressive primary brain tumour. Standard of care consists of surgical resection followed by radiotherapy and concomitant and maintenance temozolomide (temozolomide/radiotherapy→temozolomide). Corticosteroids are commonly used perioperatively to control cerebral oedema and are frequently continued throughout subsequent treatment, notably radiotherapy, for amelioration of side effects. The effects of corticosteroids such as dexamethasone on cell growth in glioma models and on patient survival have remained controversial. We performed a retrospective analysis of glioblastoma patient cohorts to determine the prognostic role of steroid administration. A disease-relevant mouse model of glioblastoma was used to characterize the effects of dexamethasone on tumour cell proliferation and death, and to identify gene signatures associated with these effects. A murine anti-VEGFA antibody was used in parallel as an alternative for oedema control. We applied the dexamethasone-induced gene signature to The Cancer Genome Atlas glioblastoma dataset to explore the association of dexamethasone exposure with outcome. Mouse experiments were used to validate the effects of dexamethasone on survival <em style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin-bottom: 0px !important; margin-left: 0px; margin-right: 0px; margin-top: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">in vivo</em>. Retrospective clinical analyses identified corticosteroid use during radiotherapy as an independent indicator of shorter survival in three independent patient cohorts. A dexamethasone-associated gene expression signature correlated with shorter survival in The Cancer Genome Atlas patient dataset. In glioma-bearing mice, dexamethasone pretreatment decreased tumour cell proliferation without affecting tumour cell viability, but reduced survival when combined with radiotherapy. Conversely, anti-VEGFA antibody decreased proliferation and increased tumour cell death, but did not affect survival when combined with radiotherapy. Clinical and mouse experimental data suggest that corticosteroids may decrease the effectiveness of treatment and shorten survival in glioblastoma. Dexamethasone-induced anti-proliferative effects may confer protection from radiotherapy- and chemotherapy-induced genotoxic stress. </div>
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<b>This study highlights the importance of identifying alternative agents such as vascular endothelial growth factor antagonists for managing oedema in glioblastoma patients. Beyond the established adverse effect profile of protracted corticosteroid use, this analysis substantiates the request for prudent and restricted use of corticosteroids in glioblastoma.</b></div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-23338603920900009482016-03-26T21:19:00.000+01:002016-03-26T21:19:03.711+01:00<header class="single-post-header" style="background-color: white; box-sizing: border-box; color: grey; font-family: Lato; font-size: 15px; line-height: 24px;"><div class="post-category" style="border: 0px; box-sizing: border-box; color: #ec407a; font-size: 10px; letter-spacing: 1px; margin: 0px 0px 5px; outline: 0px; padding: 0px; text-transform: uppercase; vertical-align: baseline;">
<a href="http://www.seor.es/categoria/pacientes/blog-para-pacientes-2-0/" rel="category tag" style="border: 0px; box-sizing: border-box; color: #e65100; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">BLOG PARA PACIENTES 2.0</a>, <a href="http://www.seor.es/categoria/noticias/" rel="category tag" style="border: 0px; box-sizing: border-box; color: #e65100; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">NOTICIAS</a></div>
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Entrevista Dra. Teresa Muñoz Migueláñez, Día Mundial del Cáncer de Cervix</h1>
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<a href="http://www.seor.es/entrevista-dra-teresa-munoz-miguelanez-dia-mundial-del-cancer-de-cervix/" style="border: 0px; box-sizing: border-box; color: black; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" title="Entrevista Dra. Teresa Muñoz Migueláñez, Día Mundial del Cáncer de Cervix"><img alt="IMG_20151013_154437" class="attachment-newmagz-single-thumbnail-large size-newmagz-single-thumbnail-large wp-post-image" height="532" src="http://www.seor.es/wp-content/uploads/2016/03/IMG_20151013_154437-826x532.jpg" style="border: 0px; box-sizing: border-box; display: block; font-family: inherit; height: auto; margin: 0px; max-width: 100%; outline: 0px; padding: 0px; vertical-align: top; width: 651.453px;" width="826" /></a></div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><u style="box-sizing: border-box;">Dra.Teresa Muñoz Migueláñez, Médico Especialista en Oncología Radioterápica del Hospital Universitario Ramón y Cajal (Madrid)</u></strong></div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">¿Cuáles son los principales factores de riesgo del cáncer de Cérvix?</strong></div>
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Entre los factores de riesgo del cáncer de cérvix nos encontramos la vida sexual temprana, la promiscuidad, la multiparidad, el tabaco (las mujeres que fuman tienen dos veces más riesgo de desarrollar cáncer de cuello uterino que las mujeres no fumadoras), el uso prolongado de anticonceptivos orales, la inmunodepresión y el más importante, que es la <strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">infección por el virus del papiloma humano VPH o HPV</strong>. Se estima que más del 90% de los cánceres de cérvix están relacionados con la infección por HPV, siendo el HPV 16 y 18 los que se asocian al 70 % de los casos.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">¿Cómo se puede prevenir? ¿La prevención con la vacuna es la solución definitiva?</strong></div>
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Para prevenir el cáncer de cérvix tenemos dos maneras:</div>
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1.- Encontrando las lesiones precancerosas y tratándolas antes de que vayan a más gracias a los métodos de cribado o “screening” con las pruebas de Papanicolau y VPH.</div>
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2.- Previniendo esas lesiones precancerosas:</div>
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Ya que el principal factor de riesgo del cáncer de cérvix es la infección por el VPH y éste se transmite de una persona a otra durante el contacto con la piel en las relaciones sexuales, evitar dicho contacto sería una forma de prevenirlo. Se ha visto que aquellas mujeres que han tenido un mayor número de parejas sexuales o han comenzado las relaciones a una edad más temprana tienen una mayor probabilidad de infectarse, así que esperar hasta una mayor edad para tener relaciones sexuales, limitar el número de parejas sexuales o evitar las relaciones con alguien que haya tenido muchas parejas sexuales podría ser una forma de prevenirlo. Otra sería empleando preservativos, que se ha visto pueden reducir la tasa de infección con VPH en aproximadamente un 70%. Que no puedan ofrecer una protección total se debe a que no pueden cubrir todas las áreas del cuerpo que pueden infectarse con el VPH, tales como la piel del área genital o anal. No obstante, protegen contra otras ETS.</div>
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Al ser el tabaquismo otro factor de riesgo del cáncer de cérvix, no fumar sería otra forma importante de reducir el riesgo.</div>
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En cuanto a las vacunas contra el VPH son una forma de prevenir la infección, pero no son un tratamiento de una infección ya existente, por lo que para que sean eficaces deben aplicarse antes de que sean sexualmente activas. En España están incluidas dentro del calendario vacunal de las niñas y tienen una pauta de vacunación diferente según el preparado: la vacuna tetravalente contra los tipos 6, 11, 16, 18 (Gardasil®) con pauta de 2 dosis (0 y 6 meses) para niñas entre 9 y 13 años y pauta de 3 dosis (0, 2, 6 meses) si 14 años o más y la bivalente contra los tipos 16 y 18 (Cevarix®) con pauta de 2 dosis (0 y 6 meses) para niñas entre 9 y 14 años y pauta de 3 dosis (0, 1, 6 meses) si 15 años o más.</div>
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Existen datos que indican que la inmunidad contra el HPV dura un mínimo de entre 3 a 5 años y será el seguimiento de las pacientes vacunadas dentro de los ensayos clínicos el que nos aporte información de la necesidad de re-vacunación. Actualmente, disponemos de ensayos clínicos que han demostrado la eficacia en la prevención de lesiones cervicales premalignas. Debido a que éstas tardan varios años en ser un cáncer infiltrante, probablemente necesitaremos unos 10 años en tener evidencia de que el número de nuevos cánceres en la población vacunada ha disminuido.</div>
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Dado que actualmente ninguna vacuna provee protección completa contra todos los tipos de VPH causantes de cáncer no son la solución definitiva y es necesario continuar con las pruebas de “screening” rutinarias, si bien está previsto que reduzcan su incidencia en las próximas dos décadas. Esta incidencia ya disminuyó dramáticamente en EEUU y Europa gracias a las pruebas de cribado.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Las <a href="http://www.webconsultas.com/categoria/salud-al-dia/enfermedades-de-transmision-sexual" style="border: 0px; box-sizing: border-box; color: black; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">infecciones de transmisión sexual</a> y otras afecciones del aparato reproductor, ¿pueden también considerarse un riesgo a la hora de desarrollar tumores malignos en el cérvix?</strong></div>
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La principal ETS relacionada con el cáncer de cérvix, como he dicho ya, es la infección por VPH, que se encuentra presente en prácticamente todos los casos. La mayoría de las infecciones se resuelven espontáneamente y se desconocen los motivos por los que sólo algunas infecciones progresan a alteraciones malignas. Al parecer, el VPH causa cambios en las células cervicales que, al principio, no son significativos, pero con el paso del tiempo pueden empeorar y evolucionar a cáncer de 10 a 15 años después de la infección inicial y sólo si ésta persiste durante este periodo de tiempo.</div>
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Otras ETS como el herpes genital también están asociadas con un mayor riesgo de cáncer de cérvix.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">¿Cuáles son los signos y síntomas?</strong></div>
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Los síntomas habitualmente no aparecen hasta que el cáncer está localmente avanzado y ha invadido otros tejidos u órganos. Se puede presentar con dispareunia, metrorragia, leucorrea, dolor pélvico y hipermenorrea, siendo el síntoma más frecuente el sangrado postocital.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">¿En qué consisten los últimos avances que se han producido en el tratamiento del cáncer de cérvix?</strong></div>
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Además del gran avance que se ha hecho en la prevención primaria con la introducción de las vacunas, también se han producido otros avances en los tratamientos:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; list-style: disc; margin: 0px 0px 4px; outline: 0px; padding: 0px; vertical-align: baseline;">Cirugía: Los avances en técnicas quirúrgicas han permitido ofrecer cirugías más conservadoras a mujeres con estadios iniciales sin factores de riesgo y/o deseo gestacional, con menor morbilidad y mejor calidad de vida.<br style="box-sizing: border-box;" />Con la introducción de la cirugía laparoscópica se obtiene la misma radicalidad que técnicas convencionales con menor morbilidad.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; list-style: disc; margin: 0px 0px 4px; outline: 0px; padding: 0px; vertical-align: baseline;">Quimioterapia: Hasta 1999 la principal opción de un tratamiento curativo en los tumores tipo bulky era la RT radical. Desde que 5 estudios prospectivos aleatorizados demostraron un incremento del control local del 10 al 15% cuando se añadía QT el tratamiento estándar es la RT radical acompañada de QT basada en los platinos. Datos confirmados en 2010, demostrando además que las pacientes que reciben un esquema de quimioterapia que no sea platino también se benefician ampliando así las opciones de tratamiento y el número de pacientes candidatas al mismo. Además, hace un par de años que la FDA ha aprobado el empleo del anitiangiogénico bevacizumab en combinación con la QT en el cáncer de cérvix persistente, recurrente o metastásico donde ha demostrado aumentar la supervivencia.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; list-style: disc; margin: 0px 0px 4px; outline: 0px; padding: 0px; vertical-align: baseline;">Radioterapia:<ul style="border: 0px; box-sizing: border-box; font-family: inherit; list-style: none; margin: 0px 24px 30px; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; box-sizing: border-box; font-family: inherit; list-style: disc; margin: 0px 0px 4px; outline: 0px; padding: 0px; vertical-align: baseline;">Radioterapia Externa: La mejora tecnológica en la planificación y el tratamiento radioterápico, con técnicas como la IMRT o la IGRT, nos ha permitido escalar la dosis a nivel del tumor y los ganglios afectos disminuyendo la dosis que reciben los órganos de riesgo (recto, intestino, vejiga…) teniendo, por tanto, menos efectos secundarios con una significativa mejoría en calidad de vida.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; list-style: disc; margin: 0px 0px 4px; outline: 0px; padding: 0px; vertical-align: baseline;">Braquiterapia: Tradicionalmente se ha tratado con la de baja tasa (LDR) en la que tenemos experiencia de más de un siglo, si bien la de alta tasa (HDR), que fue aplicada por primera vez por Henske y O´Connell a principios de los 60s, cada vez se emplea más por haber demostrado ser equivalente a la LDR en términos de control local y toxicidad, con mejor dosimetría y tratamiento ambulatorio.</li>
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Además existe una tendencia a la realización de una braquiterapia adaptativa guiada por imagen con planificación 3D con TAC o RMN, predominantemente con esta última, siendo imprescindible conocer la afectación tumoral al diagnóstico y en cada aplicación. Este tipo de BT ha modificado considerablemente el tratamiento del cáncer de cérvix. La adaptación de la dosis y la combinación de la BT endocavitaria e intersticial nos están permitiendo administrar una irradiación de alta precisión que se adapta al volumen tumoral, sin afectar otros órganos.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Es muy importante aumentar la supervivencia de las pacientes oncológicas, pero también lo es mejorar su calidad de vida, ya que algunos tratamientos resultan especialmente duros. ¿Han mejorado también los tratamientos en este aspecto?</strong></div>
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Sí, como ya he explicado anteriormente, gracias a las mejoras conseguidas en los tratamientos actualmente podemos obtener los mismos resultados con una menor morbilidad y una mejor calidad de vida. En lo que a la radioterapia se refiere, con la IMRT, la IGRT y la BT adaptativa hemos podido escalar la dosis a nivel del tumor con una menor dosis a nivel de los órganos de riesgo tales como el recto, la vejiga o el intestino permitiéndonos tener menos efectos secundarios y una mejor calidad de vida.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">¿Cuál es el papel de la Oncología Radioterápica en el tratamiento?</strong></div>
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La Oncología Radioterápica tiene un papel muy importante en el tratamiento del cáncer de cérvix, estando <strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">indicada en el 60% de las pacientes </strong>que lo padecen. La radioterapia puede emplearse en todos sus estadios: de forma complementaria a la cirugía, como tratamiento radical (generalmente asociada a QT con platinos, fundamentalmente el cisplatino semanal) o como tratamiento paliativo.</div>
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Para terminar destacar que<strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> cuando hablamos de un tratamiento radical la combinación de la radioterapia externa con la</strong> <strong style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">braquiterapia es fundamental para alcanzar una dosis curativa</strong>. Con la aparición de nuevas técnicas, tales como la IMRT o la SBRT, se ha estudiado la posibilidad de realizar todo el tratamiento con radioterapia externa y finalmente el resultado ha sido una menor supervivencia que cuando se asociaba la braquiterapia. No hay IMRT, SBRT e incluso tratamiento con protones que logre alcanzar una dosis tan alta a nivel del tumor con menor dosis a nivel de los órganos de riesgo que la braquiterapia, siendo varios los estudios que han mostrado una menor tasa de recurrencias y aumento de supervivencia cuando ésta forma parte del mismo. Si queremos obtener el mejor resultado, siempre que sea posible, ha de emplearse la braquiterapia en el tratamiento del cáncer de cérvix.</div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-17019448203470546682016-03-19T21:42:00.000+01:002016-03-19T21:48:15.392+01:00Mindfulness Meditation: OS LO RECOMIENDO, SOLO HAY QUE INICIARSE<div class="p1">
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<b>Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia</b>.</div>
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<span class="s1">Everyone knows that stubbing your toe hurts. What makes it stop hurting is the body's main pain-blocking process -- the natural production of opioids.</span></div>
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<span class="s1">Cognitive-based approaches found to reduce pain, such as hypnosis, acupuncture, distraction and even the placebo response, have been shown to work through this system. But does meditation also use opioids to reduce pain?</span></div>
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<a href="http://4.bp.blogspot.com/-VhdP4-YUOWA/Vu26S-ttLPI/AAAAAAAACNo/V67x_rLNbpg0JC7U3ocNpWyebDOiNoEUw/s1600/playa.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://4.bp.blogspot.com/-VhdP4-YUOWA/Vu26S-ttLPI/AAAAAAAACNo/V67x_rLNbpg0JC7U3ocNpWyebDOiNoEUw/s400/playa.jpg" width="225" /></a><span class="s1">In a study published in the current issue of the <i>Journal of Neuroscience</i>, a team led by Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center, reports that mindfulness meditation does not employ the endogenous opioid system to reduce pain.</span></div>
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<span class="s1">"Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain," Zeidan said.</span></div>
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<span class="s1">The Institute of Medicine estimates that approximately 100 million Americans suffer from chronic pain at a cost of more than $600 billion annually for treatment. And due to the increase in the number of people addicted to opiate drugs, from prescription medications to heroin, the Centers for Disease Control has labeled the problem an epidemic.</span></div>
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<span class="s1">To determine if meditation uses the body's opioids to reduce pain, the Wake Forest Baptist researchers injected study participants with either a drug called naloxone, which blocks the pain-reducing effects of opioids, or a saline placebo.</span></div>
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<span class="s1">In this randomized, double-blinded study, 78 healthy, pain-free volunteers were divided into four groups for the four-day (20 minutes per day) trial. The groups consisted of: meditation plus naloxone; non-meditation control plus naloxone; meditation plus saline placebo; or non-meditation control plus saline placebo.</span></div>
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<span class="s1">Pain was induced by using a thermal probe to heat a small area of the participants' skin to 49 degrees Centigrade (120.2 degrees Fahrenheit), a level of heat most people find very painful. Study participants rated their pain using a sliding scale.</span></div>
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<span class="s1">Zeidan found that the participants' pain ratings were reduced by 24 percent from the baseline measurement in the meditation group that received the naloxone. This is important because it showed that even when the body's opioid receptors were chemically blocked, meditation still was able to significantly reduce pain by using a different pathway, he said. Pain ratings also were reduced by 21 percent in the meditation group that received the placebo-saline injection.</span></div>
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<span class="s1">By comparison, the non-meditation control groups reported increases in pain regardless of whether they got the naloxone or placebo-saline injection.</span></div>
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<span class="s1">"Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain," Zeidan said. "And now this study shows that meditation doesn't work through the body's opioid system.</span></div>
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<span class="s1">"This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain. These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain."</span></div>
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<span class="s1">The next step for Zeidan's team is to determine if and how mindfulness meditation can affect a spectrum of chronic pain conditions.</span></div>
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<span class="s1">"At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs," he said.</span></div>
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<span class="s1">The study was supported by the National Center for Complementary and Integrative Health K99-AT008238, the Mind and Life Institute and the Wake Forest Translational Science Institute.</span></div>
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<span class="s1">Co-authors of the study are: A.L. Adler-Neal, M.P.H., R.E. Wells, M.D., J.C. Eisenach, M.D., and J.G. McHaffie, Ph.D., of Wake Forest Baptist; E. Stagnaro, B.S., of Wake Forest University; L.M. May, B.S., of the University of Oregon; and R.C. Coghill, Ph.D., of Cincinnati Children's Hospital Medical Center.</span></div>
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<span class="s1"><b>Story Source:</b></span></div>
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<span class="s1">The above post is reprinted from <a href="http://www.wakehealth.edu/News-Releases/2016/Mindfulness_Meditation_Provides_Opioid-Free_Pain_Relief,_Study_Finds.htm"><span class="s2">materials</span></a> provided by <a href="http://www.wfubmc.edu/"><span class="s2"><b>Wake Forest Baptist Medical Center</b></span></a>. <i>Note: Materials may be edited for content and length.</i></span></div>
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<span class="s1"><b>Journal Reference</b>:</span></div>
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<li class="li4"><span class="s1">F. Zeidan, N. M. Emerson, S. R. Farris, J. N. Ray, Y. Jung, J. G. McHaffie, R. C. Coghill. <b>Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia</b>. <i>Journal of Neuroscience</i>, 2015; 35 (46): 15307 DOI: <a href="http://dx.doi.org/10.1523/JNEUROSCI.2542-15.2015"><span class="s2">10.1523/JNEUROSCI.2542-15.2015</span></a></span></li>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-77099815599139731732015-11-13T10:30:00.000+01:002015-11-13T10:30:45.832+01:00Palliative Hypofractionated Radiotherapy For Non-Small Cell Lung Cancer(NSCLC) Patients Previously Treated By Induction Chemotherapy: Is It ForMany, Some, All, Or None?<table border="0" style="background-color: white; border-collapse: collapse; border-spacing: 0px; color: #333333; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 13px; line-height: 20px; max-width: 100%; text-align: justify; width: 90%px;"><tbody>
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<span style="font-family: "helvetica neue" , "helvetica" , "arial" , sans-serif; font-size: 13px;">Timothy D. Wagner, MD, MBA</span></div>
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Radiation Oncology Service, Department of Radiology, Brooke Army Medical Center Disclosure: The author declares no conflicts of interest.</div>
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Corresponding to: Timothy D. Wagner, MD, MBA, Major, Medical Corps, United States Army, Radiation Oncology Service, Department of Radiology, Brooke Army Medical Center. 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234. Tel: +210 916-5046; Fax: +210 916-0330. Email: timothy.d.wagner@us.army.mil or timothywagner@hotmail.com</div>
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J Thorac Dis 2009;1:1-2. DOI: 10.3978/j.issn.2072-1439.2009.12.01.e01</div>
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A pproximatelyis 30% of patients with non-smallpatients with adequate performance status, many disease that surgically unresectable (<a href="http://www.jthoracdis.com/article/view/49/89#B1" style="color: #0066cc; text-decoration: none;">1</a>). In current practice guidelines recommend that these patients be treated with a combination of chemotherapy and external beam irradiation (<a href="http://www.jthoracdis.com/article/view/49/89#B2" style="color: #0066cc; text-decoration: none;">2</a>). Over the last several years, the use of chemotherapy with radiation has been supported by several phase III multi-institutional randomized studies, with patients diagnosed with locally advanced NSCLC, having a better progression-free (PFS) and overall survival (OS) when treated with combination therapy than with radiation alone (<a href="http://www.jthoracdis.com/article/view/49/89#B3" style="color: #0066cc; text-decoration: none;">3</a>,<a href="http://www.jthoracdis.com/article/view/49/89#B4" style="color: #0066cc; text-decoration: none;">4</a>). Despite improvements in outcome, results remain modest with aggressive combined modality therapy, with 2 and 5 year survivals in the range of 30% and 20%, respectively (<a href="http://www.jthoracdis.com/article/view/49/89#B4" style="color: #0066cc; text-decoration: none;">4</a>,<a href="http://www.jthoracdis.com/article/view/49/89#B5" style="color: #0066cc; text-decoration: none;">5</a>). In addition, these combined modality approaches are associated with significant toxicity in a patient population that in many cases is already limited in terms of functional reserve before they even initiate definitive therapy. Despite curative efforts, many patients have disease progression or are overly symptomatic either from treatment or from their disease. It could be argued that for certain locally advanced patients, aggressive systemic and local treatment causes more harm than good.</div>
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In this issue of the Journal of Thoracic Disease, Plataniotis et al. report their results utilizing palliative hypofractionated radiotherapy in a certain subgroup of patients with locally advanced NSCLC who had been treated with induction systemic chemotherapy (<a href="http://www.jthoracdis.com/article/view/49/89#B6" style="color: #0066cc; text-decoration: none;">6</a>). The radiation treatment regimen delivers 17 Gray (Gy) in 2 fractions of 8.5 Gy per fraction. If one assumes an α /β of 2 for late responding tissues, 17 Gy in 2 fractions is the radiobiologic equivalent of 45 Gy in 25 fractions or 36 Gy in 12 fractions by the linear-quadratic formula (<a href="http://www.jthoracdis.com/article/view/49/89#B7" style="color: #0066cc; text-decoration: none;">7</a>). It use in the palliative setting for patients with advanced NSCLC is well-described by the current authors and others internationally, where it has compared favorably with other regimens in terms of palliation (<a href="http://www.jthoracdis.com/article/view/49/89#B8" style="color: #0066cc; text-decoration: none;">8</a>-<a href="http://www.jthoracdis.com/article/view/49/89#B10" style="color: #0066cc; text-decoration: none;">10</a>). To date, the majority of the published experience with this dosing regimen has been in the advanced, and often metastatic, setting, where it was delivered as monotherapy in previously untreated patients for symptom palliation. It has proved to be an effective regimen for palliation of many symptoms associated with advanced lung cancer such as cough, pain, hemoptysis, and dyspnea.</div>
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In their current study, Plataniotis et al., present retrospective results of 28 patients with either stage IIIA or IIIB NSCLC who were treated with a combination of induction chemotherapy followed by hypofractionated radiation therapy (17 Gy in 2 fractions). This hypofractionated regimen was reserved for patients who had locally progressive or non-responding disease, progressive symptoms (pain, dyspnea, cough, hemoptysis), worsening performance status, weight loss of >10% in the past 3 months, or the presence of a symptomatic pleural effusion (<a href="http://www.jthoracdis.com/article/view/49/89#B7" style="color: #0066cc; text-decoration: none;">7</a>). Among those treated with radiation therapy, the median Karnofsky Performance Status (KPS) was 80, with a median age of 70 years, and 50% (14/28) of patients having stage IIIA or lower disease. There was a reduction in Total Symptom Score (TSS) in 68% (19/28) of patients following radiation. Overall survival for the entire cohort was found to be 9 months, with a 1-year survival of 29.8%. No cases of grade 3 or higher esophagitis were reported, with pneumonitis documented in 7% (2/28).</div>
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Overall, this treatment strategy appears well tolerated and offers substantial palliation in the majority of patients treated. The question becomes for which patients should such a strategy be considered, and for which patients would a more aggressive treatment approach be warranted. While outcomes in locally advanced NSCLC are relatively poor, studies have shown there are long-term survivors with aggressive combined modality (<a href="http://www.jthoracdis.com/article/view/49/89#B3" style="color: #0066cc; text-decoration: none;">3</a>,<a href="http://www.jthoracdis.com/article/view/49/89#B4" style="color: #0066cc; text-decoration: none;">4</a>). In evaluating the current study, univariate analysis revealed that smaller tumor volume (< 120 cm<span style="font-size: 10.5px; line-height: 0; position: relative; top: -0.5em; vertical-align: baseline;">3</span>), response to induction chemotherapy (minimal response vs. all others), and KPS (>70) were all significant parameters for survival. A previous comparison of this hypofractionated approach vs. a more protrated regimen (39 Gy in 13 fractions) in patients with advanced NSCLC demonstrated that a more protracted regimen improved OS and freedom from metastatic disease at a cost of increased acute toxicity and slower palliation (<a href="http://www.jthoracdis.com/article/view/49/89#B10" style="color: #0066cc; text-decoration: none;">10</a>). And while acute toxicity was increased psychological stress among those receiving 39 Gy in 13 fractions was found to be lower. It is quite possible that these patients with smaller tumor volumes and better performance status could have tolerated a more prolonged radiation course, and the evidence suggests that this strategy may increase their chances for longterm survival and reduce stress albeit with the risk of increased acute toxicity.</div>
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In the current analysis, all patients received induction chemotherapy with the intent to treat with concurrent chemotherapy and radiation or radical radiation alone thereafter should they have had a response to therapy and not developed any worsening symptoms. Vokes et al. recently published their results of a phase III study evaluating induction chemotherapy followed by concurrent chemoradiation vs. concurrent chemoradiation in patients with locally advanced NSCLC. Investigators found that the addition of induction chemotherapy added toxicity but no survival benefit over concurrent chemoradiation alone (<a href="http://www.jthoracdis.com/article/view/49/89#B11" style="color: #0066cc; text-decoration: none;">11</a>). Therefore, perhaps those patients with locally advanced NSCLC with adequate performance(KPS >70) and tumor volumes that can be adequately dosed with radiation with acceptable doses to adjacent normal tissue should be strongly considered for definitive concurrent chemoradiation immediately upon completion of staging. With emerging radiation technologies such as respiratory gating, 4-dimensional planning, and daily image-guidance, the therapeutic ratio of protracted courses of thoracic radiation and chemotherapy should theoretically improve (<a href="http://www.jthoracdis.com/article/view/49/89#B12" style="color: #0066cc; text-decoration: none;">12</a>). In addition, with the advent of functional imaging such as positron emission tomography (PET) and more advanced magnetic resonance imaging (MRI) techniques, pre-treatment evaluation continues to improve in terms of detecting occult disease allowing for more accurate staging and appropriate treatment. This strategy would serve to remove the concern for disease progression or symptom development during the time of induction chemotherapy when there is no local therapy.</div>
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For those patients thought to be at high-risk for morbidity from concurrent chemoradiation either because of performance status, disease burden, or symptoms, a sequential approach is a reasonable alternative. And in those patients then progressing on induction chemotherapy, developing worsening symptoms, or experiencing declining performance status, plans for protracted radiation therapy should be reconsidered and this hypofractionated regimen should be entertained. It has been proven to be effective for palliation and convenient for patients with advanced disease, and in the current study has been shown to be safe following systemic therapy.</div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-65052141153078868692015-11-10T21:24:00.000+01:002015-11-10T21:26:07.825+01:00Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial<h2 class="article_title" style="background-color: white; border: 0px; color: #333333; font-family: 'Helvetica Neue Light', Helvetica, Arial, sans-serif; font-size: 30px; font-weight: 300; line-height: 1.2; margin: 0px; padding: 20px 0px;">
Buen artículo sobre Dexametasona, metastasis óseas y su tratamiento y por supuesto Flare asociado a metastasis óseas. Dr. Chow como siempre¡¡¡¡</h2>
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Edward Chow, Ralph M Meyer, Keyue Ding, Abdenour Nabid, Pierre Chabot, Philip Wong, Shahida Ahmed, Joda Kuk, A Rashid Dar, Aamer Mahmud, Alysa Fairchild, Carolyn F Wilson, Jackson S Y Wu, Kristopher Dennis, Michael Brundage, Carlo DeAngelis, Rebecca K S Wong</div>
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<em>Lancet Oncology 2015, 16 (15): 1463-72</em></div>
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<span class="b" style="font-weight: bold;">BACKGROUND:</span> Pain flare occurs after palliative radiotherapy, and dexamethasone has shown potential for prevention of such flare. We aimed to compare the efficacy of dexamethasone with that of placebo in terms of reduction of incidence of pain flare.</div>
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<span class="b" style="font-weight: bold;">METHODS:</span> In this double-blind, randomised, placebo-controlled phase 3 trial, patients from 23 Canadian centres were randomly allocated (1:1) with a web-based system and minimisation algorithm to receive either two 4 mg dexamethasone tablets or two placebo tablets taken orally at least 1 h before the start of radiation treatment (a single 8 Gy dose to bone metastases; day 0) and then every day for 4 days after radiotherapy (days 1-4). Patients were eligible if they had a non-haematological malignancy and bone metastasis (or metastases) corresponding to the clinically painful area or areas. Patients reported their worst pain scores and opioid analgesic intake before treatment and daily for 10 days after radiation treatment. They completed the European Organisation for Research and Treatment of Cancer (EORTC) quality of life QLQ-C15-PAL, the bone metastases module (EORTC QLQ-BM22), and the Dexamethasone Symptom Questionnaire at baseline, and at days 10 and 42 after radiation treatment. Pain flare was defined as at least a two-point increase on a scale of 0-10 in the worst pain score with no decrease in analgesic intake, or a 25% or greater increase in analgesic intake with no decrease in the worst pain score from days 0-10, followed by a return to baseline levels or below. Primary analysis of incidence of pain flare was by intention-to-treat (patients with missing primary data were classified as having pain flare). This study is registered with ClinicalTrials.gov, number NCT01248585, and is completed.</div>
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<span class="b" style="font-weight: bold;">FINDINGS:</span> Between May 30, 2011, and Dec 11, 2014, 298 patients were enrolled. 39 (26%) of 148 patients randomly allocated to the dexamethasone group and 53 (35%) of 150 patients in the placebo group had a pain flare (difference 8·9%, lower 95% confidence bound 0·0, one-sided p=0·05). Two grade 3 and one grade 4 biochemical hyperglycaemic events occurred in the dexamethasone group (without known clinical effects) compared with none in the placebo group. The most common adverse events were bone pain (61 [41%] of 147 vs 68 [48%] of 143), fatigue (58 [39%] of 147 vs 49 [34%] of 143), constipation (47 [32%] of 147 vs 37 [26%] of 143), and nausea (34 [23%] of 147 vs 34 [24%] of 143), most of which were mild grade 1 or 2.</div>
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<span class="b" style="font-weight: bold;">INTERPRETATION:</span> Dexamethasone reduces radiation-induced pain flare in the treatment of painful bone metastases.</div>
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<span class="b" style="font-weight: bold;">FUNDING:</span> The NCIC CTG's programmatic grant from the Canadian Cancer Society Research Institute.</div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-10176413830306489422015-10-19T22:00:00.000+02:002015-10-19T22:01:08.959+02:00Una persona físicamente cansada y mentalmente estresada no puede desenvolverse bien a nivel técnico: Gonzalo Brito, Psicólogo Clínico <h2 style="background-color: white; border: 0px; color: #055492; font-family: Arial, Helvetica, sans-serif; font-size: 20px; line-height: 24px; margin: 0px 0px 24px; padding: 0px;">
Una persona físicamente cansada y mentalmente estresada no puede desenvolverse bien a nivel técnico</h2>
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Don Gonzalo Brito, Psicólogo Clínico por la Universidad Pontificia de Chile y doctor en psicología del Instituto de Psicología Transpersonal (Palo Alto, EEUU), llega a Granada con la intención de hablarnos de los autocuidados de los profesionales. Pero antes de ese día, queremos conocer un poco más del tema a desarrollar en su taller. Y por eso, le hemos planteado las siguientes preguntas.</div>
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<em style="border: 0px; margin: 0px; padding: 0px;"><strong style="border: 0px; margin: 0px; padding: 0px;">1. ¿En qué medida son necesarios?</strong></em></div>
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Antes que cualquier otra herramienta o técnica adquirida, la principal herramienta con la que cuenta un profesional de la salud en <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> es su propia persona. <span style="border: 0px; margin: 0px; padding: 0px; text-decoration: underline;">Una persona físicamente cansada, mentalmente estresada y emocionalmente agobiada no puede desenvolverse bien a nivel técnico</span>, y probablemente tampoco tendrá una buena relación con sus pacientes y con sus compañeros. Su propia motivación y satisfacción personal y profesional se irán desgastando con el tiempo. El autocuidado en los equipos de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> es de suma importancia y la responsabilidad de promoverlos efectivamente no debe recaer exclusivamente en la iniciativa personal de los profesionales sino que debiese estar integrada en la estructura institucional.</div>
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<em style="border: 0px; margin: 0px; padding: 0px;"><strong style="border: 0px; margin: 0px; padding: 0px;">2. En España ha nacido una corriente especialmente preocupada en los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> a los cuidadores. ¿Ocurre lo mismo en Estados Unidos?</strong></em></div>
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Así es,. En Estados Unidos hay cerca de 90 millones de cuidadores, y desde ya casi tres décadas existen asociaciones y organizaciones dedicadas a cuidar a los cuidadores. Hoy hay más de 25 asociaciones que ofrecen formación, apoyo técnico y social, e intervenciones psico-educativas grupales orientadas específicamente a cuidar a los cuidadores.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">3. ¿Son conscientes los profesionales de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> de la necesidad de cuidarse? ¿En qué punto se detecta que un profesional necesita prestarse más atención?</strong></div>
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En el contacto que he tenido con profesionales del ámbito de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> en España noto que, en general, sí existe conciencia y preocupación por el tema y al mismo tiempo existe la sensación de que es un tema que no ha sido abordado en toda su complejidad y profundidad. Además, cuando hay recortes de recursos de los programas lo primero que desaparece es el cuidado de los profesionales. Estos condicionantes institucionales sumados a la relativa falta de conciencia en los propios profesionales de la importancia del autocuidado inciden en que la necesidad de autocuidado se detecte recién cuando las consecuencias de la falta del mismo ya afectan notoriamente el desempeño o la salud física y mental del profesional.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">4. ¿Cómo debemos fomentar el auto-cuidado?</strong></div>
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Hay aspectos del cuidado de los profesionales que deben ser asumidos por las instituciones y no por los profesionales, por ejemplo la disminución de la presión asistencial, la sobrecarga laboral, el aumento de las posibilidades de formación y promoción son algunos temas de suma importancia. También habría que ofrecer capacitación continua tanto en aspectos técnicos de su trabajo como en habilidades como los que abordaremos en el taller en el próximo congreso: regulación emocional, mindfulness, auto-compasión, compasión y comunicación consciente. Por supuesto, sumado a lo que se pueda ofrecer desde el nivel institucional es importante que los propios profesionales y los equipos poco a poco desarrollen una cultura del cuidado que los incluya como personas y como equipos.<span style="border: 0px; margin: 0px; padding: 0px; text-decoration: underline;"> El contagio emocional, el distrés empático, el burnout y lo que se ha llamado “fatiga por compasión” son riesgos reales para las personas y equipos que están constantemente expuestos al sufrimiento humano.</span></div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">5. Usted cita en el título de su ponencia el mindfulness como técnica de cuidado. ¿En qué consiste?</strong></div>
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El mindfulness y la compasión son dominios de investigación recientes en la psicología y las neurociencias que están ofreciendo luces importantes sobre el potencial humano para estar plenamente presentes con aquello que es difícil sin sacrificar nuestra salud física y mental. Mindfulness o presencia plena es la posibilidad humana de prestar atención a lo que ocurre en el momento presente desde una actitud de amabilidad y aceptación. Esta capacidad puede ser entrenada a través de prácticas formales, como la meditación, e informales, como caminar o comer en plena consciencia. Mindfulness se enseña actualmente en más de 500 hospitales y clínicas en los EE.UU. y en más de 2000 centros de salud alrededor del mundo, y existen cientos de publicaciones científicas que documentan sus beneficios, incluyendo estudios con cuidadores y profesionales de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>. Estos estudios con cuidadores muestran que quienes participan de estos programas aumentan significativamente su bienestar, auto-compasión y su salud física, al mismo tiempo que disminuye su estrés y específicamente el estrés asociado al rol del cuidador.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">6. ¿A qué se debe esta mejora?</strong></div>
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Los investigadores sugieren que las prácticas de mindfulness son útiles para los cuidadores porque promueven una interpretación no enjuiciadora de la situación de su familiar o paciente, y una mayor aceptación de su realidad. Las prácticas de mindfulness también les ayudan a observar sus pensamientos y comportamientos con menos reactividad y juicios, con lo cual pueden responder mejor a las dificultades físicas y emocionales con las que se encuentran. <span style="border: 0px; margin: 0px; padding: 0px; text-decoration: underline;">Mindfulness facilita la regulación de la propia activación a través de una conciencia clara de lo que ocurre en el cuerpo y en la mente, desacoplando las respuestas automáticas y fortaleciendo nuestra capacidad para responder en vez de reaccionar a nuestras circunstancias.</span>La conciencia refinada de los estados cuerpo/mente y el cultivo de las capacidades meta-cognitivas que permiten monitorear las propias sensaciones, pensamientos y sentimientos a través de la observación conciente son elementos claves de la práctica de mindfulness que a su vez permiten generar el espacio, el coraje y la presencia necesarios para que la empatía y la compasión puedan surgir en la interacción con los pacientes y los colegas. Mi formación principal en este ámbito ha sido en la Escuela de Medicina de la Universidad de Stanford, donde se ha creado el Centro Para la Investigación y la Educación en la Compasión y el Altruismo (CCARE, por sus siglas en inglés). Esto me parece notable y también de sentido común: ¿Por qué surge un centro de estas características en una facultad de medicina? Precisamente nace desde la observación de que la presencia plena, la empatía y la compasión están en el corazón de la medicina, y de la observación de que la práctica de la salud en occidente ha sufrido un proceso de deshumanización, donde la mirada del paciente y del profesional como seres humanos integrales y sensibles se ha perdido.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">7. ¿Es fundamental una educación bio-psico-socio-espiritual para el desempeño profesional y la propia regulación emocional del profesional?</strong></div>
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Sin duda. Cada vez contamos con más evidencia científica de que tanto el bienestar de los pacientes como la salud física y mental de los profesionales dependen en parte de la visión de ser humano que está detrás del trabajo de los equipos de salud. La era del médico afectivamente neutro y distante está llegando a su fin, pues ahora sabemos con certeza que los pacientes que se sienten tratados como seres humanos, con cercanía, se recuperan más rápido y que los profesionales de salud que se relacionan con mayor calidez con sus pacientes tienen mayor satisfacción laboral y mejor salud mental. <span style="border: 0px; margin: 0px; padding: 0px; text-decoration: underline;">Lo interesante es que estas cualidades no son fijas sino que son cultivables: la presencia, la atención plena, la empatía y la verdadera compasión -que no es lástima sino la capacidad y el coraje de entrar en contacto con el sufrimiento junto a la motivación sincera de ayudar a aliviarlo- son plenamente entrenables.</span> Investigaciones recientes sugieren que este tipo de entrenamiento puede modificar el funcionamiento y estructura del cerebro y también nuestra fisiología. En mi propia investigación en Chile con el Programa de Entrenamiento del Cultivo de la Compasión de Stanford vimos que los participantes no sólo mejoraban significativamente en todas las dimensiones de su salud mental, sino que también aumentaron sus niveles de empatía y compasión mientras que disminuyeron sus niveles de distrés empático, que es la sensación de agobio frente al sufrimiento de los otros. Si consideramos que los hospitales son potentes atractores de sufrimiento, estos resultados tienen implicancias muy significativas para los profesionales que se desempañan en estos contextos.</div>
Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-37567623033832976962015-10-19T21:54:00.001+02:002015-10-19T21:57:54.399+02:00ENTREVISTA DR. Xavier Gómez-Batiste: El 70% de lo que gastamos individualmente en salud lo consumimos en los últimos meses de vida<br />
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El 70% de lo que gastamos individualmente en salud lo consumimos en los últimos meses de vida</h2>
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El XII Congreso de la Sociedad Andaluza de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">Cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">Paliativos</a> tiene el honor de contar con Xavier Gómez-Batiste en su ponencia inaugural. Un referente a nivel nacional e internacional, conocedor en profundidad de la situación actual de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>, dentro y fuera de nuestras fronteras.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">1. Para empezar, nos gustaría darle las gracias por acudir a este encuentro en Andalucía. </strong></div>
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El honor es para mí, ya que podremos compartir vuestros logros en Andalucía y trabajar juntos para mejorar. Me hace mucha ilusión venir a Andalucía y establecer áreas de cooperación.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">2. Para empezar, nos gustaría plantearle una cuestión muy básica, ¿por qué la importancia de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a><a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> en la medicina?</strong></div>
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Por varias razones:</div>
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<a href="https://lh5.googleusercontent.com/proxy/a-QuGgSuG6UlbaDpin9FFibHIbOGCjTZzRDO0ALyt5eOrdtZtSKRaTRg5KsAMNgNK9x3BOVHr3hnp1IyzU14ZUOSced5ym1R8W8hg6rCry2U3b2t_sz6a4LVWcZFF3nPgc2kPlhUh3tSpDYsMlhU" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="xavier gomez batisteP" border="0" class="thub wp-post-image" src="http://paliativosandalucia.com/wp-content/uploads/2015/10/xavier-gomez-batisteP-230x181.jpg" height="181" style="border: 0px; color: transparent; font-size: 0px; font-weight: normal; margin-top: 0px; padding: 0px; vertical-align: middle;" width="230" /></a>1. La epidemiología y las necesidades: la mortalidad de la población sigue siendo del 100%!! Sabemos que el 75% de nuestra población muere a causa de condiciones crónicas avanzadas, y que entre el 1-1.5% padecen enfermedades o condiciones crónicas avanzadas y pronóstico de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">vida</a> limitado, fundamentalmente multi-morbilidad, fragilidad, demencia, insuficiencias orgánicas y cáncer. Tiene que ver también con el envejecimiento y con el aumento de supervivencia de enfermedades crónicas avanzadas. Cada médico de familia atiende unos 25, en los hospitales está cerca del 40% de las camas, y en residencias está entre el 40 y el 70%.</div>
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2. La ética del cuidar a personas con enfermedades crónicas avanzadas y pronóstico de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">vida</a> limitado, con enormes necesidades de atención</div>
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3. La necesidad de mejorar la eficiencia del sistema de salud, adecuando los objetivos terapéuticos y el uso de recursos con objetivos <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a></div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">3. Y la investigación, tema central de este encuentro ¿Qué peso tiene dentro de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>?</strong></div>
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La investigación es un elemento fundamental para mejorar la calidad y para avanzar en el desarrollo de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a><a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>. Específicamente, en el tema de la cronicidad y los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>, identificamos 3 grandes áreas: la epidemiológica (necesidades y características), la clínica (por ejemplo, efectividad de las intervenciones) y la de evaluación de servicios y programas (por ejemplo, eficiencia). Es una muy buena idea centrar el congreso en la investigación.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">4. ¿Cuál es su opinión acerca de la investigación en domicilio? ¿Es más sencilla o presenta dificultades añadidas frente a la hospitalaria?</strong></div>
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Es un área que deberíamos desarrollar más, ya que es uno de los servicios emblemáticos. La mayoría de las personas con enfermedades crónicas avanzadas están en el domicilio, y muy especialmente las que padecen enfermedades y condiciones crónicas diferentes del cáncer.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">5. Sin abandonar este tema, ¿cuáles son para usted más importantes, los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> domiciliarios o los hospitalarios?</strong></div>
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La atención paliativa de calidad debe ser practicada en todos los recursos del sistema de salud, ya que hay pacientes en todos ellos, y promoviendo la atención integral e integrada de todos ellos.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">6. Como encargado de diseñar el programa de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> de alcance internacional para la OMS, ¿ha detectado algún referente de investigación en <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> dentro o fuera de España? Cítenos por favor algunos ejemplos de otros lugares que lo estén haciendo especialmente bien.</strong></div>
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Hay centros referentes de investigación en Europa que nos muestran el camino a seguir: el Cicely Saunders Institute de King’s Fund, el grupo de Luc Deliens en Bruselas, el más “clínico” de Stein Kaasa de la EAPC.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">7. ¿Cómo se encuentra España con respecto a otros países de Europa en el tema de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>?</strong></div>
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Situación intermedia-alta con mucha variabilidad entre CCAA. En cuanto a investigación, hay varios grupos potentes, pero deberíamos desarrollarlo más.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">8. ¿Qué necesidades detecta en nuestro país?</strong></div>
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1. La extensión de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> a todos los pacientes, en todos los servicios</div>
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2. La mejora de la atención psicosocial y espiritual</div>
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3. La equidad entre las CCAA</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">9. ¿Cómo explicaría a los responsables políticos o institucionales la importancia de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> para la sociedad, para la <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">vida</a>?</strong></div>
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La atención paliativa responde a necesidades de la población en situación más vulnerable, de manera efectiva, eficiente, y con muy alta satisfacción, y aporta valores esenciales como la compasión y la ética del cuidar.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">10. Y en términos económicos, ¿por qué son necesarios? ¿Cree que son caros o que por el contrario, ahorran costes a la sanidad pública?</strong></div>
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Los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> bien hechos tienen su coste, pero son muy eficientes y ayudan a adecuar los recursos dedicados a la atención de la cronicidad. El 70% de lo que gastamos individualmente en salud lo consumimos en los últimos meses de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">vida</a>, con frecuencia en medidas que no mejoran la supervivencia ni la calidad de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">vida</a>. Pequeños cambios en la atención pueden mejorar substancialmente su coste, mejorando además la calidad de <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">vida</a> de los pacientes.</div>
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<strong style="border: 0px; margin: 0px; padding: 0px;">11. Para terminar, por favor, le pediría que completase la entrevista con alguna reflexión que considere oportuna.</strong></div>
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En resumen: <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a> <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a> para responder a todas las dimensiones, de todos los pacientes y familias, de todo tipo de condiciones, en todos los recursos, y en todos los momentos! Estamos construyendo la clínica, la ética y la organización que atienda precozmente a las personas con enfermedades crónicas avanzadas, basados en la experiencia de los <a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">cuidados</a><a href="http://paliativosandalucia.com/2014-11-27/que-se-debe-preguntar-enfermo-al-final-de-su-vida/" style="border: 0px; color: #5181ef; margin: 0px; padding: 0px; text-decoration: none;">paliativos</a>, y es un momento muy interesante y positivo.</div>
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<br />Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-53811712775241448632015-06-21T21:07:00.000+02:002015-06-21T21:07:26.029+02:00Recuerdos de un Congreso: SEOR 15Os dejo un video muy interesante, donde se puede observar como algunos de nosotros nos unió la inquietud, alegría, las ganas, el entusiasmo que la Dra. Virginia Ruiz nos trasmitió desde su llamada. Nos embarcamos en una aventura sin vuelta atrás, en una sociedad complicada.<br />
<span style="background-color: white; font-family: georgia, 'palatino linotype', palatino, 'times new roman', times, serif; font-size: 16px; line-height: 24px; text-align: justify;">Nos levantamos con muchísimo miedo y entusiasmo sin olvidarnos de que teníamos un día menos para trabajar y pensar en el tema que Virginia nos pidió. Lo hicimos, y sinceramente, creo que todos lo hicimos bien, era un privilegio, apuntando a lo más alto, a lo más ambicioso, romper con las tradicionales sesiones y charlas oncológicas, ofreciendo algo diferente. Es verdad, todo lo que se sueña puede hacerse realidad a través del trabajo, por eso es que lo estamos disfrutando tanto. Fue duro y difícil pero lo hicimos.</span><br />
<span style="background-color: white; font-family: georgia, 'palatino linotype', palatino, 'times new roman', times, serif; font-size: 16px; line-height: 24px; text-align: justify;">Os dejo con el video resumen que el Dr. Amadeo Wals nos mandó. </span><br />
<span style="background-color: white; font-family: georgia, 'palatino linotype', palatino, 'times new roman', times, serif; font-size: 16px; line-height: 24px; text-align: justify;">Espero os Guste</span><br />
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Sed felices, la oncología radioterápica empieza a cambiar....de forma de pensar....Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-46235086119759969022015-06-16T19:33:00.000+02:002015-06-16T19:33:07.031+02:00#yosoyradioncologo tomado de mi blog favorito "UN RAYO DE ESPERANZA" http://draruiz.blogspot.com.es/<div class="p1">
<span class="s1"><b>De mi amiga Virginia: </b></span><b>"UN RAYO DE ESPERANZA" http://draruiz.blogspot.com.es/</b><br />
<span class="s1"><b><br /></b></span>
<span class="s1"><b>LUNES, 15 DE JUNIO DE 2015</b></span></div>
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<span class="s1">¿Por qué #yosoyradioncologo?</span></div>
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Con motivo de la euforia desatada en Twitter con la crónica del Congreso Nacional a través del hashtag o etiqueta #SEOR15, surgió una iniciativa de la mano de nuestro compañero el <a href="https://www.linkedin.com/in/javierserranoandreu/en"><span class="s2"><b>Dr Javier Serrano Andreu</b></span></a> que tuvo a bien llamarla #yosoyradioncologo. Dicho encuentro digital se celebró el pasado 10 de Junio entre las 21y las 22h. Durante esa hora todos los radioncólogos tuiteros (y los que no, pues algunos se adhirieron por primera vez gracias a la campaña) nos dedicamos a enviar mensajes positivos sobre nuestra especialidad y contamos las razones por las cuales nos gusta y nos mueve el trabajo que desempeñamos en nuestro día a día. Ha sido una forma espontánea y decidida para visibilizar nuestras fortalezas refugiadas en el búnker y sacarlas a la luz de esta red social.<span class="s1"></span></div>
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<span class="s1">La verdad es que leer los mensajes que minuto a minuto se iban generando fue fantástico, llegándose a alcanzar 1.176.849 impresiones con un total de 1592 tuits, a razón de una media de 8,61 tuits por contribuyente de los 185 que participaron, conformando un "tweet-up" emocionante, rico en variedad de contenido y viral. </span></div>
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<span class="s1">Me he tomado la libertad de recoger una muestra seleccionada de aquellos mensajes enviados por mis compañeros y que demuestran que nuestra especialidad médica está muy viva, llena de vocación. Twitter se convirtió en un hervidero y altavoz de ideas. Les dejo con ellas.</span></div>
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<span class="s1"><b>#yosoyradioncologo</b></span></div>
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<span class="s1">- Porque la radioterapia es mucho más que tratar el cáncer</span></div>
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<span class="s1">- Porque desde hace más de un siglo siempre hemos sido pioneros</span></div>
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<span class="s1">- Por ese momento en el que gracias a la radioterapia controlo el dolor del paciente y vuelve a tener ganas de vivir</span></div>
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<span class="s1">- Porque además de curar el cáncer la radioterapia también es eficaz en enfermedades benignas</span></div>
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<span class="s1">- Porque existe un mar de posibilidades de ayudar a mis pacientes</span></div>
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<span class="s1">- Porque la radioterapia puede curar el cáncer</span></div>
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<span class="s1"></span><br /></div>
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<span class="s1">- Porque me interesan más las personas que los tumores</span></div>
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<span class="s1">- Porque mucho antes que Oncólogo radioterápico soy Oncólogo y mucho antes que Oncólogo soy Médico</span></div>
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<span class="s1">- Porque trabajo para acompañar a los pacientes en su lucha</span></div>
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<span class="s1">- Porque somos Personas, Médicos, Radioncólogos... es todo uno. No podemos prescindir de nada. Estaríamos incompletos. </span></div>
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<span class="s1"><b>Me siento orgullosa de mis compañeros y me siento orgullosa de ser radioncóloga... Seguiremos</b></span></div>
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<span class="s1">Podéis ver a través de este enlace de <a href="https://storify.com/MiguelDlaCamara/yosoyradioncologo"><span class="s2"><b>Storify</b></span></a> cómo se gestó y continuó esta bonita e ilusionante iniciativa. </span></div>
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<span class="s1"><a href="https://www.youtube.com/watch?v=Q0RsMNMDy7c"><b>https://www.youtube.com/watch?v=Q0RsMNMDy7c</b><span class="s2"><b></b></span></a></span></div>
Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-8930628414844197362015-06-09T21:44:00.003+02:002015-06-09T21:44:44.027+02:00 RESULTADOS PRELIMINARES: XVIII CONGRESO SEOR VALENCIA. SALUD, EMPODERAMIENTO, OPORTUNIDAD Y RETOS Nuestros Twiteros<div class="Xx xJ" style="background-color: white; font-family: Roboto, arial, sans-serif; font-size: 13px; line-height: 20.2222232818604px;">
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<b>Nuestros Twiteros</b><br />Son los resultados preliminares, los definitivos son mejores, la realidad virtual ha dejado de ser virtual. El congreso SEOR (Sociedad Española de Oncología Radioterápica) ha sido un éxito, uno de los mejores que conozco. La mesa SALUD, EMPODERAMIENTO, OPORTUNIDAD Y RETOS genial.</div>
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Gran Reunion de compañeros especialistas de distintas áreas, gran reunión de twitteros, bloggeros, gran reunión de amigos: </div>
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<span style="font-size: 12px; line-height: 16.7999992370605px;">Rt</span><span style="font-size: 12px; line-height: 16.7999992370605px;"> </span><b><span style="font-size: x-large;">#yosoyradioncologo</span></b></div>
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mañana miercoles 10-6-15 a las 21: orgulloso de ser radioncologo</div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-24136955222048180562015-06-09T21:28:00.001+02:002015-06-09T21:28:49.105+02:00Una radioterapia menos agresiva, reto frente al cáncer de mama<h3 class="post-title entry-title" itemprop="name" style="background-color: #fefdfa; color: #d52a33; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 22px; font-stretch: normal; font-weight: normal; margin: 0px; position: relative;">
Una radioterapia menos agresiva, reto frente al cáncer de mama</h3>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Identificar a los pacientes que requieren una radioterapia poco agresiva, irradiar las áreas ganglionares si están afectadas y administrar en caso de buen pronóstico la dosis necesaria en la zona tumoral en una única sesión de forma intraoperatoria, son los retos en el abordaje del cáncer de mama.<br /><br />Así lo apuntan los últimos estudios presentados en el dieciocho Congreso Nacional de la Sociedad Española de Oncología Radioterápica (SEOR), en el que se recordó que una de cada ocho mujeres desarrollará un cáncer de mama a lo largo de su vida y un 80 por ciento de ellas recibirá radioterapia.<br /><br />El jefe de Servicio de Oncología Radioterápica del Parc de Salut Mar de Barcelona, Manel Algara, señaló en el encuentro que la investigación en este campo se dirige a la identificación de los casos en los que se puede ser menos agresivo, con el objetivo último de «irradiar un menor volumen».<br /><br />Algara indicó que las técnicas de hipofracionamiento (menos sesiones de radioterapia) son «seguras y cómodas para las pacientes», y que la re-irradiación tras este tratamiento es «una opción a la que cada vez se recurre más».<br /><br />En ese sentido, remarcó que la mayoría de los Servicios de Oncología Radioterápica españoles dispone de la tecnología necesaria para ofrecer una radioterapia ajustada a los actuales estándares de calidad mundiales.</span><br /><a href="https://www.blogger.com/null" name="more"></a><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />Según el presidente de la Sociedad Europea de Oncología Radioterápica (Estro), Phillip Poortmans, el papel de la radioterapia en el abordaje del cáncer de mama es «más importante que nunca sobre todo de cara a aumentar la supervivencia a largo plazo».<br /><br />En el congreso se avanzó que algunas de las investigaciones actualmente en marcha se centran en bajar la intensidad de la radioterapia en pacientes con bajo riesgo.<br /><br />También en optimizar las combinaciones de tratamientos o aumentar las posibilidades de individualizar y personalizar el tratamiento en base a los factores del tumor, las peculiaridades de los otros tratamientos y las características del paciente (además de sus preferencias). Poortmans confirmó asimismo la importancia de la radioterapia regional en pacientes con factores de riesgo.</span><br />Fuente http://www.larazon.es/</div>
Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-50307331814187134882015-06-07T11:22:00.000+02:002015-06-07T11:22:51.678+02:00RESULTADOS PRELIMINARES: XVIII CONGRESO SEOR VALENCIA. SALUD, EMPODERAMIENTO, OPORTUNIDAD Y RETOS Nuestros Twiteros<div dir="ltr" style="text-align: left;" trbidi="on">
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Son los resultados preliminares, los definitivos son mejores, la realidad virtual ha dejado de ser virtual. El congreso SEOR (Sociedad Española de Oncología Radioterápica) ha sido un éxito, uno de los mejores que conozco. La mesa SALUD, EMPODERAMIENTO, OPORTUNIDAD Y RETOS moderada, dirigida y apoyada por la Dra. Virginia Ruiz ha sido extraordinaria, con ponentes de lujo, algo difícil de unificar en los tiempos que corren.<br />
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Felicidades a la organizadora la Dra. Virginia Ruiz, además os recomiendo no dejéis de visitar su blog: <b> http://draruiz.blogspot.com.es/</b><br />
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<b>Genial </b><br />
Dr. David Muñoz Carmona<br />
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-11422683368086760702015-06-06T19:38:00.002+02:002015-06-06T19:39:44.803+02:00XVIII CONGRESO SEOR VALENCIA. SALUD, EMPODERAMIENTO, OPORTUNIDAD Y RETOS<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://draruiz.blogspot.com.es/2015/05/seor20.html" style="color: #66cc66; text-decoration: none;">#SEOR2.0</a></h3>
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El próximo 4 de Junio, arranca el <b><a href="http://www.congresoseor.com/" style="color: #66cc66; text-decoration: none;">XVIII Congreso Nacional de SEOR</a></b> (Sociedad Española de Oncología Radioterápica) en el <b><a href="http://centroeventos.feriavalencia.com/" style="color: #66cc66; text-decoration: none;">Centro de Eventos Feria Valencia</a></b> y bajo el lema: "Tratamiento Preciso y Personalizado contra el Cáncer". Un motivo para el encuentro, el debate científico, la comunicación y el compartir experiencias.</div>
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Hace ya algunos meses propuse organizar un encuentro 2.0 en el marco del Congreso Nacional de nuestra Sociedad con los compañeros más proactivos en la red y algún que otro invitado que, afanosamente, aceptó la invitación a participar. Deseábamos presentar una gran parte de lo que las Tecnologías de la Información y la Comunicación (TIC) pueden ofrecernos para nuestro desarrollo profesional. Entendemos que las TIC no son ya un futuro más o menos lejano. Representan, aquí y ahora, un presente muy palpable y con un alto potencial, si se saben emplear bien.</div>
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Queremos que sea un encuentro abierto a la participación desde este preciso instante. Los protagonistas no somos los que vamos a hablar en el escenario, como en un principio se pudiera pensar. Quisiéramos que el verdadero protagonista fuera el público que nos escuche en directo, en streaming o en diferido compartiendo impresiones, tuits, comentarios o fotos a través de las redes sociales. Porque esa es la filosofía del encuentro digital: el conocimiento, las conversaciones y sus réplicas, el aprendizaje colaborativo, la conexión entre compañeros de diferentes ámbitos y geografías, etc. Queremos crear las condiciones para que eso sea posible de una forma amena, entrañable e incluso sorprendente y divertida.</div>
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El encuentro será moderado por el Dr <b><a href="http://www.grupoimo.com/sala-de-prensa/noticias/el-dr_-ignacio-azinovic_-nuevo-director-medico-del-grupo-imo" style="color: #66cc66; text-decoration: none;">Ignacio Azinovic</a></b> junto a una servidora que hará los honores de presentar y co-moderar el evento. El programa propuesto reza bajo el título : <b>"#SEOR2.0: Salud, Empoderamiento, Oportunidad y Retos" </b>y es sin ninguna duda toda una declaración de intenciones. Les adelanto los titulares y temas que se van a tratar. </div>
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<b><span style="font-size: 12pt;">1.- E-salud, e-pacientes y e-doctores </span></b><b><span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">¿Estamos ante una nueva era?</span></b><span style="font-size: 12pt;"> <o:p></o:p></span></div>
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<span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Miguel Ángel Máñez </span><i><span background:white="" color:="" ff="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times=""><span style="color: blue;">@manyez</span></span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Director de Gestión del Complejo Hospitalario de Toledo</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">2.- Principales Redes Sociales (RRSS) y comunidades virtuales aplicadas a la Oncología Radioterápica</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Facebook </span></b></div>
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<span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr Ignacio Rodríguez Melcón. Oncología Radioterápica. Hospital Dr Negrín. Las Palmas de Gran Canaria. <i><span style="color: blue;">@NachoRodMel</span></i></span></div>
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<b><span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Twitter</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:black="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr Joaquín J Cabrera Rodríguez. Oncología Radioterápica. Hospital Infanta Cristina. Badajoz </span><i><span color:="" ff="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times=""><span style="color: blue;">@JoaquinJCabrera</span></span></i><span style="font-size: 12pt;"><span style="color: blue;"> </span><o:p></o:p></span></div>
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<b><span style="font-size: 12pt;">Linkedin:</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr Amadeo Wals Zurita. Oncología Radioterápica. Hospital Virgen de la Macarena. Sevilla </span><span style="color: blue;"><i><span lang="ES-TRAD" style="color: #3366ff; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@AmadeoWals</span></i><span background:white="" color:="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times=""> </span></span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">¿Todo vale en las RRSS? Manual de estilo.</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr José Antonio Trujillo Ruiz. Medicina Familiar y Comunitaria. Centro de Salud La Luz. Málaga. </span><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: blue; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@Joseatrujillo</span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 12pt;"> 3.- La blogosfera: ¿Para qué escribir un blog?</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span style="font-size: 12pt;">Experiencias en nuestro país</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">Carpe Diem: </span></b><span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dra Teresa Muñoz Migueláñez. Oncología Radioterápica. Hospital Ramón y Cajal. Madrid. </span><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: blue; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@MsConcu</span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">El Lanzallamas: </span></b><span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr. Ángel Montero Luis. Oncología Radioterápica. Hospital Universitario Sanchinarro. Madrid. </span><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: blue; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@Monthy_A</span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">Oncología Canarias: </span></b><span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr Ignacio Rodríguez Melcón. Oncología radioterápica. Hospital Dr Negrín. Las Palmas de Gran Canaria. </span><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: blue; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@NachoRodMel</span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">Oncología Radioterápica Huelva: </span></b><span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr David Muñoz Carmona. Oncología Radioterápica. Hospital Juan Ramón Jiménez. Huelva. </span><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: blue; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@davidmunozca</span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">Desayuno con fotones: </span></b><span background:white="" color:black="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dra </span><span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Naia Pereda. Radiofísica Hospitalaria. Hospital de Basurto. Bilbao. </span><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: blue; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@naiapereda</span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #444444; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">Un Rayo de Esperanza: </span></b><span background:white="" color:="" lang="ES-TRAD" mso-ansi-language:es-trad="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dra. Virginia Ruiz Martín. Oncología radioterápica. Hospital Universitario de Burgos. </span><span style="color: blue;"><i><span lang="ES-TRAD" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #3366ff; font-family: '', 'Times New Roman', '', serif; font-size: 12pt;">@roentgen66</span></i><b><span style="font-size: 12pt;"> </span></b></span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">4.- Mi médico en el bolsillo: Pinceladas sobre apps (y wearables) médicos: La experiencia de iOncoR</span></b><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr Ángel Montero Luis </span><i><span style="font-size: 12pt;"><span style="color: blue;">@Monthy_A</span></span></i><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Oncología Radioterápica. Hospital Universitario Sanchinarro. Madrid.</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<b><span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">5.- Videoconferencia</span></b><span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">: <b>: Experiencia de la iniciativa #radonc y Radiation Nation</b></span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Dr Matthew Katz </span><span style="color: blue;"><i><span style="font-size: 12pt;">@subatomicdoc</span></i><span style="font-size: 12pt;"><o:p></o:p></span></span></div>
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<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Director del Departamento de Oncología Radioterápica. General Lowell Hospital Massachussets EEUU</span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Como pueden ver el programa promete. Es la primera vez que SEOR apuesta por la presencia 2.0 en el marco de un Congreso Nacional y lo ha hecho con audacia, ambición y coraje, pero también con grandes dosis de cariño y ganas. Quiero agradecer la oportunidad brindada y su paciencia infinita al <b><a href="http://www.ivo.es/pages/view/53" style="color: #66cc66; text-decoration: none;">Dr Leoncio Arribas</a></b>como cabeza visible de la organización del congreso, al <b><a href="http://www.ivo.es/pages/view/53" style="color: #66cc66; text-decoration: none;">Dr José López Torrecilla</a></b>por su confianza depositada en nosotros como Presidente de<span class="apple-converted-space"> </span><b><a href="http://www.seor.es/" style="color: #66cc66; text-decoration: none;">SEOR</a> </b>y a <b><a href="https://www.linkedin.com/pub/manuel-garcia-molina/48/53b/b98" style="color: #66cc66; text-decoration: none;">Manuel García Molina </a></b>como compañero de fatigas digitales y cuyo apoyo logístico ha sido inestimable. </span><span style="font-size: 12pt;"><o:p></o:p></span></div>
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<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times="">Así pues, nos vemos el 4 de Junio. Animo a los lectores del blog, a los compañeros participantes o a los espectadores a calentar motores utilizando el hashtag en Twitter <b>#SEOR15</b> para todo el Congreso Nacional de SEOR y, aunque sea por una vez, la Oncología Radioterápica sea un "trending topic". </span><span style="font-size: 12pt;"><o:p></o:p></span><br />
<span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times=""><br /></span><span color:black="" new="" roman="" serif="" style="font-family: '; font-size: 12pt;" times=""><i><b><u>Nota:</u></b> Hemos cambiado el hashtag o etiqueta de Twitter #SEOR2.0 por <b>#SEOR15</b>para recoger no sólo los comentarios del evento, sino de todo el XVIII Congreso Nacional de SEOR. ¡¡¡Gracias!!!</i></span></div>
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<b><a href="https://www.youtube.com/watch?v=2gfa_qTvZCI" style="color: #66cc66; text-decoration: none;"><span style="font-family: 'Times New Roman';"><span style="line-height: 21px;">https://www.youtube.com/watch?v=2gfa_qTvZCI</span></span><span style="line-height: 15.95pt; text-align: justify;"> </span></a></b></div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-41058400609704257582015-06-01T19:14:00.001+02:002015-06-01T19:16:13.484+02:00Be brave.... No lo olvidemos... Hacemos algo más que radioterapia <div dir="ltr" style="text-align: left;" trbidi="on">
<a href="https://m.youtube.com/watch?v=UTpaABPUMWY">Be brave</a><br />
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PINCHA QUE NO TE ARREPENTIRAS.......<br />
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<a class="ot-anchor aaTEdf" dir="ltr" href="https://m.youtube.com/watch?v=UTpaABPUMWY" jslog="10929; track:click" rel="nofollow" style="-webkit-transition: color 0.218s; background-color: white; color: #427fed; cursor: pointer; font-family: Roboto, arial, sans-serif; font-size: 13px; line-height: 16.5454540252686px; text-decoration: none; transition: color 0.218s;" target="_blank">https://m.youtube.com/watch?v=UTpaABPUMWY</a><span style="background-color: white; color: #404040; font-family: Roboto, arial, sans-serif; font-size: 13px; line-height: 16.5454540252686px;"></span><br />
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-66264974320954899712015-05-21T20:03:00.001+02:002015-05-21T20:03:50.432+02:00PIF (PLAN INDIVIDUALIZADO DE FORMACIÓN) DEL RESIDENTE DE ONCOLOGIA RADIOTERAPICA, para el 30 de junio...??????<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: black;"><o:p> </o:p></span><span style="font-size: 13.5pt; line-height: 19.2pt; text-align: justify;">Nuria es una joven <o:p></o:p></span><span style="font-size: 13.5pt; line-height: 19.2pt; text-align: justify;">residente que “acaba de aterrizar” como quien dice
en el Complejo Hospitalario Universitario Juan Ramón Jiménez que va a ser su
principal punto de referencia a lo largo de los próximos 4 años. Y ha tenido la
oportunidad de conocer a todo lo que va a ser su “equipo”, una experimentada
planilla de profesionales que intentarán enseñarle todo lo que pueda ella
aprender.</span></div>
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<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">Recibirá un minúsculo curso de<span style="mso-spacerun: yes;">
</span>urgencias donde, entre otras muchas cosas que debe de saber y asimilar
al comienzo para no perderse demasiado en un entorno tan complejo como es la
organización sanitaria y en una especialidad con competencias a adquirir tan
variadas y diversas, pero lo que mas le aportará será MANEJARSE EN LAS GUARDIAS
DE PUERTA (duras duras de verdad “Vietnam las llamábamos en mi época”). <o:p></o:p></span></div>
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<a href="http://3.bp.blogspot.com/-oGNkIGZ3BYQ/VV4chTPogAI/AAAAAAAABc0/cwKTwt-7iuA/s1600/8a276d0048d814d4181c7b2018969ff6_L.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="210" src="http://3.bp.blogspot.com/-oGNkIGZ3BYQ/VV4chTPogAI/AAAAAAAABc0/cwKTwt-7iuA/s320/8a276d0048d814d4181c7b2018969ff6_L.jpg" width="320" /></a><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">Le han informado de que una de las tareas que debe hacer al comienzo de
cada año de su residencia es el que denominan <span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; padding: 0cm;">Plan Individualizado de
Formación</span> (PIF), para lo cual ya debe de haber recibido unas
mínimas instrucciones, las imprescindibles para que le “vaya todo esto
sonando”.<o:p></o:p></span></div>
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<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">Probablemente Nuria esté pensando:<span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; padding: 0cm;">“Me han pedido desde la unidad
docente que haga un PIF, y la verdad, no tengo ni idea de cómo comenzar; las
guardias, los rotatorios, el programa de la especialidad, las evaluaciones
formativas, el portafolio, la investigación que debemos de hacer, la atención a
la comunidad,….,uffff, todo me parece importante e interesante a priori, pero
me siento saturado y un poco sobrepasado, ya que es difícil de asimilarla en
tan poco tiempo¡¡¡. </span><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;"><span style="mso-spacerun: yes;"> </span>“Entiendo que te sientas
así, yo también he sido residente y he pasado por lo que me cuentas;aunque en
mi época no existía el PIF, no te preocupes, que esto concretamente es mucho
más sencillo de lo que te imaginas. Eso del Plan Individualizado de Formación o
PIF, no es nada más que un cuaderno de ruta para que sobre todo tu conmigo
vayamos adaptando tu formación a tus necesidades reales. El modelo para hacerlo
que se utiliza en nuestra unidad lo han simplificado mucho para que resulte más
asequible y práctico; y además, ya sabes que si tienes alguna dificultad,
puedes contar conmigo o con algún otro responsable docente y trataremos de
solventarla entre todos”.</span><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">En esencia el PIF del Residente, es el documento o el
instrumento que recoge la planificación temporal de las actividades formativas
teórico-prácticas que debes realizar en cada uno de los periodos formativos a
lo largo de toda tu residencia. Como te han dicho ya en la unidad se elabora y
presenta anualmente, en función de las necesidades formativas que tú y yo
vayamos detectando. Es como una especie de plan de formación “a la carta”, … o
al menos así lo concibo yo. Esto se plasma en un sencillo documento (que es el
modelo de planilla que te han entregado) que tu has de rellenar (5), después de
haberla consensuado conmigo”.</span><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;"><span style="mso-spacerun: yes;"> </span>“Bueno, lo de hacer el PIF
no es algo que nos hayamos inventado nosotros, viene regulado en ciertas normas
a nivel estatal (1). Lo primero que te sugeriría que hicieras es que te leyeras
más detenidamente el <b>Programa Oficial de la Especialidad</b>(2), si no
lo has hecho ya, y el <b>Libro del Residente</b> (3), sobre todo
recomiendo que te mires el llamado “Mapa de Competencias”, pues como tu sabes
se trata de un listado bastante exhaustivo de las competencias y habilidades
que has de adquirir, por lo que te puede servir para caer en la cuenta o
reparar mejor sobre que aspectos debes priorizar en los próximos meses porque
lo percibes como una necesidad formativa. También conviene que le des un repaso
al <b>Plan General de Formación</b> que en la unidad docente te han
entregado, pues es en ese documento donde mas se concretan todas estas
cuestiones y te orientará sobre qué, como, cuando y donde tienes que adquirir
los conocimientos, destrezas y habilidades para llegar a ser médico DE
ONCOLOGIA RADIOTERAPICA. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">O sea que aunque tienes planificadas una serie de actividades,
tienes la libertad de decidir en que cosas de las que detalla el Programa estás
más necesitada de formación <o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-Xp0YlH_q2ew/VV4ckTRgwgI/AAAAAAAABc8/RUIxDAEb-30/s1600/2014-03-22%2B23.00.18.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Xp0YlH_q2ew/VV4ckTRgwgI/AAAAAAAABc8/RUIxDAEb-30/s1600/2014-03-22%2B23.00.18.jpg" /></a></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">Desde el punto de vista del residente, tener tu propio PIF te
permitirá conocer desde el primer momento cuáles son las actividades formativas
en las que participaras (no todas, ni mucho menos, sino aquellas que estimas
resulta conveniente hacer especial hincapié, como tu muy bien has comentado, y
poner una mayor atención a partir de ahora, por considerarlas prioritarias), lo
que hará reducir bastante el nivel de incertidumbre, establecer y reforzar
compromisos docentes (es lo que los teóricos llaman “Contrato pedagógico”, un
acuerdo entre docentes y discentes que tiene mucho que ver con el aprendizaje
que tú sientes realmente necesario, promoviendo a la vez tu propia autonomía)
(4). Esto según dicen los teóricos hace al alumno ser más consciente de su
propio proceso de aprendizaje, y da la posibilidad de organizar su tiempo y
recursos de forma más eficiente. El PIF nos permite organizar,
secuenciar, graduar y adaptar mejor las actividades formativas a las
características propiamente tuyas y dotar al proceso de enseñanza-aprendizaje
de una mayor claridad y coherencia funcional. </span><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">Desde luego hasta que no te pongas a repensar tus necesidades, no
te asaltarán las dudas, pero para eso me tienes a mi que trataré de orientarte
en la medida de lo posible. No hay más remedio que reflexionar sobre las muchas
cosas que tienes que aprender y lo mucho que ya sabes. Sin duda que el ir
tomando contacto con los pacientes te ayudará a empezar a delimitar estas
primeras necesidades más acuciantes y a anclar estas en lo que será tu trabajo
y tu responsabilidad con pacientes,…de manera que tranquila ,…pero sin
pausa,…empieza a actuar y verás como surgen las dudas y los miedos…para abordar
estos de manera específica debe de servirnos esta herramienta,…si no mal
asunto…otro papelito más…”.</span><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<b><span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">Bibliografía</span></b><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">1.-El Real Decreto 183/2008, de 8 de febrero por el que se determinan y
clasifican las especialidades en Ciencias de la Salud y se desarrollan
determinados aspectos del sistema de formación sanitaria especializada..
Disponible en:</span><a href="http://www.msps.es/profesionales/formacion/docs/realDecreto183_2008.pdf"><span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">http://www.msps.es/profesionales/formacion/docs/realDecreto183_2008.pdf</span></a><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">2.-Programa Docente Oficial de la Especialidad (POE) de Medicina
Familiar y Comunitaria. Disponible en:</span><a href="http://www.msc.es/profesionales/formacion/docs/medifamiliar.pdf"><span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">http://www.msc.es/profesionales/formacion/docs/medifamiliar.pdf</span></a><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">3.-Libro del Residente de Medicina Familiar y Comunitaria. Disponible
en:</span><a href="http://www.msps.es/profesionales/formacion/docs/libroResidenteMedFamiliar.pdf"><span style="border: none windowtext 1.0pt; color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-border-alt: none windowtext 0cm; mso-themecolor: text1; padding: 0cm;">http://www.msps.es/profesionales/formacion/docs/libroResidenteMedFamiliar.pdf</span></a><span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">4.-Prados J, Saura J. Los planes de formación individualizados y los
contratos pedagógicos. En: Ruiz Moral R. Educación Médica. Manual práctico para
clínicos. Editorial Panamericana, 2010. págs. 45-50.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 19.2pt; margin-bottom: 12.0pt; text-align: justify; text-justify: inter-ideograph; vertical-align: baseline;">
<span style="color: black; font-size: 13.5pt; mso-bidi-font-family: Arial; mso-themecolor: text1;">5.-Saura J, Martínez A, Gómez J, Rubio E, Monzó E, Romero E. Plan
Individualizado de Formación del Residente de Medicina Familiar: experiencia de
la Unidad Docente de Murcia, España (Primera Parte). Archivos en Medicina
Familiar 2011; 13: 30-4.<o:p></o:p></span></div>
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<span style="font-size: 28.5pt; letter-spacing: -0.75pt;">Un Plan de Formación “a la Carta”: El PIF del Residente<o:p></o:p></span></div>
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<b><span style="border: 1pt none windowtext; font-size: 13.5pt; padding: 0cm;">Tomado de Luis A Pérula de Torres. Unidad docente de medicina familiar de Córdoba. </span></b></div>
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<b><span style="border: 1pt none windowtext; font-size: 13.5pt; padding: 0cm;">Gracias Luis</span></b></div>
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<b style="line-height: 19.2pt;"><span style="border: 1pt none windowtext; font-size: 13.5pt; padding: 0cm;"><a href="http://www.doctutor.es/2013/03/05/un-plan-de-formacion-a-la-carta-el-pif-del-residente/">http://www.doctutor.es/2013/03/05/un-plan-de-formacion-a-la-carta-el-pif-del-residente/</a></span></b><span style="color: black;"><o:p> </o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-92065171176178634652015-04-28T19:12:00.000+02:002015-04-28T19:12:13.817+02:00Proton radiotherapy delivers more accurate cancer treatment, with less collateral damage<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="background-color: white; font-family: sans-serif; font-size: 16px; line-height: 22.3999996185303px;">Radiotherapy using protons can deliver more accurate treatment to a tumour while reducing the dose to surrounding tissue. However, in mobile organs such as the lung, precise targeting of the dose is difficult. Now researchers have succeeded in making a model of breathing movement that allows for the precise measurement of narrow beams to a dummy tumour by simulating the motion and physical properties of the chest anatomy in a model, the 3rd ESTRO Forum in Barcelona, Spain, will hear today (Monday).</span></div>
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Dr Rosalind Perrin, from the Centre for Proton Therapy at the Paul Scherrer Institute, Villigen, Switzerland, will describe to the conference the method she and colleagues have developed to test the application of <a class="textTag" href="http://medicalxpress.com/tags/proton+therapy/" rel="tag" style="color: #313d57; outline: 0px; text-decoration: none;">proton therapy</a> to lung cancer, using a delivery technique called rescanning, which helps to mitigate the effect of motion, and to develop practical ways to implement it in the clinic for patient treatments.</div>
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"This involved experiments using an advanced breathing model of the patient, a so-called 'anthropomorphic phantom', with integrated measurement devices to accurately measure the dose distribution. We found that our rescanning technique worked well to overcome the effect of motion on the dose delivered to the tumour, and for tumour motions of up to 1 cm," she will say.</div>
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The model developed by the researchers was made up of a sphere representing a tumour moving within an inflating lung, enclosed in a rib cage complete with surrounding muscle and skin layers. The model can be programmed to move with breathing patterns specific to each patient. Radiation dosage was measured during movement, and the researchers found that the rescanning technique allowed the application of clinically acceptable dose distribution to the tumour, and only a minimal dose to surrounding tissues.</div>
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Scanning proton therapy is an emerging technology in cancer therapy, in which a narrow particle beam, consisting of accelerated hydrogen nuclei, is scanned through the tumour and administers highly targeted radiation to the cancer cells. Because protons have a relatively large mass, the beam delivers most of its <a class="textTag" href="http://medicalxpress.com/tags/radiation+dose/" rel="tag" style="color: #313d57; outline: 0px; text-decoration: none;">radiation dose</a> towards the end of its path in tissue, and thus proton therapy can be designed to limit dose to surrounding tissues. Furthermore, a proton beam only penetrates the tissue up to a given depth, determined by its energy. So, compared with conventional radiotherapy techniques, the therapy allows a maximal dose to the tumour, while reducing the dose elsewhere.</div>
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However, for mobile tumours in the liver or lung, organ and tumour motion deteriorates the dose distribution because there may be a rift between the radiation delivery time-line and the time-line of the tumour motion: the "interplay" effect. The researchers at the Paul Scherrer Institute have worked to overcome this problem by developing a new, state-of-the art delivery system, and the technology required by these advanced "motion mitigation" methods is now operational. The rescanning technique involves scanning the tumour several times by the proton beam.</div>
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<a href="http://2.bp.blogspot.com/-L4cllwRa4no/VT--uQ-kJHI/AAAAAAAABY0/c8iyUBgE0ro/s1600/proton.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: justify;"><img border="0" src="http://2.bp.blogspot.com/-L4cllwRa4no/VT--uQ-kJHI/AAAAAAAABY0/c8iyUBgE0ro/s1600/proton.jpg" height="268" width="400" /></a></div>
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<span style="line-height: 22.3999996185303px;">"This makes it possible to average out the dose to the moving tumour, and also reduce the effect of motion on the dose delivered to it. Because of the sensitivity of the lung to radiation, as well as the proximity of the heart, oesophagus and spinal cord, it is particularly important to keep the radiation dose to surrounding tissues as low as possible in </span><a class="textTag" href="http://medicalxpress.com/tags/lung+cancer/" rel="tag" style="color: #313d57; line-height: 22.3999996185303px; outline: 0px; text-decoration: none;">lung cancer</a><span style="line-height: 22.3999996185303px;">," says Dr Perrin.</span></div>
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The next challenge for the researchers is to translate the technique into t</div>
he clinic for the benefit of patients, with the aim of improving cancer radiotherapy while reducing side effects. However, cost remains a problem. "The cost-benefit of proton therapy is a hotly-debated topic amongst national healthcare bodies and insurers. But if we can show, through randomised clinical studies, that proton therapy is better for certain cancer types, this may influence politicians and insurance providers to make appropriate decisions. This is particularly important for cancer types with a poor outcome that are subject to motion, especially advanced-stage liver and lung cancers," Dr Perrin will conclude.<br />
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<br />Professor Philip Poortmans, President of ESTRO, commented: "Proton therapy is currently attracting a lot of attention in the field of oncology as well as in the lay press. This study points out very accurately that a lot of work still has to be done before its applicability to most tumour sites will be broadly acceptable outside the field of clinical trials. The investigators focused on the challenge of the movement of the tumour within the patient's body, for example with a normal breathing cycle. The rescanning technique they describe, which compensates for <a class="textTag" href="http://medicalxpress.com/tags/tumour/" rel="tag" style="color: #313d57; outline: 0px; text-decoration: none;">tumour</a> motion, averages out the delivered dose while keeping the dose to surrounding normal tissues at a low level. The next challenge will be to bring this novel technique to the point of clinical applicability."</div>
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Espero os guste....</div>
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Tomado de ESTRO Barcelona 2015</div>
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Anonymoushttp://www.blogger.com/profile/15813728138536903553noreply@blogger.com0tag:blogger.com,1999:blog-2676255552208025902.post-46045756733517603262015-04-05T14:24:00.000+02:002015-04-05T14:26:48.339+02:00A veces cuesta esperar..... avalanchas, estampidas, peleas, todo en Semana Santa "la Madrugá"<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://1.bp.blogspot.com/-0Nq9EjU2VlE/VSEp4ZP_15I/AAAAAAAABXY/NQlPtp_ku8s/s1600/20150330_194521.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-0Nq9EjU2VlE/VSEp4ZP_15I/AAAAAAAABXY/NQlPtp_ku8s/s1600/20150330_194521.jpg" height="400" width="225" /></a></div>
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<span style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12.1000003814697px; letter-spacing: 0.242000013589859px; line-height: 19.1180000305176px;"><br /></span>
<span style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12.1000003814697px; letter-spacing: 0.242000013589859px; line-height: 19.1180000305176px;"><br /></span>
<span style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12.1000003814697px; letter-spacing: 0.242000013589859px; line-height: 19.1180000305176px;">La Madrugada de 2015 fue la más accidentada desde la de 2000. Hubo cinco estampidas, todas ellas provocadas por peleas, dos niños heridos, otros dos perdidos durante un rato, dos personas arrojadas al río, un trabajador herido por una explosión y un escape de gas que obligó a desviar la cofradía de la Macarena. Casi todos los incidentes ocurrieron entre las cuatro y las cinco de la mañana, lo que llegó a desbordar durante unos instantes a la Policía y a los servicios de emergencias. </span><br />
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