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2.0 MIR 2011: Medical Immunology, a specialty endangered Hemi-Immunology

This weekend I came home and I've come to the event for an entire graduating class of undergraduates in medicine, the conclusion of proof of access to specialized health training, or examination MIR. Is tension in the air breathed, Avenida Ramón y Cajal Viapol vertebra was completely packed. Even a passer-by asked what was happening there if it was a protest or a celebration. Rather, second, banners, clappers and other instruments of agitation and excitement mingled with the buzzing audience gathered there to encourage his people to embrace them back to reality. Congratulations you're done! It was one of the most listened to screams, and other less politically correct (Give us down, write down !)...

However this meeting as well as test the surprises themselves, has brought some others, especially with regard to the specialty of this blog is often more economical to make, Immunology, and especially of Immunology Clinic or doctor. For this promotion has been examined have been called 29 places of Immunology, of which only 7 may be filled by graduates in medicine, in Spain!

The list of hospitals that have achieved their future places for resident physicians in Immunology are:

Hospital Universitario Marqués de Valdecilla (Santander): 1 square. Complex Care
de León (León): 1 seat.
Hospital Universitario La Paz (Madrid): 1 square.
Universitario Ramón y Cajal Hospital (Madrid): 1 square.
Hospital Universitario Puerta de Hierro Majadahonda (Madrid): 1 square.
Hospital Universitario Clínico San Carlos (Madrid): 1 square.
Hospital General Universitario Gregorio Marañón (Madrid): 1 seat.

From this list, and last year, have dropped major hospitals, great weight and importance of media research and care, such as the Hospital Clinic of Barcelona, \u200b\u200bthe Hospital de la Santa Creu i Sant Pau, also in Barcelona, \u200b\u200bthe Hospital Universitario de Badajoz, Hospital Donostia-San Sebastian, Hospital Universitario Central de Asturias, Oviedo and Hospital de Son Dureta in Palma de Mallorca.

In this way, are only seven hospitals MIR offering teaching in Immunology, profiled the Community of Madrid as one of the last bastions and the largest by number of schools for Medical Immunology. It seems that at least we are there and on this boat, we picked a good place to train and develop our discipline, our profession and our vocation.

Is this a set back? What will the specialty in the future? Will there Immunology? Doctors are not needed and why this decrease in the number of seats?

is completely incomprehensible to me this drastic decrease in the number of places offered. My day to day as rotating interns in Immunology purely clinical services is teaching me that what the health claim is completely opposite, and is showing me the importance of our dual specialty, clinic and laboratory for the diagnosis of autoimmune diseases , monitoring and treatment, and therapeutic specialists and consultants as well as potential partners in multiple research projects with colleagues from other specialties in our area, one of the least known in scientific and clinical today.

This decision, I fear that Spain has sealed his resignation as an exporter of knowledge and advances in Autoimmune Diseases. Maybe we is cheaper to buy foreign technology to adjust budgets. So it is a country and then leave us. Fortunately, in other places do not follow our example.

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Since it began to take shape the idea of \u200b\u200bthe backbone for Specialized Health Care Training, rumors have been numerous. In this day and age, when the real implementation of the new system is far, theoretically, a single promotion of graduates, rumors have become ever tighter.

In the specialty of Immunology, despite the rejection of much of the medical immunologists, it seems that we can not escape from the trunk of laboratory and that the chances of becoming part of the trunk doctor are more than scarce. This, which could be described as crazy, is not as bad news if you consider the other possibility being considered is so crazy and unreal: divide Immunology Clinical Immunology Laboratory Immunology.

Our specialty is in Spain itself and the little sister of other specialties that treat autoimmune diseases related to immunity, it would thus deprived of what I believe is one of its main assets: the dual clinical and laboratory. Separating the two areas is tearing the very essence of the Specialty and deny the projection innovation and research that now has and can develop. Thus breaking Immunology is to say NO to translational research is to deny the head-based comprehensive approach and a field so unknown and not well treated as immune system diseases.

Immunology Separate into two blocs would be to dissect the Hematology, pushing its clinical-care activities of lab activity. Something as crazy as the time ... possible. We'll see how everything is.

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What Google knows Medical Records? Here come the drugs

At this point in the XXI century the health authorities finally been put to work and are most and least are prepared, if not using the tools of ICT in the day to day care to patients. But the road to EHR has been neither an easy still. The main difficulty faced by developers is the inconsistency or inability to export the data from each patient at each point of care, because they differ utiilizan programs at each hospital, even within the same region and the same health area.

Other problems have to do with the actual design of the HCE program. The programs that I could get to know so far (in my Hospital) are limited to specialties index for each of the reports made to a patient resulting from the different periods of hospitalization or consultation in the emergency department, regardless what happens in consultations and primary care specialties, that is, leaving us with digital access to such health events that have happened to a patient in each of the longest and most important periods for HEALTH (in capitals), which is none other than stay at home and their integration into society.
HCE
Other models, developed in the shadow of American private health system essentially have been conceived from a perspective diametrically opposed. Since the patient is not only patient but customer, and because it can go one day at a hospital and following a consultation with a thousand miles away, is the patient who can fill their own medical records with data and reports you are providing physicians with those obtained from devices such as blood pressure, capillary blood glucose measuring devices or scales, etc. In this line both Google with Google Health and Microsoft with HealthVault have developed programs accessible from any computer connected to the Internet for patient-consumer will enter the data from their various consultations and can show the doctors I need to see.

Another approach is the network of "social" Patients Like Me, a website where patients share the same pathology data on disability and the progression of their disease, with almost daily updates. Patients can see their progress (or regression) for themselves over time and compared with other patients, thus accessing information about their condition "equals", which can then be anonymized and exported to the Health Sector, collecting data for R + D + i. No

HCE model so far has managed to remove the final barrier to its implementation, which is the interconnection and portability of data to other systems, however, making a superficial overview of some of the designs, I try to improve easier HCE our system of collecting the different ideas applied in each of them:

• A linear model based on a time scale that emphasizes simple and visual way the most important events of all the attention in the Healthcare System so far and upcoming consultations mentioned above.
  
• A HCE program valid for the entire attendance area, including data on episodes of hospitalization, primary care, specialty, emergency, additional tests and treatments prescribed.
  
  
• An architecture that allows further analysis of all data, compared with other patients, not to lose any data and facilitate research.
  
  
• An approach consistent with the national model of health, in which the clinical history is written and directed by health care professionals but also open to participation patient's fundamental actor in the care process.
  
  
• This opening up of the patients medical history could illuminate, as it does in the American models, the dark period between consultation and consultation or hospitalization and hospitalization. Open history, or a part thereof, to patients, could thus provide us with new symptoms and know in depth the capabilities or limitations of patients in their usual social environment and could serve, if we manage to use rationality to advance , delay or include further consultation on any of the levels of care.

any event, the EHR has been, fortunately, to stay between us and sometimes even more tedious to find a free computer to write updates to every patient who only a pen and a paper, ICT will eventually be imposed for its many advantages (especially for R + D + i) versus traditional ways. It would therefore be very interesting to watch and take note of the positions that the giants of the computing and communication have taken on this matter.

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siRNA

Medical Journal today has published in its print edition (I could not find the link in your digital edition) two columns on-TKM PLK-1, a drug that based on the technique of RNA interference, is directed by invitro studies against the protein kinase Polo-like-1 (Plk1), preventing cell division and facilitating apoptosis.

I refer here to this technique because it was the same who, while claiming the opposite effect, I had the chance to meet six years ago in the laboratory of Dr. Bähr at the University of Göttingen, where he investigated with models retinal ganglion cells apoptosis process and how to get his arrest in order to shed light on diseases in which programmed cell death appeared to be critical, as was the case with the cells of the substantia nigra in Parkinson disease.