Patients may be at risk of over-treatment

Despite a health care system burdened by high costs and patients facing long waits for medical procedures, many Canadians are getting unnecessary diagnostic tests and surgeries that may leave them worse off, physicians say.

Patients in their 40s and 50s who have elective knee-replacement surgery, for example, are at increased risk for early failure of the artificial joint, said Gillian Hawker, a rheumatologist and clinical epidemiologist at the University of Toronto.

Revision surgery to repair the artificial joint is a complex procedure that does not always go well, she said. But try telling that to middle-aged patients who insist they need a new knee or hip so they can ski into their golden years, she added. “They will keep looking until they find a surgeon who will operate,” Hawker said. “Then they have surgery and are surprised that, when you hit a new joint hard, it wears out fast.”

Knee replacement surgery is on a list of procedures under review by Canadian provinces in a recent push to reduce unnecessary medical treatments and diagnostic tests. The Health Care Innovation Working Group, an interprovincial body, is re-evaluating procedures including MRIs, joint replacements and cataract removal to set new guidelines on when such interventions are necessary and when they are of questionable benefit.

In the past two years, “there’s been a groundswell of energy focused on overdiagnosis and overtreatment,” said Alan Cassels, a pharmaceutical policy researcher at the University of Victoria and the author of Seeking Sickness: Medical Screening and the Misguided Hunt for Disease (2012).

Primeiro bébé nascido de um óvulo amadurecido em laboratório e congelado

Este nascimento não é comum, senão vejamos: Un equipo de investigadores canadienses ha presentado en la Conferencia de la Sociedad Europea de Reproducción Humana y Embriología el caso del primer bebé nacido de un óvulo madurado en el laboratorio y después congelado.

Óptimas notícias, sobretudo para pessoas com problemas de infertilidade, e também para todos os que gostam dos avanços da tecnologia.

Vejamos, o que nos diz mais a notícia:

• Lo novedoso de este caso es que el embarazo se llevó a cabo después de que el oocito hubiese estado congelado.
• El bebé nació de una de las 20 mujeres con síndrome de ovario poliquístico que participaron en este estudio elaborado por el Centro de Medicina Reproductiva McGill de Montreal, Canadá.
• Las mujeres con cáncer que deben someterse a un tratamiento de quimioterapia podrían ser unas de las potenciales beneficiarias.
• Hoy en día se emplean dos técnicas para ayudar a estas pacientes: la fecundación 'in vitro' y el trasplante de tejido ovárico.
• La nueva técnica "es importante porque hasta ahora una mujer con cáncer no tenía tiempo de reaccionar, ya que el tiempo medio que se necesita desde la primera visita hasta que se extrae los óvulos maduros (tras una estimulación ovárica) es de unos 21 días. Con este método el tiempo se reduce a siete días. Algo fundamental en una paciente oncológica", señala el doctor Juan Antonio García Velasco, director del Instituto Valenciano de Infertilidad en Madrid.

Ou seja, esta nova técnica de reprodução humana, vem ajudar todas as mulheres que padeçam sobretudo de doenças oncológicas, mas que queiram ter filhos. Ainda bem, que há sempre quem traga esperança à área da saúde.

Primeira urgência hospitalar privada

A notícia é esta: Canada's first private clinic to treat emergency patients has opened.

Sabemos que o Canadá tem um dos melhores sistemas de saúde do mundo, mas o sector privado da saúde viu uma oportunidade de negócio e arrancou com uma urgência hospitalar. Contudo, parece-nos que o arranque tem algo de parecido com o exercício da medicina em Portugal, se não vejamos:

• "We've got a wonderful thing here," Dr. Gordon Bird, the facility's medical director.
• Bird is among 24 doctors who work in emergency departments around the Vancouver area and are also employed by the Urgent Care Centre.
• "That's one of the principles of our organization, that all physicians continue to practise in the public system," .
• "Isn't that dual practice, Dr. Bird?" asked a reporter. "We'll continue, we'll have more questions later," said Bird, appearing flustered.

De facto, há qualquer coisa de inconsistente, conforme observa o Primeiro Ministro Canadiano, Stephen Harper:

• "Dual practice creates conflict of interest for physicians as there would be a financial incentive for them to stream patients into the private portion of their practice,".
• "Furthermore, dual practice legitimizes queue-jumping as it provides an approved mechanism for patients to pay to seek treatment at the front of the line," .

Contudo, há quem ache que a nova clínica vem melhorar a ineficiência do sistema público: "Dr. Mark Godley, the operator of the "state-of-the-art" 10-bed clinic, has said the clinic will help ease overcrowding in emergency wards where people have to wait too long for treatment".