Sunday, August 30, 2009

Thursday, February 10, 2005

paginna dee acupuntura

Response to the House of Lords Select Committee Science and Technology, Sixth report, Complementary and Alternative Medicine From the British Medical Acupuncture Society,January 2001
The British Medical Acupuncture Society (BMAS) welcomes many of the report's findings and recommendations in particular:
acupuncture should only be accessed following conventional medical diagnosis
acupuncture practitioners should have an understanding of the principles of evidence-based medicine and health care
those offering acupuncture should be able to perform audit and keep up with current developments by regular Continuing Professional Development
a desire to fund acupuncture research to establish evidence of efficacy using randomised controlled trials and other appropriate design methodologies, together with active support for therapists embarking on research projects
acknowledgement that the holistic view of the patient is common to many conventional medical disciplines and not the exclusive province of CAM therapies.
the themes of the core curriculum suggested for CAM courses
those who practice acupuncture and who are not currently regulated by statute should seek statutory regulation
Medical Acupuncture and Traditional AcupunctureThere are many aspects of the practice of acupuncture by members of the British Medical Acupuncture Society which have not been made clear in the report.
In contrast to the position of the medical and non-medical homeopaths who share a similar philosophic view of homeopathy, the British Medical Acupuncture Society has a very different philosophy towards acupuncture compared with the British Acupuncture Council.
The members of the British Acupuncture Council use acupuncture within the context of Traditional Chinese Medicine (TCM). This is a position which has been confirmed by their representatives at all our joint meetings.
Well established acupuncture schools which are accredited by the BAcC all emphasise their TCM diagnostic and treatment methods. In contrast, the BMAS has always looked at acupuncture from a western, medical, neurophysiological and scientific point of view. Much of the scientific evidence supporting the modes of action of acupuncture was presented in both oral, published and written form to the committee.
The Evidence for AcupunctureThe evidence for the efficacy of acupuncture e.g. for nausea and pain, comes from well conducted research of the western scientific application of the treatment, not from TCM acupuncture. As is pointed out in the report, there is no established evidence base supporting TCM nor of the TCM use of acupuncture.
TrainingThe report recommends that if CAM is to be practised by any conventional health care professional they should be trained to standards comparable to those set out for that particular therapy by the appropriate single body. Further it recommends closer collaboration between the various CAM bodies, in this case the BAcC and the BMAS.
At present it is impossible to bridge the philosophical gap between our two organisations. If doctors were required to train to the same standards as traditional acupuncturists, it would imply that BMAS members should forgo their scientific understanding of pathology, disease and therapeutics to form diagnoses rooted in TCM. It would suggest that a training in e.g. pulse and tongue diagnosis (which have not been found to give a consistency of diagnosis), indicating imbalances in Qi yin and yang or the Five Elements, is required in order to practice acupuncture.
The philosophy of the BMAS has been to teach acupuncture to medical practitioners, to enable them to use it as a part of their medical practice, from an evidence base of the best of current research. There is therefore a huge gulf of philosophy between the BAcC and the BMAS and it would be unacceptable to our members to be required to train in TCM.
We support the principle that medical students and post graduates are familiarised with acupuncture. The BMAS is currently engaged in formulating an undergraduate course with Oxford University. We have an established training and accreditation programme in acupuncture for post graduate doctors.
RegulationThe members of the BMAS regard themselves primarily as doctors. Acupuncture is simply one of many techniques they can use for the benefit of patients. Our society strongly feels that the GMC should remain the single regulatory body for BMAS members practising acupuncture. The GMC is already responsible for regulating the use of all CAM therapies by doctors.
As is pointed out in the report, there is no credible evidence for TCM and the GMC is able to discipline a doctor for putting patients at risk by practising a totally unproven therapy, not supported by evidence. We therefore feel that our evidence based approach is best for use in the medical context.
Furthermore, given these fundamental philosophical differences in the basis of our diagnoses and treatments, we could not accept that the regulatory body of traditional acupuncturists would be in a position to judge whether or not our members were practising acupuncture well or poorly.
Conversely we would not seek to judge the validity or otherwise of the TCM diagnosis and treatment by traditional acupuncturists. We respect the right of those practitioners of traditional acupuncture to continue treating their patients within a statutorily regulated framework. We believe that this would give extra safeguards to the public particularly given the lack of evidence for its theoretical base in TCM.
Public informationThe BMAS is keen to collaborate more closely with all relevant bodies, to develop reliable public information sources and we are currently in discussion with the BAcC and the AACP to see if agreement can be reached. From our own standpoint we are very clear that our members are able to offer acupuncture as a therapy within the context of western medicine.
We have been informed of cases where non medically qualified acupuncturists have been using the title Dr. and have given ambiguous answers when asked if they were medically qualified. A clear statement of any acupuncture practitioner's training and background is obviously fundamentally important for patient safety and choice.
Protection of titleProtection of title is an important issue.Given the large differences in background and practice between the BMAS and the BAcC, we feel that this difference should be recognised in the titles used to differentiate between our respective members. The title medical acupuncturist is suggested for members of the BMAS. Perhaps a title such as traditional acupuncturist or professional acupuncturist could be used by those members of the BAcC who use a traditional approach. The membership of the BMAS regard themselves primarily as doctors who use acupuncture as a treatment modality. We would wish to retain the right to use the term "acupuncture" as a description of this treatment we offer.
Acupuncture in the NHSThe bulk of acupuncture in the NHS is given by BMAS members, the majority of whom are general practitioners and pain specialists. Both these medical disciplines in particular, are taught to take an holistic view of the patient tailoring each plan of treatment to the individual. Given the duty of care to the patient as well as a duty of fiscal management given the limited resources of the NHS, we feel that the teaching and practice of acupuncture should be evidence based, where this exists. Studies by our members have shown acupuncture treatment in primary care has been effective in reducing the need for referral to secondary care in certain musculoskeletal and pain conditions.
ResearchThe chairman of the BMAS research committee, Dr Adrian White, is a Research Fellow at the Department of Complemetary Health Studies at Exeter University. Advice is given to our members regarding research methodology.
The secretary of the BMAS, Dr Jacqueline Filshie, recently organised a seminar for international research workers in the field of acupuncture. The International Acupuncture Research Forum is a result of this meeting and is actively discussing how to improve trial methodology.
Audit and research has always been encouraged and disseminated at our two Scientific Meetings which are held each year.
We would be very glad to hear of any sources of future funding for research in acupuncture and would be glad to assist on any funding bodies.
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Dr Hywel WatkinPresident British Medical Acupuncture Society 11 January 2001
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Thursday, July 29, 2004

Oxímetros de pulso
Los oxímetros de pulso monitorean de forma no invasiva la saturación de oxígeno (expresada como porcentaje o en decimales) de la hemoglobina arterial midiendo los cambios de absorción de luz que resultan de las pulsaciones del flujo de la sangre arterial. Su uso permite el monitoreo continuo e instantáneo de la oxigenación; la detección temprana de hipoxia antes de que ocurran otros signos como cianosis, taquicardia o bradicardia; y reducir la frecuencia de punciones arteriales y el análisis de gases sanguíneos en el laboratorio. Puede ocurrir hipoxia si se administran involuntariamente mezclas hipóxicas de gases durante la anestesia general, si las mangueras de gas se obstruyen durante la operación, si el suministro de oxígeno se interrumpe después de la operación mientras se transporta al paciente al pabellón de recuperación o si un procedimiento o una enfermedad (por ej., anestesia espinal, broncoscopia) bloquea las vías respiratorias u obstaculiza el proceso de respiración; la hipoxia prolongada puede causar daño cerebral irreversible o la muerte.
La oximetría de pulso puede detectar el descenso de los niveles de saturación de oxígeno antes de que ocurra daño y, en general, antes de que aparezcan los signos físicos.
Antes del desarrollo de la oximetría de pulso, los métodos que generalmente se usaban paraevaluar la oxigenación de los pacientes eran visuales (por ej., se observaba la palidez o la presencia de cianosis) y el análisis de sangre arterial; ambos métodos tienen inconvenientes considerables. La observación directa no es un indicador uniforme ni fidedigno de hipoxia. El análisis de sangre arterial, aunque exacto, es invasivo, costoso y lento, y la oxigenación del paciente puede cambiar antes de que se reciban los resultados de laboratorio; además, esta técnica proporciona solo indicios intermitentes de la saturación de la sangre arterial. Los oxímetros de pulso son muy fáciles de comprender y usar y, aunque no han reemplazado el muestreo de sangre arterial, han reducido la frecuencia de los análisis de gases sanguíneos, con lo cual han eliminado muchos procedimientos costosos de laboratorio.
Los oxímetros de pulso proporcionan una evaluación espectrofotométrica de la oxigenación de la hemoglobina (SpO2) al medir la luz transmitida a través de un lecho capilar, sincronizada con el pulso. El sistema de detección consta de diodos emisores de luz (LED)de una sola longitud de onda, fotodetectores y microprocesadores.
Los oxímetros de pulso se basan en el principio de la absorción diferencial de la luz para determinar el porcentaje de saturación de oxígeno de la hemoglobina en la sangre arterial (SpO2; este valor se denomina SaO2 cuando se determina a partir de una muestra de sangre arterial).
La sonda del oxímetro de pulso se aplica a una región del cuerpo, por ejemplo, a un dedo de la mano o del pie, o a la oreja. La sonda transmite dos longitudes de onda de luz (por ej., 660 nm [roja] y 930 nm [infrarroja]) a través de la piel. Estas longitudes son absorbidas diferencialmente por la oxihemoglobina, que es roja y absorbe la luz infrarroja, y la desoxihemoglobina, que es azul y absorbe la luz roja. La razón entre la luz roja y la infrarroja se usa para derivar la saturación de oxígeno. El fotodetector al otro lado del tejido transforma la luz transmitida en señales eléctricasproporcionales a la absorción.
Luego, la señal es procesada por el microprocesador del equipo, que presenta una lectura y activa una alarma si las condiciones satisfacen los criterios de alarma.
Cada pulso de la sangre arterial hace que el lecho capilar se expanda y se relaje. Las variaciones cíclicas resultantes en la longitud de la trayectoria de la luz transmitida permiten al dispositivo distinguir entre la saturación de hemoglobina de la sangre arterial (pulsante) y la de la sangre venosa, y los componentes tisulares porque no hay ningún pulso del tejido circundante y el pulso de la sangre venosa es insignificante. El microprocesador compara la relación entre los valores de absorción de la sangre arterial pulsátil con los datos almacenados derivados de los estudios invasivos en seres humanos para calcular y presentar la SpO2. Algunos equipos sincronizan las mediciones de absorción con la onda R de la señal de electrocardiograma (ECG) para detectar artefactos de movimiento (esta técnica impide que las señales extrañas se confundan con las señales de pulso) y algunos tienen memoria para seguir la tendencia de la SpO2 de un paciente a lo largo del tiempo. A fin de reducir las pequeñas variaciones de los valores presentados de saturación de oxígeno y contrarrestar los valores falsos de las formas de onda resultantes de artefactos, los oxímetros de pulso emplean algoritmos para promediar los datos y reconocer los artefactos.
La mayoría de los oxímetros de pulso también ofrecen otras características de representación visual de los datos, incluida frecuencia de pulso, límites de alarma relativos a la saturación de oxígeno y frecuencia de pulso, pletismogramas, gráficos de cálculo análogos o de barras que indican la amplitud del pulso, y diversos mensajes del estado del sistema y de los errores. En los equipos modulares, esta representación visual de datos forma parte del dispositivo principal al cual está conectado el equipo.
Las alarmas sonoras generalmente se activan cuando se sobrepasan los límites de la SpO2 o de la frecuencia del pulso, y a menudo el tono que marca cada pulso variará conforme a los cambios de la SpO2. La mayoría de las alarmas sonoras pueden desactivarse manualmente, ya sea momentánea o permanentemente.
© ECRI. Traducido con permiso de ECRI, por la Organización Panamericana de la Salud.