Integrated patient care
It is helpful to have a goal, even in the knowledge that it can never be reached. Some enthusiasts in the Integrating the Healthare Enterprise (IHE) community, including myself, follow the road towards developing IHE integration profiles to reach the goal of an integrated patient care (IPC), see figure 1, even knowing that it means reaching for the impossible.

The eight components contributing towards IPC shown in figure 1 are not representative of healthcare in general, but may be seen in the context of decision making for patient-specific therapeutic approaches. The healthcare unit which typically plays a major role in the process of therapy decision making is the therapy planning unit or tumour board. Here, ideally, many information sources available about the patient (radiology, pathology, oncology, surgery, etc.) should be considered before subsequent diagnostic or therapeutic steps are being taken.

In a real clinical setting this means that a combination of quantitative and qualitative information about the patient has to be mentally integrated by the physician to create an abstract representation (model) of the patient. This model must be as close as possible to reality to serve as a basis for decision making in medical diagnosis and therapy.
Based on the model created in the physician

In Europe prostate cancer (PCa) is currently the most commonly diagnosed cancer in men- around one in six in the West will eventually be diagnosed with the disease- but the majority of patients will die of unrelated causes. There are two major problems related to PCa diagnosis: firstly, because of the lack of a highly sensitive and specific biomarker, many elderly men without cancer, or with clinically insignificant tumours confined to the prostate gland, are still undergoing unnecessary biopsies. Secondly because of its random nature, the standard method of biopsy, the transrectal ultrasound biopsy (TRUS), frequently detects low risk cancers that do not need aggressive therapy but fails to detect many clinically significant tumours in the less accessible areas of the gland. Recent studies suggest that multiparametric MRI (mp-MRI) pre-biopsy, to identify suspicious areas, followed by targetted biopsy using MR-ultrasound fusion, which combines detailed MRI scans with real-time ultrasound images of the prostate, is the better approach.
One preliminary prospective cohort study reported last year was carried out at the US National Cancer Institute. During a seven year period more than 1000 men underwent mp-MRI followed by MR-ultrasound fusion and concurrent TRUS. Whole-gland pathology of the prostate was also carried out after any prostatectomies. It was found that MR-ultrasound fusion diagnosed 30% more high risk tumours and 17% fewer low-risk tumours than TRUS. However data are still needed on disease recurrence and PCa mortality, and the authors consider that random clinical trials should be carried out to determine eventual clinical outcomes. A retrospective analysis involving more than 600 Brazilian patients with suspected PCa was also reported recently with 286 patients undergoing MR-ultrasound fusion biopsies and 331 patients undergoing random ultrasound-guided biopsies. Again the former technique detected significantly more patients with high-risk cancer requiring surgery and significantly fewer low-risk tumours where only surveillance was needed. There are of course financial impacts of purchasing and using such technology, but improved patient risk stratification may well result in a negligible net cost increase.
Hopefully MR-ultrasound fusion can replace techniques such as TRUS for suspected PCa diagnosis, but a question still remains. Is it really always necessary to treat clinically significant PCa by radical prostatectomy or radiotherapy of the entire organ when erectile dysfunction, urinary incontinence and intestinal problems are such common side effects? Would it not be possible to utilize appropriate imaging technologies and confine treatment to the affected area of the gland?

The communications revolution has opened up dramatic possibilities for healthcare delivery across physical/geographical boundaries. Telemedicine, once held up as a miracle, and then seemingly forgotten, has been making a comeback in one of the most challenging frontiers of modern medicine – the ICU.
High-speed communications have also paved the way for ambulance-based telemedicine.

Cardiovascular disease (CVD) is a major cause of death and disability across the world. In recent decades, the battle against CVD has focused on prevention, with the management of lifetime cardiovascular (CV) risk superseding treatment of individual cardiovascular (CV) risk factors. Such a strategy in turn is anchored in two complementary approaches – a population-based one promoting community health (e.g. anti-smoking campaigns, diet and nutritional management) and a clinical approach targeted at high-risk individuals.