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Discussion of Clinical cases

Attenzione: apre in una nuova finestra.

The constant help of the HON (Health On the Net Foundation) team is key to the dissemination of information to the 14,000 members of the OESO network.
On the last Wednesday of each month, they receive by means of the OESO Newsletter (Current Topics in Esophagology) the elements of a chosen, anonymous patient file which is put for discussion during a whole week on a special Forum organized with the University of Vienna (Prof. Pokieser and Dr A. Hirsch).

The login is free, and all the preceding cases can be accessed with the same connection: the medical history is first briefly summarized, with all relevant illustrations from the patient's file, and the starting point of the discussion is there, allowing the community to react on the case, the information being combined with the database of the OESO Foundation.

Then, on the following Monday, the additional part of the file is showed, usually dealing with therapy and the results obtained. The entire discussion will, in fine, have lasted one full week on the Forum.

To date, 18 cases have already been discussed with an overall contribution of 700 people from all countries, most of them however preferring to watch the exchanges between experts, rather than presenting their opinion worldwide.  Thus, the OESO Foundation has now at its disposal a selection of 18 cases mainly discussed between specialists, which lends particular attraction to some clinical settings such as, for instance Eosinophilic Esophagitis where the literature is somewhat new and does not commonly allow for public exchanges between top, world renowned experts.  
Access to this library of cases represents a valuable addition to the written literature that may be found on the web and has now become a valuable instrument to acquire knowledge and to enrich it month after month (J.M. Collard).

The work of OESO, functioning on high standard information technology for its database, is a perfect example for an integrated system based on a repository which is the basis for communication and multi-disciplinary actions.
The decision of the Foundation to implement a combination of its unique database with a monthly action disseminated twice among 14,000 people allowed for fostering a kind of heartbeat of the OESO, the biennial Conferences remaining the scientific grounds witnessing the scientific weight of the repository.

The discussion that follows shows the particular importance this initiative has for the reputation of OESO and how it has maintained  credibility for the undertakings of the OESO Foundation:

"Intelligence is not the neurons, but the synapses".


  • Recognition is expressed to Professor Pokieser and his team for their strict and unyielding sticking to the regular presentation of a new case (now up to 18), carefully selected and prepared in advance with 2 parts, the first one shown on the last Wednesday of each month and the second one on the following Monday, the entire file being then managed by the HON team. Month after month, the number of those connecting, mainly to observe the discussions, regularly increases, including representatives of new countries that were not formerly included in the OESO mailing list (especially in the Middle East), thanks to the HON team (V. Baujard) that developed a special software for this purpose, allowing for immediate and true evaluation of all those having connected on ones given case, or on the entirety of the cases.
  • The OESO cases could be linked to other platforms, where other colleagues will certainly be interested in contributing to the discussions.
  • The discussions proposed on the OESO Foundation website should not be of interest for esophageal experts only, but also for general practitioners, and even for patients who could express their opinions that might not relate to the case, but to common questions dealing with esophageal disease (P. Pokieser).
  • Such an eventuality may obviously pose ethical or even legal problems (J.M. Collard), but the way to proceed  is to give patients having a problem related to esophageal disease access to a Forum where they can discuss between themselves, in that case the Foundation bearing no responsibility for the opinions expressed.

- Patients could then refer to a document drawn up by the members of the Executive Committee of the Foundation comprising a number (50 to 100) of answers provided in advance in various domains to give reliable information to the patients who would know that renowned specialists were responsible for the answers.
- This incentive for patients, in addition to that already existing for physicians, would represent a huge opportunity for the OESO Foundation website to develop.

  • Public enhancement of this process has already benefited from the experience drawn from the clinical discussions on a patient forum already tested with students at the University of Vienna (P. Pokieser), with special reference cases of appearance similar to that of the expert cases, but with a didactic content specifically selected for students. Universities have not enough time to provide such information, and many students are now interested in downloading such teaching material for free on the web.
  • Indeed (Mr F. Welvaert), the patient is usually left out of the dialogue, and is not represented in this kind of forum. In the days of social media, these conditions are quickly changing and, even if there may be some ethical questions to be addressed, this initiative would be a fantastic addition to the undertakings of the Foundation, giving an even broader perspective to them. Based on the long experience of the members of the Foundation, it should be easy to identify a comprehensive series of subjects which, in different domains, constantly come back from patients during one's practice.

It should the be possible to create,
- either standard answers in a literary way,
- or in the form of a webinar where people can post on a voice mail or connect with someone who could respond to a question.

  • In addition, it should be pointed out the need for the Foundation to carefully see that scientific knowledge is translated into human language, even giving "down to earth" answers to apparently elementary questions. This, too would broaden the scope of the network of the Foundation, and make it even more powerful.
  • For this, another point to be considered is that of the language (J.M. Collard, F. Vicari): a very high percentage of Western people do not understand English and should be able to ask their questions, as well as to get the standardized replies, in their own language. Such a possibility is already available in the OESO Foundation, (R. Giuli) by means of an original tool developed with OESO by HON (V. Baujard) for the updating of the OESO books available on the website of the Foundation: audio-reading of the texts is already possible, with a choice among #10 different languages including Russian, Arabic, and Chinese, thus allowing for its easy implementation on the Forum.
  • The merit of offering patients the opportunity to share clinical experience is evident (B. de Combret). However, although broadening the scope would certainly be attempted, it should be kept in mind that OESO's main ambition is to spread clinical and technical knowledge among those who are responsible for treating patients, with a tool which is at their service in the Foundation, and which is in the hands of those who will cure them. Mixing of priorities should be evaluated with great care.