7 razones por las que vale la pena investigar en medicina en Colombia

De manera cotidiana siempre se ha considerado que el fin último de la investigación médica en cualquier país debe tener como propósito único la generación y apropiación de conocimiento necesarios para garantizar el mejor estado de salud posible sobre la mayor cantidad de pobladores que le constituyen. Se trata entonces, de una transferencia de conocimiento encaminado a utilizar la mejor evidencia disponible para ofrecer un tipo de atención médica racional e integral, y realmente bajo la óptica de una concepción filantrópica, es indudable que en cualquier latitud debe ser así

The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis

Background: Pharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country. Methods: Decision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective. Results: The model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (USD200vs USD240 average cost per patient), and higher QALYs (0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio. Conclusion: The nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries

Cost utility of fractional exhaled nitric oxide monitoring for the management of children asthma

Introduction Fractional exhaled nitric oxide is a simple, non-invasive measurement of airway inflammation with minimal discomfort to the patient and with results available within a few minutes. This study aimed to evaluate the cost-effectiveness of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age. Methods A Markov model was used to estimate the cost-utility of asthma management using fractional exhaled nitric oxide monitoring versus asthma management without using fractional exhaled nitric oxide monitoring (standard therapy) in patients between 4 and 18 years of age. Cost data were obtained from a retrospective study on asthma from a tertiary center, in Medellin, Colombia, while probabilities of the Markov model and utilities were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective. Results The model showed that fractional exhaled nitric oxide monitoring was associated with a lower total cost than standard therapy (US $1333 vs. US$1452 average cost per patient) and higher QALYs (0.93 vs. 0.92 average per patient). The probability that fractional exhaled nitric oxide monitoring provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds. Conclusion Asthma management using fractional exhaled nitric oxide monitoring was cost-effective for treating patients between 4 and 18 years of age with mild to moderate allergic asthma. Our study suggests evidence that could be used by decision-makers to improve clinical practice guidelines, but this should be replicated in different clinical settings

For which infants with viral bronchiolitis could it be deemed appropriate to use albuterol, at least on a therapeutic trial basis?

Although there is increasing evidence showing that infants with viral bronchiolitis exhibit a high degree of heterogeneity, a core uncertainty shared by many clinicians is with regard to understanding which patients are most likely to benefit from bronchodilators such as albuterol. Based on our review, we concluded that older infants with rhinovirus (RV) bronchiolitis, especially those with a nasopharyngeal microbiome dominated by Haemophilus influenzae; those affected during nonpeak months or during non-respiratory syncytial virus (RSV) predominant months; those with wheezing at presentation; those with clinical characteristics such as atopic dermatitis or a family history of asthma in a first-degree relative; and those infants infected with RSV genotypes ON1 and BA, have the greatest likelihood of benefiting from albuterol. Presently, this patient profile could serve as the basis for rational albuterol administration in patients with viral bronchiolitis, at least on a therapeutic trial basis, and it could also be the starting point for future targeted randomized clinical trials (RCTs) on the use of albuterol among a subset of infants with bronchiolitis

Impact of social containment measures during the COVID 19 pandemic on the demand for health resources due to acute respiratory infection in the Pediatric Service of the Central Military Hospital.

El propósito de esta investigación es determinar el impacto de la implementación de las medidas de salud contra Covid-19 emitidos por el ministerio de salud colombiano y la Organización Mundial de la Salud, durante la pandemia entre la semana epidemiológica 10 hasta la semana 27 de 2020, comparado con las medidas preventivas tomadas durante el mismo periodo del pico respiratorio en el 2019 en cuanto al uso de recursos sanitarios en niños mayores de 1 mes y menores de 5 años con infección respiratoria aguda que ingresan al servicio de urgencias del hospital Militar Central a través de la captura electrónica de datos de historias clínicas en los períodos analizados, la muestra fue de 583 sujetos de los cuales 542 consultaron por causa respiratoria en 2019 y 41 sujetos en 2020, encontrando una disminución significativa en las variables analizadas como ingreso a urgencias, ingreso a sala ERA, hospitalización e ingreso a unidad de cuidados intensivos pediátricos, lo que confirma una disminución en la demanda del uso de recursos sanitarios en la población estudiada, estos resultados podrán transformarse a costos sanitarios y de esta manera determinar si la estrategia de lineamientos de contención contra la pandemia Covid-19 resultarían costo-efectivas para futuras pandemias o para la contención de otros picos epidemiológicos virales.1. ÍNDICE 2 2. RESUMEN 5 3. INTRODUCCIÓN 6 4. IDENTIFICACIÓN Y FORMULACIÓN DEL PROBLEMA 5. OBJETIVOS E HIPÓTESIS 7 5.1 GENERAL 7 5.2 ESPECÍFICOS 7 5.3 HIPÓTESIS CONCEPTUAL 8 6. METODOLOGÍA. 9 6.1 LUGAR DE DESARROLLO DEL ESTUDIO 9 6.2 POBLACIÓN 9 6.3 SELECCIÓN DE LA MUESTRA 9 6.4 TAMAÑO DE LA MUESTRA 10 6.5 CRITERIOS DE SELECCIÓN 10 6.5.1 INCLUSIÓN 10 6.5.2 EXCLUSIÓN 11 6.6 PROCEDIMIENTO 11 6.6.1 DEFINICIÓN DE VARIABLES 12 6.7 ESTRATEGIAS PARA SUPRIMIR AMENAZAS 16 6.7.1 CONTROL DE ERRORES Y SESGOS 16 A. MEDICIONES E INSTRUMENTOS A REALIZAR: 17 B. PROCESOS 17 7. PLAN DE ANALISIS 18 8. RESULTADOS/PRODUCTOS ESPERADOS Y POTENCIALES BENEFICIARIOS: 19 9. ASPECTOS ÉTICOS 19 10. RESULTADOS 21 11. DISCUSIÓN 28 12. CONCLUSIÓN 34 13. REFERENCIAS BIBLIOGRÁFICAS 34 14. TRAYECTORIA DE LOS INVESTIGADORES 35 15. ANEXOS 35The purpose of this investigation is to determine the impact of the implementation of health measures against Covid-19 issued by the Colombian Ministry of Health and the World Health Organization, during the pandemic between epidemiological week 10 and week 27 of 2020, compared with the preventive measures taken during the same period of the respiratory peak in 2019 in terms of the use of health resources in children older than 1 month and younger than 5 years with acute respiratory infection who enter the emergency service of the Central Military hospital through the electronic capture of data from medical records in the periods analyzed, the sample consisted of 583 subjects, of which 542 consulted for respiratory causes in 2019 and 41 subjects in 2020, finding a significant decrease in the variables analyzed such as admission to the emergency room, admission to the ERA room, hospitalization and admission to the pediatric intensive care unit, which confirms a decrease in the demand for the use of health resources in the population studied, these results can be transformed into health costs and in this way determine if the strategy of containment guidelines against the Covid-19 pandemic would be cost-effective for future pandemics or for the containment of other viral epidemiological peaks.Especializació

The cost-utility of intravenous magnesium sulfate for treating asthma exacerbations in children

Introduction Although evidence supports the use of intravenous magnesium sulfate (MS) in asthma exacerbations, MS continues to be considered a second‐line drug for managing pediatric asthma exacerbations. This study aimed to evaluate the cost‐utility of MS in asthma exacerbations. Methods We used a decision tree model to estimate the cost‐utility of MS compared to treatment without MS (control group) in children with asthma exacerbations. Cost data were obtained from a retrospective study from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Probabilistic sensitivity analysis was carried out using the Monte Carlo technique with a simulation of a hypothetical cohort of 10 000 patients to generate expected cost utilities with 95% confidence intervals. We used a cost‐effectiveness acceptability curve to evaluate the uncertainty surrounding the cost‐utility of MS. Results The model showed that MS had a lower total cost than the control group (US $1149 vs US$1598 average cost per patient) and higher quality‐adjusted life years (0.60 vs 0.52 average per patient), showing dominance. The probability that MS provides a more cost‐effective use of resources compared with standard therapy exceeds 99% for all willingness‐to‐pay thresholds. Conclusion Intravenous MS was less expensive and more effective than treatment without intravenous MS in children with asthma exacerbations. Our study provides evidence that should be used by decision‐makers to improve clinical practice guidelines and should be replicated to validate its results in other middle‐income countries

Quality assessment of acute viral bronchiolitis clinical practice guidelines

Recently, in an attempt to reduce variability in clinical practice and produce better results for patients, several clinical practice guidelines (CPGs) for the appropriate diagnosis and management of bronchiolitis in infants have been developed. However, the quality of available CPGs for bronchiolitis management has not yet been systematically evaluated. The aim of this study was to assess the quality of acute viral bronchiolitis CPGs. We performed a systematic and exhaustive search of CPGs on bronchiolitis published from 2000 to 2014. Three independent appraisers assessed the quality of the CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. A standardized score was calculated for each of the six domains, and the CPGS were rated as recommended, recommended with modifications, or not recommended. Six CPGs published between the years 2000 and 2014 were selected from a total of 111 citations. There was substantial agreement among reviewers (ICC: 0.75; 95% CI, 0.61–0.89). The domains that scored the highest were ‘scope and purpose’, with a mean value of 92.1% (range: 77.8–100%), and ‘clarity of presentation’ [83.3% (69.4–91.7%)]. Those that scored the lowest were ‘applicability’ [44.3% (8.3–77.1%)], and ‘stakeholder involvement’ [66.7% (47.2–94.4%)]. Three CPGS were evaluated as being recommended with modifications, and only two were recommended for use in clinical practice. Available bronchiolitis CPGs vary in quality, and the findings of the present study are useful for identifying aspects or domains where there is room for improvement in future CPGs