Economic impact of pharyngocutaneou fistulae in patients laryngectomy

Objetivo: Analizar el impacto económico derivado de la hospitalización de los pacientes con fístulas faringocutá- neas (FFC) como principal evento adverso tras laringectomía total entre los años 2006 y 2011 en un hospital de segundo nivel. Método: Cálculo estimado de los costes directos generados por la FFC mediante el Grupo de Diagnóstico Relacionado (GRD) y aplicación corporativa de contabilidad analítica del Servicio Andaluz de Salud (COAN h y d) para los años mencionados. Resultados: Entre 2006 y 2011 el coste de todos pacientes con FFC fue de 3.210.586,9€, a diferencia de 1.282.708,5€ para los que no cursaron esta complicación. El coste individual en el período de estudio fue 94.429,0.26€ en las FFC y 35.630,777€ en los que no la tuvieron. Los afectados registraron un incremento de 2,66 veces en el gasto sanitario. Conclusión: La aparición de FFC tras laringectomía supone un coste elevado para el hospital y la organización sanitaria. Se deben plantear estrategias preventivas que minimicen el impacto económico de este evento adverso.Objective: To analyze the economic impact of hospitalization of patients with fistulas pharyngocutaneous (FFC) as the main adverse event after total laryngectomy between 2006 and 2011 in a secondary hospital. Method: Calculate estimated direct costs generated by the FFC using Diagnosis Related Group (DRG) and cost accounting corporate application Andalusian Health Service (COAN hyd) for those years. Results: Between 2006 and 2011 the cost of all patients was € 3,210,586.9 FFC, unlike € 1,282,708.5 for those who missed out this complication. The individual cost in the study period was € 94.429,0.26 in FFC and € 35,630.777 in those without it. The patients had an increase of 2.66 times in health spending. Conclusion: The occurrence of FFC after laryngectomy involves a high cost for the hospital and healthcare organization. Preventive strategies must be implemented to minimize the economic impact of this adverse event

Hospitalisation by tick-borne diseases in the last 10 years in two hospitals in South Spain: analysis of tick exposure data collected in the Emergency Department

Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009–2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient’s report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Promoción y desarrollo de competencias transversales y profesionales en estudiantes del grado de Psicología

Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaFALSEsubmitte