Hospital acquired infections: How much do they cost and how can we calculate them?

Presencia UniversitariaLas infecciones nosocomiales (IN) representan uno de los principales problemas para los sistemas de salud debido a que están asociadas con un aumento importante en los costos ya sea en el ámbito social o de atención hospitalaria. El impacto económico que tienen las IN se enfatiza en países como México en los que gran parte de la población carece de seguridad social y en los que el gasto gubernamental per cápita en salud es mínimo. A nivel internacional se han realizado una gran cantidad de estudios principalmente enfocados al ámbito hospitalario que exponen resultados muy inconstantes en cuanto a las estimaciones del costo de las IN. Lo anterior tiene que ver con la complejidad que representa este tipo de análisis económico ya que existe una gran cantidad de variables implicadas. A medida que en nuestro país contemos con una mayor cantidad de estudios de análisis de costos de IN realizados con una adecuada planeación y enfocados claramente a la aplicación de políticas de intervención, las instituciones de salud contarán con una valiosa herramienta para evidenciar y validar la utilidad que tienen los programas de prevención y educación en la reducción de costos.Nosocomial infections (NI) are one of the major problems for health systems, and are associated with a significant increase of costs for patients and society. The economic impact of NI might be higher in countries like Mexico where the majority of the population lacks social security and have a low healthcare expenditure per capita. Several studies have reported different estimates of the cost generated by NI, which could be attributable to the complexity of this type of economic analysis. Mexico is urged to generate a greater amount of NI cost-analysis studies, developed with suitable planning and focused on the implementation of policy interventions. These studies will provide a valuable tool to evaluate national health policies which is essential for the proper use of economic resources

Being hospitalized might be a dangerous adventure

Tema del mesLos hospitales son instituciones complejas y constituyen un eslabón importante en el sistema de salud. Su objetivo es mejorar la calidad de vida; resolver o controlar las enfermedades de la población, y ser centros de enseñanza y generación de conocimiento científico. Sin embargo, el tránsito de los pacientes en estas instituciones no está exento de riesgos o complicaciones. La seguridad del paciente se reconoce como una prioridad en términos de salud pública a nivel internacional, que requiere vigilancia y medición de manera constante. La participación en conjunto con una visión global, podría ayudar a reducir los riesgos para los pacientes en las instituciones.Hospitals are complex institutions and are an essential pillar for the health system. Their main objective is to preserve the quality of life, to solve or control diseases, to be a teaching centre and generate new scientific knowledge. However, patients are at risk of complications while they are hospitalized. Patient’s security is a public-health priority, therefore health’s systems need to improve and maintain active surveillance systems. It is essential a global health vision, to reduce the risk that face the patients

Endocarditis infecciosa: una propuesta de tamizaje basada en un perfil de riesgo, en un Hospital de concentración en la Ciudad de México , 1987-2002

Objetivo: Obtener una probabilidad preprueba de endocarditis infecciosa usando el criterio clínico identificadocomo un factor de riesgo independiente de endocarditis para ayudar a tomar la decisión con respecto al usodel ecocardiograma transtorácico en sospecha de endocarditis. Materiales y Métodos: Después de una revisión retrospectiva de las historias del 1 de enero de 1987 al 31 dediciembre del 2002 en el Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” (un centroterritorial de referencia), en la Ciudad de México se encontraron 64 pacientes con sospecha o probabilidadde endocarditis infecciosa y estudios completos que fueron incluidos en este estudio y comparados con 39sujetos control; se estableció el diagnóstico definitivo de endocarditis infecciosa de acuerdo a los criteriosde Duke, más un ecocardiograma transtorácico y/o examen citológico obtenido de material de cirugía condeterminadas características clínicas asociadas a este diagnóstico. Resultados: Los factores de riesgo independientes de endocarditis infecciosa fueron valvulopatía previa,nuevo episodio de insuficiencia cardiaca, presencia de nuevo soplo, presencia de bloqueo de rama del hazde His y presencia de embolia séptica.Conclusión: La probabilidad preprueba obtenida en este estudio clínico puede ser usada como una herramientade tamizaje para identificar sujetos con baja probabilidad de endocarditis. PALABRAS CLAVE: Endocarditis, Factores de riesgo, Marcadores Clínicos

Preferences and feasibility of long-acting technologies for treatment of hepatitis C virus in low- and middle-income countries: A survey of providers and policymakers.

Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among providers, 93% (113/122) expressed willingness to prescribe LAT and 72% (88/120) of providers preferred LAT if provided at comparable efficacy, safety and cost as current oral treatments. Of providers preferring HCV LAT to daily oral medication, 67% (59/88) preferred injection, 24% (21/88) preferred patch and 9% (8/88) preferred implant. Only 20% (24/122) would prescribe LAT if it were more costly than oral treatment. In regression analysis, no provider characteristics were associated with preference for LAT over oral treatment. Policymakers reported high likelihood that LAT would be included in treatment guidelines (42/50; 84%) and national drug formularies (39/50; 78%) if efficacy, safety and cost were similar to oral treatment. HCV LATs could advance progress to HCV elimination in LMICs by diversifying treatment options to improve treatment coverage and outcomes. Provider preferences from LMICs are a critical consideration in the development of HCV LATs to ensure its early and equitable availability in LMICs

Development of the HIV360 international core set of outcome measures for adults living with HIV: a consensus process

© 2021 British HIV AssociationObjectives: HIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care. Methods: An international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice. Results: From 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years. Conclusions: Adoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.info:eu-repo/semantics/publishedVersio

Development of the HIV360 international core set of outcome measures for adults living with HIV: A consensus process.

ObjectivesHIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care.MethodsAn international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice.ResultsFrom 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years.ConclusionsAdoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care