Predicción del riesgo individual de alto coste sanitario para la identificación de pacientes crónicos complejos

ResumenObjetivoConstruir y validar un modelo predictivo del riesgo de consumo de recursos sanitarios elevado, y evaluar su capacidad para identificar pacientes crónicos complejos.MétodosEstudio transversal realizado en una organización sanitaria integrada sobre datos individuales de residentes 2 años consecutivos (88.795 personas). Variable dependiente: coste sanitario real superior al percentil 95 (P95), incluyendo todos los servicios de la organización sanitaria integrada y las recetas de farmacia. Variables predictoras: edad, sexo, morbilidad (según los clinical risk groups [CRG]) y datos seleccionados de utilización previa (uso de hospitalización, uso de medicación hospitalaria ambulatoria, gasto en recetas de farmacia). Análisis univariado descriptivo. Construcción de un modelo de regresión logística con nivel de confianza del 95%; análisis de validez mediante sensibilidad, especificidad, valor predictivo positivo (VPP) y área bajo la curva ROC (AUC).ResultadosLas personas con coste >P95 acumulan el 44% del coste sanitario total y se concentran en las categorías ACRG3 (aggregated CRG level 3) de enfermedades crónicas múltiples o graves. La carga de morbilidad aumenta con la edad. En el modelo, todas las variables fueron estadísticamente significativas excepto el sexo. Se obtuvo una sensibilidad del 48,4% (intervalo de confianza [IC]: 46,9%-49,8%), una especificidad del 97,2% (IC: 97,0%-97,3%), un VPP del 46,5% (IC: 45,0%-47,9%) y un AUC de 0,897 (IC: 0,892-0,902).ConclusionesEl consumo sanitario elevado se relaciona con la morbilidad crónica compleja. Un modelo basado en la edad, la morbilidad y la utilización previa es válido para predecir el riesgo de alto consumo, y así identificar la población diana de estrategias de atención proactiva para pacientes crónicos complejos.AbstractObjectiveTo develop a predictive model for the risk of high consumption of healthcare resources, and assess the ability of the model to identify complex chronic patients.MethodsA cross-sectional study was performed within a healthcare management organization by using individual data from 2 consecutive years (88,795 people). The dependent variable consisted of healthcare costs above the 95th percentile (P95), including all services provided by the organization and pharmaceutical consumption outside of the institution. The predictive variables were age, sex, morbidity—based on clinical risk groups (CRG)—and selected data from previous utilization (use of hospitalization, use of high-cost drugs in ambulatory care, pharmaceutical expenditure). A univariate descriptive analysis was performed. We constructed a logistic regression model with a 95% confidence level and analyzed sensitivity, specificity, positive predictive values (PPV), and the area under the ROC curve (AUC).ResultsIndividuals incurring costs >P95 accumulated 44% of total healthcare costs and were concentrated in ACRG3 (aggregated CRG level 3) categories related to multiple chronic diseases. All variables were statistically significant except for sex. The model had a sensitivity of 48.4% (CI: 46.9%-49.8%), specificity of 97.2% (CI: 97.0%-97.3%), PPV of 46.5% (CI: 45.0%-47.9%), and an AUC of 0.897 (CI: 0.892 to 0.902).ConclusionsHigh consumption of healthcare resources is associated with complex chronic morbidity. A model based on age, morbidity, and prior utilization is able to predict high-cost risk and identify a target population requiring proactive care

Unsupervised spectral learning of WCFG as low-rank matrix completion

We derive a spectral method for unsupervised learning ofWeighted Context Free Grammars. We frame WCFG induction as finding a Hankel matrix that has low rank and is linearly constrained to represent a function computed by inside-outside recursions. The proposed algorithm picks the grammar that agrees with a sample and is the simplest with respect to the nuclear norm of the Hankel matrix.Peer ReviewedPreprin

Towards a Semantic-Aware Collaborative Working Environment

Collaborative Working Environments (CWEs) enable an efficient collaboration between professionals, specially those settled in different locations of a company or stakeholders from different companies. This can be of great help for small and medium enterprises (SMEs), as an effective way to share information. However, it can be difficult for SMEs to have access to a fully integrated CWE providing different tools (e.g., videoconferencing, instant messaging, etc.). Currently, they may define a CWE as a combination of heterogeneous and non-integrated tools which are not able to share information between them. An integrated CWE would provide SMEs with the necessary means to collaborate, making information exchange easier.&nbsp

Ultrassonografia cardíaca en individus adietes a l'heroína intravenosa assimptomàtics: evidencia de lesions valvulars induïdes per l'adicció

Echocardiograph

Effect of early cryoprecipitate transfusion versus standard care in women who develop severe postpartum haemorrhage (ACROBAT) in the UK: a protocol for a pilot cluster randomisedtrial

Introduction The incidence of severe postpartum haemorrhage (PPH) that requires blood transfusion is on the increase. Fibrinogen levels have been shown to drop early and significantly during PPH, which is associated with worse outcomes. Early fibrinogen replacement could potentially improve outcomes. No studies have investigated the clinical impact of early cryoprecipitate transfusion in PPH. Prior to performing a full-scale trial, a pilot study is needed to determine feasibility of the intervention and recruitment. Methods ACROBAT is a cluster-randomised pilot study with a qualitative evaluation. Four large London maternity units are randomised to either the intervention or control group. The intervention group will adapt their major obstetric haemorrhage procedures to administer cryoprecipitate early for primary PPH. The control group will retain their standard of care. We include women at >24 weeks gestation who are actively bleeding within 24 hours of delivery and for whom transfusion of red blood cells (RBCs) has been started. We exclude women who decline blood transfusions in advance or have inherited Factor XIII or fibrinogen deficiency. Due to the emergency nature of the intervention, informed consent for administering the intervention is waived. The primary objective is to assess the feasibility of administering cryoprecipitate within 90 min of RBC request, as compared with standard treatment where cryoprecipitate is given later or not at all. Secondary objectives include the feasibility of recruitment and data collection, reasons for and barriers to consent, preliminary maternal clinical outcomes, identification of the optimal infrastructure pathways for study delivery, and acceptability of the intervention and outcomes

Completeness in the Mackey topology

Bonet and Cascales [Non-complete Mackey topologies on Banach spaces, Bulletin of the Australian Mathematical Society, 81, 3 (2010), 409-413], answering a question of M. Kunze and W. Arendt, gave an example of a norming norm-closed subspace N of the dual of a Banach space X such that mu(X, N) is not complete,where mu(X, N) denotes the Mackey topology associated with the dual pair aEuroX, NaEuro parts per thousand. We prove in this note that we can decide on the completeness or incompleteness of topologies of this form in a quite general context, thus providing large classes of counterexamples to the aforesaid question. Moreover, our examples use subspaces N of X* that contain a predual P of X (if exists), showing that the phenomenon of noncompleteness that Kunze and Arendt were looking for is not only relatively common but illustrated by "well-located" subspaces of the dual. We discuss also the situation for a typical Banach space without a predual-the space c (0)-and for the James space J.The first author is supported in part by MICINN and FEDER (project no. MTM2008-05396), by Fundacion Seneca (project no. 08848/PI/08), by Generalitat Valenciana (GV/2010/036), and by Universitat Politecnica de Valencia (project no. PAID-06-09-2829). The second author is supported in part by MICINN project no. MTM2011-22417, by Generalitat Valenciana (GV/2010/036), and by Universidad Politecnica de Valencia (project no. PAID-06-09-2829).Guirao Sánchez, AJ.; Montesinos Santalucia, V. (2015). Completeness in the Mackey topology. Functional Analysis and Its Applications. 49(2):97-105. https://doi.org/10.1007/s10688-015-0091-2S97105492J. Bonet and B. Cascales, “Non-complete Mackey topologies on Banach spaces,” Bull. Aust. Math. Soc., 81:3 (2010), 409–413.M. Fabian, P. Habala, P. Hájek, V. Montesinos, and V. Zizler, Banach Space Theory. The Basis for Linear and Nonlinear Analysis, CMS Books in Math., Springer-Verlag, New York, 2011.P. Pérez-Carreras and J. Bonet, Barreled Locally Convex Spaces, North-Holland Mathematical Studies, vol. 131, North-Holland, Amsterdam, 1987.P. Civin and B. Yood, “Quasi-reflexive spaces,” Proc. Amer. Math. Soc., 8:5 (1957), 906–911.J. Diestel, Sequences and Series in Banach Spaces, Graduate Text in Math., vol. 92, Springer-Verlag, New York, 1984.K. Floret, Weakly Compact Sets, Lecture Notes in Math., vol. 801, Springer-Verlag, Berlin, 1980.G. Godefroy, “Boundaries of convex sets and interpolation sets,” Math. Ann., 277:2 (1987), 173–184.R. C. James, “On nonreflexive Banach space isometric with its second conjugate,” Proc. Nat. Acad. Sci. USA, 37 (1951), 174–177.G. Köthe, Topological Vector Spaces I, Springer-Verlag, New York, 1969

Osmolality predictive models of different polymers as tools in parenteral and ophthalmic formulation development.

During the development of parenteral dosage forms, different physicochemical studies are required to ensure stable, effective and safe formulations. The osmolality of this kind of dosage forms should bear a close similarity to the body fluids to prevent local irritation, pain or even more significant side effects like endothelial damage. The osmotic studies performed in Polyethylene glycol 400 (PEG 400), Polyethylene glycol 4000 (PEG 4000), Poloxamer 407 (P407), Sodium Hyaluronate (SH), Chondroitin Sulphate Sodium (CS), Cremophor RH 40 (CRE40) and Polyvinyl alcohol (PVA) aqueous solutions, showed that the theoretical determination of the osmolality based on their molecular weight as the only determinant factor did not agree with the values obtained by the measurement of colligative properties such as the freezing point depression. The data obtained from this study and its analysis, provided predictive equations that can be used as tools in the primary development to estimate formulation's osmolality at different concentrations; and its evolution over a period at the hypothetical worst-case scenario of storage temperature

Agreement Between 18F-FDG PET/CT and Whole-Body Magnetic Resonance Compared With Skeletal Survey for Initial Staging and Response at End-of-Treatment Evaluation of Patients With Multiple Myeloma

PURPOSE: To compare the agreement between whole-body (WB) magnetic resonance (MR) imaging, 18F-FDG PET/CT, and skeletal survey (SS) in patients with multiple myeloma (MM) for diagnosis, initial staging, response evaluation, and early detection of complications. METHODS: This is a retrospective cohort study including MM patients who were diagnosed, treated, and followed in 2 institutions. These patients were studied with SS, WB-MR, and/or 18F-FDG PET/CT. We studied bone lesions by anatomical locations and analyzed the concordance between SS and a tomographic technique (WB-MR or 18F-FDG PET/CT) and between both tomographic techniques (WB-MR and PET/CT). RESULTS: Forty-four MM patients with a mean age of 62.6 years (range, 38-85 years) were included from January 2012 to February 2016. Whole-body MR and 18F-FDG PET/CT found more lesions than SS in every location except in the skull. Concordance between WB-MR and 18F-FDG PET/CT was either good or excellent in most of the locations and in plasmacytoma studies. However, WB-MR was better than 18F-FDG PET/CT in the study of complications (medullar compression and vascular necrosis). CONCLUSIONS: Our results suggest the study of MM patients should include WB-MR and/or 18F-FDG PET/CT, whereas SS is only useful for the skull. Whole-body MR and 18F-FDG PET/CT are complementary techniques, because both of them show good concordance in almost every location. It is still necessary to individualize the indication of each technique according to patient characteristics.None declare