Healthcare failure mode and effects analysis and cost‑minimization analysis of three pharmaceutical services

Objetivo: El objetivo principal fue evaluar y comparar tres programas de entrega de medicamentos requeridos por los pacientes atendidos en las consultas externas de farmacia hospitalaria: mediante centros de salud, empresa de mensajería externa y oficinas de farmacia. El objetivo secundario fue analizar el coste económico desde la perspectiva del sistema público de salud. Método: Se utilizó el análisis modal de fallos y efectos para el objetivo principal. El análisis económico se realizó mediante un estudio de mini mización de costes. Resultados: Los resultados en índice de probabilidad de riesgo fueron 184 puntos para la entrega mediante centros de salud, 170 mediante mensajería y 126 mediante oficina de farmacia. El estudio económico mostró que actualmente el programa con menor coste económico fue la dispensación mediante oficina de farmacia respecto a mensajería y centros de salud (7.986,52 € versus 18.434,52 € y 11.417,08 €). Conclusiones: La entrega mediante oficina de farmacia tiene el menor índice de probabilidad de riesgo debido en gran parte al papel del farmacéutico en la custodia y conservación del medicamento. Respecto al estudio económico, también la dispensación mediante oficina de farmacia obtuvo el menor coste pero con una importante limitación: fue asignado un coste cero relativo a la empresa distribuidora y a la entrega del medicamento en las oficinas de farmacia por la colaboración altruista durante la pandemia. Si el coste fuese distinto de cero, serán necesarios nuevos estudios para evaluar el impacto económico el sistema público de salud. Objective: The main purpose of this study was to analyze and compare three different medication delivery methods used by the outpatient care unit of a hospital pharmacy, namely health center collection, community pharmacy collection and home delivery. The secondary purpose was to compare the economic cost of those methods for the Spanish health service. Method: A failure mode and effects analysis was carried out to attain the primary objective. For the secondary objective, an in-depth analysis was performed of the economic costs associated with each program using a cost-minimization analysis. Results: The failure mode and effects analysis resulted in scores of 184, 170 and 126 points for the health center collection, home delivery and community pharmacy collection programs, respectively. The eco nomic evaluation, for its part, rendered estimated costs of €18,434.52, €11,417.08 and €7,986.52 for home delivery, health center collection and community pharmacy collection services, respectively. Conclusions: The results of the study indicated that collection at the commu nity pharmacy was the program associated to the lowest risk, most likely due to the crucial role of the pharmacist regarding the custody and preservation of medicines. As regards cost, dispensation at the community pharmacy was also associated with the lowest cost. Nevertheless, this finding was biased by the fact that, given the generous collaboration of pharmaceutical distributors during the COVID-19 pandemic, the cost of transport and delivery to the pharmacy during the study period was zero. Further economic analyses are required to evaluate the costs of community pharmacy delivery and determine their impact on the public health system in cases where transport costs are different from zero

Presence of Bisphenol A and Parabens in a Neonatal Intensive Care Unit: An Exploratory Study of Potential Sources of Exposure

This paper is part of the PhD thesis developed by L.M.I.-D. in the context of the“Clinical Medicineand Public Health Program”of the University of Granada.BACKGROUND:Newborns in neonatal intensive care units (NICUs) are in contact with a variety of medical products whose production might includesynthetic chemicals with hormonal activity.OBJECTIVES:Our aim was to assess the content of bisphenol A (BPA) and parabens (PBs) and the hormone-like activities of a subset of medical prod-ucts commonly used in NICUs in prolonged intimate contact with NICU newborns.METHODS:Fifty-two NICU items were analyzed, determining the concentrations of BPA and PBs [methyl- (MeP), ethyl- (EtP), propyl- (PrP), andbutylparaben (BuP)] and using the E-Screen and PALM-luciferase assays to measure thein vitro(anti-)estrogenic and (anti-)androgenic activity,respectively, of the extracts. Items found to have elevated BPA/PB content or hormone-like activities were further extracted using leachingmethodologies.RESULTS:BPA was found in three-fifths and PBs in four-fifths of tested NICU items, and∼25%and∼10%of extracts evidenced estrogenic andanti-androgenic activity, respectively. The highest BPA content was found in the three-way stopcock (>7:000 ng=g), followed by patterned transpar-entfilm dressing, gastro-duodenal feeding tubes, sterile gloves, single-lumen umbilical catheters, and intravenous (IV) infusion extension sets (con-centrations ranged from 100 to 700 ng=g BPA). A total PB concentration (PPBs) >100 ng=g was observed in several items, including light therapyprotection glasses, patterned transparentfilm dressing, winged IV catheters, IV infusion extension sets, and textile tape. The highest estrogenic activ-ity [>450 pM estradiol equivalent (E2eq)] was found in small dummy nipples, three-way stopcocks, and patterned transparentfilm dressing and thehighest anti-androgenic activity [>5 mM procymidone equivalent units per gram (Proceq=g)] in small dummy nipples and three-way stopcocksThis research was funded in part by grants from the European Union Commission (The European Human Biomonitoring Initiative H2020-EJP-HBM4EU), the Spanish Ministry of Economy and Competitiveness, Institute of Health Carlos III - FEDER (PI16/01820, PI16/01812, PI16/01858, PI17/01743, and PI17/01526), the Andalusia Regional Government (PI-0538-2017), and the Spanish Consortium for Research on Epidemiology and Public Health(CIBERESP). The authors are also grateful to the Carlos IIIInstitute of Health (ISCIII) for the predoctoral research contract(FI17/00316) granted to L.M.I.-D., the postdoctoral researchcontract granted to C.F. (Miguel Servet-FEDER fund MS16/00085), and the José María Segovia de Arana contract granted to N.O. (INT18/00060)

Characterizing phytoplankton biomass seasonal cycles in two NE Atlantic coastal bays

The seasonal and interannual variability of chlorophyll a was studied between 2008 and 2016 in two coastal bays located in the northeastern limit of the Iberia/Canary upwelling ecosystem. The work aims (i) to understand if small latitudinal distances and/or coastline orientation can promote different chlorophyll a seasonal cycles; and (ii) to investigate if different meteorological and oceanographic variables can explain the differences observed on seasonal cycles. Results indicate three main biological seasons with different patterns in the two studied bays. A uni-modal pattern with a short early summer maximum and relatively low chlorophyll a concentration characterized the westernmost sector of the South coast, while a uni-modal pattern characterized by high biomass over a long period, slightly higher in spring than in summer, and high chlorophyll a concentration characterized the central West coast. Comparisons made between satellite estimates of chlorophyll a and in situ data in one of the bays revealed some important differences, namely the overestimation of concentrations and the anticipation of the beginning and end time of the productive period by satellite. Cross-correlation analyses were performed for phytoplankton biomass and different meteorological and oceanographic variables (SST, PAR, UI, MLD and precipitation) using different time lags to identify the drivers that promote the growth and the high levels of phytoplankton biomass. PAR contributed to the increase of phytoplankton biomass observed during winter/midspring, while upwelling and SST were the main explanatory drivers to the high Chl-a concentrations observed in late-spring/summer. Zonal transport was the variable that contributed most to the phytoplankton biomass during late-spring/summer in Lisbon Bay, while the meridional transport combined with SST was more important in Lagos Bay.FCT: SFRH/BD/52560/2014/ IPMA-BCC-2016-35/ UIDB/04292/2020/ UID/Multi/04326/2020/ UID/MAT/04561/2020 LISBOA-01-0145FEDER-031265 IPMA: MAR2020PO2M01-1490 Pinfo:eu-repo/semantics/publishedVersio

Política latinoamericana comparada

La política latinoamericana desde una perspectiva comparada ha adquirido en los últimos tiempos una mayor centralidad e importancia dentro de las ciencias sociales, generando la necesidad de reflexionar acerca de su desarrollo histórico, su estado actual y su derrotero futuro. Política Latinoamericana Comparada es un libro que busca realizar un aporte en este sentido, acercando múltiples vías de entrada y análisis de la temática, ya que conjuga miradas panorámicas, diagnósticos regionales y perspectivas ancladas en la observación de realidades nacionales, proponiendo un escenario común en el cual dialogar, debatir y encontrar puntos de encuentro y de fuga entre especialistas.Fil: Geary, Mirta. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina.Fil: Lucca, Juan Bautista. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Universidad Nacional de Rosario; Argentina.Fil: Pinillos, Cintia. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina.Fil: Fanelli, Lucrecia. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales.Fil: Schreiner, Federico. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina.Fil: Perbellini, Melina. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina.Fil: Fernández, Elías. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina.Fil: Ruiz, Valeria. Universidad Nacional de Rosario. Facultad de Ciencia Política y Relaciones Internacionales; Argentina.Fil: Orta, Melisa. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Universidad Nacional de Rosario; Argentina.Fil: Kestler, Thomas. Würzburg University; Germany.Fil: Lauth, Hans-Joachim. Würzburg University; Germany.Fil: Mohamad-Klotzbach, Christoph. Würzburg University; Germany.Fil: Borrell, Mariana. Universidad Nacional de Rosario. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); ArgentinaFil: Heinisch, Reinhard. Universidad de Salzburgo; Austria.Fil: Gugliano, Alfredo Alejandro. Universidade Federal do Rio Grande do Sul; Brasil.Fil: Rodrigues, Priscila. Universidade Federal do Rio Grande do Sul; Brasil.Fil: Batlle, Margarita. Universidad Externado, Colombia.Fil: Cascante, María José. Universidad de Costa Rica.Fil: Basabe-Serrano, Santiago. Facultad Latinoamericana de Ciencias Sociales (FLACSO), Ecuador.Fil: Caballero Santos, Sergio. Universidad Autónoma de Madrid; España.Fil: Graziano, Paolo. Universidad Bocconi, Italia.Fil: Vidal de la Rosa: Godofredo. Universidad Autónoma Metropolitana; México.Fil: Duarte Recalde, Liliana Rocío. Universidad Católica “Nuestra Señora de la Asunción”; Paraguay.Fil: Camerlo, Marcelo. Universidad de Lisboa; Portugal.Fil: Malamud, Andrés. Universidad de Lisboa; Portugal.Fil: Chasquetti, Daniel. Universidad de la República; Uruguay.Fil: Castiglioni, Rossana. Universidad Diego Portales; Chile

Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic : a matched analysis

The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with COVID-19-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior non-invasive respiratory support on outcomes. This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICU) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of intensive care unit (ICU) admission. Propensity score (PS) matching was used to achieve balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different timepoint (48 h from ICU admission) for early and delayed intubation. Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After PS matching, patients with delayed intubation presented higher hospital mortality (27.3% versus 37.1%, p =0.01), ICU mortality (25.7% versus 36.1%, p=0.007) and 90-day mortality (30.9% versus 40.2%, p=0.02) when compared to the early intubation group. Very similar findings were observed when we used a 48-hour timepoint for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth wave, respectively; first versus second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (n=294) who were intubated earlier. The subgroup of patients undergoing NIV (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received high-flow nasal cannul

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three genomic nomenclature systems to all sequence data from the World Health Organization European Region available until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation, compare the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges