Case management: cost-effectiveness analysis in continuity of patient care of the Complex Chronic Patients Unit

Objetivo: Evaluar la relación entre los costes asociados al número y días de ingresos previos y posteriores a la inclusión a la Unidad de pacientes crónicos complejos (PCC). Métodos: Se realizó un análisis de coste-efectividad, descriptivo, con cálculo de medias y desviaciones típicas; además de utilizar la t-Student para muestras pareadas, con el software SPSS v20.0, para un nivel de significación alfa <0,05. Los resultados del cómputo se obtuvieron de la Unidad de Codificación de los pacientes captados por la enfermera gestora de casos, y que sobrevivieron un año en seguimiento por la Unidad PCC. Resultados: Se captaron un total de 132 PCC, con un total de 563 ingresos previos, a 204 post inclusión. La media de número de ingresos al año antes fue de 4,27 (DT: 3,35), y se redujo a 1,55 (DT: 1,74). Por otro lado, el número de días de estancia hospitalaria total se redujo de 3.835 a 1.897 días, que equivale una diferencia de coste estimado en 11165.164,36 de euros. La media de días de ingreso antes fue de 29,05, y se redujo a 14,37 días, encontrando una significación estadística (p<0,001) entre días de ingresos previos y posteriores. Conclusiones: La inclusión en la Unidad PCC garantiza, mediante el liderazgo por la enfermera gestora de casos, una mejora coste-efectiva sin gastos añadidos, por optimizar recursos ya existentes interniveles asistenciales, mediante la identificación de PCC y sus necesidades prioritarias, planificación al alta con informes individualizados y garantizando el contacto.Objective: Evaluate the relationship between the costs associated with the number and days of admission before and after inclusion in the Complex Chronic Patients Unit (CCP). Methods: A descriptive cost-effectiveness analysis was performed, with calculation of arithmetic averages and standard deviations; in addition to using the t-Student for paired samples, with the SPSS v20.0 software, for a significance level alpha <0.05. The results of the computation were obtained from the Coding Unit of the patients recruited by the case manager nurse, who survived one year of follow-up by the CCP Unit. Results: A total of 132 CCP were recruited, with a total of 563 previous admissions, which were reduced to 204 post inclusion. The average number of admissions of the previous year was 4.27 (SD: 3.35), and it was reduced to 1.55 (SD: 1.74). On the other hand, the number of days of total hospital stay was reduced from 3,835 to 1,897 days, which is equivalent to a difference in estimated cost of 11,165,164.36 euros. The average number of days of admission before was 29.05, and it was reduced to 14.37 days, finding a statistical significance (p<0.001) between days of admission before and after. Conclusions: Inclusion in the CCP Unit guarantees, through the leadership of the case manager nurse, a cost-effective improvement without added expenses, by optimizing already existing interlevel care resources, through the identification of CCP and their priority needs, discharge planning with reports individualized and guaranteeing contact

Ni tipo 1 ni tipo 2: una diabetes de perfil infrecuente con base autoinmunitaria

We present a 66-year-old patient with history of Graves-Basedow disease, who was admitted in charge of Internal Medicine with suspected debut of diabetes mellitus, being initially catalogued as type 2. The poor response to treatment with oral antidiabetics, requiring insulin therapy to achieve a proper glycemic control, along with the underlying pathology, raised the suspicion of latent autoimmune diabetes in adults. This was confirmed by the discovery of specific positive autoantibodies. The association between these two pathologies also makes it possible to classify the patient within a group of autoimmune endocrine disorders known as type 3 polyglandular syndrome.Paciente de 66 años con antecedente de enfermedad de Graves-Basedow que ingresó a cargo de Medicina Interna por diabetes mellitus de debut, siendo inicialmente catalogada como tipo 2. La mala respuesta al tratamiento con antidiabéticos orales, precisando insulinoterapia para conseguir un correcto control glucémico, junto a su patología de base, plantearon la sospecha de diabetes autoinmune latente del adulto. Esta se confirmó con el hallazgo de autoanticuerpos específicos positivos. La asociación de estas dos patologías permite además clasificar a la paciente dentro de un grupo de trastornos endocrinos autoinmunes conocidos como síndromes poliglandulares, en este caso tipo 3

Diabetes mellitus y obesidad: la importancia de realizar un abordaje integral de ambas entidades

We present a 63-year-old woman diagnosed with type 2 diabetes mellitus in 2007 and grade III obesity, in addition to gonarthrosis and sequelae of a traffic accident. She was unable to perform physical exercise due to gonarthrosis and the aftermath of the traffic accident. Progressive treatment with oral antidiabetic agents did not achieve optimal glycemic control after several years of follow-up. Neither there was an improvement in obesity despite following several diets prescribed by specialists. We offered her therapy with insulin but the patient rejected it systematically. Finally, the use of combined treatment with agonists of the GLP-1 receptor and SGLT-2 inhibitors allowed to achieve an adequate glycemic control for the first time. In the subsequent controls, HbA1c values of less than 7% were reached, in addition to a significant reduction in body weight, with good tolerance and without adverse effects.Se presenta el caso de una mujer de 63 años diagnosticada de diabetes mellitus tipo 2 y obesidad grado III, muy limitada para la realización de ejercicio físico. Durante años no se consiguió un control glucémico óptimo con antidiabéticos orales ni una reducción del peso a pesar de seguir varias dietas pautadas por especialistas. Además rechazó sistemáticamente iniciar tratamiento insulínico. Ambos objetivos se lograron finalmente con un tratamiento combinado formado por agonistas del receptor GLP-1 e inhibidores SGLT-2, todo ello con buena tolerancia y sin aparición de efectos adversos reseñables

Acontecimiento, poder y resistencia: construcciones colectivas sobre la experiencia de la pandemia de covid-19

Agradecimientos – Presentación I. Prof. Tit. Mag. Fernando Bertolotto, Facultad de Enfermería, Universidad de la República – Presentación II. Prof. Tit. Mag. Enrico Irrazábal, Facultad de Psicología, Universidad de la República – Prólogo. Dra. Mary Jane Spink, Pontificia Universidad Católica de San Pablo, Brasil – Introducción – Primera Parte. Los procesos psicosociales en el marco de la pandemia de covid-19. Una aproximación teórica y metodológica – Segunda Parte. Los colectivos participantes – Vivencias y prácticas de los equipos del primer nivel de atención a la salud en la pandemia. Un estudio de caso / Robert Pérez (FP, CIEn) y Rosana Rodríguez (FE) – Las organizaciones de personas mayores ante la pandemia: narrativas, capacidad de acción y acontecimiento / Fernando Berriel (FP, CIEn), Luján Ríos (FP, EI) y Francis Silvera (EI) – Integralidad, cuidados y resistencias: aportes de los equipos socioeducativos a la comprensión de la dimensión psicosocial de la pandemia / Maira Castro (FE) y Alicia Rodríguez (FP) – «Doble reja»: consideraciones sobre las producciones subjetivas y las prácticas organizacionales durante el confinamiento por la pandemia de covid-19 en privación de libertad / Camila Estiben (FE), María Ana Folle (FP) y Nancy Pérez (FE) – Tercera Parte. Consideraciones finales – Índice

The Use of Corticosteroids or Tocilizumab in COVID-19 Based on Inflammatory Markers

SEMI-COVID-19 Network.[Background] The inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined.[Objective] We aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation. .[Design] A retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and d-dimer values.[Patients] A total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ).[Main Measures] The primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission.[Key Results] A total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high–risk category (31.9% vs. 23.9%, p=0.049).[Conclusions] The prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.Peer reviewe

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Innovaciones y mejoras en el proyecto tutoría entre compañeros. Curso 2015-2016

Memoria ID-0137. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016