Impact of cardiovascular illness on hospitalization costs in patients with rheumatoid arthritis

El objetivo del presente estudio fue analizar las causas y los costos directos de hospitalización de pacientes con artritis reumatoidea, establecer la morbilidad asociada y evaluar su impacto sobre los costos de la hospitalización. Para tal fin, se revisaron las historias clínicas y los registros del Departamento de Estadística y Contabilidad de todos los pacientes con artritis reumatoidea admitidos a la Clínica Universitaria Bolivariana en Medellín, en el periodo comprendido entre enero de 1999 y junio de 2003. Se hospitalizaron 41 pacientes en 62 oportunidades (0,34 hospitalizaciones por paciente por año). La principal causa de hospitalización fue la actividad de la enfermedad (60%), seguida de cirugía (18%) e infección (10%). En 30 casos hospitalizados (48,4%) se observó, al menos, una morbilidad asociada; la más frecuente fue la enfermedad cardiovascular (32%). El promedio de estancia fue de 5±6 días. El promedio de los costos totales fue de US$1.277, y el costo promedio del día de hospitalización fue de US$235. Los medicamentos representaron el 54% de los costos totales, mientras que los de asistencia médica representaron apenas el 3%. La enfermedad cardiovascular fue el determinante más importante de altos costos de hospitalización (p<0,01) En conclusión, los costos directos de hospitalización de pacientes con artritis reumatoidea son considerables y surgen principalmente del compromiso orgánico de la enfermedad. La prevención y el tratamiento de la enfermedad cardiovascular son indispensables no sólo para reducir el impacto económico de la artritis reumatoidea, sino también para disminuir el riesgo de mortalidad que la misma acarrea. Estos resultados pueden ser útiles en la definición de las políticas de salud en nuestra población.The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5±6 days. The mean total cost was US$1,277, and the mean cost per day of hospitalization was US$235. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs to reduce the economic burden of rheumatoid arthitis, but also to diminish the risk of mortality. These data assist in the estimation of health care resources and in the selection of public health policies for the improvement of patient outcomes

Impacto de la enfermedad cardiovascular en los costos de hospitalización de pacientes con artritis reumatoidea.

The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5+/-6 days. The mean total cost was 1,277 US dollars, and the mean cost per day of hospitalization was 235 US dollars. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs (pEl objetivo del presente estudio fue analizar las causas y los costos directos de hospitalización de pacientes con artritis reumatoidea, establecer la morbilidad asociada y evaluar su impacto sobre los costos de la hospitalización. Para tal fin, se revisaron las historias clínicas y los registros del Departamento de Estadística y Contabilidad de todos los pacientes con artritis reumatoidea admitidos a la Clínica Universitaria Bolivariana en Medellín, en el periodo comprendido entre enero de 1999 y junio de 2003. Se hospitalizaron 41 pacientes en 62 oportunidades (0,34 hospitalizaciones por paciente por año). La principal causa de hospitalización fue la actividad de la enfermedad (60%), seguida de cirugía (18%) e infección (10%). En 30 casos hospitalizados (48,4%) se observó, al menos, una morbilidad asociada; la más frecuente fue la enfermedad cardiovascular (32%). El promedio de estancia fue de 5±6 días. El promedio de los costos totales fue de US$1.277, y el costo promedio del día de hospitalización fue de US$235. Los medicamentos representaron el 54% de los costos totales, mientras que los de asistencia médica representaron apenas el 3%. La enfermedad cardiovascular fue el determinante más importante de altos costos de hospitalización (

Tuberculosis en pacientes tratados con antagonistas del factor de necrosis tumoral alfa en un área endémica, ¿vale la pena el riesgo?

Tumor necrosis factor alpha antagonists (TNFA) are biological agents to treat chronic inflammatory and autoimmune diseases. However, their use is associated with an increased rate of tuberculosis, endemic mycoses, and intracellular bacterial infections. Since tuberculosis is moderately to highly endemic in Colombia, the risk of these infections in patients treated with TNFAs may be higher than previously reported in Colombia. Recently, four patients have developed tuberculosis during TNFA therapy. Tuberculosis appeared between 3 to 24 months after initiation of TFNA therapy and was independent of previous tuberculin skin test status. A review of the relevant literature and recommLos antagonistas del factor de necrosis tumoral alfa (infliximab, adalimumab y etanercept) son agentes biológicos utilizados en el tratamiento de enfermedades inflamatorias crónicas y autoinmunes. Sin embargo, su uso está asociado con el incremento de la tasa de tuberculosis, micosis endémicas e infecciones bacterianas intracelulares. Dado que la tuberculosis es moderada/altamente endémica en Colombia, el riesgo de esta infección en los pacientes tratados con estos agentes biológicos puede incrementarse y hacer dicha tasa mayor que la informada previamente (tanto en Colombia como en el mundo). Se presentan cuatro pacientes que desarrollaron tuberculosis durante el tratamiento con antagonistas del factor de necrosis tumoral alfa. La presentación de la tuberculosis ocurrió en promedio 15 meses después del inicio del agente biológico y fue independiente de la prueba de tuberculina. Se hace una revisión del tema y se plantea la necesidad de implementar guías y estrategias gubernamentales orientadas a la detección y profilaxis de tuberculosis en este grupo de pacientes

Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Background and aimsPediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico.MethodsPatients &lt;18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined.ResultsOverall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 103/mm3. CNS-1 status was reported in 1,810 (85.5%), CNS-2 in 67 (3.2%), and CNS-3 in 61 (2.9%). A total of 1,488 patients (70.4%) were classified as high-risk at diagnosis. However, in 52.5% (991/1,889) of patients with B-cell ALL, the reported risk group did not match the calculated risk group allocation based on National Cancer Institute (NCI) criteria. Fluorescence in situ hybridization (FISH) and PCR tests were performed for 407 (19.2%) and 736 (34.8%) patients, respectively. Minimal residual disease (MRD) during induction was performed in 1,158 patients (54.7%). The median follow-up was 3.7 years. During induction, 191 patients died (9.1%), and 45 patients (2.1%) experienced induction failure. A total of 365 deaths (17.3%) occurred, including 174 deaths after remission. Six percent (176) of patients abandoned treatment. The 5-year event-free survival (EFS) was 58.9% ± 1.7% for B-cell ALL and 47.4% ± 5.9% for T-cell ALL, while the 5-year overall survival (OS) was 67.5% ± 1.6% for B-cell ALL and 54.3% ± 0.6% for T-cell ALL. The 5-year cumulative incidence of central nervous system (CNS) relapse was 5.5% ± 0.6%. For the whole cohort, significantly higher outcomes were seen for patients aged 1–10 years, with DNA index &gt;0.9, with hyperdiploid ALL, and without substantial treatment modifications. In multivariable analyses, age and Day 15 MRD continued to have a significant effect on EFS.ConclusionOutcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Impacto de la enfermedad cardiovascular en los costos de hospitalización de pacientes con artritis reumatoidea \ rImpacto de la enfermedad cardiovascular en los costos de hospitalización en pacientes con artritis reumatoide

El objetivo del presente estudio fue analizar las causas y los costos directos de hospitalización de pacientes con artritis reumatoidea, establecer la morbilidad asociada y evaluar su impacto sobre los costos de la hospitalización. Para tal fin, se revisaron las historias clínicas y los registros del Departamento de Estadística y Contabilidad de todos los pacientes con artritis reumatoidea admitidos a la Clínica Universitaria Bolivariana en Medellín, en el periodo comprendido entre enero de 1999 y junio de 2003. Se hospitalizaron 41 pacientes en 62 oportunidades (0,34 hospitalizaciones por paciente por año). La principal causa de hospitalización fue la actividad de la enfermedad (60%), seguida de cirugía (18%) e infección (10%). En 30 casos hospitalizados (48,4%) se observó, al menos, una morbilidad asociada; la más frecuente fue la enfermedad cardiovascular (32%). El promedio de estancia fue de 5±6 días. El promedio de los costos totales fue de US$1.277, y el costo promedio del día de hospitalización fue de US$235. Los medicamentos representaron el 54% de los costos totales, mientras que los de asistencia médica representaron apenas el 3%. La enfermedad cardiovascular fue el determinante más importante de altos costos de hospitalización ( p<0,01). En conclusión, los costos directos de hospitalización de pacientes con artritis reumatoidea son considerables y surgen principalmente del compromiso orgánico de la enfermedad. La prevención y el tratamiento de la enfermedad cardiovascular son indispensables no sólo para reducir el impacto económico de la artritis reumatoidea, sino también para disminuir el riesgo de mortalidad que la misma acarrea. Estos resultados pueden ser útiles en la definición de las políticas de salud en nuestra población.The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5±6 days. The mean total cost was US$1,277, and the mean cost per day of hospitalization was US$235. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs ( p<0.01). In conclusion, the direct costs for inpatients with rheumatoid arthritis were considerable, and arose mainly from organic complications. Prevention and treatment of cardiovascular disease are indispensable not only to reduce the economic burden of rheumatoid arthitis, but also to diminish the risk of mortality. These data assist in the estimation of health care resources and in the selection of public health policies for the improvement of patient outcomes

Impact of cardiovascular illness on hospitalization costs in patients with rheumatoid arthritis

El objetivo del presente estudio fue analizar las causas y los costos directos de hospitalización de pacientes con artritis reumatoidea, establecer la morbilidad asociada y evaluar su impacto sobre los costos de la hospitalización. Para tal fin, se revisaron las historias clínicas y los registros del Departamento de Estadística y Contabilidad de todos los pacientes con artritis reumatoidea admitidos a la Clínica Universitaria Bolivariana en Medellín, en el periodo comprendido entre enero de 1999 y junio de 2003. Se hospitalizaron 41 pacientes en 62 oportunidades (0,34 hospitalizaciones por paciente por año). La principal causa de hospitalización fue la actividad de la enfermedad (60%), seguida de cirugía (18%) e infección (10%). En 30 casos hospitalizados (48,4%) se observó, al menos, una morbilidad asociada; la más frecuente fue la enfermedad cardiovascular (32%). El promedio de estancia fue de 5±6 días. El promedio de los costos totales fue de US$1.277, y el costo promedio del día de hospitalización fue de US$235. Los medicamentos representaron el 54% de los costos totales, mientras que los de asistencia médica representaron apenas el 3%. La enfermedad cardiovascular fue el determinante más importante de altos costos de hospitalización (p<0,01) En conclusión, los costos directos de hospitalización de pacientes con artritis reumatoidea son considerables y surgen principalmente del compromiso orgánico de la enfermedad. La prevención y el tratamiento de la enfermedad cardiovascular son indispensables no sólo para reducir el impacto económico de la artritis reumatoidea, sino también para disminuir el riesgo de mortalidad que la misma acarrea. Estos resultados pueden ser útiles en la definición de las políticas de salud en nuestra población.The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5±6 days. The mean total cost was US$1,277, and the mean cost per day of hospitalization was US$235. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs to reduce the economic burden of rheumatoid arthitis, but also to diminish the risk of mortality. These data assist in the estimation of health care resources and in the selection of public health policies for the improvement of patient outcomes