End of Life Cost Savings in the Palliative Care Unit Compared to Other Services.

Context Hospital deaths carry a significant healthcare cost that has been confirmed to be lower when palliative care units (PCUs) are available. Objectives To compare the last admission hospital health care cost of dying in a first-level hospital between the PCU and the rest of the hospital services. Methods A retrospective, comparative, observational study evaluating costs from the payer perspective on treatments and diagnostic-therapeutic tests performed on patients who die in first-level hospital, comparing whether they were treated by the PCU or another unit (Non-PCU). Patients with a mortality risk >2 were included according to the Severity of Illness Index (SOI) and Risk of Mortality (MOR). All cost express in €, median per patient and interquartile range (IQR). Results From 1,833 patients who died, 1,389 were included, 442 (31.1%) treated by PCU and 928 (68.9%) Non-PCU. Statistical differences were found for the last admission total cost (€262.8 (€470.1) for PCU versus €515.3 (€980.48) in Non-PCU), daily total cost (€74.27 (€127.4) vs €115.8 (€142.4) Non-PCU). Savings were maintained when the sample was broken down by diagnosis-related group (DRG) and a multivariate analysis was performed to determine how the different patients baseline characteristics between PCU and Non-PCU patients influenced the results obtained. Conclusions Data from this study show that cost is significantly lower when the patients are treated by a PCU during their last hospital stay when they pass away.post-print159 K

Intangibles factors and quality assessment of the service received in travel agencies

La adaptación de las agencias de viajes a los patrones de la Nueva Economía nos conduce a una tendencia hacia la reestructuración del sector, centrada en la búsqueda de nuevas estrategias competitivas. La creciente importancia de los activos intangibles para la consecución de dichas estrategias ha motivado este estudio, que trata de identificar aquellos factores intangibles, presentes en la prestación de este servicio, y que están directamente relacionados con la percepción, por parte del cliente, de una diferenciación en el servicio recibido.Adaptation of travel agencies to the standards of the New Economy is leading to a trend towards restructuring the sector aimed at finding new competitive strategies. The growing importance of intangible assets in achieving such strategies has motivated this study, which has tried to identify those intangible factors, present in the provision of the service, that have a direct relationship with the client´s perception of a differentiation in the service received

Measures to evaluate quality of care in head and neck cancer: Results of a Delphi study.

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Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn’s Disease Might Be Associated With Increased Rates of Stoma Construction.

Background: Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn’s disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods: This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results: Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Conclusions: Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors.post-print179 K

Measures to evaluate quality of care in renal cancer: results of a Delphi study in Spain.

Purpose: To review current measures for renal cancer care and develop a comprehensive and updated list of measures for their practical use. Methods: The study was developed by Fundación ECO, a Spanish foundation aiming to improve oncology quality of care. A systematic literature review was carried out to identify measures and knowledge gaps. A scientific committee composed of 9 experts reviewed the literature findings and added measures. A preliminary list of 42 measures was evaluated with the Delphi method to gather feedback from 47 medical oncology experts in Spain. Experts scored the appropriateness of the measures and ranked their priority in 2 consecutive online surveys. The scientific committee reviewed the Delphi results and developed the measures. A technical group from Universidad Francisco de Vitoria conducted and oversaw the Delphi method. Results: The Delphi method led to consensus on all 42 measures. The scientific committee used a prioritisation matrix to select 25 of these measures for evaluating quality of care in renal cancer. These measures regarded structure, process, and outcome and covered general management, diagnosis, treatment, follow-up, and evaluation of health outcomes. Easy-to-use index cards were developed for all 25 measures, including their definition, formula, acceptable level of attainment, and rationale. Conclusions: This manuscript aims to provide healthcare professionals with expert- and evidence-based measures that are useful for evaluating quality of care in renal cancer and cover all aspects and stages.pre-print451 K

A survey of deep learning models in medical therapeutic areas.

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Cardiovascular Screening Practices and Statin Prescription Habits in Patients with Psoriasis among Dermatologists, Rheumatologists and Primary Care Physicians.

Patients with psoriasis have a higher prevalence of cardiovascular risk factors. This study evaluated cardiovascular screening practices and statin prescribing habits among dermatologists, rheumatologists and primary care physicians (PCPs) through an online questionnaire, which was distributed through the Spanish scientific societies of the above-mentioned specialties. A total of 299 physicians (103 dermatologists, 94 rheumatologists and 102 PCPs) responded to the questionnaire. Of these, 74.6% reported screening for smoking, 37.8% for hypertension, 80.3% for dyslipidaemia, and 79.6% for diabetes mellitus. Notably, only 28.4% performed global screening, defined as screening for smoking, hypertension, dyslipidaemia, and diabetes mellitus by the same physician, and 24.4% reported calculating 10-year cardiovascular disease (CVD) risk, probably reflecting a lack of comprehensive cardiovascular risk assessment in these patients. This study also identified unmet needs for awareness of cardiovascular comorbidities in psoriasis and corresponding screening and treatment recommendations among PCPs. Of PCPs, 61.2% reported not being aware of the association between psoriasis and CVD and/or not being aware of its screening recommendations, and 67.6% did not consider psoriasis as a risk-enhancing factor when deciding on statin prescription. Thirteen dermatologists (12.6%) and 35 rheumatologists (37.2%) reported prescribing statins. Among those who do not prescribe, 49.7% would be willing to start their prescription.post-print492 K

Electronic Noses and Tongues in Wine Industry

Producción CientíficaThe quality of wines is usually evaluated by a sensory panel formed of trained experts or traditional chemical analysis. Over the last few decades, electronic noses (e-noses) and electronic tongues have been developed to determine the quality of foods and beverages. They consist of arrays of sensors with cross-sensitivity, combined with pattern recognition software, which provide a fingerprint of the samples that can be used to discriminate or classify the samples. This holistic approach is inspired by the method used in mammals to recognize food through their senses. They have been widely applied to the analysis of wines, including quality control, aging control, or the detection of fraudulence, among others. In this paper, the current status of research and development in the field of e-noses and tongues applied to the analysis of wines is reviewed. Their potential applications in the wine industry are described. The review ends with a final comment about expected future developments.CM-P agradece a la Universidad de Valladolid por su beca PIF-UVa y CG-H por su contrato pre-doctoral JCYL (BOCYL-D-24112015-9).Ministerio de Economía, Industria y Competitividad – FEDER (Grant AGL2015-67482-R)Junta de Castilla y León (programa de apoyo a proyectos de investigación - Ref. VA-032U13

Economic Evaluation of Fluticasone Propionate/ Formoterol (Flutiform ) vs. Fluticasone/Salmeterol and Budesonide/Formoterol in Spain.

Introduction: The aim of this economic evaluation was to estimate the cost-effectiveness of fluticasone propionate/formoterol (FP/FORM; Flutiform ) and compare it to those of fluticasone/ salmeterol (FS) and budesonide/formoterol (BF) when used in the treatment of adult patients with moderate-to-severe asthma. Methods: A Markov model was developed with five asthma health states: successful control, suboptimal control, outpatient-managed exacerbation, inpatient-managed exacerbation, and death. The time horizon was set at 12 months. Transition probabilities and indirect resource utilization were derived from previous international and Spanish publications. Univariate and probabilistic sensitivity analyses (SAs) were applied. Results: FP/FORM was less expensive to acquire than FS or BF (20% lower than FS and 30% lower than BF), while the quality-adjusted life years (QALYs) of the three options compared were very similar. Cost per patient in the FP/FORM cohort was 9326€/year, making it the cheapest option, 1.5% cheaper than FS and 2.6% cheaper than BF. The suboptimal control health state dominated the costs (80% of the total cost) in each of the analyzed options and scenarios. The results of the SAs verified the data obtained from the base case scenario. Conclusions: From a Spanish societal perspective, in 2014, FP/FORM produced a similar gain in QALYs but at a lower cost when compared to FS and BF in a highly meaningful number of replications and scenarios. FP/FORM can therefore be considered a cost-effective option in the treatment of moderate-to-severe asthma in Spain. The cost savings were mainly due to the significantly lower acquisition cost of FP/FORM than the other two options.post-print872 K

Subphthalocyanines as electron mediators in biosensors based on phenol oxidases

The electron mediator properties of three subphthalocyanines (SubPcs) [hexa-chloro boron subphthalocyanine (ClSubPc), tri-tert-butyl boron subphthalocyanine (t-BuSubPc) and hexa-phenoxy boron subphthalocyanine (PhOSubPc)] in Tyrosinase and Laccase biosensors (deposited on ITO glass) for the detection of catechol and hydroquinone were evidenced. A particularly remarkable performance was observed in the PhOSubPc-Tyr sensor, which takes account of the π-π interactions between subphthalocyanine rings and the active sites of the enzymes. Mediated electron transfer between redox enzymes and the ITO electrode improved the limits of detection by one order of magnitude, reaching 10−7 mol·L−1 values. Studies at increasing scan rates confirmed the improvement of the charge transfer rates caused by the presence of the SubPcs. A bioelectronic tongue formed by an array of the SubPc based biosensors has been able to discriminate red wines according to their Total Polyphenol Index.2020-07-102020-07-1