Consumo de recursos sanitarios y pérdida de productividad en la enfermedad por reflujo gastroesofágico: resultados de un estudio transversal en el ámbito de la atención primaria en España

ResumenObjetivoEvaluar el consumo de recursos sanitarios y la productividad en pacientes con enfermedad por reflujo gastroesofágico (ERGE), y la influencia de la gravedad de la sintomatología sobre estos factores.DiseñoSubanálisis de la población española de un estudio multinacional con una fase retrospectiva de 4 meses para la identificación y selección de pacientes, y otra transversal para recoger información clínica y consumo de recursos sanitarios, realizado entre octubre de 2007 y enero de 2008.EmplazamientoCentros de atención primaria.Participantes477 pacientes que habían consultado por algún motivo relacionado con la ERGE.Mediciones principalesConsumo de recursos sanitarios, cambios en la productividad evaluada mediante el Cuestionario de Alteración de la Actividad y Productividad Laboral (WPAI-GERD).ResultadosA pesar de recibir tratamiento farmacológico en la visita índice, tras una mediana de 5,1 meses de seguimiento (rango 2,1-8,1), en la visita de recogida de datos un 15,9% (IC 95%=12,8-19,5) de los pacientes continuaba presentando sintomatología de ERGE clínicamente relevante. Los costes médicos directos anuales asociados a pruebas diagnósticas y a consultas médicas en pacientes con y sin sintomatología de ERGE clínicamente relevante fueron 666 € (DE: 2.097 €) y 370 € (DE: 2.060 €), respectivamente. El coste medio anual de la pérdida de productividad (17%) fue de 5.316 € (DE: 8.615 €). En pacientes con síntomas clínicamente relevantes de ERGE este coste fue 4 veces superior al de pacientes sin sintomatología relevante (15.188 € [DE: 11.206 €] vs 3.926 € [DE: 7.232 €]).ConclusiónLos pacientes con ERGE consumen importantes recursos sanitarios, atribuibles a los costes médicos asociados y a la notable pérdida de productividad, incluso aunque reciban tratamiento.AbstractObjectiveTo evaluate healthcare resource use and productivity in patients with gastro-esophageal reflux disease (GERD) and the influence of disease severity on these two factors.DesignSub-analysis of the Spanish population of a multinational study with a 4-month retrospective period for the identification and selection of patients, and a clinical visit to obtain clinical information and data on use of healthcare resources, carried out between October 2007 and January 2008.PopulationA total of 477 patients attending a Primary Care centre, with a medical consultation for GERD.Main variablesUse of healthcare resources, changes in productivity based on the Work Productivity and Activity Impairment Questionnaire for GERD patients (WPAI-GERD).ResultsDespite having received pharmacological treatment at the baseline visit, after a median of 5.1 months follow-up (range 2.1-8.1), up to 15.9% (95% CI; 12.8-19.5) patients still showed clinically relevant GERD symptoms. Direct medical costs per year associated with diagnostic tests and medical consultations in patients with or without clinically relevant GERD symptoms were 666 € (SD: 2,097 €) and 370 € (SD: 2,060 €), respectively. The mean annual cost of reduced productivity (17%) was 5,316 € (SD: 8,615 €). This cost was 4 times higher for patients with clinically relevant GERD symptoms than for patients with no relevant symptoms (15,188€ [SD: 11,206 €] vs 3,926 € [SD: 7,232 €]).ConclusionPatients with GERD use significant healthcare resources, attributable to associated medical costs and marked reduction in productivity, even though they receive pharmacological treatment

Observational studies assessing the pharmacological treatment of obstructive lung disease : strengths, challenges and considerations for study design

Acknowledgements: Editorial support under the direction of the authors was provided by Richard Knight, CMC Connect, McCann Health Medical Communications, and funded by AstraZeneca in accordance with Good Publication Practice guidelines. The first draft of the manuscript was written in three sections by J. Vestbo, C. Janson and D. Price. Editorial support specifically for D. Price was provided by Antony Hardjojo of the Observational and Pragmatic Research Institute, Singapore. J. Vestbo is supported by the NIHR Manchester BRC.Peer reviewedPublisher PD

Factors associated with health-related quality of life in adults with asthma. A cross-sectional study

Background: The measurement of health-related quality of life (HRQoL) is increasingly recognized as an important endpoint, as a reflection of the effects of the disease from a patient perspective. Our aim was to evaluate the factors determining the HRQoL in patients with asthma, according to the EQ-5D questionnaire. Methods: Patients were included using multi-stage sampling, from Primary Care clinics from all the Autonomous Communities in Spain. The patients included were: over 18 years-old, with a confirmed diagnosis of asthma for at least one year, and had visited a Health Centre in the previous 2 years. The characteristics of the asthma disease, the adherence to treatment, the socio-demographic variables, the smoking habits, and the asthma control were collected using a questionnaire. The influence of the different variables included in the study on the EQ-5D was evaluated using multivariate logistic regression analysis. Results: A total of 2,125 patients were finally included (57.7% females, mean age 48 years). The response rate was 95.4%. Some factors showed a considerable detrimental effect on the HRQoL of asthmatics. Advanced age, lower educational level and poor control of asthma are significantly associated with a worse quality of life in all the dimensions assessed by the EQ-5D scale. The baseline severity of the asthma, and having been admitted to hospital are related to a worse quality of life in 5 of the 6 dimensions analyzed. Conclusion: In our study, we could identify some factors related to quality of life in asthma patients. The most important were advanced age, lower education level, and poor control of the asthma.S

Clinical results before and after implementation of a Fast - Track protocol for 507 patients who underwent total knee arthroplasty surgery: A retrospective, observational study.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. !is study aimed to assess the e'ects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: !is is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. !e variables studied were active knee #exion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. !e mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active #exion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. !e mean active extension was: -5.37º (SD = 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more signi$cant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in #exion and extension). However, the exact role of the Flexet device is still to be determined. Keywords: Total Knee Arthroplasty, Fast-Track, Rapid-Recovery, ROM, early mobilization, active physiotherapy

Experience with Artificial Neural Networks Applied in Multi-object Adaptive Optics

The use of artificial Intelligence techniques has become widespread in many fields of science, due to their ability to learn from real data and adjust to complex models with ease. These techniques have landed in the field of adaptive optics, and are being used to correct distortions caused by atmospheric turbulence in astronomical images obtained by ground-based telescopes. Advances for multi-object adaptive optics are considered here, focusing particularly on artificial neural networks, which have shown great performance and robustness when compared with other artificial intelligence techniques. The use of artificial neural networks has evolved to the extent of the creation of a reconstruction technique that is capable of estimating the wavefront of light after being deformed by the atmosphere. Based on this idea, different solutions have been proposed in recent years, including the use of new types of artificial neural networks. The results of techniques based on artificial neural networks have led to further applications in the field of adaptive optics, which are included in here, such as the development of new techniques for solar observation or their application in novel types of sensors

Multi-frequency point source detection with fully convolutional networks: Performance in realistic microwave sky simulations

Context. Point source (PS) detection is an important issue for future cosmic microwave background (CMB) experiments since they are one of the main contaminants to the recovery of CMB signal on small scales. Improving its multi-frequency detection would allow us to take into account valuable information otherwise neglected when extracting PS using a channel-by-channel approach. Aims. We aim to develop an artificial intelligence method based on fully convolutional neural networks to detect PS in multi-frequency realistic simulations and compare its performance against one of the most popular multi-frequency PS detection methods, the matrix filters. The frequencies used in our analysis are 143, 217, and 353 GHz, and we imposed a Galactic cut of 30°. Methods. We produced multi-frequency realistic simulations of the sky by adding contaminating signals to the PS maps as the CMB, the cosmic infrared background, the Galactic thermal emission, the thermal Sunyaev-Zel’dovich effect, and the instrumental and PS shot noises. These simulations were used to train two neural networks called flat and spectral MultiPoSeIDoNs. The first one considers PS with a flat spectrum, and the second one is more realistic and general because it takes into account the spectral behaviour of the PS. Then, we compared the performance on reliability, completeness, and flux density estimation accuracy for both MultiPoSeIDoNs and the matrix filters. Results. Using a flux detection limit of 60 mJy, MultiPoSeIDoN successfully recovered PS reaching the 90% completeness level at 58 mJy for the flat case, and at 79, 71, and 60 mJy for the spectral case at 143, 217, and 353 GHz, respectively. The matrix filters reach the 90% completeness level at 84, 79, and 123 mJy. To reduce the number of spurious sources, we used a safer 4σ flux density detection limit for the matrix filters, the same as was used in the Planck catalogues, obtaining the 90% of completeness level at 113, 92, and 398 mJy. In all cases, MultiPoSeIDoN obtains a much lower number of spurious sources with respect to the filtering method. The recovering of the flux density of the detections, attending to the results on photometry, is better for the neural networks, which have a relative error of 10% above 100 mJy for the three frequencies, while the filter obtains a 10% relative error above 150 mJy for 143 and 217 GHz, and above 200 mJy for 353 GHz. Conclusions. Based on the results, neural networks are the perfect candidates to substitute filtering methods to detect multi-frequency PS in future CMB experiments. Moreover, we show that a multi-frequency approach can detect sources with higher accuracy than single-frequency approaches also based on neural networks.We warmly thank the anonymous referee for the very useful comments on the original manuscript. J.M.C., J.G.N., L.B., M.M.C. and D.C. acknowledge financial support from the PGC 2018 project PGC2018-101948-B-I00 (MICINN, FEDER). DH acknowledges the Spanish MINECO and the Spanish Ministerio de Ciencia, Innovación y Universidades for partial financial support under project PGC2018-101814-B-I00. M.M.C. acknowledges PAPI-20-PF-23 (Universidad de Oviedo). J.D.C.J., M.L.S., S.L.S.G., J.D.S. and F.S.L. acknowledge financial support from the I+D 2017 project AYA2017-89121-P and support from the European Union’s Horizon 2020 research and innovation programme under the H2020-INFRAIA-2018-2020 grant agreement No 210489629. This research has made use of the python packages ipython (Pérez & Granger 2007), matplotlib (Hunter 2007), TensorFlow (Abadi et al. 2015), Numpy (Oliphant 2006) and Scipy (Jones et al. 2001), also the HEALPix (Górski et al. 2005) and healpy (Zonca et al. 2019) packages

Impact of gastroesophageal reflux disease on work absenteeism, presenteeism and productivity in daily life: a European observational study

<p>Abstract</p> <p>Background</p> <p>The RANGE (<it>R</it>etrospective <it>AN</it>alysis of <it>G</it>astro<it>E</it>sophageal reflux disease [GERD]) study assessed differences among patients consulting a primary care physician due to GERD-related reasons in terms of: symptoms, diagnosis and management, response to treatment, and effects on productivity, costs and health-related quality of life. This subanalysis of RANGE determined the impact of GERD on productivity in work and daily life.</p> <p>Methods</p> <p>RANGE was conducted at 134 primary care sites across six European countries (Germany, Greece, Norway, Spain, Sweden and the UK). All subjects (aged ≥18 years) who consulted with their primary care physician over a 4-month identification period were screened retrospectively, and those consulting at least once for GERD-related reasons were identified (index visit). From this population, a random sample was selected to enter the study and attended a follow-up appointment, during which the impact of GERD on productivity while working (absenteeism and presenteeism) and in daily life was evaluated using the self-reported Work Productivity and Activity Impairment Questionnaire for patients with GERD (WPAI-GERD).</p> <p>Results</p> <p>Overall, 373,610 subjects consulted with their primary care physician over the 4-month identification period, 12,815 for GERD-related reasons (3.4%); 2678 randomly selected patients attended the follow-up appointment. Average absenteeism due to GERD was highest in Germany (3.2 hours/week) and lowest in the UK (0.4 hours/week), with an average of up to 6.7 additional hours/week lost due to presenteeism in Norway. The average monetary impact of GERD-related work absenteeism and presenteeism were substantial in all countries (from €55/week per employed patient in the UK to €273/patient in Sweden). Reductions in productivity in daily life of up to 26% were observed across the European countries.</p> <p>Conclusion</p> <p>GERD places a significant burden on primary care patients, in terms of work absenteeism and presenteeism and in daily life. The resulting costs to the local economy may be substantial. Improved management of GERD could be expected to lessen the impact of GERD on productivity and reduce costs.</p

Clinical Results Before and After Implementation of a Fast - Track Protocol For 507 Patients Who Underwent Total Knee Arthroplasty Surgery: A Retrospective, Observational Study

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. This study aimed to assess the effects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: This is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. The variables studied were active knee flexion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. The mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active flexion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. The mean active extension was: -5.37º (SD= 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more significant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in flexion and extension). However, the exact role of the Flexet device is still to be determined

Prospective observational study in patients with obstructive lung disease : NOVELTY design

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