RESUMEN
INTRODUCTION: The use of abdominal radiography (AXR) apparently continues to be widespread despite its limited indications, the potential radiation and unnecessary costs associated. In addition, the interpretation and its report seem variable and not always performed by a radiologist. Our objective is to analyze the use, adequacy and usefulness of AXR in the emergency of a tertiary referral hospital. MATERIAL AND METHODS: We retrospectively reviewed all the AXR performed in January 2020 in the emergency of our centre, as well as the patient's demographics and medical records, technical quality of the radiographs, indications according to the SERAM (Spanish Society of Radiology) Appropriateness Guidelines, presence of a formal radiology report, and impact on the clinical management of the patient. Of all non-appropriated AXR we calculated the radiation received by the patients and its extra costs. RESULTS: In January 2020, 429 AXR (9.1% of all radiographies) were performed in the emergency of our centre. The most frequent indication was abdominal pain (40%, nâ¯=â¯176), followed by low back pain (21.4%, nâ¯=â¯92). 12.4% of AXR requested did not include any clinical information. Most of the AXR (79.6%) had sufficient technical quality. 61.3% (nâ¯=â¯263) of the AXR performed were not indicated, assuming an average unjustified radiation dose per patient of 0.50⯱â¯0.33â¯mSv, and a total additional cost of 6575;. Only 6% of the inadequate AXRs led to a change in the clinical management of the patient, compared to 29% of the adequate AXR (pâ¯<â¯0.001). Only 3% of the AXR had a formal radiology report. CONCLUSIONS: AXR is still common in the emergency setting, although most of them might be inadequate according to the SERAM Appropriateness Guidelines. Its use should be optimized to avoid unnecessary radiation and costs. Radiologists must have a more active participation in the management of AXR.
Asunto(s)
Servicio de Urgencia en Hospital , Radiografía Abdominal , Humanos , Estudios Retrospectivos , Servicio de Urgencia en Hospital/economía , Radiografía Abdominal/economía , Femenino , Masculino , Persona de Mediana Edad , Adulto , Protección Radiológica/economía , Anciano , Anciano de 80 o más Años , Utilización de Procedimientos y Técnicas , Adolescente , Adulto JovenRESUMEN
INTRODUCTION: The number of urodynamic studies (UDS) has been declining steadily in recent decades, yet the reasons behind this trend remain poorly understood. This study aims to investigate the structural aspects of UDS in urology and explore the factors contributing to this decline. MATERIAL & METHODS: We surveyed all urological departments performing UDS as well as a representative sample of private practices in Germany in 2023. We examined structural situation, waiting times, capacities and limitations of UDS. All invasive urodynamic examinations were defined as UDS. RESULTS: In 2019, 259/474 (55%) urological departments in Germany performed UDS. 206/259 (80%) urological departments responded to the survey. 163/200 (82%) urological departments stated that their capacities were exhausted, a main reason being lack of medical and nursing staff. 54.8% urological departments performed more than 50% of their UDS for referring physicians. Urological departments with a low number of UDS/year (≤ 100) showed a shorter waiting time (up to 4 weeks: 49% vs. 30%; p = 0.01), reduced UDS capacities (55% vs. 12%; p < 0.001) and these capacities were often not fully utilized (25% vs. 9%; p = 0.007). 122/280 (44%) office urologists responded to the survey. 18/122 (15%) office urologists performed UDS. Main reasons for not offering UDS were lack of personnel and low reimbursement. CONCLUSION: In German urological departments, UDS capacities are consistently fully utilized, primarily due to staffing shortages. This trend towards centralization prompts questions about the role of UDS in urologists' training.
Asunto(s)
Urodinámica , Urología , Humanos , Alemania , Utilización de Procedimientos y Técnicas/estadística & datos numéricosRESUMEN
OBJECTIVE: To characterize differences between urologists and advanced practice providers (APPs) in the utilization of cystoscopy for hematuria. METHODS: We identified patients initially evaluated for hematuria by a urologist or urology APP between 2015 and 2020 in the MarketScan Research Databases. We determined whether they received a cystoscopy within 6 months of their urology visit and the number of days until cystoscopy. We used multivariable regression to analyze the association between these outcomes and whether the urology clinician was an advanced practice registered nurse (APRN), physician assistant (PA), or urologist. RESULTS: We identified 34,470 patients with microscopic hematuria and 17,328 patients with gross hematuria. Patients evaluated by urologists more often received a same-day cystoscopy than those evaluated by APPs (13% vs 5.8%). The odds that patients evaluated for microscopic and gross hematuria received a cystoscopy were 46.2% and 26.2% lower, respectively, if they were evaluated by an APRN vs a urologist. Patients seeing an APRN for microscopic and gross hematuria also waited approximately 7 and 14 days longer for their cystoscopy, respectively. No differences were observed for patients evaluated by PAs vs urologists. CONCLUSION: Patients evaluated for hematuria by an APRN were less likely to receive a cystoscopy and had a longer wait until the procedure compared to those evaluated by a urologist; however, no differences were observed between PAs and urologists. Better understanding APP integration into urology clinics is warranted.
Asunto(s)
Cistoscopía , Hematuria , Urólogos , Humanos , Hematuria/diagnóstico , Hematuria/etiología , Masculino , Femenino , Persona de Mediana Edad , Urólogos/estadística & datos numéricos , Factores de Tiempo , Anciano , Adulto , Urología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Asistentes Médicos/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricosRESUMEN
OBJECTIVE: The objective was to describe the characteristics of the use of clinical ultrasound in two health centers (SC) of Health Area VII of the Region of Murcia (CS Murcia-Sur and CS Floridablanca). DESIGN: Observational, descriptive, longitudinal, prospective and multicenter study. SITE: CS Murcia-Sur and CS Floridablanca (Health Area VII of the Region of Murcia). PARTICIPANTS: One hundred and thirty-five patients were included. INTERVENTIONS: Performance of clinical ultrasound in the primary care (PC) consultation. MAIN MEASUREMENTS: Demographic variables (age, sex), as well as clinical variables (reason for consultation, type of ultrasound, results, referrals to the second hospital level, degree of diagnostic agreement) were collected. RESULTS: One hundred and thirty-five patients were included, more than 50% were female. The main reason for consultation was musculoskeletal and soft tissue symptoms (44.4%), followed by digestive symptoms (21.5%). 44.4% of the ultrasounds were classified as normal, while pathological findings were found in 55.6%. Confirmatory tests were requested in 43.7% and the findings were confirmed in 67% of the patients. CONCLUSIONS: The use of ultrasound in PC allows to show the high prevalence of pathological findings in the examination of patients. In a technique that helps the clinician in his diagnostic-therapeutic process. The integration of clinical ultrasound in the PC consultation can save complementary studies and referrals to a second level of care. Its implementation in PC requires proper training of professionals.
Asunto(s)
Atención Primaria de Salud , Ultrasonografía , Humanos , Femenino , Estudios Prospectivos , Masculino , Ultrasonografía/estadística & datos numéricos , Ultrasonografía/métodos , Persona de Mediana Edad , Adulto , Anciano , Estudios Longitudinales , Adolescente , Adulto Joven , Anciano de 80 o más Años , Utilización de Procedimientos y Técnicas/estadística & datos numéricosRESUMEN
Background: Second-hand economy is a universal phenomenon. In Nigeria, it cut across many decades and all spectrums of life even in childcarepractice. The role of second-hand products in childcare practice and provisioning has been under reported in scholarly discuss in Nigeria. Hence,the prevalence of secondhand childcare products utilization, different categories of secondhand products available for childcare, the perceived health hazards and the reasons why consumers patronize secondhand products for childcareamong mothers of under five years in Ibadan Nigeria.Methods:A cross sectional concurrent mix-methods approach was used in the study. The quantitative and qualitative data weredone simultaneously. While mothers of under-five children were purposively selected for in-depth interviews, a total sampling of all consenting mothers of under-five found at immunization clinic of Primary health care centres were sampled for survey. A total number of 403 mothers of under five children participated in the survey while 50 IDIs were conducted with buyers (mothers) and traders of secondhand children's products. Qualitative data were subjected to thematic analysis, while the quantitative data were analyzed with descriptive statistics and chi-square test.Results:The mean age of mothers is ± SD 28.6 ± 5.4. Majority of respondents 209 (51.9%) had senior secondary education, 140 (34.7%) had tertiary education and only 2 (0.5%) had no formal education. About 339 (84.1%) utilized secondhand childcare products, while 64 (15.9%) never used secondhand childcare products. Mothers with at least senior secondary education 209 (51.9%) were found to be the highest users of secondhand childcare products. Procurement and utilization of secondhand childcare products was based on quality value, availability, affordability attached to constructed superiority of western civilization wrapped around provisioning in childcare. Conclusion: Many mothers of under-five children in Ibadan utilizes secondhand products in childcare. Embedding secondhand products health hazard in health talk during immunization clinics will be beneficial and help in educating mothers on reduced and safe utilization of secondhand products in childcare
Asunto(s)
Humanos , Cuidado del Niño , Utilización de Procedimientos y Técnicas , Ciudades , Riesgo a la SaludRESUMEN
BACKGROUND: The Health Extension Program (HEP) was introduced in 2003 to extend primary health care services by institutionalizing the former volunteer-based village health services. However, this program is not comprehensively evaluated. MATERIALS AND METHODS: The 2019 comprehensive national assessment of HEP involved (1) assessment through quantitative and qualitative primary data, (2) a thorough systematic review of the HEP literature, and (3) a synthesis of evidence from the two sources. The assessment included household survey(n=7122), a survey of health extension workers (HEWs) (n=584) _, and an assessment of health posts (HPs)(n=343) and their supervising health centers (HCs)(n=179) from 62 randomly selected woredas. As part of the comprehensive assessment. OUTPUT AND RESULTS: The outputs were (a) full and abridged reports, (b) 40 posters, (c) seven published, three under review scientific papers and (d) seven papers in this special issue. During the one-year period preceding the study, 54.8% of women, 32.1% of men, and 21.9% of female youths had at least a one-time interaction with HEWs. HPs and HEWs were universally available. There were critical gaps in the skills and motivation of HEWs and fulfillment of HP standards: 57.3% of HEWs were certified, average satisfaction score of HEWs was 48.6%, and 5.4% of HPs fulfilled equipment standards. CONCLUSIONS: The findings informed policy and program decisions of the Ministry of Health, including the design of the HEP Optimization Roadmap 20202035 and the development Health Sector Transformation Plan II. It is also shared with global community through published papers.
Asunto(s)
Humanos , Salud Pública , Servicios de Salud Materno-Infantil , Sistemas de Información en Salud , Centros de Salud , Atención Ambulatoria , Utilización de Procedimientos y TécnicasRESUMEN
INTRODUCTION: The SARS-CoV-2 pandemic has given rise to a major change in healthcare and brought teleconsultation to the forefront. In neurology, headaches are the most frequent reason for visits. AIM: To assess the impact of the COVID-19 pandemic on the structure of headache units in Andalusia and the adaptations made to healthcare that are potentially useful innovations that can continue to be developed when the pandemic is over. MATERIALS AND METHODS: Cross-sectional observational study using an online survey of neurologists responsible for headache units and specialised consultations in Andalusia. RESULTS: During the state of alarm, all respondents used teleconsultation. The vast majority (92.8%) maintained some face-to-face activity, mostly for invasive techniques and new patients, using individual protection measures and as a way to avoid crowds. Half of them (50%) maintained botulinum toxin administrations at the scheduled times and 78.6% continued to prescribe monoclonal antibodies against calcitonin gene-related peptide. Altogether 78.5% are generally satisfied with the use of teleconsultation and 57.1% think it could be quite useful in the future. The main advantages reported were avoiding the need for the patient to travel and time savings; the disadvantages were the absence of physical examinations and difficulties in communicating. The most frequently expressed need for improvement was the use of video-calls. CONCLUSIONS: Some of the changes adopted during this time could continue to be useful in the future and, in the case of headaches, teleconsultation could be used as an option for following up patients who have already been diagnosed and do not require any invasive techniques.
TITLE: Adaptación de las unidades de cefalea de Andalucía a la pandemia por COVID-19. Análisis del Grupo de Estudio de Cefaleas de la Sociedad Andaluza de Neurología.Introducción. La pandemia por SARS-CoV-2 ha supuesto un gran cambio en la atención sanitaria y ha dado protagonismo a la teleconsulta. En neurología, las cefaleas constituyen el motivo más frecuente de consulta. Objetivo. Evaluar el impacto de la pandemia por COVID-19 en la estructura de las unidades de cefaleas de Andalucía y las adaptaciones asistenciales potencialmente útiles tras ella. Materiales y métodos. Estudio observacional transversal mediante encuesta en línea a los neurólogos responsables de las unidades y consultas monográficas de cefaleas de Andalucía. Resultados. Durante el estado de alarma, todos los encuestados usaron teleconsulta. El 92,8% mantuvo alguna actividad presencial, fundamentalmente para técnicas invasivas y pacientes nuevos, utilizando medidas de protección individual y para evitar aglomeraciones. El 50% mantuvo las administraciones de toxina botulínica en los tiempos adecuados y el 78,6% siguió prescribiendo anticuerpos monoclonales frente al péptido relacionado con el gen de la calcitonina. El 78,5% se encuentra globalmente satisfecho con el uso de la teleconsulta y el 57,1% considera que podría ser bastante útil de cara al futuro. Las principales ventajas expresadas fueron evitar el desplazamiento de los pacientes y el ahorro de tiempo; los inconvenientes, la ausencia de exploración física y la dificultad de comunicación. La necesidad de mejora más expresada fue el uso de videollamada. Conclusiones. Algunos de los cambios adoptados en este tiempo podrían seguir siendo útiles en el futuro y, en el caso de las cefaleas, la teleconsulta se podría emplear como opción para el seguimiento de pacientes ya diagnosticados y que no requieran técnicas invasivas.
Asunto(s)
COVID-19/epidemiología , Cefalea , Unidades Hospitalarias/organización & administración , Hospitales Universitarios/organización & administración , Neurología/organización & administración , Pandemias , SARS-CoV-2 , Telemedicina/tendencias , Anticuerpos Monoclonales/uso terapéutico , Actitud del Personal de Salud , Toxinas Botulínicas Tipo A/uso terapéutico , Estudios Transversales , Cefalea/epidemiología , Cefalea/terapia , Encuestas de Atención de la Salud , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Neurólogos/psicología , Neurología/métodos , Satisfacción Personal , Utilización de Procedimientos y Técnicas , España/epidemiología , Telemedicina/estadística & datos numéricos , Factores de TiempoRESUMEN
BACKGROUND: Ureteroscopy is becoming the primary treatment for ureteral stones. As a standard of care, ureteroscopy is performed under the supervision of fluoroscopy. Recent advances in endourological technology make the need for fluoroscopy questionable. OBJECTIVES: To summarize our experience with a no-fluoroscopy technique for selected cases of ureteral stones. METHODS: Patients were considered suitable for fluoroless ureteroscopy if they had one or two non-impacted stones, in any location in the ureter, 5-10 mm size, with a normal contralateral renal unit and no urinary tract infection. Procedures were performed using rigid scopes, nitinol baskets/forceps for stone retrieval, and Holmium:YAG laser for lithotripsy. Stents were placed per surgeon's decision. RESULTS: During an 18-month period, 103 patients underwent fluoroless ureteroscopy. In 94 patients stones were removed successfully. In six, the stones were pushed to the kidney and treated successfully on a separate session by shock wave lithotripsy. In three patients no stone was found in the ureter. In five patients, miniature perforations in the ureter were noted and an indwelling double J stent was placed. CONCLUSIONS: Fluoroless ureteroscopy resulted in a high rate of success. We believe that in selected cases it can be used with minimal adverse events.
Asunto(s)
Fluoroscopía , Complicaciones Posoperatorias , Cirugía Asistida por Computador , Cálculos Ureterales , Ureteroscopía , Femenino , Fluoroscopía/métodos , Fluoroscopía/estadística & datos numéricos , Humanos , Israel/epidemiología , Litotricia/métodos , Litotricia/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Selección de Paciente , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Salud Radiológica/métodos , Stents/estadística & datos numéricos , Cirugía Asistida por Computador/efectos adversos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Cálculos Ureterales/diagnóstico por imagen , Cálculos Ureterales/epidemiología , Cálculos Ureterales/cirugía , Ureteroscopía/efectos adversos , Ureteroscopía/métodosRESUMEN
OBJECTIVE: To examine the relationship between hospital volume and the management of bladder cancer variant histology. Variant histologies of bladder cancer are rare which limits the ability for providers to develop expertise however there is a clear hospital and/or surgeon-volume relationship for management of rare or complex surgical and/or medical diseases. METHODS: We queried the National Cancer Database from 2004-2016 for all cases of bladder cancer, identifying cases of variant histology. Our primary outcome was overall survival while secondary outcomes included identifying treatment patterns. Hospitals were stratified into those that managed ≤2, >2-4, >4-6, and ≥6 cases per year of variant histology. RESULTS: We identified 23,284 patients with bladder cancer of variant histology who were treated at 1301 hospitals. Few institutions had high volume experience with this disease: 18.5% (n = 241) treated >2 patients annually and 5.7% (n = 76) treated >4 cases annually. Hospital volume positively correlated with utilization of early radical cystectomy (RC) in non-muscle invasive disease and neoadjuvant chemotherapy in muscle-invasive disease. On multivariable analysis, increased hospital volume was associated with improved survival. After stratifying by sub-type, hospital volume continued to be associated with improved survival for squamous, small cell, and sarcomatoid cancers. CONCLUSION: Management of variant histology urothelial carcinoma at high-volume centers is associated with improved overall survival. The mechanisms of this are multifactorial, and future research should focus on improvement opportunities for low-volume hospitals, centralization of care, and/or increased access to care at high-volume centers.
Asunto(s)
Carcinoma de Células Renales , Cistectomía , Hospitales de Alto Volumen/estadística & datos numéricos , Complicaciones Posoperatorias , Competencia Profesional/normas , Neoplasias de la Vejiga Urinaria , Anciano , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/terapia , Cistectomía/efectos adversos , Cistectomía/métodos , Cistectomía/estadística & datos numéricos , Femenino , Hospitales de Bajo Volumen/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Terapia Neoadyuvante/estadística & datos numéricos , Invasividad Neoplásica , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Análisis de Supervivencia , Estados Unidos/epidemiología , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
OBJECTIVE: To define geographic variations in emergency general surgery (EGS) care, we sought to determine how much variability exists in the rates of EGS operations and subsequent mortality in the Northeastern and Southeastern United States (US). SUMMARY BACKGROUND DATA: While some geographic variations in healthcare are normal, unwarranted variations raise questions about the quality, appropriateness, and cost-effectiveness of care in different areas. METHODS: Patients ≥18 years who underwent 1 of 10 common EGS operations were identified using the State Inpatient Databases (2011-2012) for 6 states, representing Northeastern (New York) and Southeastern (Florida, Georgia, Kentucky, North Carolina, Mississippi) US. Geographic unit of analysis was the hospital service area (HSA). Age-standardized rates of operations and in-hospital mortality were calculated and mapped. Differences in rates across geographic areas were compared using the Kruskal-Wallis test, and variance quantified using linear random-effects models. Variation profiles were tabulated via standardized rates of utilization and mortality to compare geographically heterogenous areas. RESULTS: 227,109 EGS operations were geospatially analyzed across the 6 states. Age-standardized EGS operation rates varied significantly by region (Northeast rate of 22.7 EGS operations per 10,000 in population versus Southeast 21.9; P < 0.001), state (ranging from 9.9 to 29.1; P < 0.001), and HSA (1.9-56.7; P < 0.001). The geographic variability in age-standardized EGS mortality rates was also significant at the region level (Northeast mortality rate 7.2 per 1000 operations vs Southeast 7.4; P < 0.001), state-level (ranging from 5.9 to 9.0 deaths per 1000 EGS operations; P < 0.001), and HSA-level (0.0-77.3; P < 0.001). Maps and variation profiles visually exhibited widespread and substantial differences in EGS use and morality. CONCLUSIONS: Wide geographic variations exist across 6 Northeastern and Southeastern US states in the rates of EGS operations and subsequent mortality. More detailed geographic analyses are needed to determine the basis of these variations and how they can be minimized.
Asunto(s)
Tratamiento de Urgencia/estadística & datos numéricos , Complicaciones Posoperatorias/mortalidad , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estudios de Cohortes , Cirugía General , Humanos , New England/epidemiología , Estudios Retrospectivos , Sudeste de Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: There are limited data on the temporal trends, incidence, and outcomes of ST-segment-elevation myocardial infarction-cardiogenic shock (STEMI-CS). METHODS: Adult (>18âyears) STEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011, 2012-2017). Outcomes of interest included temporal trends, acute organ failure, cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. RESULTS: In â¼4.3 million STEMI admissions, CS was noted in 368,820 (8.5%). STEMI-CS incidence increased from 5.8% in 2000 to 13.0% in 2017 (patient and hospital characteristics adjusted odds ratio [aOR] 2.45 [95% confidence interval {CI} 2.40-2.49]; Pâ<â0.001). Multiorgan failure increased from 55.5% (2000-2005) to 74.3% (2012-2017). Between 2000 and 2017, coronary angiography and percutaneous coronary intervention use increased from 58.8% to 80.1% and 38.6% to 70.6%, whereas coronary artery bypass grafting decreased from 14.9% to 10.4% (all Pâ<â0.001). Over the study period, the use of intra-aortic balloon pump (40.6%-37.6%) decreased, and both percutaneous left ventricular assist devices (0%-12.9%) and extra-corporeal membrane oxygenation (0%-2.8%) increased (all Pâ<â0.001). In hospital mortality decreased from 49.6% in 2000 to 32.7% in 2017 (aOR 0.29 [95% CI 0.28-0.31]; Pâ<â0.001). During the 18-year period, hospital lengths of stay decreased, hospitalization costs increased and use of durable left ventricular assist device /cardiac transplantation remained stable (Pâ>â0.05). CONCLUSIONS: In the United States, incidence of CS in STEMI has increased 2.5-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and PCI increased during the study period.
Asunto(s)
Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Choque Cardiogénico/epidemiología , Choque Cardiogénico/terapia , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardiovasculares , Estudios de Cohortes , Angiografía Coronaria/estadística & datos numéricos , Bases de Datos Factuales , Femenino , Costos de Hospital , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Contrapulsador Intraaórtico/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Utilización de Procedimientos y Técnicas , Infarto del Miocardio con Elevación del ST/mortalidad , Choque Cardiogénico/diagnóstico , Factores de Tiempo , Estados UnidosRESUMEN
OBJECTIVE: Transcatheter aortic valve replacement technology is increasingly used for aortic valve stenosis. We sought to evaluate the adoption of transcatheter aortic valve replacement technology with respect to overall surgical aortic valve replacement volume in Florida. METHODS: The 2010-2019 Florida Agency for Health Care Administration data set was queried. Difference-in-difference analysis was used to evaluate the impact of transcatheter aortic valve replacement on the total aortic valve surgical volume of transcatheter aortic valve replacement versus nonperforming hospitals. Length of stay and elements of charges were compared for the raw and 1:1 propensity matched data. RESULTS: A total of 46,032 surgical aortic valve procedures were performed at 88 hospitals. Transcatheter aortic valve replacement performing hospitals experienced a 21% increase in total aortic valve surgical volume. Length of stay was significantly less for patients undergoing transcatheter aortic valve replacement. Propensity matched transcatheter aortic valve replacement patients had less gross total charges. CONCLUSION: Introduction of transcatheter aortic valve replacement technology significantly increased overall surgical aortic valve volume and may be associated with less gross total hospital charges.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Reemplazo de la Válvula Aórtica Transcatéter/estadística & datos numéricos , Adulto , Anciano , Bases de Datos Factuales , Femenino , Florida , Precios de Hospital , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Utilización de Procedimientos y Técnicas , Puntaje de Propensión , Estudios Retrospectivos , Reemplazo de la Válvula Aórtica Transcatéter/economíaRESUMEN
BACKGROUND: Transsternal open thymectomy has long been the most widely used approach for thymectomy, but recent decades have seen the introduction of minimally invasive surgery (MIS), such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) thymectomy. This retrospective cohort study provides a national comparison of trends, outcomes, and resource utilization of open, VATS, and RATS thymectomy. METHODS: Admissions for thymectomies from 2008 to 2014 were identified in the National Inpatient Sample. Patients were identified as undergoing open, VATS, or RATS thymectomy. Propensity score-matched analyses were used to compare overall complication rates, length of stay (LOS), and cost of VATS and RATS thymectomies. RESULTS: An estimated 23,087 patients underwent thymectomy during the study period: open in 16,025 (69%) and MIS in 7217 (31%). Of the MIS cohort, 4119 (18%) underwent VATS and 3097 (13%) underwent RATS. Performance of RATS and VATS thymectomy increased while that of open thymectomy declined. Baseline characteristics between VATS and RATS were similar, except more women underwent VATS thymectomy. No differences in LOS or overall complication rates were appreciable in this study. VATS was associated with the lowest cost of the 3 approaches. CONCLUSIONS: Our findings demonstrate the increasing adoption of MIS and declining use of the open surgical approach for thymectomy. There are no differences in overall complication rates between RATS and VATS thymectomy, but RATS is associated with greater cost and lower cardiac complication rates.
Asunto(s)
Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Cirugía Torácica Asistida por Video/estadística & datos numéricos , Timectomía/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
PURPOSES: The spread of coronavirus disease 2019 (COVID-19) has affected socioeconomic and healthcare systems in many countries. Accordingly, many individuals may have canceled their annual health-check programs, including esophagogastroduodenoscopy, which would have resulted in lower numbers of newly diagnosed patients with gastric cancer in comparison to other times. METHODS: Questionnaires were distributed to 62 hospitals every week from May 2020 to August 2020 (total 744) through mailing lists of the Stomach Cancer Study Group of the Japan Clinical Oncology Group. The number of patients with gastric cancer and hospital systems during the COVID-19 pandemic were surveyed. RESULTS: In total, 74% (551 out of 744) of the questionnaires were answered and analyzed. In early May, approximately 50% of hospitals had to restrict surgical slots due to the COVID-19 pandemic. However, they gradually loosened the restrictions thereafter. The number of gastrectomies was < 80% that of the same period in the previous year, and hospitals in Tokyo were seriously affected by a 50% decrease in the number of gastrectomies. CONCLUSIONS: The number of gastrectomies was lower than that in the previous year. Further multi-center follow-up studies are required to evaluate the long-term effects of COVID-19 on the clinical outcomes of patients with gastric cancer.
Asunto(s)
COVID-19/epidemiología , Atención a la Salud/organización & administración , Hospitales de Alto Volumen/estadística & datos numéricos , Control de Infecciones/organización & administración , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , COVID-19/prevención & control , COVID-19/transmisión , Endoscopía del Sistema Digestivo/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Gastrectomía/estadística & datos numéricos , Humanos , Japón , Utilización de Procedimientos y Técnicas , Neoplasias Gástricas/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: There are no reports on nationwide trends in subtotal cholecystectomy (STC) and cholecystostomy in England. We hypothesized that, as in the United States, a substantial increase in the utilization of these surgical procedures, over time, may be observed. We aimed to generate a reliable report on 4 of the most common gallbladder surgical procedures in England to allow cross-procedure comparisons and highlight significant changes in the management of benign gallbladder disease over time. METHODS: We obtained data from NHS Digital and extracted population estimates from the Office of National Statistics. We examined the trends in the use of STC, cholecystostomy, cholecystolithotomy and total cholecystectomy (TC) between 2000 and 2019. RESULTS: Of the 1,234,319 gallbladder surgeries performed, TC accounted for 96.8% (n = 1,194,786) and the other 3 surgeries for 3.2% (n = 39,533). The total number of gallbladder surgeries performed annually increased by 80.4% from 2000 to 2019. We detected increases in the counts of cholecystostomies by 723.1% (n = 290 in 2000 vs n = 2,387 in 2019) and STCs by 716.6% (n = 217 in 2000 vs n = 1,772 in 2019). Consequently, there was a decrease in the ratio of TC to STC (180:1 in 2000 vs 38:1 in 2019). A similar decrease was observed in the ratio of cholecystectomy to cholecystostomy (135:1 in 2000 vs 29:1 in 2019). CONCLUSION: Increased utilization of STC and cholecystostomy was detected in England. These findings highlight the importance of regular monitoring of nationwide trends in gallbladder surgery and the associated clinical outcomes.
Asunto(s)
Colecistectomía/tendencias , Colecistostomía/tendencias , Enfermedades de la Vesícula Biliar/cirugía , Vesícula Biliar/cirugía , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Colecistectomía/estadística & datos numéricos , Colecistostomía/estadística & datos numéricos , Inglaterra , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Utilización de Procedimientos y Técnicas , Estudios Retrospectivos , Distribución por Sexo , Adulto JovenRESUMEN
Introducción: La cirugía de la artroplastia y el recambio de una prótesis de cadera es una cirugía compleja y costosa. La estrategia quirúrgica y componentes protésicos son completamente diferentes en función de las deformidades óseas existentes y características anatómicas personales de cada paciente, por tanto, la planificación de suministros de los diferentes componentes es básica para cubrir las demandas de la población necesitada y la adecuada eficiencia económica para evitar gastos innecesarios por sobreestimación o infraestimación de las demandas. Objetivos: Determinar las necesidades por medidas de los diferentes tipos de componentes protésicos utilizados en la artroplastia total de cadera en las provincias centrales y de este modo optimizar las inversiones, con las ventajas económicas que supone. Métodos: Estudio longitudinal descriptivo retrospectivo de los casos operados de artroplastia total de cadera en el Hospital Arnaldo Milián Castro de Villa Clara, desde diciembre de 1998 hasta la fecha. Se analizan las variables edad, sexo, procedencia y componentes protésicos. Se recoge la información en la base de datos creada en SPSS, donde se realizan los análisis estadísticos. Resultados: La edad media fue 62,36 años. El grupo de 61 - 80 años fue el de mayor incidencia con 215 pacientes. Predominó el sexo masculino 51,8 por ciento. La mayor incidencia, correspondió a Villa Clara con 692 pacientes. Los componentes cementados 46 - 50 fueron los más usados y en los no cementados los más usados fueron 48-56. Vástagos Tipo Müller 7.5 - 12.5. RALCA Cementadas T0-T4, no cementados T1-T3. En las SLA, 11.5 y 13. Los cuellos estándar fueron los de mayor incidencia con 390 pacientes. Conclusiones: Con las incidencias de las diferentes medidas utilizadas por cada uno de los componentes expresados, se puede determinar con bastante exactitud la demanda de cada medida por cada 100 casos pendientes de operación. Esto permite satisfacer las demandas de las medidas más usadas y hacer una distribución apropiada a la hora del suministro, lo que redundaría en un beneficio económico vital en las actuales condiciones del país(AU)
Introduction: The arthroplasty surgery and the replacement of a hip replacement is a complex and expensive surgery. The surgical strategy and prosthetic components are completely different depending on the existing bone deformities and personal anatomical characteristics of each patient, therefore, the planning of supplies of the different components is essential to meet the demands of the needy population and adequate economic efficiency to avoid unnecessary expenses due to overestimation or underestimation of claims. Objective: To determine the needs by measurements of the different types of prosthetic components used in total hip arthroplasty in the central provinces and thus optimize investments, with the economic advantages that it entails. Methods: A retrospective descriptive longitudinal study was carried out of the total hip arthroplasty operated cases at Arnaldo Milián Castro Hospital in Villa Clara, from December 1998 to date. Age, sex, origin and prosthetic components are the variables examined. The information is collected in the database created in SPSS, statistical analyzes was performed. Results: The mean age was 62.36 years. The group of 61-80 years was the one with the highest incidence (215 patients). Male sex predominated (51.8 percent). The highest incidence corresponded to Villa Clara (692 patients). The cemented components 46-50 were the most used and in the uncemented components the most used were 48-56. Müller Stems 7.5 - 12.5. RALCA Cemented T0-T4, uncemented T1-T3. In the SLA the most used were 11.5 and 13 respectively. Standard necks were those with the highest incidence (390 patients). Conclusions: The demand for each measure can be determined quite accurately for every 100 cases pending operation with the incidents of the different measures used by each of the components expressed, allowing to meet the demands of the most used measures and appropriate distribution at supplying, which would result in vital economic benefit in the current conditions of the country(AU)
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Incidencia , Artroplastia de Reemplazo de Cadera/métodos , Utilización de Procedimientos y Técnicas , Prótesis Articulares , Estudios Retrospectivos , Estudios LongitudinalesRESUMEN
INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.
TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.
Asunto(s)
COVID-19/epidemiología , Epilepsia/tratamiento farmacológico , Pandemias , Consulta Remota/estadística & datos numéricos , SARS-CoV-2 , Centros de Atención Terciaria/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anticonvulsivantes/uso terapéutico , Niño , Preescolar , Manejo de la Enfermedad , Epilepsia Refractaria/tratamiento farmacológico , Epilepsia Refractaria/epidemiología , Epilepsias Parciales/tratamiento farmacológico , Epilepsias Parciales/epidemiología , Epilepsia/epidemiología , Femenino , Guatemala/epidemiología , Clausura de las Instituciones de Salud , Humanos , Lactante , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Visita a Consultorio Médico/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Consulta Remota/tendencias , Estudios Retrospectivos , Convulsiones/epidemiología , Convulsiones/prevención & control , Teléfono , Centros de Atención Terciaria/organización & administración , Resultado del Tratamiento , Comunicación por Videoconferencia , Adulto JovenAsunto(s)
Infecciones por Mycoplasma , Mycoplasma genitalium , Técnicas de Amplificación de Ácido Nucleico/métodos , Enfermedades de Transmisión Sexual , Uretritis , Cervicitis Uterina , Adolescente , Adulto , Femenino , Humanos , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/microbiología , Mycoplasma genitalium/genética , Mycoplasma genitalium/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico/economía , Prevalencia , Utilización de Procedimientos y Técnicas/economía , ARN Ribosómico 16S/aislamiento & purificación , ARN Ribosómico 23S/aislamiento & purificación , Sensibilidad y Especificidad , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/microbiología , Manejo de Especímenes/métodos , Estados Unidos/epidemiología , Uretritis/diagnóstico , Uretritis/epidemiología , Uretritis/microbiología , Cervicitis Uterina/diagnóstico , Cervicitis Uterina/epidemiología , Cervicitis Uterina/microbiologíaAsunto(s)
Ecocardiografía Tridimensional/métodos , Ventrículos Cardíacos , Imagen por Resonancia Cinemagnética/métodos , Hipertensión Arterial Pulmonar , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Utilización de Procedimientos y Técnicas , Pronóstico , Hipertensión Arterial Pulmonar/diagnóstico , Hipertensión Arterial Pulmonar/fisiopatologíaRESUMEN
OBJECTIVE: To describe the long-term hemodialysis arteriovenous fistula (AVF) patency, incidence of AVF use, incidence and nature of AVF complications and surgery in patients after kidney transplantation. PATIENTS AND METHODS: We retrospectively analysed the AVF outcome and complications in all adult kidney allograft recipients transplanted between January 1st, 2000 and December 31, 2015 with a functional AVF at the time of transplantation. Follow-up was until December 31, 2019. RESULTS: We included 626 patients. Median AVF follow-up was 4.9 years. One month after kidney transplantation estimated AVF patency rate was 90%, at 1 year it was 82%, at 3 years it was 70% and at 5 years it was 61%; median estimated AVF patency was 7.9 years. The main cause of AVF failure was spontaneous thrombosis occurring in 76% of AVF failure cases, whereas 24% of AVFs were ligated or extirpated. In a Cox multivariate model female sex and grafts were independently associated with more frequent AVF thrombosis. AVF was used in about one third of our patients. AVF-related complications occurred in 29% of patients and included: growing aneurysms, complicated thrombosis, high-flow AVF, signs of distal hypoperfusion, venous hypertension, trauma of the AVF arm, or pain in the AVF/arm. CONCLUSIONS: AVFs remain functional after kidney transplantation in the majority of patients and are often re-used after graft failure. AVF-related complications are common and require proper care.