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1.
Rev. colomb. anestesiol ; 50(3): e300, July-Sept. 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1388932

RESUMO

Abstract The evidence regarding logistic considerations and safety events associated with prone position ventilation (PPV) is summarized and a flow diagrama for safe provision of mechanical ventilation in the setting of the COVID-19 pandemic is proposed. A review of the literature was conducted in the Medline via Pubmed, Embase, and Lilacs databases, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database, and Google scholar. Overall, 31 articles were selected for the analysis. The incidence of PPV-related safety events varies between 1% and 11.9% and the most frequent complications are pressure ulcers and airway complications. Early initiation of enteral nutrition is recommended, and transfers are possible in patients on PPV. There is controversy regarding contraindications and recommendations for PPV. Recommendations for its safe provision are based on expert opinions and the establishment of protocols for healthcare staff training. Clinical studies are required to determine which are the recommendations that should be considered for safe and reproducible PPV use during this pandemic.


Resumen Sintetizamos la evidencia con respecto a las consideraciones logísticas y los eventos de seguridad asociados a la ventilación mecánica en posición prona (VMPP) y proponemos un flujograma para realizarla de manera segura en el escenario de la pandemia por COVID-19. Para ello, realizamos una búsqueda de la literatura en las bases de datos Medline vía PubMed, Embase, Lilacs, Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database y Google académico. Se incluyeron 31 artículos para ser analizados. La incidencia de eventos de seguridad relacionados a la VMPP varía entre 1 % a 11.9 %, las complicaciones más frecuentes son las úlceras por presión y de la vía aérea. Se recomienda iniciar nutrición enteral temprana y es posible realizar traslado de pacientes con VMPP. Existe controversia acerca de las contraindicaciones y recomendaciones de la VMPP. Las recomendaciones para realizarla de forma segura se basan en opiniones de expertos y en la instauración de protocolos para el entrenamiento del personal de salud. Se requieren estudios clínicos para determinar cuáles recomendaciones son necesarias para que la VMPP se realice de forma segura y reproducible durante esta pandemia.


Assuntos
Pâncreas Divisum
2.
Rev. nefrol. diál. traspl ; Rev. nefrol. diál. traspl. (En línea);39(2): 115-119, jun. 2019. tabl.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1352751

RESUMO

El quiloperitoneo es una condición infrecuente que se asocia a diálisis peritoneal; en la mayoría de los casos se puede confundir con peritonitis bacteriana, aunque puede ser la consecuencia de esta infección. Se reporta el desarrollo espontáneo de quiloperitoneo en un paciente de 54 años con enfermedad renal crónica secundaria a nefropatía diabética, en diálisis peritoneal manual desde hacía 5 años. El tratamiento consistió en suspensión temporal de la diálisis peritoneal, reposo intestinal, suministro de una dieta con alto contenido de ácidos grasos de cadena media e infusión de octreotide, con lo cual a los 10 días el paciente mostró mejoría, y se reinició la diálisis peritoneal. Una búsqueda sistemática de la literatura encontró 16 casos publicados (11 mujeres), con edades desde neonato hasta 88 años.


Chyloperitoneum is a rare condition associated with peritoneal dialysis. In most cases it is misdiagnosed as bacterial peritonitis, but it can also be a consequence of this infection. We present the spontaneous development of chyloperitoneum in a 54 year old patient with chronic kidney disease secondary to diabetic nephropathy, in manual peritoneal dialysis for 5 years. The treatment consisted of temporary suspension of peritoneal dialysis, bowel rest, supply of a diet with a high content of medium chain fatty acids and infusion of octreotide. After 10 days the patient showed improvement, and peritoneal dialysis was restarted. A systematic search of the literature found 16 published cases (11 women), ranging in age from newborn to 88 years.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Ascite Quilosa/diagnóstico , Ascite Quilosa/dietoterapia , Ascite Quilosa/tratamento farmacológico , Diálise Peritoneal/efeitos adversos , Diálise Renal , Doenças Raras
3.
Rev. gerenc. políticas salud ; 17(34): 112-118, ene.-jun. 2018. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-978527

RESUMO

Resumen Las enfermedades de baja prevalencia requieren modelos de gestión diferentes a los de otras condiciones. Este trabajo buscó recoger las experiencias internacionales. Se realizaron búsquedas en numerosas bases de datos de literatura indexada y de documentos grises. Un panel de expertos de diferentes disciplinas revisó los resúmenes de la literatura y su posible adaptación al contexto colombiano. La búsqueda inicial arrojó 5604 referencias; la búsqueda manual adicionó 31 referencias, finalmente 78 artículos aportaron información útil para el análisis. Los resultados permiten afirmar que existen varios componentes de un modelo de gestión, estos son: políticas, legislación y aspectos administrativos; definición y codificación de enfermedades; investigación y educación; centros especializados, centros de excelencia y redes de atención; diagnóstico, tamizaje, prevención y promoción; inclusión de medicamentos huérfanos; rehabilitación y manejo paliativo; organizaciones de pacientes, grupos o redes de apoyo; y apoyo sociosanitario (inclusión laboral y educativa).


Abstract Low prevalence diseases require management models different from those used in other conditions. This work was intended to gather international experiences on this issue. Searches were made in many indexed literature databases as well as in those with gray literature. A panel of experts from different disciplines checked the abstracts and their potential adaptation into the Colombian context. The initial search retrieved 5604 references and the manual search added other 31 references. At the end, 78 articles provided useful information for the analysis. The results allow to state that a management model consists of several components, to wit: policies, legislation and administrative aspects; definition and coding of the diseases; research and education; specialized centers; excellence centers and service networks; diagnosis, screening, prevention, and promotion; orphan drug inclusion; rehabilitation and palliative care; organizations of patients and support groups or networks; and social-sanitary support (labor and educational inclusion).


Resumo As doenças de baixa prevalência requerem modelos de gestão diferentes aos de outras condições. Este trabalho visou coletar experiências internacionais. Realizaram-se pesquisas em numerosos bancos de dados de literatura indexada e documentos cinza. Um painel de expertos de diferentes disciplinas revisou os resumos da literatura e sua possível adaptação no contexto colombiano. A procura inicial resultou em 5604 referências; a procura manual adicionou 31 referências, por fim 78 artigos forneceram informações úteis para a análise. Os resultados permitem afirmar que existem vários componentes de um modelo de gestão, quais são: políticas, legislações e aspetos administrativos; definição e codificação de doenças; pesquisa e ensino; centros especializados, centros de excelência e redes de atendimento; diagnóstico, triagem, prevenção e promoção; inclusão de medicamentos órfãos; reabilitação e cuidados paliativos; organizações de pacientes, grupos ou redes de apoio; e apoio sócio-sanitário (inclusão laboral e educativa).


Assuntos
Humanos , Administração Hospitalar , Organizações de Serviços Gerenciais , Doenças Raras , Medicamentos do Componente Especializado da Assistência Farmacêutica
4.
Biomedica ; 38(1): 77-85, 2018 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-29668137

RESUMO

Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva.Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia.Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi.Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed).Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456.Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.


Assuntos
Análise Custo-Benefício , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Colômbia , Transplante de Rim
5.
Biomédica (Bogotá) ; Biomédica (Bogotá);38(1): 77-85, ene.-mar. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-888550

RESUMO

Resumen Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva. Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia. Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi. Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed). Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456. Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.


Abstract Introduction: Cytomegalovirus (CMV) is the most frequent opportunistic infection after renal transplantation. There are two strategies for its prevention: Universal prophylaxis, with valganciclovir for 90 days, and anticipated therapy, using weekly viral load surveillance, and therapy only if positive. Meta-analysis directly comparing both strategies have shown them to have similar effectiveness. Objective: To determine which strategy is more cost-effective in intermediate risk patients in Colombia. Materials and methods: We designed a third-party payer perspective decision tree, considering only direct medical costs in 2014 Colombian pesos (COP) (USD$ 1=COP$ 2,000) and a time horizon of one year. The target population was intermediate CMV risk patients (positive receptor). Transition probabilities were extracted from clinical studies, validated with a Delphi expert panel method; procedural costs were obtained from the ISS 2001 manual with a 33% increment based on the Consumer Price Index for 2014, while medication costs were obtained from the official Ministry of Health information system. Results: Universal prophylaxis with valganciclovir was dominant, with lower costs and less probability of infection. The average cost of the first year in anticipated therapy would be COP$ 30,961,290, whereas in the case of universal therapy the cost would be COP$ 29,967,834 (incremental cost of COP$ 993,456). Conclusions: For Colombian renal transplant patients at intermediate risk for CMV infection, universal prophylaxis strategy is the best option.


Assuntos
Análise Custo-Benefício , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Transplante de Rim , Colômbia
6.
Value Health Reg Issues ; 14: 35-40, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29254540

RESUMO

BACKGROUND: Diabetes treatment includes very diverse drugs. It is essential to identify which drugs offer the best value for their costs. OBJECTIVES: To estimate comparative cost effectiveness for treating diabetes mellitus with dulaglutide, liraglutide, or glargine in Colombia. METHODS: A Markov model including diabetic microvascular and macrovascular complications was used to estimate cost-effectiveness. We used annual cycles, a 5-year time horizon, 5% discount rate, and third-party payer's perspective. Main outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Transition probabilities were obtained from primary studies and costs from local databases and studies. We used a threshold of 3 times the Colombian per capita gross domestic product (US $17,270 for 2015; US $1 = 2,743 Columbian pesos) to assess cost effectiveness. RESULTS: Total costs related to dulaglutide, liraglutide, and glargine were US $8,633, US $10,756, and US $5,783, yielding 3.311 QALYs, 3.229 QALYs, and 3.156 QALYs, respectively. Dulaglutide dominated liraglutide given lower total costs and higher QALYs. The estimated ICER for dulaglutide compared with glargine was US $18,385, greater than the accepted threshold. Sensibility analysis shows that decreased dulaglutide cost, increased consumption of glargine, nondaily injection, and number and cost of glucometry could result in ICERs lower than the threshold. Probabilistic sensitivity analysis showed consistent results. CONCLUSIONS: This estimation indicates that dulaglutide dominates liraglutide. Its ICER is, however, greater than the accepted threshold for Colombia in base case compared with glargine. By increasing population weight or glargine consumption, dulaglutide becomes cost effective compared with glargine, which could identify a niche where dulaglutide is the best option.


Assuntos
Análise Custo-Benefício , Diabetes Mellitus Tipo 2/tratamento farmacológico , Quimioterapia Combinada , Peptídeos Semelhantes ao Glucagon/análogos & derivados , Hipoglicemiantes/administração & dosagem , Fragmentos Fc das Imunoglobulinas/administração & dosagem , Insulina Glargina/administração & dosagem , Liraglutida/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Colômbia , Diabetes Mellitus Tipo 2/economia , Peptídeos Semelhantes ao Glucagon/administração & dosagem , Hemoglobinas Glicadas , Humanos , Hipoglicemiantes/economia , Anos de Vida Ajustados por Qualidade de Vida
7.
World Neurosurg ; 93: 44-9, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27216925

RESUMO

BACKGROUND: Parkinson disease (PD) is a chronic multifaceted neurodegenerative disorder of adult onset that affects quality of life and places a burden on patients, caregivers, and society. In early disease, dopaminergic therapy improves motor symptoms, but as the disease progresses, symptoms tend to increase in frequency and severity, even with best medical treatment (BMT). Deep brain stimulation (DBS) becomes an option for certain patients, but cost becomes an important issue. OBJECTIVE: We performed a systematic review of the literature of economic studies of the use of DBS in patients with PD, including costs studies or economic evaluations expressed as cost per improvement in quality life, decrease in dose of pharmacological treatments, and the decrease of caregiver burden. METHODS: We reviewed the following databases: Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform ICTRP portal and ClinicalTrials.gov from 1980 to 2015. Costs have been converted or adjusted to 2016 US dollars (US$). RESULTS: Nine studies were identified. The average cost of DBS for a patient with PD in 5 years is US$186,244. The quality-adjusted life year was higher in DBS compared with BMT after at least 2 years of treatment, with an average incremental cost utility ratio of US$41,932 per additional quality-adjusted life year gained. Costs in the first year are higher with DBS because of direct costs related to the surgical procedure, the device, and the more frequent controls. Studies show better results with a longer time horizon (up to 5 years). CONCLUSION: DBS is a cost-effective intervention for patients with advanced PD, but it has a high initial cost compared with BMT. However, DBS reduces pharmacologic treatment costs and should also reduce direct, indirect, and social costs of PD on the long term.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Estimulação Encefálica Profunda/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Doença de Parkinson/economia , Doença de Parkinson/terapia , Antiparkinsonianos/economia , Antiparkinsonianos/uso terapêutico , Cuidadores/estatística & dados numéricos , Terapia Combinada/economia , Terapia Combinada/estatística & dados numéricos , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricos , Estimulação Encefálica Profunda/estatística & dados numéricos , Humanos , Internacionalidade , Doença de Parkinson/mortalidade , Prevalência , Qualidade de Vida , Taxa de Sobrevida , Resultado do Tratamento
8.
Acta neurol. colomb ; 31(4): 385-390, oct. 2015. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-776249

RESUMO

Introducción: Dos estudios epidemiológicos de esclerosis múltiple (EM) la describen como de bajo riesgo en Colombia. Hay, sin embargo, nuevos sistemas de información que permiten una aproximación más precisa. Objetivo:Estimar la prevalencia nacional de EM, así como por regiones del país, y analizar los costos de los fármacos usados en Colombia. Materiales y métodos: Se obtuvieron datos del Registro Individual de Prestación de Servicios de Salud (RIPS), con el código diagnóstico G35X para esclerosis múltiple, tomando los diagnósticos confirmados nuevos y repetidos entre 2009 y 2013, por sexo, grupo etario y departamento. Para el análisis de medicamentos se usó la base de datos Sismed del 2014, incluyendo los fármacos disponibles en Colombia: interferón beta-1A, interferón beta-1B, acetato de glatiramer, natalizumab, fingolimod y mitoxantrona. Resultados:Según los RIPS, en Colombia se atendieron, en el período 2009-2013, un total de 3.462 personas con diagnóstico de esclerosis múltiple. La prevalencia nacional para el período fue de 7,52/100.000, con las cifras más altas en Bogotá (16,25), donde se atendieron 1.213 pacientes, seguido de los departamentos del Quindío (13,03) y Risaralda (11,18). La mayor proporción de pacientes se encuentra entre los 50 y 54 años de edad, y las mujeres representan más del 70%. Adicionalmente, en 2014 se invirtieron 86.000 millones de pesos (43 millones de dólares) en medicamentos para esclerosis múltiple, lo que equivale a cerca de 25 millones por paciente. Conclusión: Colombia podría ser un país con riesgo intermedio para esclerosis múltiple, una enfermedad que acarrea altos costos para el sistema de salud.


Introduction: Two local epidemiological studies describe Colombia as low risk for multiple sclerosis (MS). New information systems, which allow for a more accurate approximation, are currently available. Objective: To estimate the national prevalence of MS, as well as by regions, and to analyze national drug costs. Materials and methods: We obtained data from the Individual Registry of Health care provision (RIPS), with the diagnosis code G35x for multiple sclerosis, taking the confirmed new and repeated diagnoses between 2009 and 2013, by gender, age group and geographical location. For the analysis of medications, we use the database SISMED 2014 searching for all drugs available in Colombia: interferon beta 1A, interferon beta 1B, glatiramer acetate, natalizumab, mitoxantrone and fingolimod. Results: According to the RIPS, 3,462 patients with diagnosis of MS contacted the health system in Colombia during the period 2009-2013. The national prevalence for the period was 7.52 / 100,000, with the highest figure in Bogota (16.25) with 1213 patients, followed by Quindío (13.03) and Risaralda (11.18). The largest proportion of patients were in the 50 to 54 years age group, and 70% were women. Additionally, in 2014 Colombia spent COP $ 86 billion pesos (43 million US dollars) for MS drugs, around US$12,500 per patient/year. Conclusion: Colombia is a country with intermediate risk for MS, a disease that implies a high direct cost for the health system.

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