ABSTRACT
INTRODUCCIÓN: El objetivo de este estudio es el análisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en los pacientes con esclerosis múltiple (EM), en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. MÉTODOS: Estudio observacional retrospectivo de una muestra de pacientes ingresados con EM recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Se calculó la mortalidad, la prolongación de estancias y los sobrecostes atribuibles a los TCA controlando mediante análisis multivariado de la covarianza variables como la edad y el sexo, el tipo de hospital, el tipo de ingreso, otros trastornos adictivos y las comorbilidades. RESULTADOS: Se estudiaron 10.249 ingresos por EM de 18 a 74 años de edad, entre los cuales hubo 215 pacientes con TCA. Los ingresos con EM y TCA fueron predominantemente varones, mayor frecuencia de ingresos urgentes, con mayor prevalencia de trastornos por tabaco y drogas y con índices de comorbilidad de Charlson más elevados. Los pacientes con EM y TCA presentaron importantes excesos de mortalidad (94,1%), prolongación indebida de estancias (2,4 días) y sobrecostes por alta (1.116,9 euros). CONCLUSIONES: De acuerdo a los resultados de este estudio, los TCA en pacientes con EM aumentaron significativamente la mortalidad, la duración de la estancia hospitalaria y sus costes
INTRODUCTION: The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS: We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS: The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS: According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Multiple Sclerosis/complications , Alcoholism/complications , Health Care Costs , Medical Overuse/economics , Multiple Sclerosis/mortality , Hospital Mortality , Retrospective StudiesABSTRACT
INTRODUCTION: The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS: We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS: The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS: According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.
ABSTRACT
Introducción: El objetivo de este estudio es el análisis del impacto de las infecciones de localización quirúrgica (ILQ) en los pacientes tratados con cistectomía radical, en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes tratados con cistectomía radical recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Resultados: Se estudió a 4.377 pacientes tratados con cistectomía radical, 3.904 varones y 473 mujeres, de los cuales 849 (19,4%) experimentaron una ILQ. Los pacientes con ILQ fueron predominantemente varones, de mayor edad, con mayor prevalencia de trastornos asociados al consumo de alcohol y con más comorbilidades. Los pacientes con ILQ presentaron importantes excesos de mortalidad (125,6%), prolongación indebida de estancias (17,8 días) y sobrecostes (14.875,7 euros). Conclusiones: Controlando mediante el emparejamiento multivariado las variables demográficas, el tipo de hospital, los trastornos adictivos y las comorbilidades, la aparición de ILQ en pacientes tratados con cistectomía radical aumenta significativamente la mortalidad, la duración de la estancia y su coste. Ciertas medidas preventivas ya consagradas en estudios previos podrían disminuir su incidencia y su impacto sanitario y económico
Background: The aim of this study was to analyze the impact of surgical site infections (SSI) in patients who underwent radical cystectomy, in terms of excess hospital mortality, stay prolongation and cost overruns. Material and methods: A retrospective observational study was conducted on a sample of patients who underwent radical cystectomy as recorded in the basic minimum data sets of 87 Spanish hospitals from 2008-2010. Results: We studied 4377 patients who underwent radical cystectomy (3904 men and 473 women) of whom 849 (19.4%) experienced an SSI. The patients with SSI were predominantly men, elderly and had a higher prevalence of alcohol-related disorders and more comorbidities. The patients with SSI had significant excess mortality (125.6%), undue stay prolongation (17.8 days) and cost overruns (14,875.70 euros). Conclusions: After controlling for demographic variables, hospital type, addiction disorders and comorbidities using multivariate pairing, the onset of SSI in patients who underwent radical cystectomy significantly increased the mortality, stay and cost. Certain preventive measures already established in previous studies could reduce the incidence of SSI and its healthcare and financial impact
Subject(s)
Humans , Male , Female , Aged , Middle Aged , Surgical Wound Infection/epidemiology , Cystectomy/statistics & numerical data , Urinary Bladder Neoplasms/surgery , Postoperative Complications/epidemiology , Length of Stay/statistics & numerical data , Direct Service Costs/statistics & numerical data , Retrospective Studies , Smoking/epidemiology , Observational StudyABSTRACT
BACKGROUND: The aim of this study was to analyze the impact of surgical site infections (SSI) in patients who underwent radical cystectomy, in terms of excess hospital mortality, stay prolongation and cost overruns. MATERIAL AND METHODS: A retrospective observational study was conducted on a sample of patients who underwent radical cystectomy as recorded in the basic minimum data sets of 87 Spanish hospitals from 2008-2010. RESULTS: We studied 4377 patients who underwent radical cystectomy (3904 men and 473 women) of whom 849 (19.4%) experienced an SSI. The patients with SSI were predominantly men, elderly and had a higher prevalence of alcohol-related disorders and more comorbidities. The patients with SSI had significant excess mortality (125.6%), undue stay prolongation (17.8 days) and cost overruns (14,875.70 euros). CONCLUSIONS: After controlling for demographic variables, hospital type, addiction disorders and comorbidities using multivariate pairing, the onset of SSI in patients who underwent radical cystectomy significantly increased the mortality, stay and cost. Certain preventive measures already established in previous studies could reduce the incidence of SSI and its healthcare and financial impact.
Subject(s)
Cystectomy , Surgical Wound Infection/mortality , Aged , Alcohol-Related Disorders/epidemiology , Cardiovascular Diseases/epidemiology , Comorbidity , Diabetes Complications/epidemiology , Female , Humans , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Retrospective Studies , Smoking/epidemiology , Spain/epidemiology , Surgical Wound Infection/economics , Urinary Bladder Neoplasms/epidemiology , Urinary Bladder Neoplasms/surgerySubject(s)
Iron Metabolism Disorders/diagnosis , Iron/metabolism , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/metabolism , Anemia, Iron-Deficiency/physiopathology , Humans , Intestinal Mucosa/metabolism , Iron Metabolism Disorders/drug therapy , Iron Metabolism Disorders/etiology , Kidney Failure, Chronic/complicationsABSTRACT
BACKGROUND: Salvaged autologous blood in orthopedic surgery may contain tissular debris such as fat particles (FP), possibly increasing the risk of fat embolism after bone surgery. Therefore, this study was initiated to ascertain the capacity of leukocyte filters to remove FP using in vitro models. METHODS: All experiments were performed in triplicate using donor blood bags within 15 days of their donation. Five different olive oil volumes were added to blood to obtain 5 oil concentrations (1% to 5%), and blood was subsequently filtered through a PureCell (Pall Biomedical, Portsmouth, UK) leukocyte-reduction filter. In another set of experiments, 5 different oil volumes (1, 2.5, 5, 7.5 or 10 mL) were injected into the line during filtration of oil-free blood. In addition, 3 preparations of blood supplemented with 5% oil were processed in the autotransfusion device OrthoPAT (Haemonetics Corp, Braintree, MA, USA), and the obtained red cell concentrate was subsequently filtered through PureCell. We collected samples for cell counting and analysis and FP detection with a Pentra 120 Retic (ABX, Montpellier, France) flow cytometer. RESULTS: Specific signals corresponding to FP were clearly detected in the white blood cell scattergrams yielded by the cytometer for oil supplemented blood. PureCell removed FP up to an oil concentration of 3% or up to an injected oil volume of less than 10 mL. Addition of a filtration step through a PureCell filter after blood washing by the OrthoPAT device completely removed FP. CONCLUSIONS: Leukocyte filters seem to be useful for removing FP from unprocessed blood with a low degree of fat contamination (less than 10 mL) and to complete FP removal from processed blood. Therefore, using a leukocyte filter in the patient's line should contribute to improving the safety of perioperative autologous blood salvage.
Subject(s)
Fats , Leukocyte Reduction Procedures/instrumentation , Micropore Filters , Orthopedic Procedures , Humans , Olive Oil , Plant OilsABSTRACT
OBJETIVOS: La sangre autóloga recuperada en cirugía ortopédica puede contener detritus tisulares, como partículas grasas (PG),con riesgo de embolismo graso. Se ha estudiado la capacidad de los filtros de leucocitos en la eliminación de PG, utilizando diferentes modelos in vitro . MÉTODOS: Todos los ensayos se realizaron por triplicado utilizando bolsas de sangre con menos de 15 días de almacenamiento. Se añadieron diferentes volúmenes de aceite de oliva a la sangre, para obtener 5 concentraciones de aceite (1 a 5%),siendo posteriormente filtrada a través del filtro de leucocitos PureCell (Pall). En otra serie de experimentos, se inyectaron diferentes volúmenes de aceite (1;2,5;5;7,5 ó 10 ml)en el circuito durante la filtración de sangre sin grasa. Además, se procesaron 3 preparaciones de sangre con aceite al 5% en el autotransfusor OrthoPAT (Haemonetics)y el con- centrado de hematíes obtenido se filtró a través de PureCell.Se tomaron muestras para hematimetría y detección de PG (analizador Pentra 120 Retic,ABX). RESULTADOS: En los diagramas de dispersión de leucocitos obtenidos para la sangre que contenía aceite, se detectaron claramente las señales específicas correspondientes a PG. El filtro PureCell eliminó las PG hasta una concentración de aceite del 3%o hasta un volumen de aceite inyectado en el circuito inferior a 10 ml. Además, PureCell eliminó totalmente las PG remanentes en sangre procesada por OrthoPAT. CONCLUSIONES: Los filtros de leucocitos parecen ser útiles para eliminar las PG de sangre no procesa- da con bajo grado de contaminación grasa (inferior a 10 mL),y para completar la eliminación de PG en sangre procesada. Por tanto, su uso en la línea de infusión al paciente podría contribuir a aumentar la seguridad de la recuperación perioperatoria de sangre autóloga
BACKGROUND: Salvaged autologous blood in ortho- pedic surgery may contain tissular debris such as fat par- ticles (FP), possibly increasing the risk of fat embolism after bone surgery. Therefore, this study was initiated to ascertain the capacity of leukocyte filters to remove FP using in vitro models. METHODS: All experiments were performed in triplicate using donor blood bags within 15 days of their donation. Five different olive oil volumes were added to blood to obtain 5 oil concentrations (1%to 5%),and blood was subsequently filtered through a PureCell (Pall Biomedical,Portsmouth,UK)leukocyte-reduction filter. In another set of experiments,5 different oil volumes (1, 2.5,5,7.5 or 10 mL)were injected into the line during filtration of oil-free blood.In addition,3 preparations of blood supplemented with 5%oil were processed in the autotransfusion device OrthoPAT (Haemonetics Corp, Braintree, MA, USA),and the obtained red cell concentrate was subsequently filtered through PureCell. We collected samples for cell counting and analysis and FP detection with a Pentra 120 Retic (ABX, Montpellier, France)flow cytometer. RESULTS: Specific signals corresponding to FP were cle- arly detected in the white blood cell scattergrams yielded by the cytometer for oil supplemented blood. PureCell removed FP up to an oil concentration of 3%or up to an injected oil volume of less than 10 mL. Addition of a filtration step through a PureCell filter after blood washing by the OrthoPAT device completely removed FP. CONCLUSIONS: Leukocyte filters seem to be useful for removing FP from unprocessed blood with a low degree of fat contamination (less than 10 mL)and to complete FP removal from processed blood. Therefore, using a leukocyte filter in the patient s line should contribute to improving the safety of perioperative autologous blood salvage
Subject(s)
Humans , Fats , Micropore Filters , Plant OilsABSTRACT
No disponible
Subject(s)
Humans , Iron/metabolism , Iron Metabolism Disorders/diagnosis , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/metabolism , Anemia, Iron-Deficiency/physiopathology , Intestines/metabolism , Iron Metabolism Disorders/drug therapy , Iron Metabolism Disorders/etiology , Renal Insufficiency, Chronic/complicationsABSTRACT
No disponible
Subject(s)
Humans , Renal Dialysis , Renal Insufficiency, Chronic , Hemoglobinometry , Anemia, Iron-DeficiencySubject(s)
Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/etiology , Hemoglobinometry/instrumentation , Kidney Failure, Chronic/complications , Renal Dialysis/methods , Anemia, Iron-Deficiency/therapy , Hemoglobinometry/methods , Humans , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapyABSTRACT
OBJECTIVES: The prevalence of anemia among emergency, surgery and critically ill patients is high. As a consequence, many of these patients receive transfusions of packed red cells, with hemoglobin (Hb) concentration being one of the most widely applied criteria for prescription. Accordingly, this study was undertaken 1) to ascertain the accuracy and precision of point-of-care Hb measurements obtained with the portable photometric HemoCue B-Hemoglobin analyzer (HBH) in comparison those performed with the reference cell counter Pentra 120 Retic (ABX), and 2) to evaluate the potential clinical utility of the HCB. MATERIALS AND METHODS: Patients from postanaesthesic recovery unit (PRU, n = 37), intensive care unit (ICU, n = 43) were enrolled and capillary and venous blood samples were taken; emergency room patients with bleeding (ER, n = 35) were also enrolled and arterial blood samples were taken. Hb concentrations were measured 3 times for each patient, using both the HBH and the ABX analyzers. RESULTS: No significant differences between mean Hb values obtained with the HBH and the ABX were found; nor were coefficients of variation significantly different. The coefficients of correlation (Pearson'sr) between the 2 devices were > 0.95 for both arterial and venous blood samples, whereas the correlations for capillary blood samples were 0.747 for PRU patients and 0.859 for ICU patients. CONCLUSION: Based on the reliable results obtained for venous and arterial blood samples, Hb concentrations determined with the portable HBH analyzer may be highly useful for point-of-care monitoring of anemia and evaluating the transfusion requirements of ER, PRU, and ICU patients. However, the degree of inaccuracy and variability of Hb measurements in capillary blood samples would discourage us from using it in these patients.
Subject(s)
Anemia/diagnosis , Critical Care/methods , Emergency Medical Services/methods , Hemoglobinometry/instrumentation , Point-of-Care Systems , Postoperative Care/methods , Anemia/blood , Arteries , Blood Transfusion , Capillaries , Hemoglobinometry/methods , Hemorrhage/blood , Humans , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Organ Specificity , Postoperative Care/instrumentation , Reproducibility of Results , VeinsABSTRACT
OBJETIVOS: La anemia tiene una gran prevalencia entre los pacientes urgentes, quirúrgicos y críticos, por lo que un alto porcentaje de ellos reciben concentrados de hematíes, siendo la concentración de hemoglobina (Hb) uno de los parámetros más frecuentemente usados en su prescripción. Los objetivos de este estudio han sido: comprobar la exactitud y precisión de la determinación inmediata de la Hb con el HemoCue B Hemoglobin (HBH) en relación al contador automatizado Pentra 120 Retic (ABX); y evaluar su posible utilidad clínica en estos pacientes. PACIENTES Y MÉTODOS: Se han incluido pacientes de la Unidad de Recuperación Postanestésica (URPA, n=37), de la Unidad de Cuidados Intensivos (UCI, n=43) (sangre capilar y venosa), y del Área de Urgencias Hospitalaria (AUH, n=35) con patología sangrante (sangre arterial), en los que se midió por triplicado el nivel de Hb en el HBH y el ABX. RESULTADOS: No hubo diferencias entre los valores de Hb obtenidos con el ABX y el HBH, ni entre sus coeficientes de variación. Los coeficientes de correlación (r de Pearson) fueron >0,95 en muestras venosas y arteriales, mientras que en muestras capilares fueron de 0,747 (URPA) y 0,859 (UCI). CONCLUSIONES: Dada la fiabilidad de los valores obtenidos en muestras venosas y arteriales, la determinación de Hb con el HBH podría ser de gran utilidad para el control de la anemia y los requerimientos transfusionales en los pacientes de AUH, URPA y UCI. Sin embargo, debido al grado de inexactitud y variabilidad de los resultados obtenidos con muestras capilares no se aconseja su uso en estos pacientes (AU)
Subject(s)
Humans , Point-of-Care Systems , Veins , Reproducibility of Results , Monitoring, Physiologic , Organ Specificity , Postoperative Care , Arteries , Blood Transfusion , Capillaries , Critical Care , Anemia , Hemorrhage , Emergency Medical Services , HemoglobinometrySubject(s)
Multiple Myeloma/diagnosis , Pleural Effusion/etiology , Aged , Humans , Male , Multiple Myeloma/complicationsABSTRACT
Oak wood used for wine barrels was immersed into a model wine containing eight aroma compounds (e.g., aromatic and terpene alcohols, ethyl esters, and aldehyde), for which activity coefficients in water and model wine were determined using the mutual solubility measurement. A mass balance of these volatiles considering their reactivity in model wine was established. For most of the studied aroma compounds, and mainly for linalool and ethyl octanoate, a sorption behavior into wood was reported for the first time. This phenomenon was selective and could not be related to the solubilities in model wine and hydrophobicities of the studied aroma compounds, suggesting that acid-base and polar characteristics of wood were more involved in this sorption mechanism. This study has also shown that the level of sorption is a function of the ratio of wood surface area/solution volume.
