ABSTRACT
BACKGROUND: Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain. METHODS: The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding. RESULTS: Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was 1753 with a benefit of 503, achieving a net economic benefit of 4·8 million per year. Given the annual cost of the intervention (17·4 million, of which 5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to 1·29 per 1 of investment. CONCLUSION: From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.
ANTECEDENTES: Ser fumador activo hasta el momento de la cirugía se asocia con complicaciones postoperatorias. Se ha descrito una disminución de las complicaciones durante la hospitalización al abandonar el hábito de fumar antes de la cirugía. Este trabajo analizó si una intervención preoperatoria para dejar de fumar es económicamente beneficiosa cuando se financia por el Sistema Nacional de Salud (SNS) en España. MÉTODOS: En el análisis económico se consideraron tantos los costes como los beneficios de la intervención para el SNS, en euros, correspondientes al año 2016. La población que se beneficiaría eran fumadores adultos dispuestos a dejar de fumar, en los que se programase una intervención quirúrgica con hospitalización. La intervención, una combinación de asesoramiento médico y tratamiento farmacológico para dejar de fumar, se llevó a cabo a las 12 semanas antes de la cirugía, considerando únicamente un intento para dejar de fumar. Los beneficios fueron los costes evitados por una reducción en la tasa de complicaciones postoperatorias en los casos en los que se hubiese conseguido la eliminación del hábito. El análisis comparó el resultado económico neto (beneficio menos coste de la intervención) y el retorno de la inversión (return on investment, ROI), cuando la intervención era financiada por el SNS en comparación con la situación actual sin financiamiento público. RESULTADOS: La tasa de abandono del hábito tabáquico aumentó en un 21,8%; 32,5% cuando se financiaba frente al 10,7% sin financiación, consiguiendo un extra de 9.611 personas que dejaron de fumar. El coste por fumador rescatado fue de 1753 con un beneficio de 503, por lo que el beneficio económico neto conseguido fue de 4,8 millones por año. Dado que el coste anual de la intervención (17,4 millones, de los cuales 5,6 millones corresponden a fármacos (32%)), el ROI anual fue del 28,7% con un beneficio de 1,29 por cada 1 de inversión. CONCLUSIÓN: Desde la perspectiva del SNS español, los beneficios de financiar el abandono del hábito de fumar en el preoperatorio de los pacientes, en términos de ahorro de costes parecen ser muy superiores a los costes de la intervención.
Subject(s)
Cost-Benefit Analysis , Health Care Costs/statistics & numerical data , Postoperative Complications/prevention & control , Preoperative Care/economics , Smoking Cessation/economics , Smoking/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Complications/economics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Preoperative Care/methods , Smoking/adverse effects , Smoking/economics , Smoking Cessation/methods , Smoking Cessation/statistics & numerical data , Spain , Treatment Outcome , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Tobacco Smoke Pollution/legislation & jurisprudence , Tobacco Use Disorder/prevention & control , Smoking Prevention , Tobacco Industry/legislation & jurisprudence , Legislation as Topic , Tobacco-Derived Products Commerce , Tobacco-Derived Products PublicityABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Smoking/adverse effects , Smoking/metabolism , Research/education , Pulmonary Medicine/education , Thoracic Surgery/methods , Attitude of Health Personnel , Spain/ethnology , Pharmaceutical Preparations/administration & dosage , Smoking/prevention & control , Smoking/therapy , Research/classification , Pulmonary Medicine/methods , Thoracic Surgery , Prevalence , Pharmaceutical Preparations/metabolismABSTRACT
No disponible
Subject(s)
Humans , Smoking/therapy , Smoking Cessation/methods , Nebulizers and Vaporizers , Tobacco Use Cessation Devices , Societies, MedicalABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Product Packaging/legislation & jurisprudence , Product Packaging/methods , Tobacco Smoke Pollution/legislation & jurisprudence , Smoking/legislation & jurisprudence , Smoking Prevention , Smoking Prevention , Product Packaging/standards , Product Packaging/trendsSubject(s)
Humans , Male , Female , Tobacco Smoke Pollution/prevention & control , Smoking/prevention & control , Smoking/therapy , Lung Diseases/complications , Lung Diseases/epidemiology , Pulmonary Medicine/organization & administration , Socioeconomic Survey , Tobacco Use Disorder/prevention & controlABSTRACT
BACKGROUND: Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF). OBJECTIVES: To evaluate the safety of a new method to perform FB in patients with ARF. METHODS: Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S(a)O(2)) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion. RESULTS: Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P(a)O(2)/F(i)O(2) ratio 168 ± 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S(a)O(2) 93 ± 3 to 94 ± 5%, heart rate 95 ± 17 to 99 ± 22 b.p.m. and respiratory rate 24 ± 11 to 25 ± 11 respirations/min. The lowest S(a)O(2) value reached during the procedure was 86 ± 3% and the maximal ETCO(2) rise was 41 ± 4 mm Hg. Leakage was <50 ml/s in 32 patients. The clinical course was favorable in 66%. Invasive ventilation was necessary in 11%, 5 ± 4 days after FB. Twelve patients (33%) died 3 ± 2 days after FB as a result of their underlying disease. CONCLUSIONS: The system allowed to perform FB safely in patients with ARF. Although there is a relatively high rate of intubation and invasive mechanical ventilation due to illness severity, there was no worsening of oxygenation or complications attributable to the procedure.
Subject(s)
Bronchoscopy/instrumentation , Respiratory Distress Syndrome/diagnosis , Adult , Aged , Aged, 80 and over , Female , Fiber Optic Technology , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
A new method is described for performing oral fiberoptic bronchoscopy during noninvasive ventilation through the nose. The technique was successfully applied in 2 patients suffering from acute respiratory failure. The bronchoscope was inserted through a glove finger fitted into a mouth guard. The system works as a valve and does not affect performance of the bronchoscopy procedure or the pressures administered during noninvasive ventilation. We conclude that the procedure has potential advantages over bronchoscopy through the nose and face masks or helmets, particularly for the management of secretions or in special clinical circumstances (hemoptysis or presence of foreign bodies). This method can be used to substitute for or complement other bronchoscopy techniques performed with other interfaces.
Subject(s)
Bronchoscopy/methods , Masks , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Acute Disease , Aged , Female , Fiber Optic Technology , Humans , Male , Middle AgedABSTRACT
Se describe un nuevo método para la realización de fibrobroncoscopia (FB) por vía bucal durante la administración de ventilación no invasiva por vía nasal, que se aplicó con éxito en 2 pacientes afectados de insuficiencia respiratoria aguda. La FB se realizó a través de una pieza de protección bucal a la que se adaptó un dedo de guante por dentro del cual se introdujo el fibrobroncoscopio. El sistema actúa como una válvula y no interfiere con las presiones administradas durante la ventilación no invasiva ni con los procedimientos broncoscópicos. Se concluye que el procedimiento presenta ventajas potenciales frente a la vía nasal por mascarilla facial o helmet, sobre todo en el manejo de secreciones o en circunstancias especiales (hemoptisis o cuerpo extraño), y permite alternar o complementar la FB practicada con otras interfaces
A new method is described for performing oral fiberoptic bronchoscopy during noninvasive ventilation through the nose. The technique was successfully applied in 2 patients suffering from acute respiratory failure. The bronchoscope was inserted through a glove finger fitted into a mouth guard. The system works as a valve and does not affect performance of the bronchoscopy procedure or the pressures administered during noninvasive ventilation. We conclude that the procedure has potential advantages over bronchoscopy through the nose and face masks or helmets, particularly for the management of secretions or in special clinical circumstances (hemoptysis or presence of foreign bodies). This method can be used to substitute for or complement other bronchoscopy techniques performed with other interfaces
Subject(s)
Male , Female , Aged , Middle Aged , Humans , Bronchoscopy/methods , Masks , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Acute Disease , Optical FibersABSTRACT
Three cases of thoracic actinomycosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empyema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are thoroughly analyzed.
Subject(s)
Actinomycosis/diagnosis , Lung Diseases/microbiology , Adult , Aged , Humans , Lung Diseases/diagnosis , Male , Risk FactorsABSTRACT
Se describen tres casos de actinomicosis torácica, dos asociados a obstrucción bronquial (cuerpo extraño y carcinoma broncogénico) y uno en un paciente con empiema. Se revisan las manifestaciones clínico radiológicas de la misma, los criterios diagnósticos y se exponen de forma pormenorizada todos los casos publicados en la literatura española
Three cases of thoracic actinomicosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empiema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are throughly analyzed
Subject(s)
Male , Female , Adult , Humans , Actinomycosis/diagnosis , Lung Diseases/microbiology , Risk Factors , Lung Diseases/diagnosisABSTRACT
No disponible
Subject(s)
Female , Humans , Middle Aged , Pleural Effusion , Triptorelin Pamoate , Antineoplastic Agents, Hormonal , Leiomyoma , Ovarian Hyperstimulation Syndrome , Uterine Neoplasms , Uterine NeoplasmsSubject(s)
Pneumonia, Mycoplasma/complications , Respiratory Distress Syndrome/microbiology , Adult , Humans , MaleABSTRACT
No disponible
Subject(s)
Adult , Male , Humans , Pneumonia, Mycoplasma , Respiratory Distress SyndromeABSTRACT
We describe the case of a 30-year-old asymptomatic farmer who underwent a pulmonary segmentectomy due to the casual finding of a pulmonary nodule in preoperative chest radiography. As bronchoscopic samples rule out mycobacterium infection and malignancy, surgery could have been avoided with the use of serological tests and radiographic follow-up based on epidemiology of dirofilariasis in our country.
Subject(s)
Dirofilariasis/diagnosis , Lung Diseases, Parasitic/diagnosis , Lung Neoplasms/diagnosis , Adult , Bronchoscopy , Diagnosis, Differential , Dirofilariasis/diagnostic imaging , Dirofilariasis/pathology , Dirofilariasis/surgery , Humans , Lung Diseases, Parasitic/diagnostic imaging , Lung Diseases, Parasitic/pathology , Lung Diseases, Parasitic/surgery , Male , Radiography , Unnecessary ProceduresABSTRACT
The Lambert-Eaton myasthenic syndrome is a rare disorder of neuromuscular transmission, usually presenting as a paraneoplastic process associated with a small cell lung cancer. Recently, respiratory muscular impairment has been described in these patients. Acute respiratory failure as a presenting symptom has been reported in few cases. We present a case of acute ventilatory failure as the first manifestation of Lambert-Eaton myasthenic syndrome associated with small cell lung cancer and discuss the main features of this disease, including its treatment. The Lambert-Eaton myasthenic syndrome should be considered in cases of unexplained acute respiratory failure and clinical evidence of neoplasic disease. We thought that electromyographic studies could reveal the real involvement of respiratory muscles, including diaphragm, in this condition.
Subject(s)
Carcinoma, Small Cell/complications , Lambert-Eaton Myasthenic Syndrome/complications , Lung Neoplasms/complications , Respiratory Insufficiency/etiology , Acute Disease , Carcinoma, Small Cell/diagnosis , Humans , Lambert-Eaton Myasthenic Syndrome/diagnosis , Lung Neoplasms/diagnosis , Male , Middle AgedABSTRACT
El síndrome de Lambert-Eaton (SLE) es un trastorno raro de la transmisión neuromuscular que se presenta habitualmente como un proceso paraneoplásico frecuentemente asociado al carcinoma pulmonar de células pequeñas. Varios estudios han demostrado la existencia de disfunción de la musculatura respiratoria en estos pacientes. La insuficiencia respiratoria aguda como presentación del SLE ha sido descrita de forma excepcional. Se describe un caso de insuficiencia respiratoria aguda como forma de debut de SLE asociado a un carcinoma microcítico de pulmón, repasando las principales características del cuadro y su tratamiento. El SLE debería ser considerado en casos de insuficiencia respiratoria aguda sin causa aparente y sospecha de enfermedad neoplásica de base. Proponemos la realización de estudios electromiográficos que detecten alteraciones en la función muscular respiratoria, incluyendo el diafragma, para descartar su existencia (AU)
Subject(s)
Middle Aged , Male , Humans , Lambert-Eaton Myasthenic Syndrome , Respiratory Insufficiency , Acute Disease , Carcinoma, Small Cell , Lung NeoplasmsABSTRACT
A 52-yr-old man with a residual phase of schizophrenia developed sleep apnoea-hypopnoea syndrome (SAHS). After five days of continuous positive airway pressure (CPAP) treatment, the patient developed an aggressive mood with incoherence, prominent hallucinations and agitation, and attempted to hit his relatives. He was finally admitted to the hospital with an acute psychotic episode. Withdrawal of CPAP, and neuroleptic treatment controlled the episode, and clinical symptoms of SAHS reappeared 10 days later. Schizophrenia associated to sleep apnoea-hypopnoea syndrome has rarely been reported, but, to the authors' knowledge, the induction of a psychotic episode by continuous positive airway pressure treatment in a patient with sleep apnoea-hypopnoea syndrome and coexisting schizophrenia has never been previously reported.
