Identification of p53-target genes in human papillomavirus-associated head and neck cancer by integrative bioinformatics analysis.

Introduction: Head and neck cancer (HNC) is a highly prevalent and heterogeneous malignancy. Although extensive efforts have been made to advance its treatment, the prognosis remained poor with increased mortality. Human papillomaviruses (HPV) have been associated with high risk in HNC. TP53, a tumor suppressor, is the most frequently altered gene in HNC, therefore, investigating its target genes for the identification of novel biomarkers or therapeutic targets in HPV-related HNC progression is highly recommended. Methods: Transcriptomic profiles from three independent gene expression omnibus (GEO) datasets, including 44 HPV+ and 70 HPV- HNC patients, were subjected to integrative statistical and Bioinformatics analyses. For the top-selected marker, further in-silico validation in TCGA and GTEx databases and experimental validation in 65 (51 HPV- and 14 HPV+) subjects with histologically confirmed head and neck squamous cell carcinoma (HNSCC) have been performed. Results: A total of 498 differentially expressed genes (DEGs) were identified including 291 up-regulated genes and 207 down-regulated genes in HPV+ compared to HPV- HNSCC patients. Functional annotations and gene set enrichment analysis (GSEA) showed that the up-regulated genes were significantly involved in p53-related pathways. The integrative analysis between the Hub-genes identified in the complex protein-protein network and the top frequent genes resulting from GSEA showed an intriguing correlation with five biomarkers which are EZH2, MDM2, PCNA, STAT5A and TYMS. Importantly, the MDM2 gene showed the highest gene expression difference between HPV+ and HPV- HNSCC (Average log2FC = 1.89). Further in-silico validation in a large HNSCC cohort from TCGA and GTEx databases confirmed the over-expression of MDM2 in HPV+ compared to HPV- HNSCC patients (p = 2.39E-05). IHC scoring showed that MDM2 protein expression was significantly higher in HPV+ compared to HPV- HNSCC patients (p = 0.031). Discussion: Our findings showed evidence that over-expression of MDM2, proto-oncogene, may affect the occurrence and proliferation of HPV-associated HNSCC by disturbing the p53-target genes and consequently the p53-related pathways.

Problem instances dataset of a real-world sequencing problem with transition constraints and asymmetric costs.

This data article describes 30 instances of the real-world problem of sequencing steel coils in a continuous galvanizing line. Each instance is represented by a cost matrix that gives information of the cost of sequencing each pair of coils or items together (e.g. a transition). Some transitions are forbidden due to technical limitations of the line and/or because of the properties of the coils, what makes the problem more challenging. These costs were previously obtained by a cost model that estimates the final cost of each transition for a set of coils to be sequenced in the line. Although the instances come from this real context, the problem can be theoretically seen as finding a minimum cost Hamiltonian path (e.g. a minimum cost feasible production sequence with all the coils appearing just once). It is a well-known NP-Hard combinatorial optimization problem. Since these instances represent real challenges found in the industry, they can be very useful for algorithm development and testing. Due to the cost distributions obtained for the given coils, just finding a feasible sequence can be a challenging task, especially for some types of approximate algorithms (Alvarez-Gil et al., 2022).

The effects of quantity discounts on supply chain performance: Looking through the Bullwhip lens.

Quantity discounts are a common pricing mechanism to stimulate large orders. We explore their impact on the dynamic behaviour of production and distribution systems by studying key operational and economic metrics. In a three-echelon supply chain, we observe that the discount generally increases the Bullwhip Effect, which especially harms the manufacturer. The discount also reduces the retailer's purchase costs, but increases its inventory- and capacity-related costs. A key trade-off thus emerges, which manifests itself through a U-shaped relationship between the total cost and the discount acceptance parameter. In the light of this trade-off, we discuss how key factors should affect the retailer's willingness to pursue the discount. We observe that managers that need to deal with tougher environmental conditions, such as high demand uncertainty and long lead times, should be less reluctant to increase orders up to the discount quantity. We also discuss in detail other valuable insights for professionals, both from the perspective of sellers and buyers.

On strategic choices faced by large pharmaceutical laboratories and their effect on innovation risk under fuzzy conditions.

OBJECTIVES: We develop a fuzzy evaluation model that provides managers at different responsibility levels in pharmaceutical laboratories with a rich picture of their innovation risk as well as that of competitors. This would help them take better strategic decisions around the management of their present and future portfolio of clinical trials in an uncertain environment. Through three structured fuzzy inference systems (FISs), the model evaluates the overall innovation risk of the laboratories by capturing the financial and pipeline sides of the risk. METHODS AND MATERIALS: Three FISs, based on the Mamdani model, determine the level of innovation risk of large pharmaceutical laboratories according to their strategic choices. Two subsystems measure different aspects of innovation risk while the third one builds on the results of the previous two. In all of them, both the partitions of the variables and the rules of the knowledge base are agreed through an innovative 2-tuple-based method. With the aid of experts, we have embedded knowledge into the FIS and later validated the model. RESULTS: In an empirical application of the proposed methodology, we evaluate a sample of 31 large pharmaceutical laboratories in the period 2008-2013. Depending on the relative weight of the two subsystems in the first layer (capturing the financial and the pipeline sides of innovation risk), we estimate the overall risk. Comparisons across laboratories are made and graphical surfaces are analyzed in order to interpret our results. We have also run regressions to better understand the implications of our results. CONCLUSIONS: The main contribution of this work is the development of an innovative fuzzy evaluation model that is useful for analyzing the innovation risk characteristics of large pharmaceutical laboratories given their strategic choices. The methodology is valid for carrying out a systematic analysis of the potential for developing new drugs over time and in a stable manner while managing the risks involved. We provide all the necessary tools and datasets to facilitate the replication of our system, which also may be easily applied to other settings.

Measuring the efficiency of large pharmaceutical companies: an industry analysis.

This paper evaluates the relative efficiency of a sample of 37 large pharmaceutical laboratories in the period 2008-2013 using a data envelopment analysis (DEA) approach. We describe in detail the procedure followed to select and construct relevant inputs and outputs that characterize the production and innovation activity of these pharmaceutical firms. Models are estimated with financial information from Datastream, including R&D investment, and the number of new drugs authorized by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) considering the time effect. The relative performances of these firms-taking into consideration the strategic importance of R&D-suggest that the pharmaceutical industry is a highly competitive sector given that there are many laboratories at the efficient frontier and many inefficient laboratories close to this border. Additionally, we use data from S&P Capital IQ to analyze 2071 financial transactions announced by our sample of laboratories as an alternative way to gain access to new drugs, and we link these transactions with R&D investment and DEA efficiency. We find that efficient laboratories make on average more financial transactions, and the relative size of each transaction is larger. However, pharmaceutical companies that simultaneously are more efficient and invest more internally in R&D announce smaller transactions relative to total assets.

[The advertising message of drugs advertisements in Spanish medical journals]. / El mensaje publicitario de los anuncios de fármacos en las revistas médicas españolas.

OBJECTIVE: To describe the characteristics of advertising in Spanish medical journals and to analyze the advertising message in drug advertisements. METHODS: Six issues of 4 Spanish medical journals published in 2001 were reviewed to identify the number of advertisements and their characteristics. The journals selected were Atención Primaria, Anales Españoles de Pediatría, Medicina Clínica and Gaceta Sanitaria. The advertising message was analyzed by evaluating 5 factors: communication aim, sales argument, communication treatment, and use of text and image. RESULTS: 609 advertisements were found. Drug advertisements were the most numerous (69.9%). Advertising pressure was highest in Atención Primaria (36%), followed by Anales Españoles de Pediatría (22%), Medicina Clínica (12%) and Gaceta Sanitaria (4%). Of the 195 drug advertisements analyzed, the aim of the advertising message was mostly to present or remind readers of an existing product (70.8%). The sales argument was rational in 86.5%. The communication treatment was advertising in 72.6%. The text of the advertisement contained a headline in 82.4% or a slogan in 50.8%. The advertisement image was a photograph in 74.7% and the aim of the image was to present the product (48.7%), to promise a benefit (45.1%), or to argue its qualities (31.1%). CONCLUSIONS: In the journals aimed at prescribing physicians advertising pressure was higher and advertisements were intercalated in article text. Advertising concerned already existing products, used rational arguments, and the communication treatment was advertising.

El mensaje publicitario de los anuncios de fármacos en las revistas médicas españolas / The advertising message of drugs advertisements in Spanish medical journals

Objetivos: Describir las características de la publicidad en las revistas médicas españolas y analizar el mensaje publicitario en los anuncios de fármacos. Métodos: Se revisaron 6 números del año 2001 de 4 revistas médicas españolas: Atención Primaria, Anales Españoles de Pediatría, Medicina Clínica y Gaceta Sanitaria, para identificar el número de anuncios y sus características. El mensaje publicitario se analizó evaluando 5 áreas: objetivo de la comunicación, argumento de venta, tratamiento de la comunicación, texto e imagen empleados. Resultados: Se encontraron 609 anuncios, y los anuncios de fármacos fueron los más numerosos (69,9%). La presión publicitaria fue mayor en Atención Primaria (36%) seguida de Anales Españoles de Pediatría (22%), Medicina Clínica (12%) y Gaceta Sanitaria (4%). En los 195 anuncios de fármacos analizados el objetivo del mensaje publicitario fue mayoritariamente el recuerdo o presentación de un producto ya existente (70,8%), el argumento de venta era racional en un 86,5%, el tratamiento de la comunicación fue publicitario (72,6%), presentaban un titular el 82,4% y eslogan el 50,8%; utilizaban una fotografía el 74,7% y el objetivo de la imagen fue presentar el producto (48,7%), prometer un beneficio (45,1%) o argumentar sus cualidades (31,1%). Conclusiones: En las revistas dirigidas a médicos prescriptores, la presión publicitaria es mayor e intercalan publicidad en los artículos. La publicidad de fármacos es sobre productos ya existentes y utiliza argumentos racionales con un tratamiento de la comunicación publicitario

Objective: To describe the characteristics of advertising in Spanish medical journals and to analyze the advertising message in drug advertisements. Methods: Six issues of 4 Spanish medical journals published in 2001 were reviewed to identify the number of advertisements and their characteristics. The journals selected were Atención Primaria, Anales Españoles de Pediatría, Medicina Clínica and Gaceta Sanitaria. The advertising message was analyzed by evaluating 5 factors: communication aim, sales argument, communication treatment, and use of text and image. Results: 609 advertisements were found. Drug advertisements were the most numerous (69.9%). Advertising pressure was highest in Atención Primaria (36%), followed by Anales Españoles de Pediatría (22%), Medicina Clínica (12%) and Gaceta Sanitaria (4%). Of the 195 drug advertisements analyzed, the aim of the advertising message was mostly to present or remind readers of an existing product (70.8%). The sales argument was rational in 86.5%. The communication treatment was advertising in 72.6%. The text of the advertisement contained a headline in 82.4% or a slogan in 50.8%. The advertisement image was a photograph in 74.7% and the aim of the image was to present the product (48.7%), to promise a benefit (45.1%), or to argue its qualities (31.1%). Conclusions: In the journals aimed at prescribing physicians advertising pressure was higher and advertisements were intercalated in article text. Advertising concerned already existing products, used rational arguments, and the communication treatment was advertising

[Hospital and primary care emergency services in Asturias [Spain]: variations among health areas and trends between 1994-2001]. / Urgencias hospitalarias y de atención primaria en Asturias: variaciones entre áreas sanitarias y evolución desde 1994 hasta 2001.

OBJECTIVE: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. METHODS: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. RESULTS: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. CONCLUSIONS: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts.

On macroeconomic characteristics of pharmaceutical generics and the potential for manufacturing and consumption under fuzzy conditions.

OBJECTIVE: The aim of this paper is to develop a methodology that is useful for analyzing, from a macroeconomic perspective, the aggregate demand and the aggregate supply features of the market of pharmaceutical generics. In order to determine the potential consumption and the potential production of pharmaceutical generics in different countries, two fuzzy decision support systems are proposed. METHODS AND MATERIALS: Two fuzzy decision support systems, both based on the Mamdani model, were applied in this paper. These systems, generated by Matlab Toolbox 'Fuzzy' (v. 2.0), are able to determine the potential of a country for the manufacturing or the consumption of pharmaceutical generics. The systems make use of three macroeconomic input variables. RESULTS: In an empirical application of our proposed methodology, the potential towards consumption and manufacturing in Holland, Sweden, Italy and Spain has been estimated from national indicators. Cross-country comparisons are made and graphical surfaces are analyzed in order to interpret the results. CONCLUSIONS: The main contribution of this work is the development of a methodology that is useful for analyzing aggregate demand and aggregate supply characteristics of pharmaceutical generics. The methodology is valid for carrying out a systematic analysis of the potential generics have at a macrolevel in different countries. The main advantages of the use of fuzzy decision support systems in the context of pharmaceutical generics are the flexibility in the construction of the system, the speed in interpreting the results offered by the inference and surface maps and the ease with which a sensitivity analysis of the potential behavior of a given country may be performed.

[Impact in Asturias of primary care emergencies on hospital emergencies for the 1994-2001 period. A time series cointegration analysis]. / Impacto en asturias de las urgencias de atención primaria sobre las hospitalarias. Un análisis de cointegración de series temporales.

BACKGROUND: Greater accessibility to the primary care continuing care points (CCP's) could reduce the visits to the Hospital Emergency Services (HES's). This study analyses whether Primary Care can replace and Hospital Services in emergencies. METHODS: All of the emergency visits (n=6.454.034) made to the HES's and Primary Care CCP's in Asturias and of each one of the healthcare districts within the 1994-2001 period were calculated. The time series were constructed with monthly frequencies for Asturias and each one of the districts, a cointegration analysis having been made to assess whether the two series are inter-replaceable. RESULTS: A mean annual increase of the total number of emergencies in Asturias of 6.2% (CCP: 7,8%; HES: 5.1%) was found, with different growth among the healthcare districts. In the time series cointegration analysis, no replaceability was found between the primary care and hospital emergencies for Asturias and for the healthcare districts, except for the healthcare district of Oviedo, where a 10% growth rate in primary would lower hospital emergencies by 2.7%. CONCLUSIONS: The greater accessibility to the Primary Care CCP's increases the use thereof without reducing the visits to the HES's. Therefore, the increase in Primary Cart resources does not seem to be an effective alternative for reducing the visits to the HES's.

Urgencias hospitalarias y de atención primaria en Asturias: variaciones entre áreas sanitarias y evolución desde 1994 hasta 2001 / Hospital and primary care emergency services in Asturias [Spain]: variations among health areas and trends between 1994-2001

Objetivo: Describir la frecuencia de utilización de los servicios de urgencias en las áreas sanitarias de Asturias desde 1994 a 2001 y analizar su variabilidad. Métodos: Se estimó la demanda de urgencias hospitalarias y de atención primaria en las 8 áreas sanitarias de Asturias, y se analizó su evolución y las diferencias entre áreas, usando la estandarización indirecta y estadísticos de variabilidad. Resultados: Entre 1994 y 2001 se realizaron casi 6,5 millones de urgencias (un 43,8% en hospitales), con un crecimiento medio anual del 6,2% (un 7,8% en atención primaria y un 5,1% en hospitales) con gran heterogeneidad entre áreas. La variabilidad fue mayor en atención primaria y disminuyó en el período estudiado (coeficientes de variación: 0,38 y 0,27 para 1994 y 2001 en atención primaria, y 0,14 y 0,11 en hospitales, respectivamente). Conclusiones: La utilización de las urgencias creció en el período estudiado y se observa una gran variabilidad entre áreas sanitarias

Objective: To describe primary care and hospital emergency utilization rates in Asturias health districts from 1994 to 2001 and to analyse their variability. Methods: Hospital and primary care rates from 1994 to 2001 in the 8 Asturias health districts were estimated. Their variability was analysed using indirect standardisation and small area variation statistics. Results: Almost 6.5 million of emergencies (hospitals: 43.8%) were attended in Asturias from 1994 to 2001. The average annual growth was 6.2% (primary care: 7.8%; hospitals: 5.1%) with differences among districts. Primary care variability was higher (variation coefficient: 0.38 and 0.27 in 1994 and 2001) than hospital variability (variation coefficient: 0.14 and 0.11) and it decreased in the period. Conclusions: Emergency Health Services utilization growth between 1994 and 2001, with strong variability among health districts

Impacto en Asturias de las urgencias de atención primaria sobre las hospitalarias: un análisis de cointegración de series temporales / Impact in Asturias of primary care emergencies on hospital emergencies for the 1994-2001 period. A time series cointegration analysis

Fundamento: La mayor accesibilidad a los puntos de atención continuada (PAC) de la atención primaria podría disminuir las visitas en los Servicios de Urgencias Hospitalarias (SUH). En este estudio se analiza si existe sustituibilidad entre las urgencias de Atención Primaria y Hospitalaria. Métodos: Se analiza la totalidad de las visitas urgentes (n=6.454.034) realizadas en los SUH de los hospitales y PAC de Atención Primaria de Asturias y de cada una de las áreas sanitarias entre 1994 y 2001. Se construyeron las series temporales con frecuencias mensuales para Asturias y cada una de las áreas y se realizó un análisis de cointegración para evaluar si existe sustituibilidad entre ambas series. Resultados: Se observó un incremento medio anual de las urgencias totales en Asturias del 6,2% (PAC: 7,8%; SUH: 5,1%), con diferente crecimiento entre las áreas sanitarias. En el análisis de cointegración de las series temporales no se detectó sustituibilidad entre las urgencias de atención primaria y hospitalaria para Asturias y para las áreas sanitarias, salvo en el área sanitaria de Oviedo, donde una tasa de crecimiento del 10% en primaria reduciría un 2,7% las urgencias hospitalarias. Conclusiones: La mayor accesibilidad a los PAC de Atención Primaria incrementa su utilización sin reducir las visitas en los SUH. En consecuencia, el incremento de recursos en Atención Primaria no parece constituir una alternativa eficaz para disminuir las visitas en los SUH

Background: Greater accessibility to the primary care continuing care points (CCP’s) could reduce the visits to the Hospital Emergency Services (HES’s). This study analyses whether Primary Care can replace and Hospital Services in emergencies. Methods: All of the emergency visits (n=6.454.034) made to the HES’s and Primary Care CCP’s in Asturias and of each one of the healthcare districts within the 1994-2001 period were calculated. The time series were constructed with monthly frequencies for Asturias and each one of the districts, a cointegration analysis having been made to assess whether the two series are inter-replaceable. Results: A mean annual increase of the total number of emergencies in Asturias of 6.2% (CCP: 7,8%; HES: 5.1%) was found, with different growth among the healthcare districts. In the time series cointegration analysis, no replaceability was found between the primary care and hospital emergencies for Asturias and for the healthcare districts, except for the healthcare district of Oviedo, where a 10% growth rate in primary would lower hospital emergencies by 2.7%. Conclusions: The greater accessibility to the Primary Care CCP’s increases the use thereof without reducing the visits to the HES’s. Therefore, the increase in Primary Care resources does not seem to be an effective alternative for reducing the visits to the HES’s

Adecuación de la tromboprofilaxis en pacientes hospitalizados en servicios médicos y quirúrgicos / Appropriateness of thromboprophylaxis in medical and surgical inpatients

Objetivo: Identificar la adecuación de la tromboprofilaxis (TP) (prescripción del fármaco en función de su necesidad) en pacientes hospitalizados y las diferencias entre servicios médicos (SM) y quirúrgicos (SQ). Material y método: Se revisaron 421 historias clínicas (SM, 210 y SQ, 211). Para valorar la necesidad de tromboprofilaxis se utilizó la Guía PRETEMED para pacientes médicos y el Informativo de Trombosis y Medicina Vascular para pacientes quirúrgicos. Se consideró tromboprofilaxis adecuada si el paciente que cumplía criterios de necesidad según las guías de práctica clínica utilizadas recibía tratamiento con heparina de bajo peso molecular (HBPM) o, no cumpliendo criterios, no recibía tratamiento; se consideró tromboprofilaxis inadecuada cuando, cumpliendo criterios de necesidad, no recibía tratamiento con HBPM (inadecuación por defecto) o no cumpliendo criterios se le administraba HBPM (inadecuación por exceso). Resultados: La tromboprofilaxis estaba indicada en 312 (74,1%) pacientes y se administró HBPM a 230 (54,6%). La inadecuación fue del 22,8%, y la mayor parte de la inadecuación fue por defecto (21,1%), mientras que la inadecuación por exceso fue del 1,7%, sin diferencias entre servicios. La inadecuación de la TP fue menor en los pacientes menores de 40 años y mayor en las estancias inferiores a 8 días. Conclusiones: La TP es adecuada en el 77,8% de los pacientes y la inadecuación es en su mayoría por defecto, sin diferencias entre servicios médicos y quirúrgicos. La inadecuación es menor en pacientes más jóvenes y mayor cuando la estancia media es más corta

Objective: To identify the appropriateness of thromboprophylaxis (TP) (drug prescription according to need) in inpatients and differences between medical (MD) and surgical departments (SD). Material and method: We reviewed 421 medical records (210 in medical departments and 211 in surgery departments). To evaluate the need for TP, the Guía PRETEMED was used for medical patients and the "Informativo de Trombosis y Medicina Vascular" was used for surgical patients. TP was considered to be appropriate if patients meeting the criteria for need according to the clinical practice guidelines used received treatment with low molecular weight heparin (LMWH) and if patients not meeting these criteria did not receive LMWH. TP was deemed inappropriate when patients meeting the criteria for need did not receive LMWH (inappropriate undertreatment) or when patients not meeting the criteria for need received LMWH (inappropriate overtreatment). Results: TP was indicated in 312 patients (74.1%) and LMWH was administered to 230 (54.6%). Inappropriateness was found in 22.8%, undertreatment being more frequent (21.1%) than overtreatment (1.7%), with no differences between medical and surgical departments. Inappropriate TP was less frequent in patients aged less than 40 years old and was more frequent in hospital stays of less than 8 days. Conclusions: Use of TP was appropriate in 77.8% of patients and most cases of inappropriate use involved undertreatment. No differences were found between medical and surgical departments. Inappropriateness was less frequent in younger patients and was more frequent in short hospital stays

Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de asturias / Impact on hospital days of care due to unnecessary emergency admissions

Fundamento: Los ingresos innecesarios en los hospitales deagudos tienen importantes consecuencias sobre su eficiencia y organización.El objetivo de este estudio es identificar el grado de inadecuaciónde los ingresos realizados desde un servicio de urgenciashospitalario y sus causas, así como cuantificar las estancias inadecuadasgeneradas por estos ingresos.Método: Se evaluó la adecuación de 622 ingresos realizados enal año 2002 seleccionados aleatoriamente, y la del total de estanciasgeneradas por los ingresos inadecuados y una muestra representativade los ingresos adecuados de un hospital de segundo nivel de Asturias.El instrumento de revisión fue el Appropiateness EvaluationProtocol. Se realizó un análisis descriptivo de la muestra, un análisisbivariante y un análisis de regresión logística multivariante.Resultados: Se consideraron inadecuados 63 ingresos (10,1%).La principal causa de inadecuación fueron los ingresos para realizarpruebas diagnósticas y/o tratamientos que podrían realizarse de formaambulatoria. Los ingresos innecesarios generaron un 78,2% deestancias innecesarias y los necesarios un 24,8%. Incrementaron elriesgo de ingresos innecesarios la derivación a urgencias desde consultasexternas del propio hospital (OR:4,50, IC 95%: 1,59-12,76),ingresar en horario de mañana (OR: 13,97, IC 95%: 1,86-104,76) otarde (OR: 7,70, IC 95%: 1,01-58,72), ingresar en los servicios decardiología (OR: 3,93, IC 95%: 1,22-12,70) y neurología (OR: 5,86,IC 95%: 1,88-18,30) disminuyó el riesgo de ingreso innecesario laexperiencia de ingresos previos (OR: 0,34, IC 95%: 0,18-0,65).Conclusiones: Los ingresos innecesarios generan tres veces másestancias inadecuadas que los necesarios. Los problemas organizativosdel centro son la principal causa de ingresos inadecuados

Background: Unnecessary admissions of acute cases havemajor impacts on hospital efficiency and organization. This study isaimed to identify percentage of unnecessary admissions from a hospitalemergency department and the reasons why, as well as toquantify the unnecessary hospital days of care generated by theseadmissions.Methods: It has been analyzed the appropriateness of 622admissions made in 2002, selected at random, all of the hospital staysgenerated by the inappropriate admissions and a representative sampleof the appropriate admissions of a second-level hospital in Asturias.The review tool was the Appropriateness Evaluation Protocol.A descriptive analysis, a bivariate analysis and a multivariate logicregression analysis were made.Results: A total of 63 admissions (10.1%) were judged inappropriate.The main cause of inappropriateness were admissions for performingdiagnostic tests and/or treatments, which could be carried outon an outpatient basis. These unnecessary admissions generated78.2% of unnecessary stays, and the appropriate admissions generated24.8% of unnecessary stays. Referrals to hospital emergency roomsfrom physicians outside of the hospital proper heightened the risk ofunnecessary admissions (OR:4.50, 95% CI: 1.59-12.76), daytimeadmissions (OR: 13.97, 95% CI: 1.86-104.76) or evening admissions(OR: 7.70, 95% CI: 1.01-58.72), admissions to cardiology wards (OR:3.93, 95% CI: 1.22-12.70) and neurology wards (OR: 5.86, 95% CI:1.88-18.30), the experience of prior admissions having lowered therisk of unnecessary admission (OR: 0.34, 95% CI: 0.18-0.65).Conclusions: Unnecessary admissions generate three timesmore inappropriate stays than the necessary admissions. Hospitalorganization-related problems are the main cause of inappropriateadmissions

[Impact on hospital days of care due to unnecessary emergency admissions]. / Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de asturias.

BACKGROUND: Unnecessary admissions of acute cases have major impacts on hospital efficiency and organization. This study is aimed to identify percentage of unnecessary admissions from a hospital emergency department and the reasons why, as well as to quantify the unnecessary hospital days of care generated by these admissions. METHODS: It has been analyzed the appropriateness of 622 admissions made in 2002, selected at random, all of the hospital stays generated by the inappropriate admissions and a representative sample of the appropriate admissions of a second-level hospital in Asturias. The review tool was the Appropriateness Evaluation Protocol. A descriptive analysis, a bivariate analysis and a multivariate logic regression analysis were made. RESULTS: A total of 63 admissions (10.1%) were judged inappropriate. The main cause of inappropriateness were admissions for performing diagnostic tests and/or treatments, which could be carried out on an outpatient basis. These unnecessary admissions generated 78.2% of unnecessary stays, and the appropriate admissions generated 24.8% of unnecessary stays. Referrals to hospital emergency rooms from physicians outside of the hospital proper heightened the risk of unnecessary admissions (OR:4.50, 95% CI: 1.59-12.76), daytime admissions (OR: 13.97, 95% CI: 1.86-104.76) or evening admissions (OR: 7.70, 95% CI: 1.01-58.72), admissions to cardiology wards (OR: 3.93, 95% CI: 1.22-12.70) and neurology wards (OR: 5.86, 95% CI: 1.88-18.30), the experience of prior admissions having lowered the risk of unnecessary admission (OR: 0.34, 95% CI: 0.18-0.65). CONCLUSIONS: Unnecessary admissions generate three times more inappropriate stays than the necessary admissions. Hospital organization-related problems are the main cause of inappropriate admissions.

Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años / Factors associated with hospitalization use and appropriateness for patients over 64 years of age

Fundamento: Algunas características sociales, médicas o funcionales se asocian a mayor consumo de recursos sanitarios, sin que esto signifique un uso inapropiado de éstos. El objetivo de este trabajo es conocer la influencia del estado de salud y otros factores sobre las estancias hospitalarias y las estancias inapropiadas en la población mayor de 64 años.Método: Una cohorte representativa de la población mayor de 64 años del Partido Judicial de Toledo (n=3.214) en la que se había valorado el estado de salud, fue seguida durante 18 meses, identificando sus ingresos y estancias hospitalarias, cuya adecuación fue evaluada con el Appropiateness Evaluation Protocol. Se analizaron las asociaciones entre las características socio-demográficas, de estado de salud y morbilidad de la cohorte con las tasas de frecuentación y hospitalización y con la proporción de estancias e ingresos inadecuados. Resultados: Durante los 18 meses de seguimiento fueron hospitalizados 410 individuos (12,8 por ciento), que generaron 546 ingresos (tasa de frecuentación=17,0 ingresos/100 habitantes) y 7.015 días de estancia (tasa de hospitalización = 218,3 estancias/100 habitantes). El 18,9 por ciento de los ingresos y el 49,9 por ciento de las estancias fueron evaluadas como inadecuados. La hospitalización se asoció al peor estado de salud, institucionalización, género masculino, determinadas patologías y a la utilización previa de servicios sanitarios. No se hallaron asociaciones entre características de los pacientes y proporción de estancias inadecuadas. El 97,5 por ciento de las estancias innecesarias fue atribuido a problemas de programación hospitalaria y estilo de practica de los médicos. Conclusiones: Los factores socio-demográficos, de morbilidad, estado de salud y utilización previa de servicios se muestran como buenos predictores de hospitalización en las personas mayores, pero no se relacionan con el uso inadecuado de la hospitalización (AU)

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Estado de salud de las personas ancianas y hospitalización en servicios geriátricos, médicos y quirúrgicos. Estudio poblacional en Toledo / Senior citizen health conditions and hospitilization on geriatric, general and surgical floors. A population study conducted in Toledo

Fundamento: El estado de salud y algunas características clínicas configuran un grupo de ancianos que necesitan más cuidados, que podrían beneficiarse de asistencia geriátrica especializada, aunque no existe consenso para identificar estos pacientes. El objetivo de este trabajo es describir el perfil de los pacientes mayores de 64 años ingresados en una unidad geriátrica y compararlo con los mayores de esta edad ingresados en los servicios médicos y quirúrgicos. Método: Durante 18 meses se siguió una cohorte representativa de la población mayor de 64 años del Partido Judicial de Toledo (n=3214), para identificar los ingresos y estancias hospitalarias en los hospitales públicos del área sanitaria. Las variables sobre estado de salud, se recogieron por entrevista personal, y los ingresos y sus características según datos del servicio de admisiones hospitalario. Resultados: Ingresaron 410 personas (12,8 por ciento), en geriatría 168 pacientes (30,7 por ciento), en servicios médicos 204 (37,3 por ciento) y en servicios quirúrgicos 174 (32,0 por ciento). En geriatría la edad media fue significativamente mayor (77,4 años), sin diferencias en la estancia media (12,8 días;IC95 por ciento:10,6-14,0), fallecieron 44 pacientes (8,1 por ciento), ingresados en geriatría 26 (59,1 por ciento). En los servicios quirúrgicos ingresaron más mujeres, pacientes más jóvenes y con déficit leve de visión y audición; en geriatría, respecto a servicios médicos, más pacientes mayores de 80 años, viviendo en residencias, sin pareja, dependencia funcional moderada-severa, deterioro cognitivo, depresión, mala calidad de vida y escasos recursos sociales. Conclusiones: No se observaron diferencias en el estado de salud entre los mayores de 64 años ingresados en servicios no quirúrgicos y quirúrgicos. En geriatría, respecto a los otros grupos de servicios, los pacientes tuvieron una edad media más elevada, peor estado de salud, mayor mortalidad y estancia media similar (AU)