RESUMEN
OBJECTIVES: Patients undergoing radical cystectomy represent a particularly resource-intensive patient population. Time-driven activity based costing (TDABC) assigns time to events and then costs are based on the people involved in providing care for specific events. To determine the major cost drivers of radical cystectomy care we used a TDABC analysis for the cystectomy care pathway. SUBJECTS AND METHODS: We retrospectively reviewed a random sample of 100 patients out of 717 eligible patients undergoing open radical cystectomy and ileal conduit for bladder cancer at our institution between 2012 and 2015. We defined the cycle of care as beginning at the preoperative clinic visit and ending with the 90-day postoperative clinic visit. TDABC was carried out with construction of detailed process maps. Capacity cost rates were calculated and the care cycle was divided into 3 phases: surgical, inpatient, and readmissions. Costs were normalized to the lowest cost driver within the cohort. RESULTS: The mean length of stay was 6.9 days. Total inpatient care was the main driver of cost for radical cystectomy making up 32% of the total costs. Inpatient costs were mainly driven by inpatient staff care (76%). Readmissions were responsible for 29% of costs. Surgery was 31% of the costs, with the majority derived from operating room staff costs (65%). CONCLUSION: The major driver of cost in a radical cystectomy pathway is the inpatient stay, closely followed by operating room costs. Surgical costs, inpatient care and readmissions all remain significant sources of expense for cystectomy and efforts to reduce cystectomy costs should be focused in these areas.
Asunto(s)
Costos y Análisis de Costo , Cistectomía/economía , Cistectomía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/economía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
We present the case of a 68-year-old man with a tibioperoneal trunk mycotic pseudoaneurysm, a rarity in the modern age of antibiotics. We describe the patient's hospitalizations and workups that ultimately led to this diagnosis and our management with open ligation without bypass. This case highlights the importance of combining a thorough history and physical examination with laboratory and imaging data while keeping in mind a broad differential diagnosis.
RESUMEN
Salvia subgenus Calosphace (Lamiaceae) is economically and ethnomedicinally significant and comprised of more than 500 species. Although strongly supported as monophyletic, it has received no comprehensive systematic research since the initial establishment of 91 taxonomic sections in 1939. Representative taxa of 73 sections of Calosphace were sampled to investigate the phylogenetic relationships and identify major lineages using chloroplast (intergenic spacer psbA-trnH) and nuclear ribosomal DNA (internal transcribed spacer). Phylogenetic analysis of the combined data sets established monophyly of seven sections (Blakea, Corrugatae, Erythrostachys, Hastatae, Incarnatae, Microsphace, and Sigmoideae) and four major lineages (S. axillaris, "Hastatae clade", "Uliginosae clade", and "core Calosphace"). Sections spanning two or more centers of diversity are not supported by our results; rather, supported relationships exhibit significant geographic structure. Mexico is supported as the geographic origin of Calosphace, and no more than seven dispersal events to South America are required to account for current disjunct distributions.
Asunto(s)
ADN de Plantas/química , Filogenia , Salvia/clasificación , ADN de Cloroplastos/química , ADN de Cloroplastos/genética , ADN Intergénico/química , ADN Intergénico/genética , ADN de Plantas/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Geografía , Mutación INDEL , México , Salvia/genética , Análisis de Secuencia de ADN , América del SurRESUMEN
A buspirona foi comaprada com alprazolam e lorazepam no tratamento da ansiedade generalizada durante 4 semanas, num estudo duplo-cego de 60 pacientes. Todas as três medicaçöes foram eficazes e semelhantes em produzir reduçöes significativas da ansiedade conforme determinado por escalas percentuais padronizadas e por avaliaçöes globais dos pacientes realizadas pelos médicos. Houve diferenças significativas quanto ao surgimento de sonolência, letargia e/ou fadiga: poucos pacientes no grupo buspirona experimentaram esses efeitos colaterias indesejáveis em comparaçäo com o grupo alprazolam (16 vs. 60 por cento, respectivamente; p < .01) ou com o grupo lorazepam (16 por cento, respectivamente: p <.0003). Essa demonstraçäo de similaridade da eficácia e superioridade na segurança poderá favorecer a buspirona no tratamento da ansiedade generalizada
Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Trastornos de Ansiedad/tratamiento farmacológico , Buspirona/uso terapéutico , Alprazolam/uso terapéutico , Método Doble Ciego , Lorazepam/uso terapéuticoRESUMEN
Bases para una endodoncia exitosa. Diagnóstico y plan de tratamiento. Enfermedades de la pulpa y el periápice. Cronogramas endodónticos. Tratamiento endodónticos de emergencia. Accesos endodónticos eficientes. procedimientos para el tratamiento dentro de los conductos. Obturación de conductos con materiales semisólidos. Obturación de conductos con materiales sólidos. Cirugía periapical. Amputaciones radiculares. Problemas endodónticos periodontales. Microbiología y endododoncia. Restauración del diente endodóntico endodónticamente tratado. Terapéutica medicamentosa utilizada en endodoncia
Asunto(s)
Endodoncia , Pulpa Dental , Pulpa Dental/patología , Obturación del Conducto RadicularRESUMEN
Bases para una endodoncia exitosa. Diagnóstico y plan de tratamiento. Enfermedades de la pulpa y el periápice. Cronogramas endodónticos. Tratamiento endodónticos de emergencia. Accesos endodónticos eficientes. procedimientos para el tratamiento dentro de los conductos. Obturación de conductos con materiales semisólidos. Obturación de conductos con materiales sólidos. Cirugía periapical. Amputaciones radiculares. Problemas endodónticos periodontales. Microbiología y endododoncia. Restauración del diente endodóntico endodónticamente tratado. Terapéutica medicamentosa utilizada en endodoncia