Aporte de un sistema predictivo de contraloría médica en la gestión de licencias médicas electrónicas / Contributions of a predictive medical audit system in the electronic management of sick leaves

INTRODUCCIÓN: El retraso del procesamiento de las licencias médicas (LMs) representa un problema de salud pública en Chile, considerando que esto afecta el pago del subsidio a las personas destinado a realizar el reposo médico prescrito mientras no se pueda trabajar. El objetivo de este estudio fue explorar las diferencias en el tiempo de procesamiento de las licencias médicas electrónicas (LMEs) evaluadas por contraloría médica (CM) y las evaluadas por un sistema predictivo de contraloría médica (SPCM) basado en redes neuronales artificiales. MATERIALES Y MÉTODOS: El tiempo de procesamiento de LMEs procesadas con SPCM fue comparado con el tiempo de procesamiento de LMEs examinadas solo con CM, usando curvas de Kaplan Meier, prueba de log-rank y modelos multivariados de Cox. RESULTADOS: La tasa de procesamiento del SPCM fue entre 1,7 a 5,5 veces más rápida que la tasa de procesamiento de la CM, ajustando por potenciales confusores. DISCUSIÓN: La implementación del SPCM permitió disminuir el tiempo de procesamiento de las LMEs, beneficiando a los trabajadores afiliados al seguro público.

INTRODUCTION: The delay in the processing of sick leaves (SLs) is a public health pro-blem in Chile, considering that this affects the payment of the subsidy to the indivi-duals destined to perform the prescribed medical rest while unable to work. The aim of this study was to explore the differences in the processing time of electronic SLs (ESLs) evaluated by medical audit (MA) and the SLs evaluated by a predictive medi-cal audit system (PMAS) based on artificial neural networks. MATERIALS AND METHODS:The processing time of the ESLs that were processed by PMAS was compared with the processing time of those that were examined only by MA, using Kaplan Meier curves, log-rank test, and multivariate Cox models. RESULTS: The processing rate for PMAS was 1.7-fold to 5.5-fold faster than MA, after adjusting for potential confoun-ding variables. DISCUSSION: The implementation of the PMAS reduced the processing time of ESLs, which benefits the workers affiliated to the public insurance system in Chile. (AU)

Low anonymous voting compliance with the novel policy for managing conflicts of interest implemented in the 9th version of the American College of Chest Physicians antithrombotic guidelines.

BACKGROUND: The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a strategy to limit the impact of conflict of interest (COI) on recommendations. This policy excluded conflicted panelists from voting on recommendations with which they had conflicts. The objective of the study is to explore the compliance of the attendees of the AT9 final conference. METHODS: We conducted a survey and reviewed public declarations of COI of all the final AT9 conference attendees. For each of the controversies on which voting occurred (nine of 628 total recommendations), we estimated the compliance with COI policy as the proportion of attendees who recused themselves from voting on controversies for which they were conflicted. To evaluate the potential effect of noncompliance, we assumed that every vote cast by an ineligible conference attendee was cast in direction of the majority vote. RESULTS: Sixty-three panelists voted in at least one controversy at the final conference; the percentage of conflicted panelists varied from 6% to 39% for eight controversies. The compliance with the COI policy was 14 of 14 (100%) for one controversy, and varied from one of 19 (5%) to one of three (33%) in the remaining seven. In two of the eight controversies ("Compression device plus aspirin vs low-molecular-weight heparin in tromboprophylaxis in orthopedic surgery" and "Low-molecular-weight heparin vs vitamin K antagonists for treatment"), the low compliance may have affected the final recommendations. CONCLUSIONS: The low compliance raises concerns about implementation of COI restrictions in the context of anonymous voting.

One year improvements in cardiovascular risk factors: a comparative trial of laparoscopic Roux-en-Y gastric bypass vs. adjustable gastric banding.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in the industrialized world with obesity as a leading preventable risk factor. Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) have been shown to improve certain biochemical cardiovascular risk factors (BCRFs) at 1 year post-op, however no study has directly compared the 12-month BCRF improvements of RYGB vs. LAGB. METHODS: At a single academic institution (2004-2009), we measured BCRF in 838 consecutive bariatric patients (765 RYGB, 73 LAGB) pre-operatively and at 12 months post-operatively. BCRF included total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (Trig), Trig/HDL ratio, lipoprotein(a) (Lp(a)), homocysteine (HmC), high sensitivity C-reactive protein (hs-CRP), fasting insulin (FI), and hemoglobin A1C (Hgb A1C). Pre-op and 12-month post-op values were compared by a paired t test of equal variance. RESULTS: At 12 months post-op, RYGB patients had lost 77% of their excess weight and had significant improvements in TC, LDL, HDL, Trig, Trig/HDL, HmC, hs-CRP, FI, and Hgb A1C. LAGB patients lost 47.6% of their excess weight and had significant improvements in Trig, Trig/HDL, HmC, hs-CRP, and Hgb A1C. Having RYGB instead of LAGB was predictive of significantly greater improvements in TC at 12 months post-operatively. CONCLUSIONS: In this study, both RYGB and LAGB demonstrated significant weight loss and improvements in BCRF at 12 months post-op. RYGB produced significant improvements in a greater number of BCRFs and in some instances the 12-month post-op BCRF values were significantly lower risk in RYGB vs. LAGB patients.