Cystic fibrosis outpatient treatment and medical costs: a retrospective analysis / Tratamiento ambulatorio de fibrois quística y costes médicos: un análisis retrospectivo

BACKGROUND: Cystic fibrosis (CF) is the most serious and frequent hereditary autosomal disease that causes respiratory, hepatic and pancreatic dysfunction. The aim of the study was to assess the pharmaceutical and medical cost in CF outpatients from the Adult Cystic Fibrosis Unit at third level hospital. MATERIAL AND METHODS: Retrospective observational study in adult CF patients throughout the year 2017. Demographic and clinical variables were included. All of the medical variables considered were directly related to the disease. Considered cost were laboratory selling price notified in Nomenclator. Medical costs were calculated based on laboratory's price list and hospital medical procedures. RESULTS: 89 CF patients enter the study, and 57 patients were finally included. The mean age was 32.5 years, 56.1% were female. 36.5% patients were homozygous for Phe508del, 40.4% heterozygous, and 22.8% had another mutation. The average FEV1 was 72.2%. 33.3% patients were colonized by sensitive Pseudomonas aeruginosa (PA) and 7.0% by multidrug-resistant PA. Total costs per year was EUR 623,981.3, (87.6% drug costs and 12.4% medical costs). Medical, drug and total costs were higher in Phe508del/Phe508del mutation group than Phe508del/other and other/other (p < 0.05). Microbial colonization increased costs (p < 0.05); colonized by sensitive PA had statistically significant higher drug and total costs, similar in multidrug resistant PA. Medical costs increase with severity level of lung function (p = 0.001), also drug and total costs with the exception of severe patients. CF is a relative costly disease for the healthcare system. In our study homozygous Phe508del mutation patients, lows values of FEV1 and colonization had higher cost

INTRODUCCIÓN: La fibrosis quística (FQ) es la enfermedad autosómica hereditaria más grave y frecuente que cursa con disfunción respiratoria, hepática y pancreática. El objetivo del estudio fue evaluar el coste farmacéutico y médico directo en pacientes ambulatorios de FQ de la Unidad de Fibrosis Quística de Adultos en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo, en pacientes adultos con FQ a lo largo del año 2017. Se recogieron variables demográficas y clínicas. Todas las variables médicas consideradas estaban directamente relacionadas con la enfermedad. Los costes considerados fueron los precios de venta de laboratorio notificado en Nomenclator. Los costes médicos se calcularon en base a la lista de precios del laboratorio y los procedimientos médicos hospitalarios. RESULTADOS: Se realizó el screening en 89 pacientes con FQ, y finalmente se incluyeron 57 pacientes. La edad media fue de 32,5 años, el 56,1% eran mujeres. El 36,5% de los pacientes eran homocigotos para Phe508del, el 40,4% heterocigoto y el 22,8% tenían otra mutación. El FEV1 medio fue de 72,2%. El 33,3% de los pacientes estaban colonizados por Pseudomonas aeruginosa (PA) sensibles y 7,0% por PA multirresistentes. Los costes totales anuales fueron de 623.981,3 euros (87,6% de costes de medicamentos y 12,4% de gastos médicos directos). Los costes médicos, farmacéuticos y totales fueron mayores en el grupo de mutación Phe508del/Phe508del, que en Phe508del/otro y otros (p < 0.05). La colonización microbiana aumentó los costes (p < 0,05); la colonización por PA sensibles supuso costes más altos de fármacos y totales, de manera similar para PA multirresistentes, todas las diferencias estadísticamente significativas. Los costes médicos aumentaron con el nivel de gravedad de la función pulmonar (p < 0,001), también los costes de medicamentos y totales, con la excepción de los pacientes más graves. CONCLUSIÓN: La CF es una enfermedad relativamente costosa para el sistema de salud. En nuestro estudio, los pacientes con mutación homocigota Phe508del, los valores bajos de FEV1 y la colonización tuvieron un costo más alto

Asthma exacerbations: risk factors for hospital readmissions.

OBJECTIVE: The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. STUDY DESIGN: We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. METHODS: The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. RESULTS: This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. CONCLUSIONS: About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

Factors associated with the incidence of serious adverse events in patients admitted with COPD acute exacerbation.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospitalization. Patient outcome and prognosis following AECOPD are variable. The aim of this study is to identify the factors associated with the incidence of serious adverse events (SAE), defined as need for ICU admission, noninvasive ventilation, death during hospitalization or early readmission, in those patients admitted with AECOPD. METHODS: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with SAE incidence, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. RESULTS: 757 patients were assessed (mean age 74.8 years, SD 11.26), 77.2 % male, and 186 (24.6 %) of the patients assessed experienced an SAE. Factors associated with SAE in multivariate analysis were anticholinergic therapy (OR 3.19; CI 95 %: 1.16; 8.82), oxygen therapy at home (OR 3.72; CI 95 %: 1.62; 8.57), oxygen saturation at admission (OR 0.93; CI 95 %: 0.88; 0.99) and serum albumin (OR 0.26; CI 95 %: 0.1; 0.66). CONCLUSION: Oxygen therapy at home, anticholinergic therapy as baseline treatment, lower oxygen saturation at admission and lower serum albumin level seem to be associated with higher incidence of SAE in patients with AECOPD.

Mediastinitis / Mediastinitis

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Effects of pork vs veal consumption on serum lipids in healthy subjects / Efecto del consumo de cerdo y de ternera sobre el perfil lipídico de sujetos sanos

AIMS: To analyse the influence of lean pork (P) and veal (V) consumption on the lipid profile of healthy subjects within the framework of a healthy diet comprising low levels of total fat (TF), saturated fatty acids (SFA) and cholesterol. DESIGN: Double-crossover, randomized and controlled trial SUBJECTS: 44 healthy individuals (22 male and 22 female), recruited voluntarily from the University Complutense of Madrid. The weight and lipid profiles of these volunteers were normal and their dietary patterns were typical for people in our area. INTERVENTIONS: The study comprised 4 phases: stabilisation phase (5 weeks), the participants followed their normal diet; second phase (6 weeks), half of the subjects, were randomised to lean pork or veal consumption, 150 g per day, for their main meal of the day; washout period (5 weeks) and final phase, which was the second phase of intervention (6 weeks). During the intervention stages, only the main meal of the day was taken in the Hospital. The rest of the subjects' diets consisted of different fortnightly menus designed in accordance with the recommendations of the Spanish Society of Arteriosclerosis (SEA). RESULTS: After both stages of intervention had been completed, there was a mean reduction of 5.5% in lowdensity lipoprotein cholesterol. However, after each intervention there were no significant differences between those who had consumed P, 2.62 (0.55) mmol/L and those who had consumed V, 2.71 (0.47) mmol/L. No differences were observed in any of the other parameters between those who had consumed P and those who had consumed V. CONCLUSIONS: Lean pork and veal produces similar effects on the lipid profiles of healthy subjects. Its consumption, as part of the saturated fat and cholesterolcontrolled diet, could therefore be included in food guidelines, both for normal and therapeutic diets (AU)

OBJETIVO: Analizar la influencia del consumo de carne magra de cerdo (P) y de ternera (V) en el perfil lipídico de sujetos sanos, cuando se realiza dentro de un patrón de dieta saludable con bajo contenido en grasa total (TF), ácidos grasos saturados (SFA) y en colesterol. DISEÑO: Ensayo cruzado doble, aleatorizado y controlado. SUJETOS: 44 sujetos sanos (22 varones y 22 mujeres), reclutados de forma voluntaria de la Universidad Complutense de Madrid. Los pesos y los perfiles lipídicos de estos voluntarios y su patrón de alimentación eran típicos de las personas de nuestra área. INTERVENCIONES: El estudio consta de 4 fases: fase de estabilización (5 semanas), los participantes seguían su dieta normal; segunda fase (6 semanas), la mitad de los sujetos se randomizaron para que consumieran carne magra de cerdo o de ternera, 150 g al día, durante la principal comida del día; periodo de lavado (5 semanas) y fase final, que era la segunda fase de intervención (6 semanas). Durante las fases de intervención, sólo la principal comida se realizaba en el hospital. El resto de las dietas de los sujetos estaba constituida por menús diferentes para 2 semanas que seguían las recomendaciones de la Sociedad Española de Arteriosclerosis (SEA). RESULTADOS: Tras ambas intervenciones, hubo una reducción media de un 5,5% en el LDL colesterol. Sin embargo, después de cada intervención no encontramos diferencias significativas entre los que consumieron P, 2.62 (0.55) mmol/L y estos que consumieron V, 2.71 (0.47) mmol/L. No se observó diferencias en el resto de los parámetros analizados entre los que consumieron P y los que consumieron V. CONCLUSIONES: El consumo de P y B produce efectos similares sobre el perfil lipídico de sujetos sanos. Su consumo, formando parte de dietas controladas en grasa saturada y colesterol, podrían incluirse en pautas alimentarias, tanto de dietas normales como terapéuticas (AU)