2011 October 19

Diagnosing acute coronary syndrome in primary care: comparison of the physicians’ risk estimation and a clinical decision rule.

Oct 192011

Diagnosing acute coronary syndrome in primary care: comparison of the physicians' risk estimation and a clinical decision rule.

Fam Pract. 2011 Jun;28(3):323-8

Authors: Bruins Slot MH, Rutten FH, van der Heijden GJ, Geersing GJ, Glatz JF, Hoes AW

Abstract
BACKGROUND: Diagnosing acute coronary syndrome (ACS) in a primary care setting poses a diagnostic dilemma for physicians.
OBJECTIVE: We directly compared the diagnostic accuracy of a clinical decision rule (CDR) based on history taking and physical examination in suspected ACS with the risk estimates of the attending GP.
METHODS: In a prospective multicenter study, patients suspected of ACS were included by the GP. GPs were asked to estimate the probability (0%-100%) of the presence of ACS. GPs collected patient data, but they were not aware of the CDR and did not score the patient accordingly.
RESULTS: Two hundred and ninety-eight patients were included (52% female, mean age 66 years, 22% ACS). The area under the receiver operating characteristic (ROC) curve (AUC) was 0.75 [95% confidence interval (CI) 0.68-0.82] for the GP risk estimate and 0.66 (95% CI 0.58-0.73) for the CDR. There was an agreement between the risk estimation of the GP and a CDR in 51% and the prevalence of ACS in predefined low-, intermediate- and high-risk groups was similar for the GP and CDR estimates. In the low-risk group, according to the GP, four patients (8.2%) suffered an ACS. These four patients were all identified by the decision rule as high risk.
CONCLUSIONS: The GP classified patients as ACS or no ACS more adequately than the CDR, judged by the AUC. However, the use of a CDR in patients that are considered at low risk for ACS by the GP could reduce the amount of missed myocardial infarctions.

PMID: 21239470 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations.

Pharmacoepidemiol Drug Saf Start a Discussion »

Oct 192011

Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations.

Pharmacoepidemiol Drug Saf. 2011 Jun;20(6):626-34

Authors: Rottenkolber D, Schmiedl S, Rottenkolber M, Farker K, Saljé K, Mueller S, Hippius M, Thuermann PA, Hasford J,

Abstract
PURPOSE: German hospital reimbursement modalities changed as a result of the introduction of Diagnosis Related Groups (DRG) in 2004. Therefore, no data on the direct costs of adverse drug reactions (ADRs) resulting in admissions to departments of internal medicine are available. The objective was to quantify the ADR-related economic burden (direct costs) of hospitalizations in internal medicine wards in Germany.
METHODS: Record-based study analyzing the patient records of about 57,000 hospitalizations between 2006 and 2007 of the Net of Regional Pharmacovigilance Centers (Germany). All ADRs were evaluated by a team of experts in pharmacovigilance for severity, causality, and preventability. The calculation of accurate person-related costs for ADRs relied on the German DRG system (G-DRG 2009). Descriptive and bootstrap statistical methods were applied for data analysis.
RESULTS: The incidence of hospitalization due to at least 'possible' serious outpatient ADRs was estimated to be approximately 3.25%. Mean age of the 1834 patients was 71.0 years (SD 14.7). Most frequent ADRs were gastrointestinal hemorrhage (n = 336) and drug-induced hypoglycemia (n = 270). Average inpatient length-of-stay was 9.3 days (SD 7.1). Average treatment costs of a single ADR were estimated to be approximately €2250. The total costs sum to €434 million per year for Germany. Considering the proportion of preventable cases (20.1%), this equals a saving potential of €87 million per year.
CONCLUSIONS: Preventing ADRs is advisable in order to realize significant nationwide savings potential. Our cost estimates provide a reliable benchmark as they were calculated based on an intensified ADR surveillance and an accurate person-related cost application.

PMID: 21384463 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

A study of costs and length of stay of inpatient naturopathy–evidence from Germany.

Complement Ther Clin Pract Start a Discussion »

Oct 192011

A study of costs and length of stay of inpatient naturopathy--evidence from Germany.

Complement Ther Clin Pract. 2011 May;17(2):90-5

Authors: Romeyke T, Stummer H

Abstract
BACKGROUND: Classical naturopathy in an acute, inpatient, internal medicine setting is rare in Germany. Procedure 8-975 regulates the structures and processes for providing naturopathic complex therapy in German hospitals. An interdisciplinary team is required to provide therapy from at least five therapeutic areas of classical naturopathy, all applied within a narrow time-frame. The entry criteria for being entitled to receive naturopathy in an acute hospital depend upon the degree of chronicity, the intensity of the symptoms and the complexity of the disease.
METHODS: In the present study, a total of 918 patients who received naturopathic complex therapy were investigated regarding their clinical picture and the length of their stay in hospital.
RESULTS: The results showed that the duration of hospitalization was significantly greater than that of the comparison group of patients (cases from 263 German hospitals) receiving purely internal medical treatment in hospitals at national level.

PMID: 21457898 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Upper gastrointestinal bleeding: risk factors for mortality in two urban centres in Latin America.

Rev Esp Enferm Dig Start a Discussion »

Oct 192011

Upper gastrointestinal bleeding: risk factors for mortality in two urban centres in Latin America.

Rev Esp Enferm Dig. 2011 Jan;103(1):20-4

Authors: Morales Uribe CH, Sierra Sierra S, Hernández Hernández AM, Arango Durango AF, López GA

Abstract
OBJECTIVE: To describe the experience with upper gastrointestinal bleeding in two major Latin American hospitals; presenting its main causes, treatment, and prognosis, while exploring some risk factors associated with death.
DESIGN: Prospective cohort study.
PATIENTS AND METHODS: Four hundred and sixty four patients were admitted into any of the 2 hospitals and were at least 15 years of age. Some variables demographics, clinics and treatment were studied. The association between those variables and the death were explored.
RESULTS: Mean age was 57.9 years; the men:women ratio was 1.4:1. Three hundred and fifty nine patients (77.3%) presented as outpatients and 105 patients (22.6%) were inpatients presenting with UGIB. 71.6% of patients had an upper GI endoscopy within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 41%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty four patients died (9.5%). Bleeding as an inpatient has a higher mortality risk than does bleeding as an outpatient (RR 2.4 IC 95% 1.2-4.6). An increasing number of comorbidities such as those described in the Rockall Score are also associated with a higher risk of dying (RR 2.5 IC 95% 1.1-5.4).
CONCLUSION: UGIB as an inpatient and the presence of comorbidities should alert the clinician in identifying patients at higher risk of a fatal outcome, these patients should have a more aggressive management and be entitled to an early intervention.

PMID: 21341933 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Identifying patients harboring extended-spectrum-beta-lactamase-producing Enterobacteriaceae on hospital admission: derivation and validation of a scoring system.

Antimicrob Agents Chemother Start a Discussion »

Oct 192011

Identifying patients harboring extended-spectrum-beta-lactamase-producing Enterobacteriaceae on hospital admission: derivation and validation of a scoring system.

Antimicrob Agents Chemother. 2011 Jul;55(7):3485-90

Authors: Tumbarello M, Trecarichi EM, Bassetti M, De Rosa FG, Spanu T, Di Meco E, Losito AR, Parisini A, Pagani N, Cauda R

Abstract
Increases in community-acquired infections caused by extended-spectrum-?-lactamase (ESBL)-producing Enterobacteriaceae have important implications for hospital infection control and empirical antibiotic therapy protocols. We developed and validated a tool for identifying patients harboring these organisms at hospital admission. We retrospectively analyzed chart data for 849 adult inpatients. The derivation cohort included 339 patients admitted to a large hospital in Rome during 2008, with (n = 113) or without (n = 226) culture positivity for ESBL-producing Escherichia coli, Klebsiella spp., or Proteus mirabilis within 48 h after admission. Logistic-regression-based prediction scores were calculated based on variables independently associated with the outcome. The model was validated in a second cohort (n = 510) selected with identical criteria in hospitals in Genoa and Turin during 2009. Prediction scores were based on the following six variables (reported with odds ratio for study outcome and the 95% confidence intervals in brackets): recent (? 12 months before admission) hospitalization (5.69 [2.94 to 10.99]), transfer from another health care facility (5.61 [1.65 to 19.08]), Charlson comorbidity score ? 4 (3.80 [1.90 to 7.59]), recent (? 3 months before admission) ?-lactam and/or fluoroquinolone treatment (3.68 [1.96 to 6.91]), recent urinary catheterization (3.52 [1.96 to 6.91]), and age ? 70 years (3.20 [1.79 to 5.70]). The model displayed good calibration and good-to-excellent discrimination in the derivation and validation sets (Hosmer-Lemshow ?(2) = 15.28 and 14.07; P = 0.17 and 0.23; areas under the receiver-operating characteristic curve, 0.83 and 0.92). It reliably identified patients likely to be harboring ESBL-producing Enterobacteriaceae at hospital admission who may need special infection control measures. Further study is needed to confirm this model's potential as a guide for prescribing empirical antibiotic therapy.

PMID: 21537020 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Short-term therapy with enoxaparin or unfractionated heparin for venous thromboembolism in hospitalized patients: utilization study and cost-minimization analysis.

Value Health Start a Discussion »

Oct 192011

Short-term therapy with enoxaparin or unfractionated heparin for venous thromboembolism in hospitalized patients: utilization study and cost-minimization analysis.

Value Health. 2011 Jul-Aug;14(5 Suppl 1):S89-92

Authors: Argenta C, Ferreira MA, Sander GB, Moreira LB

Abstract
OBJECTIVES: To evaluate the direct costs of venous thromboembolism (VTE) treatment with unfractionated heparin (UFH) and low-molecular weight heparin, from the institutional perspective.
METHODS: This is a real-world cohort study that included inpatients treated with UFH or enoxaparin for deep venous thromboembolism or pulmonary embolism in a tertiary public hospital. To estimate medical costs we computed the acquisition costs of drugs, supplies for administration, laboratory tests, and hospitalization cost according to the patient ward.
RESULTS: One hundred sixty-seven patients aged 18 to 92 years were studied (50 treated with UFH and 117 with enoxaparin). The median of days in use of heparin was the same in both groups. Activated partial thromboplastin time was monitored in 98% of patients using UFH and 56.4% using enoxaparin. Nonstatistically significant differences were observed between groups in the number of bleeding events (10.0% and 9.4%; P = 1.00); blood transfusion (2.0% and 2.6%; P = 1.00); death (8.0% and 3.4%; P = 0.24); and recurrent VTE, bleeding, or death (20.0% and 14.5%; P = 0.38). Daily mean cost per patient was US$12.63 ± $4.01 for UFH and US$9.87 ± $2.44 for enoxaparin (P < 0.001). The total costs considering the mean time of use were US$88.39 and US$69.11.
CONCLUSION: The treatment of VTE with enoxaparin provided cost savings in a large teaching hospital located in southern Brazil.

PMID: 21839908 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Older Entries

October 2011
M	T	W	T	F	S	S
« Sep				Nov »
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30
31