RESUMO
BACKGROUND: A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs. METHODS: A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models. FINDINGS: Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6-15%], emergency admissions by 25% [20-39%] and length of stay by 11% [3-18%] (with an additional month-by-month decrease of 28% [24-34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021. INTERPRETATION: The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents.
Assuntos
Tecnologia Digital , Atenção Secundária à Saúde , Humanos , Estudos Retrospectivos , Hospitalização , TriagemRESUMO
El papel que desempeñan las alteraciones genéticas en el desarrollo dental es fundamental. Se ha descubierto que si no existe una correcta expresión del gen o se da una mutación de este, el individuo podría presentar ausencias o malformaciones de estructuras de la boca. Por esta razón se describe la forma en que se da el desarrollo de las estructuras dentales, teniendo en cuenta cómo las interacciones genética y ambiental influyen en su correcto desarrollo. Entre los genes involucrados se encuentran el PAX9 y el MSX1, que según recientes investigaciones son los implicados en las ausencias congénitas de estructuras dentarias o sus posibles alteraciones, teniendo en cuenta que la delación de estos genes o su mutación son factores hereditarios. Los genes odontogénicos PAX9 y MSX1, son genes homeóticos (homebox) que codifican para factores de transcripción y son responsables, durante la odontogénesis, de la expresión de genes asociados con la regulación espacial y temporal dentro del primer arco braquial. En determinado momento de la organogénesis pueden darse fallas en la expresión de los factores necesarios para la formación y buen desarrollo dental, causando anomalías como la Odontodisplasia Regional (OR), también denominada diente fantasma o detención localizada del desarrollo dental, la cual es una anomalía estructural del desarrollo, compleja y rara; parece ser el resultado de una o más mutaciones puntuales en el cromosoma 4 y 14. Se reportan dos casos donde se describen las características clínicas, radiográficas, y el seguimiento clínico.
The role of genetic alterations in tooth development is essential. It has been discovered that if there is a correct expression of the gene or there is a mutation of this, the individual could present absence or malformations of structures of the oral cavity or other body parts. For this reason we describe how given the development of dental structures, taking into account how genetic and environmental interactions influence their proper development. Among the genes involved are in the PAX9 and MSX1, which according to recent research are involved in congenital absence of dental structures or alterations, considering that the denunciation of these genes or the mutation is inherited. The odontogenic PAX9 and MSX1 genes are homeotic genes (homebox) that encode for transcription factors and are responsible, during odontogenesis, the expression of genes associated with spatial and temporal regulation within the first brachial arch. At some point during organogenesis may be flaws in the expression of the factors necessary for the formation and tooth development, causing among other abnormalities Regional Odontodysplasia (RO), also called ghost tooth or detention tooth dental development located, which is a structural anomaly development complex and rare; seems to be the result of one or more point mutations in the chromosome 4 and 14. In this report we show two cases with odontodysplasia where there are clinical and radiographic features of two patients with this anomaly, one of them has been made up and treatment, and the other begins his analysis stage.