RESUMO
Objective: To evaluate the cost-effectiveness of ceftolozane/tazobactam + metronidazole (C/T+M) and ceftolozane/tazobactam (C/T) compared with 8 alternatives used in the treatment of complicated intraabdominal infection (cIAI) and complicated urinary tract infection (cUTI) respectively. Methods: A Monte Carlo simulation decision model was used for the estimation and comparison of treatment-related costs, and quality adjusted life years for patients with cIAI treated with C/T+M in comparison with cefepime + metronidazole, ciprofloxacin + metronidazole, doripenem, levofloxacin + metronidazole, meropenem, piperacillin/tazobactam, ceftazidime + metronidazole or imipenem/cilastatin and patients with cUTI treated with C/T in comparison with cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin. Local costs were estimated using base cases identified by experts and consulting local databases. Sensitivity values of the PACTS (Program to Assess Ceftolozane/Tazobactam Susceptibility) study in Latin America were used in the model. Results: C/T+M and C/T obtained incremental cost-effectiveness ratios (ICER) that were below the Colombian cost-effectiveness threshold (3 GDP per capita) in most comparisons, and were dominated by meropenem, considering only gram-negative microorganisms. Sensitivity assessments were also carried out, in which only the population with P. aeruginosa infections was considered, showing positive results for C/T+M and C/T (cost-effective or dominant with regards to all comparators). Conclusions: C/T+M and C/T could be cost-effective alternatives in the treatment of CIAI and CUTI in Colombia, when there is an adequate and rational use of antibiotics. The results of the sensitivity analyses showed dominance and cost-effectiveness with regards to every comparator in patients infected with P. aeruginosa
Objetivo: Evaluar la costo-efectividad de ceftolozano/tazobactam + metronidazol (C/T + M) y ceftolozano/tazobactam (C/T) en comparación con 8 alternativas utilizadas en el tratamiento de las infecciones intraabdominales complicadas (IAAc) e infecciones del tracto urinario complicadas (ITUc) respectivamente. Métodos: Se usó un modelo de decisión de simulación de Monte Carlo para la estimación y comparación de los costos relacionados con el tratamiento y los años de vida ajustados por calidad para pacientes con IAAc tratados con C/T + M, en comparación con cefepima + metronidazol, ciprofloxacina + metronidazol, doripenem , levofloxacina + metronidazol, meropenem, piperacilina / tazobactam, ceftazidima + metronidazol o imipenem/cilastatina, y pacientes con ITUc tratados con C/T en comparación con cefepime, ciprofloxacina, doripenem, levofloxacina, meropenem, piperacilina / tazobactam, ceftazidima o imipenem/cilastatina . Los costos locales se estimaron por medio de casos base identificados por expertos y consultando bases de datos locales. Se utilizaron los valores de sensibilidad bacteriana del estudio PACTS (Programa para evaluar la susceptibilidad al ceftolozano/tazobactam) en América Latina para poblar el modelo. Resultados: C/T + M y C/T obtuvieron razones de costo-efectividad incrementales (RCEI) que estaban por debajo del umbral de costo-efectividad colombiano (3 PIB per cápita) en la mayoría de las comparaciones, y fueron dominados por meropenem, considerando solo microorganismos gran-negativos También se llevaron a cabo análisis de sensibilidad, en los que solo se consideró la población con infecciones por P. aeruginosa, mostrando resultados positivos para C/T + M y C/T (costo efectivo o dominante con respecto a todos los comparadores). Conclusiones: C/T + M y C/T podrían ser alternativas costo efectivas en el tratamiento de IAAc e ITUc en Colombia, cuando existe un uso adecuado y racional de antibióticos. Los resultados de los análisis de sensibilidad mostraron dominio y costo-efectividad en relación con todos los comparadores en pacientes infectados con P. aeruginosa.
Assuntos
Humanos , Feminino , Sistema Urinário , Infecções Intra-Abdominais , Tazobactam , Análise Custo-Benefício , Colômbia , Sepse , Metronidazol/farmacologia , Antibacterianos/farmacologiaRESUMO
Las reformas educativas enfatizan una educación orientada al desarrollo de competencias. Las universidades deben introducir modelos que formen profesionales competentes. El objetivo fue conocer a través de egresados, en qué medida las competencias declaradas en el perfil son logradas durante la formación. Se usó un instrumento con indicadores de desempeño del quehacer profesional. Se solicitó a los egresados que valoraran la formación entregada para el logro de las competencias. Se analizaron los resultados en categorías referidas al logro de las competencias y se consideró como deseable que más del 75 por ciento de los egresados manifiesten el logro en grado Alto. Para el dominio asistencial 16 de 25 indicadores son alcanzados en grado Alto por más del 75 por ciento de los egresados. En investigación 4 de 6 indicadores se presentan en igual categoría. Los dominios administración y educación no presentan indicadores en el rango deseable. Se concluye que las trayectorias de aprendizaje y malla curricular deben ser revisadas para asegurar el logro de todas las competencias comprometidas en el perfil en el nivel deseable(AU)
Educational reforms make emphasis on the competence development-oriented education and thus the universities should implement models that train competent professionals. The objective of this paper was to find out through the graduates' opinions to what extent the stated competencies in the profile were achieved during the formation at university. An instrument with performance indicators in the professional work was used. The graduates were asked to assess the formation received in terms of acquisition of competencies. The category results related to the acquisition of competencies was analyzed, thus considering as desirable that over 75 percent of graduates showed high standard achievement. Regarding the medical assistance domain, 16 out of 25 indicators were highly fulfilled by over 75 percent of graduates. Four out of six indicators of the research appeared in the same category. The domains called management and education did not have indicators in the desirable range. It was concluded that learning and curricular architecture routes should be reviewed in order to assure the acquisition of all the competencies involved in the profile at desirable level(AU)
Assuntos
Humanos , Competência Profissional , Avaliação Educacional/métodos , Aprendizagem , Epidemiologia Descritiva , Estudos Transversais , Educação Baseada em Competências/métodos , Tecnologia Biomédica/educaçãoRESUMO
The identification of the brain regions involved in the neuropharmacological action is a potential procedure for drug development. These regions are commonly determined by the voxels showing significant statistical differences after comparing placebo-induced effects with drug-elicited effects. LORETA is an electroencephalography (EEG) source imaging technique frequently used to identify brain structures affected by the drug. The aim of the present study was to evaluate different methods for the correction of multiple comparisons in the LORETA maps. These methods which have been commonly used in neuroimaging and also simulated studies have been applied on a real case of pharmaco-EEG study where the effects of increasing benzodiazepine doses on the central nervous system measured by LORETA were investigated. Data consisted of EEG recordings obtained from nine volunteers who received single oral doses of alprazolam 0.25, 0.5, and 1 mg, and placebo in a randomized crossover double-blind design. The identification of active regions was highly dependent on the selected multiple test correction procedure. The combined criteria approach known as cluster mass was useful to reveal that increasing drug doses led to higher intensity and spread of the pharmacologically induced changes in intracerebral current density.
