Considering equity in priority setting using transmission models: Recommendations and data needs.

OBJECTIVES: Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS: We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS: We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS: Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.

Real-life cost-effectiveness of benralizumab in patients with severe asthma.

BACKGROUND: Availability of clinically effective and cost-effective treatments for severe asthma would be beneficial to patients and national healthcare systems. The aim of this study was to evaluate clinical outcomes and healthcare expenditure after incorporating benralizumab into the standard treatment of refractory eosinophilic asthma. METHODS: This was a cross-sectional multicentre study of consecutive patients with refractory eosinophilic asthma who received treatment with benralizumab during at least 12 months. Patient follow-up was performed in specialised severe asthma units. The main effectiveness parameters measured were: the avoidance of one asthma exacerbation, a 3-point increase in the asthma control test (ACT) score, and the difference in utility scores (health-related quality of life) between a 1-year baseline treatment and 1-year benralizumab treatment. The health economic evaluation included direct costs and incremental cost-effectiveness ratios (ICERs). RESULTS: After 1 year of treatment with benralizumab, patients with refractory eosinophilic asthma showed an improvement in all the effectiveness parameters analysed: improvement of asthma control and lung function, and decrease in the number of exacerbations, oral corticosteroid (both as corticosteroid courses and maintenance therapy), and inhaled corticosteroid use. The total annual cost per patient for the baseline and benralizumab treatment periods were €11,544 and €14,043, respectively, reflecting an increase in costs due to the price of the biological agent but a decrease in costs for the remaining parameters. The ICER was €602 per avoided exacerbation and €983.86 for every 3-point increase in the ACT score. CONCLUSIONS: All the pharmacoeconomic parameters analysed show that treatment with benralizumab is a cost-effective option as an add-on therapy in patients with refractory eosinophilic asthma.

Enhancing violations of Leggett-Garg inequalities in nonequilibrium correlated many-body systems by interactions and decoherence.

We identify different schemes to enhance the violation of Leggett-Garg inequalities in open many-body systems. Considering a nonequilibrium archetypical setup of quantum transport, we show that particle interactions control the direction and amplitude of maximal violation, and that in the strongly-interacting and strongly-driven regime bulk dephasing enhances the violation. Through an analytical study of a minimal model we unravel the basic ingredients to explain this decoherence-enhanced quantumness, illustrating that such an effect emerges in a wide variety of systems.

Applying Data Science methods and tools to unveil healthcare use of lung cancer patients in a teaching hospital in Spain.

PURPOSE: Our primary goal was to study the use of outpatient attendances by lung cancer patients in Hospital Universitario Puerta de Hierro Majadahonda (HUPHM), Spain, by leveraging our Electronic Patient Record (EPR) and structured clinical registry of lung cancer cases as well as assessing current Data Science methods and tools. METHODS/PATIENTS: We applied the Cross-Industry Standard Process for Data Mining (CRISP-DM) to integrate and analyze activity data extracted from the EPR (9.3 million records) and clinical data of lung cancer patients from a previous registry that was curated into a new, structured database based on REDCap. We have described and quantified factors with an influence in outpatient care use from univariate and multivariate points of view (through Poisson and negative binomial regression). RESULTS: Three cycles of CRISP-DM were performed resulting in a curated database of 522 lung cancer patients with 133 variables which generated 43,197 outpatient visits and tests, 1538 ER visits and 753 inpatient admissions. Stage and ECOG-PS at diagnosis and Charlson Comorbidity Index were major contributors to healthcare use. We also found that the patients' pattern of healthcare use (even before diagnosis), the existence of a history of cancer in first-grade relatives, smoking habits, or even age at diagnosis, could play a relevant role. CONCLUSIONS: Integrating activity data from EPR and clinical structured data from lung cancer patients and applying CRISP-DM has allowed us to describe healthcare use in connection with clinical variables that could be used to plan resources and improve quality of care.

Assessment of three electrolyte-molecule electrostatic interaction models for 2D material based BioFETs.

BioFETs based on two-dimensional materials (2DMs) offer a unique opportunity to enhance, at a low cost, the sensitivity of current biosensors enabling the design of compact devices compatible with standard CMOS technology. The unique combination of large exposed surface areas and minimal thicknesses of 2DMs is an outstanding feature for these devices, and the assessment of their behaviour requires combined experimental and theoretical efforts. In this work we present a 2D-material based BioFET simulator including complex electrolyte reactions and analysing different models for the electrolyte-molecule interaction. These models describe how the molecular charge is screened by the electrolyte ions when their distributions are modified. The electrolyte simulation is validated against experimental results as well as against the analytical predictions of the Debye-Hückel approximation. The role of the electrolyte charge screening as well as the impact of the interaction model on the device responsivity are analysed in detail. The results are discussed in order to conclude about the consequences of employing different interaction approximations for the simulation of BioFETs and more generally on the correct modelling of biomolecule-device interaction in BioFETs.

[Analysis of economic cost of missed outpatient appointments]. / Análisis del coste económico del absentismo de pacientes en consultas externas.

AIM: To estimate the economic costs of missed Outpatient appointments by the Costa del Sol Health Agency (ASCS). METHOD: An analysis was performed on the costs arising from missed outpatient appointments (first appointment and examinations) of each of the specialities in the Centres belonging to the ASCS. A formula was used to determine the unit cost per appointment and per centre and speciality. This involved the direct imputation of the controllable costs and the indirect imputation of the service costs, together with an estimated cost of re-appointments based on a previous case-control study. RESULTS: The cost of missed appointments per centre in the Costa del Sol Hospital was €2,475,640, with a failure rate of 14.2% (256,377 appointments). In the Benalmádena High Resolution Hospital it was €515,936, with an absence rate of 12.2% (44,848 appointments), and in the Mijas High Resolution Centre, a cost of €395,342 with an absence rate of the 13.5% (99,536 appointments). The mean extra cost of a re-appointment was €12.95. The specialities with a higher medium cost were Digestive Diseases, Internal Medicine, and Rehabilitation. CONCLUSIONS: The economic cost of patients not turning up for scheduled appointments in the ASCS was greater than 3 million Euros for a non-attendance rate of the 13.8%, with Mijas High Resolution Centre being the centre that showed the lowest mean unitary cost per medical appointment.

Interfacial properties of binary mixtures of square-well molecules from Monte Carlo simulation.

We determine the interfacial properties of mixtures of spherical square-well molecules from direct simulation of the vapor-liquid interface. We consider mixtures with the same molecular size and intermolecular potential range but different dispersive energy parameter values. We perform Monte Carlo simulations in the canonical ensemble to obtain the interfacial properties of mixtures of square-well molecules. In particular, we determine the pressuretensor using the mechanical (virial) route and the vapor-liquid interfacial tension evaluated using the Irving-Kirkwood method. In addition to the pressuretensor and the surface tension, we also obtain density profiles, coexistence densities, and interfacial thickness as functions of pressure, at a given temperature. This work can be considered as the extension of our previous work [F. J. Martínez-Ruiz and F. J. Blas, Mol. Phys. 113, 1217 (2015)] to deal with mixtures of spherical molecules that interact through a discontinuous intermolecular potential. According to our results, the main effect of increasing the ratio between the dispersive energy parameters of the mixture, ϵ22/ϵ11, is to sharpen the vapor-liquid interface and to increase the width of the biphasic coexistence region. Particularly interesting is the presence of a relative maximum in the density profiles of the more volatile component at the interface. This maximum is related with adsorption or accumulation of these molecules at the interface, since there are stronger attractive interactions between these molecules in comparison with the rest of intermolecular interactions. Also, the interfacial thickness decreases and the surface tension increases as ϵ22/ϵ11 is larger, a direct consequence of the increasing of the cohesive energy of the system.

Cost-effectiveness analysis of febuxostat in patients with gout in Spain.

UNLABELLED: Objectives Cost-effectiveness of febuxostat compared with allopurinol in the treatment of hyperuricemia in patients with gout. Methods Costs, clinical outcomes, and QALYs were estimated using a Markov model. Febuxostat 80 mg and 120 mg sequentially, used as first line and second line therapy, was compared with allopurinol 300 mg. Patients switched to the next treatment in the sequence according to a dichotomous response vs no response (target serum urate level < 6 mg/dl outcome) after 3 months of active treatment. A 3% discount rate and 5-year time horizon were applied. PERSPECTIVE: National Health System. Results The addition of febuxostat to any therapeutic strategy was an efficient option, with incremental cost-effectiveness ratios (ICER) compared with allopurinol 300 mg ranging from €5268-€9737. Conclusions Febuxostat is a cost-effective treatment in Spain for the management of hyperuricemia in gout patients, with ICERs far below accepted Spanish efficiency thresholds (30 000€/QALY).

[Determinants and economic cost of patient absenteeism in outpatient departments of the Costa del Sol Health Agency]. / Factores determinantes y coste económico del absentismo de pacientes en consultas externas de la Agencia Sanitaria Costa del Sol.

BACKGROUND: To identify factors related to the people, the process and the context that determine patient compliance with their appointments in the ambulatory outpatient services in the Costa del Sol Health Care Agency; and to obtain the profile of patients who fail to keep their appointments, the reasons for this failure and an estimation of its economic cost. METHODS: Observational multicenter case-control study, through a survey carried out on patients with an appointment in the ambulatory outpatient services during 2013 and 2014, and analysis of the cost per appointment. RESULTS: In total, 882 patients participated in the study (294 cases and 588 controls). The main reasons for missing an appointment were forgetting about it (29, 6%; n=87), and failure in communication (16%; n=47). A shorter time period before the appointment and older age were significantly associated with fewer absences, as well as the fact of having attended more consultations in the past year. The economic cost was more than 3 million euros for a non-attendance rate of 13.8%. CONCLUSIONS: Young patients who usually do not visit outpatient clinics are at greatest risk of absence from scheduled appointments in our health area. The main reasons for absenteeism are preventable and interventions such as improved communication procedures or appointment reminder systems could be beneficial.

Análisis del tipo de publicación y áreas del conocimiento de Enfermería en la evaluación interna de la Revista Enfermería Universitaria 2007-2011 / Publication type and nursing knowledge areas analysis as part of the internal assessment of Enfermería Universitaria Journal, 2007-2011

Introducción: Analizar las publicaciones de una disciplina determinada permite evaluar su avance o consolidación en la construcción del conocimiento, identificar las áreas de interés de los propios investigadores y aquellas que requieren de fomento. Objetivo: Analizar el tipo de artículo y áreas del conocimiento en los artículos publicados en la revista enfermería universitaria en el periodo 2007-2011. Material y métodos: el diseño metodológico fue de corte cuantitativo, transversal, descriptivo. Se evaluó el tipo de artículos publicados y las áreas del conocimiento de Enfermería. La muestra de estudio fue el total de artículos publicados durante los años 2007 a 2011. Resultados: Respecto al tipo de artículos producidos: el 45.9% fueron de investigación, 21.8% de innovación para la práctica, 8.3% de revisión y 7.5% de docencia. En cuanto a las áreas de conocimiento se publicaron en mayor medida artículos de aspectos metodológicos, relacionados con la enseñanza-aprendizaje y con la administración-gestión. Conclusiones: el predominio, en cuanto a tipo, de artículos de investigación pudiera considerarse un avance en esta área, aunque es preciso continuar mejorando este indicador. Además se requiere apoyar a profesionales de Enfermería del área clínico-asistencial para que incursionen en la investigación y publicación de aspectos vinculados a su práctica cotidiana.

Introduction: Analyzing a determined discipline's publications allows an assessment of its development or consolidation towards knowledge construction, and an identification of the researchers' areas of interest, as well as those which require further impulse. Objective: to analyze the study type and knowledge areas of the published articles of Enfermería Universitaria Journal during the period 2007-2011. Material and methods: the study was quantitative, transversal, and descriptive. The article type and nursing knowledge areas of the journal publications from 2007 to 2011 were assessed. Results: Regarding the study types, 45.9% were identified as research, 21.8% as practice innovation, 8.3% as revision, and 7.5% as academic. Regarding the areas of knowledge, most published articles were related to methodological, teaching-learning, and managerial aspects. Conclusions: An interesting finding was the proportion of research articles published. Moreover, supporting nursing professionals within the clinical-assistance areas to conduct and publish re-search studies related to their practices is also suggested.

Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

BACKGROUND: The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. OBJECTIVES: To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. SECONDARY OBJECTIVE: To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. MATERIAL AND METHODS: Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. RESULTS: The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). CONCLUSIONS: The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG.

Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project.

BACKGROUND: National Institute for Health and Care Excellence (NICE) clinical guidelines (CGs) make recommendations across large, complex care pathways for broad groups of patients. They rely on cost-effectiveness evidence from the literature and from new analyses for selected high-priority topics. An alternative approach would be to build a model of the full care pathway and to use this as a platform to evaluate the cost-effectiveness of multiple topics across the guideline recommendations. OBJECTIVES: In this project we aimed to test the feasibility of building full guideline models for NICE guidelines and to assess if, and how, such models can be used as a basis for cost-effectiveness analysis (CEA). DATA SOURCES: A 'best evidence' approach was used to inform the model parameters. Data were drawn from the guideline documentation, advice from clinical experts and rapid literature reviews on selected topics. Where possible we relied on good-quality, recent UK systematic reviews and meta-analyses. REVIEW METHODS: Two published NICE guidelines were used as case studies: prostate cancer and atrial fibrillation (AF). Discrete event simulation (DES) was used to model the recommended care pathways and to estimate consequent costs and outcomes. For each guideline, researchers not involved in model development collated a shortlist of topics suggested for updating. The modelling teams then attempted to evaluate options related to these topics. Cost-effectiveness results were compared with opinions about the importance of the topics elicited in a survey of stakeholders. RESULTS: The modelling teams developed simulations of the guideline pathways and disease processes. Development took longer and required more analytical time than anticipated. Estimates of cost-effectiveness were produced for six of the nine prostate cancer topics considered, and for five of eight AF topics. The other topics were not evaluated owing to lack of data or time constraints. The modelled results suggested 'economic priorities' for an update that differed from priorities expressed in the stakeholder survey. LIMITATIONS: We did not conduct systematic reviews to inform the model parameters, and so the results might not reflect all current evidence. Data limitations and time constraints restricted the number of analyses that we could conduct. We were also unable to obtain feedback from guideline stakeholders about the usefulness of the models within project time scales. CONCLUSIONS: Discrete event simulation can be used to model full guideline pathways for CEA, although this requires a substantial investment of clinical and analytic time and expertise. For some topics lack of data may limit the potential for modelling. There are also uncertainties over the accessibility and adaptability of full guideline models. However, full guideline modelling offers the potential to strengthen and extend the analytical basis of NICE's CGs. Further work is needed to extend the analysis of our case study models to estimate population-level budget and health impacts. The practical usefulness of our models to guideline developers and users should also be investigated, as should the feasibility and usefulness of whole guideline modelling alongside development of a new CG. FUNDING: This project was funded by the Medical Research Council and the National Institute for Health Research through the Methodology Research Programme [grant number G0901504] and will be published in full in Health Technology Assessment; Vol. 17, No. 58. See the NIHR Journals Library website for further project information.

Preoperative 15-MHz ultrasound assessment of tumor thickness in malignant melanoma.

BACKGROUND: Tumor thickness is of great importance in the management of cutaneous malignant melanoma (MM): this variable not only affects prognosis but is also a key factor in planning surgical margins and selecting candidates for sentinel node biopsy. Breslow depth is the standard histologic measure of thickness, but technological advances have provided imaging techniques such as cutaneous ultrasound that can potentially assess tumor thickness and enable prompt initiation of definitive treatment. OBJECTIVES: a) To evaluate the utility of ultrasound assessment of tumor thickness in MM, and b) to analyze histologic variables that affect ultrasound assessments of thickness. MATERIALS AND METHODS: Retrospective study of a consecutive series of 79 primary cutaneous MMs in which tumor thickness had been assessed by 15-MHz ultrasound before surgery. We gathered data from histology reports, studying Breslow depth and the presence of ulceration, regression, inflammatory infiltrate, and associated nevi. Correlation coefficients were calculated to evaluate the strength of association between Breslow depth and thickness assessed by ultrasound. We also calculated the sensitivity, specificity, and positive and negative predictive values of ultrasound measurement in the diagnosis of MMs more than 1mm thick. Associations between histologic variables and the overestimation of thickness by ultrasound were also analyzed. RESULTS: The 79 primary MMs studied had a mean (SD) Breslow depth of 0.8 (1.4) mm. There was moderate correlation and agreement between Breslow depth and the ultrasound assessment of thickness (Pearson correlation coefficient, 0.678; intraclass correlation coefficient, 0.78). The tendency of ultrasound to overestimate thickness was nonsignificantly related to the presence of a moderate to intense infiltrate and associated nevi (P>.05). The sensitivity of ultrasound for the diagnosis of MM over 1mm thick was 82%; specificity was 80%, and positive and negative predictive values were 54% and 94%, respectively. CONCLUSIONS: Ultrasound imaging quite correctly identifies thin MMs and can be useful for planning adequate surgical margins; however, there are limitations on its usefulness in the diagnosis of thick MMs. Additional studies are required to confirm whether certain histologic characteristics, such as the presence of a moderate to intense inflammatory infiltrate or associated nevi can lead to overestimation of thickness by ultrasound, limiting the clinical utility of this imaging technique in MM management.

Potentiometric strip cell based on carbon nanotubes as transducer layer: toward low-cost decentralized measurements.

In this study, we developed a potentiometric planar strip cell based on single-walled carbon nanotubes that aims to exploit the attributes of solid-contact ion-selective electrodes for decentralized measurements. That is, the ion-selective and reference electrodes have been simultaneously miniaturized onto a plastic planar substrate by screen-printing and drop-casting techniques, obtaining disposable strip cells with satisfactory performance characteristics (i.e., the sensitivity is 57.4 ± 1.3 mV/dec, the response time is ≤30 s within the linear range from log a(K+) = -5 to -2, and the limit of detection is -6.5), no need of maintenance during long dry storage, quick signal stabilization, and light insensitivity in short-term measurements. We also show how the new potentiometric strip cell makes it possible to perform decentralized and rapid determinations of ions in real samples, such as saliva or beverages.

[Patient satisfaction when seen in the Emergency room of San Juan de Dios del Aljarafe Hospital (Spain)]. / Satisfacción de los pacientes atendidos en el Servicio de Urgencias del Hospital San Juan de Dios del Aljarafe.

OBJECTIVES: To find out the level of satisfaction of patients seen in the Emergency room of the of San Juan de Dios Hospital, Aljarafe; to identify the determining factors and to define the areas that need improvement and reinforcement in order to improve the quality of care. MATERIAL AND METHODS: A telephone survey was carried out between July and September, 2008, containing 44 questions, 2 with a closed response, 3 with yes/no answers and the remaining questions scored based on a Likert type scale of 1 (most negative answer) to 5 (most positive answer). Observations were also recorded. RESULTS: Overall satisfaction was 84.7%: 82% would recommend this Emergency room, and 59.6% considered it better than others. The aspects to be emphasised are: respect (97.6%), cleanliness (97.1%) and intimacy (94.6%). Following these were: the doctor's disposition to listen (93.1%); the preparation of the professionals (from 92.3% for the administration professionals to 88.6% for auxiliary nurses); kindness (from 91.8% for doctors to 89.9% for nurses); and the ease of getting orientated (90%). The information given was evaluated positively by 70.3%, and 87% acknowledged understanding this information. However, 52.4% of patients were satisfied with the information given during triage related to the stay in the emergency room, and, 22.3% as regards the probable waiting period. The satisfaction with the waiting between triage and first medical consultation was higher in the one-two-triage patients and was lower in the four-triage ones; in the waiting between first medical consultation and the discharge, the one-triage patients were more satisfied than the rest. Nevertheless, there were no statistically significant differences with satisfaction with the waiting until the triage. CONCLUSIONS: The percentages of satisfaction was greater than 80% in 23 of the 34 items, with certain aspects having a satisfaction rate over 90%: respect, cleanliness, the doctor's predisposition to listen, qualification and kindness of the personnel. On the contrary, others items were scored under a rate of 70%: information at triage, attention to pain, waiting periods for triage-doctor's first visit and subsequent visit for discharge, and personnel identification.

[Cost analysis of Mohs micrographic surgery in high-risk facial basal cell carcinoma]. / Análisis de costes de la cirugía micrográfica de Mohs en el carcinoma basocelular facial de alto riesgo.

INTRODUCTION: Mohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost. OBJECTIVES: To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS. MATERIAL AND METHODS: Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence. RESULTS: Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was e106,129.07 and e1325.80, respectively (compared to e97 700 and e1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=0.534). CONCLUSIONS: MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Inserción laboral de las (os) egresadas (os) del Plan único de especializacion en enfermeria de la ENEO-UNAM: una experiencia de diez años / Insertion of the (old) graduates (i) the plan of speciallization in nursing only ENEO-UNAM: a ten years experience

El objetivo de este documento es analizar las características de la Inserción laboral de los egresados (as) del Plan Único de Especialización de Enfermería (PUEE) de la Escuela Nacional de Enfermería y Obstetricia (ENEO) de la UNAM en doce generaciones. La información proviene de una investigación de tipo transversal y descriptiva. Metodología . El universo lo constituyen los 1067 egresados de las generaciones de 1997 al 2008 que acepten participar en el estudio. Los datos que se reportan constituyen una tercera parte de ese universo (31.1%). Los resultados muestran que los egresados en su mayoría laboran en el D.F. o Estado de México (85 y 7% respectivamente). Nueve de cada diez laboran en las principales instituciones públicas del país (62% en instituciones para población abierta y 29% de seguridad social). El 28% tiene la categoría de Enfermera Especialista y otro 20% ocupa puestos de mayor responsabilidad. En cuanto a las funciones principales 68% realizan actividades que implican el trato directo con el paciente, 21% de tipo administrativo, y sólo 1.2% participa en actividades de investigación. Discusión: las instituciones deben continuar implementando estrategias que faciliten la culminación del proceso de los estudios de posgrado ya que como se observó en este estudio quienes se han graduado tienen en mayor medida mejor posición en el empleo. Es necesaria la vinculación Universidad ­ Mercado laboral a fin de incorporar con mayor facilidad a los egresados en dichos escenarios. En conclusión. Las instituciones educativas además de considerar las características del mercado laboral deben continuar implementando estrategias que faciliten la culminación del proceso de los estudios de posgrado ya que como se observó en este estudio quienes se han graduado tienen en mayor medida mejor posición en el empleo.

Objective: the objective of this research is to analyze the employment placing process of 12 generations from the eneo-unam's Nursing Specialization Unique Plan. Methodology: Basic descriptive study on a sample from the 1997-2008 generations' 1,067 total graduates. Results: findings show that 85% and 7% are employed by the Federal District and State of Mexico respectively. Nine out of ten graduates are employed by the country's principal public institutions (62% in open-population institutions and 29% in social security institutions). 28% are employed as specialist nurses, and 20% assume roles with more responsibilities. 68% perform activities related to the direct management of patients, 21% have administrative duties, and only 1.2% is fully engaged in research. Discussion: considering the results, and that graduates hold better labor positions; and in order to promote post-graduatestudies completion, education institutions should keep improving their post-graduate programs and also support their links with the shifting labor markets. Conclusion: it is necessary to strengthen the strategies which promote the synergies that contribute to the presence of the eneo-unam's Nursing Specialization Unique Plan graduates in the Nursing profession and labor markets.

Cost Analysis of Mohs Micrographic Surgery in High-Risk Facial Basal Cell Carcinoma. / Análisis de costes de la cirugía micrográfica de Mohs en el carcinoma basocelular facial de alto riesgo.

INTRODUCTION: Mohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost. OBJECTIVES: To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS. MATERIAL AND METHODS: Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence. RESULTS: Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was e106,129.07 and e1325.80, respectively (compared to e97 700 and e1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=0.534). CONCLUSIONS: MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Prophylaxis against infective endocarditis for dental procedures--summary of the NICE guideline.

The National Institute for Health and Clinical Excellence (NICE) has developed a guideline on 'Prophylaxis against infective endocarditis'. This paper details the recommendations from these guidelines which relate to dental practice and discusses the clinical and cost-effectiveness evidence pertaining to them. This is taken from the full NICE guideline, which also includes guidance relating to non-dental procedures (http://www.nice.org.uk/CG064).