Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach.

BACKGROUND: Readmission followed by surgery to treat spinal fractures has a substantial impact on patient care costs and reflects a hospital's quality standards. This article analyzes the factors associated with hospital readmission followed by surgery to treat spinal fractures. METHODS: This was a cross-sectional study with time-series analysis. For prediction analysis, we used Cox proportional hazards and machine-learning models, using data from the Healthcare Cost and Utilization Project, Inpatient Database from Florida (USA). RESULTS: The sample comprised 215,999 patients, 8.8% of whom were readmitted within 30 days. The factors associated with a risk of readmission were male sex (1.1 [95% confidence interval 1.06-1.13]) and >60 years of age (1.74 [95% CI: 1.69-1.8]). Surgeons with a higher annual patient volume presented a lower risk of readmission (0.61 [95% CI: 0.59-0.63]) and hospitals with an annual volume >393 presented a lower risk (0.92 [95% CI: 0.89-0.95]). CONCLUSION: Surgical procedures and other selected predictors and machine-learning models can be used to reduce 30-day readmissions after spinal surgery. Identification of patients at higher risk for readmission and complications is the first step to reducing unplanned readmissions.

Time-driven activity-based costing as a strategy to increase efficiency: An analyses of interventional coronary procedures.

Monitoring the costs is one of the key components underlying value-based health care. This study aimed to evaluate the cost-saving opportunities of interventional coronary procedures (ICPs). Data from 90 patients submitted to elective ICP were evaluated in five Brazilian hospitals. Time-driven activity-based costing, that guides the cost estimates using the time consumed and the capacity cost rates per resource as the data input, was used to assess costs and the time spent over the care pathway. Descriptive cost analyses were followed by a labour cost-saving estimate potentially achieved by the redesign of the ICP pathway. The mean cost per patient varied from $807 to $2639. The length of the procedure phase per patient was similar among the hospitals, while the post-procedure phase presented the highest variation in length. The highest direct cost saving opportunities are concentrated in the procedure phase. By comparing the benchmark service with the most expensive one, it was estimated that redesigning physician practices could decrease 51% of the procedure cost. This application is pioneered in Brazil and demonstrates how detailed cost information can contribute to driving health care management to value by identifying cost-saving opportunities.

Cost-effectiveness analysis of XELOX versus XELOX plus bevacizumab for metastatic colorectal cancer in a public hospital school.

BACKGROUND: Metastatic colorectal cancer imposes a substantial burden on patients and society. Over the last years, progresses in the treatment have been made especially due to the introduction of monoclonal antibodies, such as bevacizumab which, on the other hand, has considerably increased the costs of treatment. We performed a cost-effectiveness analysis of bevacizumab plus XELOX in comparison with XELOX alone in metastatic colorectal cancer in first-line therapy, from the perspective of a public hospital school in Brazil. METHODS: This was a cost-effectiveness analysis performed by a decision tree and Markov models. Costs were expressed in local currency and outcomes were expressed in months of life gained. The model was constructed using the TreeAge Pro 2013® software. RESULTS: The incremental difference in years of life gained was 2.25 months, with an extra cost of 47,833.57 BRL, resulting in an incremental cost-effectiveness of 21,231.43 BRL per month of life gained. CONCLUSIONS: Although the XELOX plus bevacizumab regimen is a more expensive and more effective treatment than XELOX, it does not fit the reimbursement values fixed by the public healthcare system in Brazil.

Diagnosis and Prevalence of Prominent Lobules in Otoplasty: Analysis of 120 Patients with Prominent Ears.

BACKGROUND: The prominence of the ear lobule is considered an anomaly of secondary importance and receives correspondingly less attention in literature. We reviewed a case series of otoplasty patients and analyzed the prevalence of lobule prominence. METHODS: Records of otoplasties between 2007 and 2013 were reviewed. Inclusion criteria were: (1) primary otoplasties; (2) prominence of both ears; and (3) otoplasties conducted by the main author. Patients were divided into two groups: (1) A general group (GG) containing all the patients, and (2) a lobule correction group (LG)-a subgroup of GG containing only the patients who needed lobule correction. RESULTS: From a total of 291 patients, 120 patients were included in GG and 27 patients in LG. There was no statistical difference between groups GG and LG in terms of age and gender. Preoperative diagnosis of lobule prominence was correctly established in 14 patients; 13 patients were diagnosed during surgery. CONCLUSIONS: Lobule prominence should not be underestimated since its diagnosis may be missed in the preoperative period-nearly 50 % in our case. Also its prevalence (22.5 %) is not as infrequent as some may think. Knowledge of lobule correction techniques before surgery is important to avoid less than optimal results in otoplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Vagus nerve stimulation in pediatric patients: Is it really worthwhile?

Vagus nerve stimulation (VNS) seems to be effective in the management of selected cases of pharmacoresistant epilepsy in children. This was a case-control prospective study of children with refractory epilepsy submitted to vagal nerve stimulator implantation and a control group with epilepsy treated with antiepileptic drugs. Patients under 18years of age who underwent clinical or surgical treatment because of pharmacoresistant epilepsy from January 2009 to January 2012 were followed and compared with an age-matched control group at final evaluation. Statistically significant differences were observed considering age at epilepsy onset (VNS group - 1.33±1.45years; controls - 3.23±3.11; p=0.0001), abnormal findings in neurological examination (p=0.01), history of previous ineffective epilepsy surgery (p=0.03), and baseline seizure frequency (p=0.0001). At long-term follow-up, 55.4% of the patients in the VNS group had at least 50% reduction of seizure frequency, with 11.1% of the patients presenting 95% reduction on seizure frequency. Also, a decrease in traumas and hospitalization due to seizures and a subjective improvement in mood and alertness were observed. The control group did not show a significant modification in seizure frequency during the study. In this series, VNS patients evolved with a statistically significant reduction of the number of seizures, a decreased morbidity of the seizures, and the number of days in inpatient care. In accordance with the current literature, VNS has been proven to be an effective alternative in the treatment of pediatric patients with drug-resistant epilepsy.

Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis.

BACKGROUND: Patients may acquire ventilator-associated pneumonia (VAP) by aspirating the condensate that originates in the ventilator circuit upon use of a conventional humidifier. The bacteria that colonize the patients themselves can proliferate in the condensate and then return to the airways and lungs when the patient aspirates this contaminated material. Therefore, the use of HME might contribute to preventing pneumonia and lowering the VAP incidence. The aim of this study was to evaluate how the use of HME impacts the probability of VAP occurrence in critically ill patients. METHODS: On the basis of the acronym "PICO" (Patient, Intervention, Comparison, Outcome), the question that guided this review was "Do critically ill patients under invasive mechanical ventilation present lower VAP incidence when they use HME as compared with HH?". Two of the authors of this review searched the databases PUBMED/Medline, The Cochrane Library, and Latin-American and Caribbean Literature in Health Sciences, LILACS independently; they used the following keywords: "heat and moisture exchanger", AND "heated humidifier", AND "ventilator-associated pneumonia prevention". This review included papers in the English language published from January 1990 to December 2012. RESULTS: This review included ten studies. Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I(2) < 50%). Information about the outcome mortality was available in only eight of the ten studies. The use of HME and HH did not afford different results in terms of mortality (OR = 1.09; 95% CI: 0.864-1.376). The total sample size was 884 and 762 patients, respectively. Heterogeneity among the studies was low (I(2) = 0.0%). CONCLUSION: Current meta-analysis was not sufficient to definitely exclude an associate between heat and moisture exchangers and VAP. Despite the methodological limitations found in selected clinical trials, the current meta-analysis suggests that HME does not decrease VAP incidence or mortality in critically ill patients.

Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression.

Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients' outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66-1.0; (p < 0.001). Twenty-seven studies (65.9%) had MTM-PC models outlined by the clinical team, showing as characteristics the mean of 10.0 ± 10.7 months of follow-up of hypertensive patients, with 7.7 ± 4.9 consultations. Instruments to assess the quality of life measured the enhancement by 13.4 ± 10.7% (p = 0.047). The findings of the meta-analysis show a mean reduction of -7.71 (95% CI, -10.93 to -4.48) and -3.66 (95% CI, -5.51 to -1.80), (p < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life.

COSTS ANALYSIS OF SPINAL COLUMN METASTASES SURGICAL TREATMENT.

Introduction: End-of-life cancer treatment is associated with substantial healthcare costs. Objective: This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods: A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results: The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion: The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study .

Introdução: O tratamento do câncer em fim de vida está associado a custos substanciais em saúde. Objetivo: O objetivo do estudo foi analisar o custo do tratamento cirúrgico de pacientes com metástase espinhal e compressão peridural submetidos ao tratamento cirúrgico. Métodos: Uma análise retrospectiva de custos de 81 pacientes com metástase espinhal e compressão peridural submetidos a tratamento cirúrgico. A avaliação de custos foi definida nas seguintes categorias: medicamentos, exames laboratoriais e de imagem, enfermaria, sala de recuperação, unidade de terapia intensiva, procedimento cirúrgico e material consignado. O custo relacionado à melhora da dor, atividade funcional e sobrevida também foi avaliado. Resultados: O custo total do tratamento cirúrgico de 81 pacientes foi de R $ 3.604.334,26 e o valor médio de cada paciente foi de R $ 44.497,95. Os maiores gastos foram relacionados com implantes (41,1%), seguidos de internação (27,3%) e procedimento cirúrgico (19,7%). Conclusão: O custo do tratamento cirúrgico para metástases espinhais é um dos mais caros entre as complicações ósseas em pacientes com câncer. O custo do tratamento relacionado aos desfechos apresentou diferença de acordo com o desfecho analisado e a permanência hospitalar, exames, medicamentos e terapia intensiva tem papel importante em alguns dos custos relacionados ao desfecho específico. Nível de Evidência II, Estudo retrospectivo .

Comorbidities and the risk of death among individuals infected by COVID-19 in Espírito Santo, Brazil.

INTRODUCTION: We investigated the association of self-reported comorbidities with fatality risk among individuals infected with Coronavirus disease 2019 (COVID-19) in Espírito Santo State, Brazil. METHODS: We included 212,620 individuals, ≥30 years old. The data were obtained from the COVID-19 panel. Kaplan-Meier curves and Cox regression model were used. RESULTS: COVID-19-positive individuals presenting with chronic conditions were at a higher risk of fatality than individuals without these comorbidities. Age had a significant effect on these relationships. CONCLUSIONS: Comorbidities were associated with an increased risk of fatality. Middle-aged people (30-59 years) with comorbidities should also be considered as a vulnerable group.

Prevalence of rotavirus in acute diarrhea and its association with clinical signs and symptoms.

Rotaviruses are the main etiological agents of acute infectious diarrhea in children. Thus, the objective of this study is to contribute to the information about the rotavirus variants circulating in Brazil. A cross-sectional study was conducted on 124 fecal samples collected from children up to the age of 5 years, with acute gastroenteritis. Thirty-one samples were positive for rotavirus A. Regarding the G genotyping, 16 (80%) were classified as G1 and regarding P genotyping all strains were classified as P[8]. The determination of the prevalence of rotavirus infection and the characterization of the viral strains circulating are expected to contribute to the information we have about the molecular biology and epidemiology of disease.

Long-term forecasts of the COVID-19 epidemic: a dangerous idea.

INTRODUCTION: Mathematical models have been used to obtain long-term forecasts of the COVID-19 epidemic. METHODS: The daily COVID-19 case count in two Brazilian states was used to show the potential limitations of long-term forecasting through the application of a mathematical model to the data. RESULTS: The predicted number of cases at the end of the epidemic and at the moment that the peak occurs, is highly dependent on the length of the time series used in the predictive model. CONCLUSIONS: Predictions obtained during the course of the COVID-19 pandemic need to be viewed with caution.

Short-term forecasting of daily COVID-19 cases in Brazil by using the Holt's model.

INTRODUCTION: We evaluated the performance of the Holt's model to forecast the daily COVID-19 reported cases in Brazil and three Brazilian states. METHODS: We chose the date of the first COVID-19 case to April 25, 2020, as the training period, and April 26 to May 3, 2020, as the test period. RESULTS: The Holt's model performed well in forecasting the cases in Brazil and in São Paulo and Minas Gerais states, but the forecasts were underestimated in Rio de Janeiro state. CONCLUSIONS: The Holt's model can be an adequate short-term forecasting method if their assumptions are adequately verified and validated by experts.

Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador.

INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo's Kichwa population may have contributed to the observed clinical response to CAP treatment.

Temporal trend of HIV/AIDS cases in the state of Minas Gerais, Brazil, 2007-2016. / Tendência temporal dos casos de HIV/aids no estado de Minas Gerais, 2007 a 2016.

OBJECTIVE: to analyze the temporal trend of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) incidence, detection and mortality coefficients in the state of Minas Gerais between 2007 and 2016. METHODS: this was a time series study of data held on the Notifiable Health Conditions Information System (Sinan) using Prais-Winsten regression. RESULTS: in the period studied, 35,349 cases were notified, with predominance of sexually transmitted cases (81.7%), 50.3% of which were heterosexual cases and 22.8% were homosexual cases. AIDS incidence increased (annual change 1.6%; 95%CI 0.0;3.3) as did HIV detection (annual change 60.3%; 95%CI 22.9;109.0). The mortality rate was stationary; HIV+ notifications increased from 3.8% in 2007 to 65.1% in 2016. CONCLUSION: the growing trend of HIV+ detection coincided with the government strategy to identify cases. AIDS incidence increased.

Pertussis epidemiological pattern and disease burden in Brazil: an analysis of national public health surveillance data.

Objective: We described pertussis epidemiological trends in Brazil between 2010 and 2015. We also assessed tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women from 2014, the year of the introduction of Tdap maternal immunization recommendation in Brazil, to 2016.Methods: Epidemiological data for incidence, prevalence, hospitalization, mortality, and maternal vaccination coverage were calculated based on the Brazilian public surveillance databases.Results: The epidemiological data analysis results showed that the pertussis average incidence rate (IR) was 2.19/100,000 inhabitants for all ages, with a peak in 2014 (4.03/100,000 inhabitants) and highest incidence in <1-year-old children (IR = 175.20/100,000). 97.6% of pertussis deaths (405/415) were in <1-year-old children. Maternal immunization coverage was 9.2% in 2014, 40.4% in 2015, and 33.8% in 2016.Conclusions: Pertussis incidence and pertussis-related deaths increased in Brazil from 2010 to 2014 and decreased in 2015. In the two years, 2015 and 2016 that followed the NIP recommendation, Tdap vaccination coverage of pregnant women was low and varying from region to region. More efforts and national plans would help increase awareness and maternal immunization coverage.

Validation of the Fall Risk Tracking Tool (FRRISque) in elderly community dwellers. / Validação da Ferramenta de Rastreio de Risco de quedas (FRRISque) em pessoas idosas que vivem na comunidade.

This study aimed to validate of Fall Risk Tracking Tool (FRRISque) in elderly community dwellers. A cross-sectional evaluative screening study was carried out on a sample of 854 elderly. In addition to the pilot version of FRRISque, the QuickScreen® tool was applied as a standard reference in order to validate a concurrent criterion, determining sensitivity and specificity values. Most of the elderly people were female (57.6%) with an average age of 71.87 years. The multivariate logistic regression analyses showed that only 10 FRRISque items contribute to increased elderly fall risk and they refer to the risk factors of previous falls, use of a walking aid device, polypharmacy, use of psychotropic substances, difficulty to ascend and descend a slope, difficulty to walk for a distance of 100 meters, visual and hearing impairment, low physical activity and poorly lit environment. This risk stratification model assumes sensitivity values of 91.3% and specificity values of 73.4%. The FRRISque is defined as a valid, simple, low-cost and of easy and rapid application tool that can be used by all primary health care professionals, including community health workers.

Objetivou validar a Ferramenta de Rastreamento do Risco de Quedas (FRRISque) em pessoas idosas que vivem na comunidade. Realizou-se um estudo transversal, do tipo screening avaliativo. A amostra foi composta por 854 idosos. Além da versão piloto da FRRISque, foi aplicado o instrumento QuickScreen® como referência padrão no intuito de realizar a validade de critério concorrente, determinando os valores de sensibilidade e especificidade. A maioria das pessoas idosas era do sexo feminino (57,6%), com média de idade de 71,87 anos. Nas análises por regressão logística, evidenciou-se que apenas 10 itens da FRRISque contribuem para o aumento do risco de quedas em idosos e referem-se aos fatores de risco queda anterior, uso de dispositivo de auxílio à marcha, polifarmácia, uso de psicotrópicos, dificuldade para subir ou descer uma ladeira, dificuldade para andar 100 metros, déficit visual e auditivo, baixa atividade física e ambiente mal iluminado. Este modelo de estratificação de risco assume valores de sensibilidade de 91,3% e especificidade de 73,4%. A FRRISque se caracteriza como instrumento válido, simples, porém denso, de baixo custo e de fácil e rápida aplicação, podendo ser empregado por todos os profissionais de saúde da atenção básica, inclusive por agentes comunitários de saúde.

Impact of vaccination on the incidence of varicella hospitalizations in a state in Southeast Brazil.

INTRODUCTION: This study aimed to analyze cases of complicated varicella and the impact of varicella vaccination in Minas Gerais, Brazil. METHODS: This was a time series study of a territorial basis using data on varicella cases from 2010 to 2016, which was provided by the State Health Department of Minas Gerais on . Descriptive statistics were used for the analysis, and the generalized linear regression model proposed by Prais-Winsten was used for the time tendency, adopting a significance level of 5% and the integrated autoregressive modeling of moving averages. RESULTS: There were 1,635 cases of varicella; out of which cellulitis (44%) was the predominant complication. The home-acquired cases were 38.9% and 464 cases (40.6%) were not previously vaccinated. There was a significant decrease in the incidence coefficient when comparing the pre- and post- immunization periods, from 1.95 cases/100,000 inhabitants in 2010 to 0.24 cases/100.000 inhabitants in 2016 (p<0.05). There was a higher incidence of cases recorded among males, with higher prevalence in the age group of 1-4 years (54.7%). Lethality was higher between 5-9 years of age (44%). Mortality was higher in the age group of 0-4 years and among females (2.58/100,000 inhabitants/year). The overall trend of the incidence coefficient was a decreasing one, with an annual percentage variation. CONCLUSIONS: The number of complicated varicella cases notified decreased, coincidentally, in the post-immunization period. However, the immunization coverage period was restricted for the assessment of the correlation between immunization coverage and incidence.

Seasonal variation of femoral fractures in the state of São Paulo, Southeast Brazil.

OBJECTIVE: To examine the effect of seasonality on femoral fracture incidence among people residing in the state of São Paulo, Brazil. METHODS: Ecological study based on a consecutive series of 216,348 reports of hospital admissions caused by femoral fractures. A Bayesian statistical model was used for time series analysis, considering the monthly average number of events of femoral fractures per day as a dependent variable. RESULTS: Among the female population, significant seasonal effects were observed only for older women, aged 60 years or more. Among younger men (aged less than 20 years) there is not a clear seasonal effect, but among the other age groups there seems to exist a higher number of cases of femoral fractures during the coldest months of the year. CONCLUSIONS: In general, more cases of fractures occur during the coldest months of the year; however, men and women have different patterns of incidence according to each age group.

Notifications of adverse events: characterization of the events that occurred in a hospital complex. / Notificação de eventos adversos: caracterização dos eventos ocorridos em um complexo hospitalar.

OBJECTIVE: Analyze incident notifications related to the patient's safety. METHOD: Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS: 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION: Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

Spatiotemporal patterns of AIDS incidence among adults in São Paulo, Brazil.

INTRODUCTION: AIDS remains a major public health concern in Brazil. METHODS: This study investigated spatiotemporal patterns of reported AIDS cases among adults in São Paulo between 2000 and 2016, and their associations with human development index. RESULTS: In the early 20th century, the more developed administrative districts (ADs) indicated higher AIDS incidences among men. From the 2010s, ADs with lower development indicate higher rates of the disease among women. CONCLUSIONS: The results are useful to support the planning of actions aimed at controlling the incidence and transmission of AIDS in certain areas, based on diversification by gender and risk populations.