Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation.

Introduction: This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods: A prepost intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results: In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 (p < 0.001). In total, 43.5% of cases were solved via physician-to-physiciane-consultation. A total of 2,223 patients needed a face-to-face visit, with a mean wait time of 7.5 days. The mean of patients in the waiting listing decreased from 450.8 in 2019 to 44.8 in 2021 (90% reduction). The annual time devoted to e-consultations and first face-to-face visits following an e-consultation diminished significantly after the intervention (1,724 hours versus 2,312.8; 25.4% reduction). Each query solved via e-consultation represented a saving of €652.8, resulting in a total annual saving of €827,062. Conclusions: Physician-to-physiciane-consultations reduce waiting times, improve access of complex patients to specialty care, and ensure that cases are managed at the appropriate level. E-consultation reduces costs, which benefits both, society and the healthcare system.

Identification of Toxicity Effects of Cu2O Materials on C. elegans as a Function of Environmental Ionic Composition.

Previous work has shown that spherical CuO nanomaterials show negative effects on cell and animal physiology. The biological effects of Cu2O materials, which posess unique chemical features compared to CuO nanomaterials and can be synthesized in a similarly large variety of shapes and sizes, are comparatively less studied. Here, we synthesized truncated octahedral Cu2O particles and characterized their structure, stability, and physiological effects in the nematode worm animal model, Caenorhabditis elegans. Cu2O particles were found to be generally stable in aqueous media, although the particles did show signs of oxidation and leaching of Cu2+ within hours in worm growth media. The particles were found to be especially sensitive to inorganic phosphate (PO4 3-) found in standard NGM nematode growth medium. Cu2O particles were observed being taken up into the nematode pharynx and detected in the lumen of the gut. Toxicity experiments revealed that treatment with Cu2O particles caused a significant reduction in animal size and lifespan. These toxic effects resembled treatment with Cu2+, but measurements of Cu leaching, worm size, and long-term behavior experiments show the particles are more toxic than expected from Cu ion leaching alone. These results suggest worm ingestion of intact Cu2O particles enhances their toxicity and behavior effects while particle exposure to environmental phosphate precipitates leached Cu2+ into biounavailable phosphate salts. Interestingly, the worms showed an acute avoidance of bacterial food with Cu2O particles, suggesting that animals can detect chemical features of the particles and/or their breakdown products and actively avoid areas with them. These results will help to understand how specific, chemically-defined particles proposed for use in polluted soil and wastewater remediation affect animal toxicity and behaviors in their natural environment.

Trends in stroke outcomes in the last ten years in a European tertiary hospital.

BACKGROUND: Studying the impact of demographic changes and progress in the management of stroke patients is necessary in order to organize care structures for the coming years. Consequently, we analyzed the prognostic trends of patients admitted to the Stroke Unit of a tertiary hospital in the last ten years. METHODS: The University Clinical Hospital of Santiago de Compostela is the referral hospital for stroke in a catchment area that accounts for 16.5% of the population of Galicia. Data from patients admitted to the Stroke Unit were registered prospectively. A multinomial logistic regression was performed to determine the influence of new trends in demographic factors and in the management of patients with acute stroke. For the expected trend of progression, a 2008-2011 and 2012-2017 time series model was made by selecting the most appropriate model. RESULTS: In the last 10 years, the age of stroke onset has only increased in women (from 74.4 ± 2.2 years in 2008 to 78.8 ± 2.1 years in 2017; p = 0.037), and the same happens with the severity of neurological symptoms (ischemic stroke (IS), p < 0.0001; from 14 [10, 19] in 2008 to 19 [15, 26] in 2017), with a higher percentage of cardioembolic strokes (40.7% vs. 32.2% of cardioembolic strokes in women vs. men, p < 0.0001). In a multiple linear regression model, hospital improvement was mainly associated with the use of reperfusion treatment (B 53.11, CI 95% 49.87, 56.36, p < 0.0001). A differentiated multinomial logistic regression analysis conducted for the whole sample with ischemic strokes in the two time periods (2008-2011 and 2012-2017) showed no differences in the influence of factors associated with higher morbidity and mortality. The modeling of time series showed a distinct falling trend in mortality, with a slight increase in good outcome as well as morbidity in both ischemic and hemorrhagic stroke. CONCLUSIONS: Our results showed that mortality decreased in the entire sample; however, although outcome at discharge improved in ischemic stroke, severe disability also increased in these patients. Importantly, this tendency towards increased morbidity seems to be confirmed for the coming years.

Walking ability after stroke in patients from Argentina: predictive values of two tests in subjects with subacute hemiplegia.

[Purpose] This study aimed to determine the predictive values of the trunk control test (TCT) and functional ambulation category (FAC) for independent walking up to 6 months post stroke. [Subjects] Twenty-seven subjects with hemiplegia secondary to a unilateral hemisphere stroke were included. [Methods] The protocol was started at 45 days post stroke, with the TCT and FAC as walking predictors. At 90, 120, and 180 days post stroke, the subjects' independent walking ability was assessed by using the Wald test. [Results] The TCT was identified as an independent predictor of ambulation at 90, 120, and 180 days. Subjects who scored ≥ 49 in the initial test had 93.8% probability of achieving independent gait at 6 months. The FAC proved that 100% of the subjects who scored 2 at 45 days post stroke walked independently at 90 days, 100% of the subjects who scored 1 walked independently at 120 days, and only 33.3% of the subjects who scored 0 walked independently at 180 days. [Conclusion] The TCT and FAC can predict independent walking at 45 days post stroke. In subjects with FAC 0, the TCT should be used to predict patients who will be able to walk independently.

Anafilaxia transoperatoria en cirugía de enfermedad hidatidica: Reporte de caso / Transoperative anaphylaxis in the surgery of Hydatidic disease

La enfermedad hidatidica (Equinococosis) existe en todo el mundo: Su frecuencia en el ser humano depende de la incidencia de la enfermedad en huéspedes intermediarios. El quiste hidatidico más frecuente es el causado por el Echinococcus Granulosus, estos pueden alojarse en cualquier órgano o tejido pero la mayoría de las veces se aloja en el hígado y pulmones. El goteo del líquido del quiste produce sensibilización y origina eosinofilia; si el goteo es importante, ya sea espontáneo, traumático o por intervención quirúrgica, puede presentar una reacción anafilactica grave o hasta mortal. Presentamos un caso de reacción anafilactica en un paciente con quiste hidatidico el cual fue tratado quirúrgicamente. Se presenta la revisión de la literatura y se sugiere un manejo transoperatorio