Economic burden of skin and skin structure infections due to Gram-positive bacteria in patients on hospital at home-based outpatient parenteral antibiotic therapy (OPAT).

OBJECTIVE: To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain. METHODS: Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros. RESULTS: We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was €7,326 (95% confidence interval: €6,316-€8,416). CONCLUSIONS: Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission.

[Erectile dysfunction: an insufficiently valued problem in Internal Medicine. Study of patients and related medication]. / Disfunción eréctil: un problema poco valorado en Medicina Interna. Estudio de pacientes y medicación relacionada.

INTRODUCTION: Erectile dysfunction (ED) is a common disease and may be due to psychological or organic causes. It might point to a silent disease and its value could not only be in life quality but also directly resolving the health problem laying beneath. The evaluation of ED begins with sexual records and physical examination which have been reported to have a 95 percent sensitivity, and a 50 percent specificity. Additional diagnostic tests are needed to maximize specificity. Sexual impairment in general Internal Medicine patients has not been sufficiently studied yet. PATIENTS AND METHODS: Unselected ambulatory and hospital admitted patients were interviewed during 2003 using the International Index of Erectile Function (IIEF) ad the Sexual Health Interview for Men (SHIM). The cut-off point was 21. RESULTS: A total of 51 male patients were interviewed, middle age was 65 years old (30-88). Of these, 27 denied sexual activity (group I). Middle age in this group was 64 years old. In the 24 patients with sexual activity (group II) middle age was 61 years old. The IIEF score was less than 45 in 11 patients (groups I and II of erectile dysfunction) The SHIM middle score was 26 points. The score was < 21 in 10 patients (41.6%). Concordance between both test was 90.9%. Risk factors included: tobacco (12 patients), alcohol (9), hypertension (8), and diabetes (7) among others. CONCLUSION: Our investigation seems to show that a great number of patients attended by Internists have sexual impairment (41.6%). None of these were under specific therapy nor consulted for this disease. Middle age is lower among patients with sexual activity as compared with the group without sexual activity. This assessment should be included in the medical interview with the aim of prescribing specific therapy to improve patient's quality of life.

Disfunción eréctil: un problema poco valorado en Medicina Interna. Estudio de pacientes y medicación relacionada / Erectile dysfunction: a non sufficiently valued problem in internal medicine. Study of patients and related medication

Introducción: La disfunción eréctil (DE) es habitual y puede estar relacionada con causas psicológicas u orgánicas. La realización de una historia sexual y la exploración física, demuestran una sensibilidad del 95%, y especificidad del 50% en la determinación de la causa de la DE. Se precisan test diagnósticos adicionales para incrementar la especificidad. No hay información disponible sobre las alteraciones en la función sexual en pacientes de Medicina Interna. Pacientes y métodos: Entrevistas a pacientes no seleccionados tanto ambulatorios como hospitalizados aplicando el Índice Internacional de Disfunción Eréctil (IIDE) y la Entrevista de Salud Sexual para Hombres (ESSH) durante el año 2003. Resultados: Se entrevistaron 51 varones de edad media 65 años (30-88). Entre ellos, 27 negaron actividad sexual (grupo I), la edad media en este grupo fue de 64 años. En los 24 pacientes con actividad sexual (grupo II) la edad media fue de 61 años. El IIDE mostró puntuaciones menores de 45 puntos en 11 pacientes (grupos I y II de disfunción eréctil). La puntuación media para el ESSH fue de 26 puntos. La puntuación fue < 21 en 10 pacientes (41,6%). La concordancia entre ambos test fue del 90,9%. Los factores de riesgo incluían: tabaco (12 pacientes), alcohol (9), HTA (8) y DM (7). Conclusión: Parece existir una alta prevalencia de DE entre los pacientes atendidos por Internistas (41,6%). Ninguno de éstos recibía tratamiento por esta enfermedad ni habían consultado nunca por ello. La edad media es inferior en los pacientes que mantienen actividad sexual. Consideramos necesario incluir esta patología en la anamnesis a todo paciente asistido para posibilitar la prescripción de tratamiento que podría mejorar notablemente su calidad de vida

Introduction: Erectile dysfunction (ED) is a common disease and may be due to psychological or organic causes. It might point to a silent disease and its value could not only be in life quality but also directly resolving the health problem laying beneath. The evaluation of ED begins with sexual records and physical examination which have been reported to have a 95 percent sensitivity, and a 50 percent specificity. Additional diagnostic tests are needed to maximize specificity. Sexual impairment in general Internal Medicine patients has not been sufficiently studied yet. Patients and methods: Unselected ambulatory and hospital admitted patients were interviewed during 2003 using the International Index of Erectile Function (IIEF) ad the Sexual Health Interview for Men (SHIM). The cut-off point was 21. Results: A total of 51 male patients were interviewed, middle age was 65 years old (30-88). Of these, 27 denied sexual activity (group I). Middle age in this group was 64 years old. In the 24 patients with sexual activity (group II) middle age was 61 years old. The IIEF score was less than 45 in 11 patients (groups I and II of erectile dysfunction) The SHIM middle score was 26 points. The score was < 21 in 10 patients (41,6%). Concordance between both test was 90.9%. Risk factors included: tobacco (12 patients), alcohol (9), hypertension (8), and diabetes (7) among others. Conclusion: Our investigation seems to show that a great number of patients attended by Internists have sexual impairment (41.6%). None of these were under specific therapy nor consulted for this disease. Middle age is lower among patients with sexual activity as compared with the group without sexual activity. This assessment should be included in the medical interview with the aim of prescribing specific therapy to improve patient’s quality of life

[Health impact of 2003 heat wave at Hospital de Riveira (A Coruña)]. / Impacto de la ola de calor de 2003 en el Hospital de Riveira (A Coruña).

OBJECTIVES: Last summer 2003 took place an atmospheric situation considered as a heat wave. Importance of environmental factors in chronic diseases is well known, but few works analyse those of heat excess as we do in this paper. METHODS: We studied the effects of high temperatures on admission and mortality in Riveira, A Coruña, Spain, during the period from July 15th to August 15th 2003. RESULTS: Mean maximum temperature in this period was 26.1 degrees C. One hundred and thirty seven patients were admitted, age ranges between 16 and 93 years old. Sixteen died. Fifty four admissions (38.7%) were identified as related with heat wave and of those patients, 8 died. No heat stroke cases were identified. Main risk factors in our heat related admitted population, were previous lung disease and overweight. CONCLUSION: Heat related pathology is difficult to evaluate although it is quite important. It seems to be necessary to take measures in order to identify population at risk and reduce the effects related to this environmental factor since high risk patients are quite common in our daily practice.

Impacto de la ola de calor de 2003 en el Hospital de Riveira (A Coruña) / Health impact of 2003 heat wave at Hospital de Riveira (A Coruña)

Objetivo: El pasado verano de 2003 se vivió una situación atmosférica considerada como ola de calor. Es conocida la importancia de los factores ambientales sobre enfermos portadores de patologías crónicas, aunque existen pocos trabajos que analicen los derivados del exceso de calor, como los que estudiamos en este documento. Método: Evaluamos el impacto de las altas temperaturas en los ingresos y la mortalidad en el área de Riveira, A Coruña, durante el periodo entre el 15 de julio y el 15 de agosto de 2003. Resultados: La temperatura media máxima en este periodo se fue de 26,1 ºC. Durante este periodo ingresaron 137 pacientes de edades comprendidas entre los 16 y los 93 años. Fallecieron 16 pacientes. Se identificaron 54 casos de ingresos relacionados con efecto del calor (38,7%), con 8 fallecimientos en este grupo. Ningún caso pudo atribuirse a golpe de calor. Los principales factores de riesgo identificados en los ingresados por efecto del calor, fueron patología pulmonar previa y obesidad. Conclusión: Si bien los efectos del calor son difíciles de evaluar, su importancia es clara. Es necesario adoptar medidas para identificar la población de riesgo y reducir los efectos por este fenómeno atmosférico dado que los pacientes de riesgo son altamente prevalentes en nuestra práctica diaria

Objectives: Last summer 2003 took place an atmospheric situation considered as a heat wave. Importance of environmental factors in chronic diseases is well known, but few works analyse those of heat excess as we do in this paper. Methods: We studied the effects of high temperatures on admission and mortality in Riveira, A Coruña, Spain, during the period from July 15th to august 15th 2003. Results: Mean maximum temperature in this period was 26.1 ºC. One hundred and thirty seven patients were admitted, age ranges between 16 and 93 years old. Sixteen died. Fifty four admissions (38, 7%) were identified as related with heat wave and of those patients, 8 died. No heat stroke cases were identified. Main risk factors in our heat related admitted population, were previous lung disease and overweight. Conclusion: Heat related pathology is difficult to evaluate although it is quite important. It seems to be necessary to take measures in order to identify population at risk and reduce the effects related to this environmental factor since high risk patients are quite common in our daily practice