Guía de Práctica Clínica en atresia esofágica / Clinical practice guide on esophageal atresia

La atresia esofágica es una de las anomalías congénitas más frecuentes en la práctica quirúrgica neonatal. Se estima que tiene una incidencia de 1 por cada 3500 recién nacidos vivos a nivel mundial. La preparación de guías de actuación y protocolos asistenciales es tendencia en la práctica médica actual. Esta Guía de Práctica Clínica se elaboró respondiendo a la necesidad de protocolizar la atención médico-quirúrgica de la atresia esofágica. En el Centro Territorial de Cirugía Neonatal de Holguín, donde se regionaliza la atención a neonatos de las cinco provincias orientales del país con afecciones congénitas y quirúrgicas de alta complejidad, la atresia esofágica fue la afección quirúrgica más frecuente en los últimos diez años, con una supervivencia ascendente que alcanzó 94,4 por ciento en 2019. La guía que se presenta se aprobó en el Primer Consenso Nacional de Guías de Prácticas Clínicas en Cirugía Pediátrica, en Varadero, Matanzas en 2019. Incluye las principales pautas para el diagnóstico, tratamiento y seguimiento de los pacientes afectados y se considera una herramienta eficiente para mejorar los resultados en la asistencia médica y quirúrgica neonatal(AU)

Esophageal atresia is one of the most common congenital anomalies in neonatal surgical practice. It is estimated to have an incidence of 1 per 3500 live newborns globally. The preparation of action guides and care protocols is a trend in current medical practice. This Clinical Practice Guide was prepared in response to the need to protocolize the medical-surgical care of esophageal atresia. In the Territorial Center for Neonatal Surgery of Holguín, where the care of neonates from the five eastern provinces of the country with congenital and surgical conditions of high complexity is regionalized, esophageal atresia was the most frequent surgical condition in the last ten years, with an ascending survival that reached 94.4 percent in 2019. The guideline presented was approved in the First National Consensus of Clinical Practice Guidelines in Pediatric Surgery, in Varadero, Matanzas in 2019. It includes the main guidelines for the diagnosis, treatment and follow-up of affected patients and is considered an efficient tool to improve outcomes in neonatal medical and surgical care(AU)

Cost Avoidance Analysis of Medication Conversions on the Treatment of Gastroesophageal Reflux Disease in a Medication Therapy Management Call Center: A Budgetary Perspective.

BACKGROUND: The burden of prescription drug prices affects patients and health system, creating a need for pharmacists to use their medication expertise to recommend the most cost-effective treatment for patients. OBJECTIVE: The study aimed to analyze the cost avoidance for medication conversions related to GERD from an integrated medication therapy management call center. METHODS: A quasi-experimental study was conducted at a call center during a 12-month intervention. Adult patients aged ≥18 years who received highercost PPIs were included. The pharmacists provided MTM services to patients telephonically to review all aspects of the patients' medication regimen as well as conversion recommendation to lower-cost PPIs. The cost avoidance analysis and sensitivity analysis were conducted. RESULTS: Of 40 eligible patients, 9 patients accepted the medication conversion, resulting in a 22.5% acceptance rate. The total cost avoidance from medication conversions was $19,937.1 per year, which equated to $2,215.2 per patient. The adjusted cost avoidance of medication conversion was estimated by assuming the patients who accepted the conversion continued taking the medication for 365 days and resulted in a total savings of $40,370.7 per year, which equated to $4,485.6 per patient. There were no significant association between the acceptance of medication conversions and patient's age(P = 0.15), gender(P = 0.73), and insurance status(P = 0.96). CONCLUSION: The study results showed that the call-center MTM with medicationconversion interventions successfully demonstrated an economically advantageous impact from a budgetary perspective. Further studies should explore methods to increase acceptance of MTM services and promote awareness of the profound effect on public health and well-being.

The Effect of Zero Copayments on Medication Adherence in a Community Pharmacy Setting.

BACKGROUND: Prescription medication copayments can be a financial burden to many patients. When patients cannot afford their medications, they may become nonadherent, and as a result, this can lead to an increase in chronic disease complications and healthcare costs. OBJECTIVE: The objective of this study was to determine if zero copayments have an effect on medication adherence in a community pharmacy. METHODS: This retrospective cohort study examined the prescription refill records of patients who filled specific generic medications for hypertension, hyperlipidemia, and gastroesophageal reflux disease (GERD) in 2016 at the NSU Clinic Pharmacy. The adherence rates of patients with zero copayments were compared to the adherence rates of patients with copayments greater than $0. Adherence was determined by calculating the proportion of days covered (PDC). Patients were considered adherent if their PDC was greater than or equal to 80%. RESULTS: GERD patients with no copayments had average PDC ratios of 87.4% and were statistically significantly more adherent than GERD patients with copayments, who had average PDC ratios of 76.7% (P = 0.042). Hyperlipidemia and hypertension patients with no copayments had average PDC ratios of 89.3% and 90.3%, respectively, and those with copayments had PDC ratios of 85.3% (P = 0.314) and 87.9% (P = 0.534). CONCLUSION: Overall, patients with $0 copayments had higher adherence rates than patients with copayments greater than $0. GERD patients with no copayments were significantly more adherent than GERD patients with copayments. However, no statistically significant difference was found between patients with or without copayments in the hyperlipidemia and hypertension cohorts. Further studies are recommended to analyze additional factors that may influence medication adherence.

A community-based pilot study of a diabetes pharmacist intervention in Latinos: impact on weight and hemoglobin A1c.

Type 2 diabetes disproportionately affects Latinos increasing their risk of diabetes-related complications. This study used a randomized controlled design with a community-based approach to evaluate the impact of a culturally tailored pharmacist intervention on clinical outcomes in Latino diabetics. The intervention included a focused discussion and two individual pharmacist counseling sessions on medication, nutrition, exercise, and self-care to promote behavior changes. Sessions were culturally adapted for language, diet, family participation, and cultural beliefs. Clinical outcomes were measured at baseline and three months. Nineteen intervention and 24 control participants completed the study. Mean BMI reduction was greater for intervention than for control group participants (-0.73 ± 0.07 kg/m2 versus + 0.37 ± 0.02 kg/m2 p<.009 respectively). Hemoglobin A1c was significantly reduced by 0.93 ± 0.45% in the intervention group only. There was no significant difference in blood glucose, blood pressure, or lipid levels. An innovative culturally-sensitive pharmacist intervention improved selected clinical outcomes among Latino diabetics.

Comparing the T scores from bone sonometer measurements in Hispanic and non-Hispanic white women

Ethnicity is an important risk factor for the development of osteoporosis. Non-Hispanic white or Asian women are commonly considered at higher risk than other ethnicities. Hispanics in the U.S. are of Mexican, Caribbean, Central American, or South American descent. Conclusive data on the relative risk of osteoporosis in Hispanic women based upon heritage within the Hispanic population are not available. Objective: To investigate whether Hispanic white women are at a significantly lower risk than non-Hispanic whites for the development of osteoporosis. Methods: Cross-sectional study. Setting: Community health screenings. Participants: Hispanic and non-Hispanic white women. Intervention: Bone density measurements of the non-dominant heel. Descriptive statistics and inferential statistics including regression analyses were performed using SPSS 14.0. Main Outcomes Measure: T scores. Results: Overall, measurements were obtained from 352 women (209 Hispanic & 143 non-Hispanic white) ranging in age from 55-97 years old. The mean T score obtained for Hispanic women was -1.194 and -1.280 for non-Hispanic white women. The correlation between the obtained T score and age was negative (r = -0.36, p<0.01), reflecting bone loss with increasing age. Regression analysis using age and ethnicity showed that ethnicity was a non-significant contributor to the best-fit regression line (t=0.60, p=0.55). Conclusion: This study indicates that Hispanic white women may be at comparable risk of developing osteoporosis as non-Hispanic white women (AU)

La etnia es un importante factor de riesgo para el desarrollo de la osteoporosis. Las mujeres blancas o asiáticas están consideradas como de mayor riesgo que otras etnias. Los hispanos en los Estados Unidos son descendientes de mejicanos, caribeños, centro o sudamericanos. No están disponibles datos concluyentes del riesgo relativo de osteoporosis en mujeres hispanas en base a la herencia en la población hispana. Objetivo: Investigar si las mujeres hispanas blancas tienen significativamente menor riesgo de desarrollar osteoporosis que las blancas no hispanas. Métodos: Estudio transversal. Ámbito: cribado de salud comunitaria. Participantes: Mujeres blancas hispanas y no hispanas. Intervención: medidas de densidad ósea en el talón no dominante. Se realizó estadística descriptiva e inferencial, incluyendo un análisis de regresión, utilizando SPSS 14.0. Variables de resultados principales: T score. Resultados: Se obtuvieron medidas de 352 mujeres blancas (209 hispanas y 143 no hispanas) que oscilaban entre 55-97 años. La media de T score obtenido de las mujeres blancas hispanas fue de -1,194 y el de las no hispanas de -1,280. La correlación entre el T score obtenido y la edad fue negativa (r= -0,36, p<0,01), reflejando que la perdida de peso aumenta con la edad. El análisis de regresión usando edad y etnia mostró que la etnia no era un contribuidor significativo para un mejor ajuste de la línea de regresión (t=0,60, p=0,55). Conclusión: Este indica que las mujeres blancas hispanas tienen un riesgo comparable de desarrollar osteoporosis que las mujeres blancas no hispanas (AU)

Comparing the T scores from bone sonometer measurements in Hispanic and non-Hispanic white women.

UNLABELLED: Ethnicity is an important risk factor for the development of osteoporosis. Non-Hispanic white or Asian women are commonly considered at higher risk than other ethnicities. Hispanics in the U.S. are of Mexican, Caribbean, Central American, or South American descent. Conclusive data on the relative risk of osteoporosis in Hispanic women based upon heritage within the Hispanic population are not available. OBJECTIVE: To investigate whether Hispanic white women are at a significantly lower risk than non- Hispanic whites for the development of osteoporosis. METHODS: Cross-sectional study. SETTING: Community health screenings. PARTICIPANTS: Hispanic and non-Hispanic white women. INTERVENTION: Bone density measurements of the non-dominant heel. Descriptive statistics and inferential statistics including regression analyses were performed using SPSS 14.0. MAIN OUTCOMES MEASURE: T scores. RESULTS: Overall, measurements were obtained from 352 women (209 Hispanic & 143 non-Hispanic white) ranging in age from 55-97 years old. The mean T score obtained for Hispanic women was - 1.194 and -1.280 for non-Hispanic white women. The correlation between the obtained T score and age was negative (r = -0.36, p<0.01), reflecting bone loss with increasing age. Regression analysis using age and ethnicity showed that ethnicity was a non-significant contributor to the best-fit regression line (t=0.60, p=0.55). CONCLUSION: This study indicates that Hispanic white women may be at comparable risk of developing osteoporosis as non-Hispanic white women.

Tratamiento combinado del onfalocele grande con saco intacto: presentación de un caso

El onfalocele es el resultado de una fallo en la formación de la pared abdominal anterior durante la vida fetal. Ocurre en 1 de cada 3000 a 10000 nacimientos y puede ser tratado de forma conservadora o quirúrgica. Con el objetivo de perfeccionar la conducta ante esta emergencia neonatal, se presenta un niño con un onfalocele grande y saco integro que se trató con ambrocaciones, "silo externo", y cierre primario diferido a los 10 días de nacido, del cual evolucionó favorablemente y fue egresado a los 17 días de operado. Se revisa la literatura y se discuten las ventajas de esta modalidad de tratamiento (AU)