[Implementation of diagnosis related groups in a high-complexity health institution in Colombia]. / Implementación de los Grupos relacionados de diagnóstico en una institución de salud de alta complejidad en Colombia.

BACKGROUND: One of the greatest challenges for health care institutions is to know the hospital product (HP), defined as patients, diagnoses and resources used in health care. Proper measurement of HP allows an effective resource management. The Diagnosis Related Groups (DRG) system facilitates the measurement of HP, classifying patients according to their characteristics, complexity, and resource consumption. AIM: To describe the implementation of DRGs in a high complexity health care institution in Colombia and to describe the incidence of coding errors. MATERIAL AND METHODS: A random sample of 98 episodes was selected out of 3802 episodes registered from June to September 2019. We described the cumulative incidence of errors in the assignment of main diagnoses, procedures and the variable "Present on admission" (POA). RESULTS: An incorrect assignment of the main diagnosis was found in 18/98 episodes (18%, 95% confidence intervals (CI)11-27). Seventeen of 98(17%-95% CI10.4-26) and 8/98(8%-95% CI 3.6-15) had incorrect assignment of POA ("NO" or "YES" respectively). Eighteen episodes had at least one procedure incorrectly assigned (19% - 95%CI (11.4 - 28.5)). CONCLUSIONS: The use of DRGs improves hospital efficiency. Its implementation is possible in health care institutions in Colombia. However, the commitment of the institution's clinical and administrative staff is essential.

Implementación de los Grupos relacionados de diagnóstico en una institución de salud de alta complejidad en Colombia

Background: One of the greatest challenges for health care institutions is to know the hospital product (HP), defined as patients, diagnoses and resources used in health care. Proper measurement of HP allows an effective resource management. The Diagnosis Related Groups (DRG) system facilitates the measurement of HP, classifying patients according to their characteristics, complexity, and resource consumption. Aim: To describe the implementation of DRGs in a high complexity health care institution in Colombia and to describe the incidence of coding errors. Material and Methods: A random sample of 98 episodes was selected out of 3802 episodes registered from June to September 2019. We described the cumulative incidence of errors in the assignment of main diagnoses, procedures and the variable "Present on admission" (POA). Results: An incorrect assignment of the main diagnosis was found in 18/98 episodes (18%, 95% confidence intervals (CI)11-27). Seventeen of 98(17%-95% CI10.4-26) and 8/98(8%-95% CI 3.6-15) had incorrect assignment of POA ("NO" or "YES" respectively). Eighteen episodes had at least one procedure incorrectly assigned (19% − 95%CI (11.4 − 28.5)). Conclusions: The use of DRGs improves hospital efficiency. Its implementation is possible in health care institutions in Colombia. However, the commitment of the institution's clinical and administrative staff is essential.

Complications of bronchial thermoplasty using laryngeal mask: case series / Complicaciones de la termoplastia bronquial usando máscara laríngea: serie de casos

Abstract Severe asthma affects more than 250 million people and represents high healthcare costs. Bronchial thermoplasty is a relatively new technique in interventional pulmonology for managing this condition. The procedure is done under general anesthesia and the patients are mostly ASA II and III; therefore, the anesthesia plan must be safe. The purpose of the article is to describe the anesthetic technique used (general anesthesia and laryngeal mask) and the immediate and early complications of the procedure. Four patients were included, each undergoing three sessions. The complications during and immediately after the procedure, as well as the early complications (up to seven days post-procedure) that could have required hospital management were discussed. In three of the sessions at least one acute bronchospasm event presented, but only one patient required hospital admission for more than 24 hours. Experience suggests that thermoplasty may be safely conducted under general anesthesia and laryngeal mask.

Resumen El asma grave afecta a más de 250 millones de personas y genera altos costos en el sistema de salud. La termoplastia bronquial es una técnica relativamente novedosa de la neumología intervencionista para el manejo de esta condición. Este procedimiento se realiza bajo anestesia general, y los pacientes son en su mayoría ASA II y III, por lo que el plan anestésico debe ser seguro. El objetivo del artículo es describir la técnica anestésica utilizada (anestesia general y máscara laríngea) y las complicaciones inmediatas y tempranas del procedimiento. Se incluyeron cuatro pacientes, cada uno de los cuales fue sometido a tres sesiones. Se describieron las complicaciones durante e inmediatamente después del procedimiento y las complicaciones tempranas (hasta siete días posprocedimiento), que hubieran requerido manejo hospitalario. En tres de las sesiones se presentó al menos un evento agudo de broncoespasmo y solo un paciente requirió hospitalización mayor a 24 horas. La experiencia sugiere que la termoplastia puede ser llevada a cabo de manera segura bajo anestesia general y mascara laríngea.

Efectos de la Estimulación Acústica Personalizada en Pacientes con Tinnitus / Effects of Personalized Acoustic Stimulation in Patients with Tinnitus

En el mundo se reportan más de 600 millones de personas que experimentan tinnitus. Aproximadamente 20% de las personas con tinnitus subjetivo permanente presentan incomodidad significativa, interviniendo negativamente en su calidad de vida, con inducción de estados depresivos. Existen diferentes estrategias de intervención para el manejo del tinnitus, entre ellas la estimulación acústica. El objetivo de este estudio fue evaluar el impacto de la estimulación acústica pasiva en la severidad del tinnitus y en la calidad de vida de los pacientes con tinnitus subjetivo crónico mediante la Escala Visual Análoga(VAS)y el Inventario de Discapacidad del Tinnitus(THI). Estudio descriptivo de cohorte histórico que incluyó a pacientes >18 años con tinnitus subjetivo crónico que recibieron manejo con estimulación acústica pasiva entre 2017-2018. A los pacientes se les aplicó la VAS y el THI antes, durante y después del tratamiento. Se evidenciaron cambios significativos (p<0,05) entre las medianas en dos de los tres dominios del VAS y en todos los dominios pre y post tratamiento del THI. En las pruebas post hoc se encontraron diferencias (p<0.05) entre las medianas de los puntajes al inicio y a los tres meses y entre los puntajes al inicio y a los seis meses en todos los dominios y en el puntaje total de la escala THI. La estimulación acústica pasiva generó cambios en la discapacidad generada por el tinnitus. Se sugiere complementar los abordajes de tratamiento con estrategias que favorezcan también los mecanismos de memoria, atención y conciencia para aumentar la efectividad de las intervenciones

More than 600 million people worldwide are reported to experience tinnitus. Approximately 20% of people with permanent subjective tinnitus present significant discomfort, interfering negatively in their quality of life, inducing depressive states. There are different intervention strategies for the management of tinnitus, including acoustic stimulation. The aim of this study was to evaluate the impact of passive acoustic stimulation on tinnitus severity and quality of life in patients with chronic subjective tinnitus using the Visual Analogue Scale (VAS) and the Tinnitus Disability Inventory (THI). Descriptive historical cohort study including patients >18 years with chronic subjective tinnitus who received management with passive acoustic stimulation between 2017-2018. Patients were administered VAS and THI before, during and after treatment. Significant changes (p<0.05) between medians were evident in two of the three VAS domains and in all pre ­ and post-treatment domains of THI. In post hoc tests, differences (p<0.05) were found between the medians of scores at baseline and at three months and between scores at baseline and at six months in all of the domains and in the total THI scale score. Passive acoustic stimulation generated changes in tinnitus-generated disability. It is suggested to complement treatment approaches with strategies that also favor memory, attention and awareness mechanisms to increase the effectiveness of the inter ventions

Hipotalamotomía en pacientes con agresividad refractaria: resultados funcionales / Hypothalamotomy in patients with treatment-resistant aggressiveness: functional outcomes

INTRODUCCIÓN: La agresividad forma parte de las manifestaciones comportamentales asociadas a algunos trastornos mentales, es un síntoma de difícil manejo y, con frecuencia, es refractaria a las medidas farmacológicas. La cirugía de los trastornos del comportamiento surge como una alternativa terapéutica. Este procedimiento consiste en realizar intervenciones sobre distintas estructuras del sistema límbico, con el fin de corregir la alteración del circuito que estaría implicado en la producción de los síntomas. OBJETIVO: Describir los resultados clínicos de la hipotalamotomía posterior con gamma knife en el control de la agresividad en 20 pacientes refractarios al tratamiento, intervenidos en el Centro Médico Imbanaco entre 2013 y 2018. PACIENTES Y MÉTODOS: La gravedad de la agresividad se cuantificó mediante la escala de agresividad manifiesta (OAS) y la escala de impresión clínica global (CGI-SI), y su impacto funcional, a través de la escala de evaluación de la actividad global (EEAG). RESULTADOS: El control de la agresividad se observó en todos los pacientes tratados con hipotalamotomía posterior con gamma knife, evidenciado por la disminución en las puntuaciones de la OAS y la CGI-SI y la mejoría en la EEAG. CONCLUSIONES: La hipotalamotomía posterior muestra bajas complicaciones, seguridad en el procedimiento y buenos resultados, lo cual sugiere que podría ser una buena alternativa de tratamiento en los casos de agresividad refractaria donde las medidas farmacológicas y terapéuticas parecen agotarse

INTRODUCTION: Aggressiveness is part of the behavioural manifestations associated with some mental disorders; it is a symptom that is difficult to manage and is often resistant to pharmacological measures. Surgery for behavioural disorders emerges as a therapeutic alternative. This procedure consists in performing interventions on different structures of the limbic system in order to correct the alteration of the circuit involved in producing the symptoms. AIM: To describe the clinical outcomes of a posterior hypothalamotomy with gamma knife to control aggressiveness in 20 patients resistant to treatment, who underwent surgery at the Imbanaco Medical Centre between 2013 and 2018. PATIENTS AND METHODS: The severity of the aggressiveness was quantified using the Overt Aggression Scale (OAS) and the Clinical Global Impression Scale (CGI-SI), and its functional impact is evaluated using the Global Assessment of Functioning scale (GAF). RESULTS: Control over aggressiveness was observed in all patients treated by posterior hypothalamotomy with gamma knife, evidenced by a decrease in the scores on the OAS and CGI-SI and an improvement in the GAF. CONCLUSIONS: Posterior hypothalamotomy gives rise to few complications, is a safe procedure and offers good results, suggesting that it could be a good alternative treatment in cases of treatment-resistant aggressiveness where it seems that all the possible pharmacological and therapeutic measures have failed

Prevalence of cystic fibrosis pathogens in the oropharynx of healthy children and implications for cystic fibrosis care.

OBJECTIVE: To describe the prevalence of the CF pathogens Pseudomonas aeruginosa, Staphylococcus aureus and Haemophilus influenzae in OP cultures from healthy children. METHODS: Oropharyngeal (OP) swabs were collected from 100 healthy children ≤18 years of age undergoing a clinically indicated procedure. RESULTS: P. aeruginosa was isolated from the OP swab of one participant, S. aureus from 48 participants (including 4 methicillin-resistant) and H. influenzae from 47 participants. Cultures from 75 participants grew one or more of these organisms (55 grew one, 19 grew 2 and one grew 3 organisms). CONCLUSION: P. aeruginosa is rarely recovered from the oropharynx of healthy children ≤18 years of age, while recovery of S. aureus and H. influenzae is common. It is important to understand what the "normal" prevalence of CF pathogens is in the oropharynx in order to aid interpretation of OP cultures in CF patients.

Impacto de un depósito de residuos sólidos en el crecimiento físico infantil / Impact of a waste disposal site on children physical growth

Antecedentes: Varios estudios epidemiológicos han mostrado un aumento en el riesgo de presentar problemas de salud entre las personas que habitan cerca a los rellenos sanitarios. En este estudio se evaluó el impacto de un depósito municipal de residuos sólidos en el crecimiento de los niños entre 0 y 3 años de edad. Materiales y métodos: Los niños expuestos se seleccionaron en sitios con alta probabilidad de exposición a los agentes provenientes del depósito por dispersión aérea. Se seleccionó un grupo control cuya distancia y ubicación hacía poco probable que estuviera expuesto a dichos agentes. Se obtuvieron medidas antropométricas a la captación y en dos visitas de seguimiento, con intervalos de 3 meses. Se obtuvieron los puntajes estandarizados de Z del peso para la talla (PT) y talla para la edad (TE). demßs, se realizaron cuestionarios acerca de condiciones socio-económicas y morbilidad en la captación y en las visitas de seguimiento. Resultados: Los ni±os expuestos tuvieron en promedio 0.16 desviaciones estandar (DE) menos en el PT al compararlo con el grupo control (intervalo de confianza 95% [IC]: -0.34, 0.01). Entre los que habían habitado >50% de sus vidas en el area de estudio, se observó un menor valor de TE (-0.12) asociado con la exposición. Los datos también sugirieron un mayor efecto de la exposición en el PT entre los niños que presentaron síntomas respiratorios durante el seguimiento en comparación con los ni±os que permanecieron asintomaticos (p=0.08).Conclusiones: La exposición al depósito de residuos sólidos se asoció con un menor valor en los índices de crecimiento pondo-estatural.

Background: Several epidemiological studies have shown an increased risk of health problems among population living close to landfills. We evaluated the impact of a municipal solid waste disposal site on childrenÆs growth between 0-3 years of age. Methods: Children were selected in sites likely to receive dispersion of air compounds from the waste disposal site and also in a control area, in Cali, Colombia, in 2005. Anthropometric measures were obtained at enrollment and in two follow-up visits at 3 months intervals to obtain standardized z scores of weight for height (WHZ) and height for age (HAZ). In addition, questionnaires including information of socio-economical conditions and morbidity were applied at enrolment and during follow-up visits.Results: Children exposed had on average 0.16 less standard deviations (SD) in WHZ scores when compared to control group (95% Confidence Interval [CI]: -0.34, 0.01). Among those who have lived >50% of their life in the study area, a significantly lower HAZ score was observed (-0.12) associated with exposure. Our data also suggest a larger effect of exposure to the waste disposal site in WHZ among children with symptoms of respiratory disease than among asymptomatic children (p=0.08).Conclusions: Exposure to this waste disposal site was found associated with lower childrenÆs growth indexes.