[Tele-rehabilitation program in patients with distal radius fracture: a controlled clinical trial]. / Programa de telerrehabilitación en pacientes con fractura de radio distal: ensayo clínico controlado.

Background: Distal radius fractures are very frequent fractures in the world, so it is necessary to establish new rehabilitation strategies. Objective: To determine the effectiveness of tele rehabilitation versus supervised treatment in the functional recovery of patients with distal radius fracture. Method: A randomized clinical trial was conducted that included 91 patients with distal radius fractures grades AO23 A and AO23B, which were randomly assigned to a treatment group, the supervised rehabilitation group received for two weeks a program of 10 treatment sessions and the tele rehabilitation group received through the Moodle platform instructions to carry out the rehabilitation program. Outcome measures (functionality, active range of motion, hand grip strength, quality of life and pain) were measured at the time of admission to rehabilitation and at 1, 3 and 6 months. Results: In both treatment groups at 6 months, statistically significant intragroup differences in functionality were demonstrated, with no intergroup differences. Conclusions: At 6 months, both rehabilitation programs increase functionality, range of motion, quality of life and decrease pain, without statistically significant differences intergroup.

Antecedentes: Las fracturas de radio distal son fracturas muy frecuentes en el mundo, por lo que es necesario establecer nuevas estrategias de rehabilitación. Objetivo: Determinar la efectividad de la telerrehabilitación en comparación con el tratamiento supervisado en la recuperación funcional de los pacientes con fractura de radio distal. Método: Se realizó un ensayo clínico aleatorizado que incluyó 91 pacientes con fracturas de radio distal de grados AO23A y AO23B, los cuales se asignaron aleatoriamente a un grupo de rehabilitación supervisado que recibió durante 2 semanas un programa de 10 sesiones de tratamiento o un grupo de telerrehabilitación que mediante la plataforma de Moodle recibió instrucciones para realizar el programa de rehabilitación. Las medidas de resultado (funcionalidad, rango de movimiento activo, fuerza de prensión de la mano, calidad de vida y dolor) se midieron en el momento del ingreso a rehabilitación y a los 1, 3 y 6 meses. Resultados: A los 6 meses, ambos grupos de tratamiento demostraron diferencias estadísticamente significativas intragrupo en la funcionalidad, sin diferencias intergrupo. Conclusiones: A los 6 meses, ambos programas de rehabilitación aumentan la funcionalidad, el rango de movimiento y la calidad de vida, y disminuyen el dolor, sin diferencias estadísticamente significativas intergrupo.

Uncertain project network analysis with fuzzy-PERT and Interval Type-2 fuzzy activity durations.

Project network analysis is often subject to different uncertainties that can occur in real world scenarios. These uncertainties are not always measurable which makes its statistical estimation hard, so the use of third party information coming from experts is useful to provide an estimation of activity durations of the project. Projects usually have multiple experts who provide different estimates of their perceptions about activity durations which can be represented as Type-2 fuzzy sets in cases where experts do not agree on their estimates. Such disagreement/ambiguitites can be either expressed with Interval Type-2 fuzzy numbers or the proposed fuzzy-PERT set which is an extension of the classical PERT distribution to a fuzzy environment. To do so, a mathematical formulation of the fuzzy problem is presented, two solution methods are described and two illustrative examples are solved.

A global satisfaction degree method for fuzzy capacitated vehicle routing problems.

There are several uncertain capacitated vehicle routing problems whose delivery costs and demands cannot be estimated using deterministic/statistical methods due to a lack of available and/or reliable data. To overcome this lack of data, third-party information coming from experts can be used to represent those uncertain costs/demands as fuzzy numbers which combined to an iterative-integer programming method and a global satisfaction degree is able to find a global optimal solution. The proposed method uses two auxiliary variables α , λ and the cumulative membership function of a fuzzy set to obtain real-valued costs and demands prior to find a deterministic solution and then iteratively find an equilibrium between fuzzy costs/demands via α and λ. The performed experiments allow us to verify the convergence of the proposed algorithm no matter the initial selection of parameters and the size of the problem/instance.

Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care / Evolución del estadio de la enfermedad renal crónica desde el diagnóstico de hipertensión arterial en atención primaria

Objective: To analyze the evolution of the stages of CKD and the progression of the estimation of glomerular filtration rate (eGFR) in patients with newly diagnosed hypertension. Design-: Retrospective cohort.SiteFamily Medicine Unit No. 31, Mexican Social Security Institute, Mexico City. Participants: Patients with hypertension who have been diagnosed in primary care and have developed chronic kidney disease .Main measurements: The eGFR was calculated with the CKD Epi formula in three moments, the first measurement was at the time of diagnosis of hypertension, the second measurement was made when it arrived a change in CKD stage and the last one at the end of the study, with which the evolution time from one stage to another was obtained, as well as the drop in eGFR. Results: The sample consisted of 207 electronic health records of patients, with an average follow-up of 10.2 years from the moment of diagnosis of hypertension until the end of the study. The average time to go from one baseline stage of CKD to another was 7 years (average decline in eGFR of 5.8ml/min/year) and to have a second stage change was 3.2 years (average decline in eGFR of 6.8ml/min/year), with a statistically significant repeated measures ANOVA (p<0.001). Conclusions: Patients with newly diagnosed hypertension remain longer in the initial stages of CKD, to later evolve and change more quickly.(AU)

Objetivo: Analizar la evolución de los estadios de la enfermedad renal crónica (ERC) y la progresión de la estimación de la tasa de filtración glomerular (eTFG) en pacientes con hipertensión arterial de nuevo diagnóstico. Diseño: Cohorte retrospectiva. Emplazamiento: Unidad de Medicina Familiar N.° 31, Instituto Mexicano del Seguro Social, Ciudad de México. Participantes: Pacientes hipertensos que hayan sido diagnosticados en atención primaria y hayan desarrollado ERC. Mediciones principales: La eTFG se calculó con la fórmula CKD Epi en 3 momentos. La primera medición fue al momento del diagnóstico de hipertensión arterial, la segunda medición se realizó cuando se presentó un cambio de estadio de la ERC y la última, al final del estudio, con el que se obtuvo el tiempo de evolución de un estadio a otro, así como el descenso de la eTFG. Resultados: La muestra estuvo constituida por 207 historias clínicas electrónicas de pacientes, con un seguimiento promedio de 10,2 años desde el momento del diagnóstico de hipertensión arterial hasta el final del estudio. El tiempo promedio para pasar de una etapa inicial de la ERC a otra fue de 7 años (disminución promedio de la eTFG de 5,8ml/min/año) y para tener un cambio de segunda etapa fue de 3,2 años (disminución promedio de la eTFG de 6,8ml/min/año), con un ANOVA de medidas repetidas estadísticamente significativo (p < 0,001). Conclusiones: Los pacientes con hipertensión arterial de nuevo diagnóstico permanecen más tiempo en los estadios iniciales de la ERC, para luego evolucionar y cambiar más rápidamente.(AU)

Evolution of the stage of chronic kidney disease from the diagnosis of hypertension in primary care.

OBJECTIVE: To analyze the evolution of the stages of CKD and the progression of the estimation of glomerular filtration rate (eGFR) in patients with newly diagnosed hypertension. DESIGN: Retrospective cohort. SITE: Family Medicine Unit No. 31, Mexican Social Security Institute, Mexico City. PARTICIPANTS: Patients with hypertension who have been diagnosed in primary care and have developed chronic kidney disease. MAIN MEASUREMENTS: The eGFR was calculated with the CKD Epi formula in three moments, the first measurement was at the time of diagnosis of hypertension, the second measurement was made when it arrived a change in CKD stage and the last one at the end of the study, with which the evolution time from one stage to another was obtained, as well as the drop in eGFR. RESULTS: The sample consisted of 207 electronic health records of patients, with an average follow-up of 10.2 years from the moment of diagnosis of hypertension until the end of the study. The average time to go from one baseline stage of CKD to another was 7 years (average decline in eGFR of 5.8ml/min/year) and to have a second stage change was 3.2 years (average decline in eGFR of 6.8ml/min/year), with a statistically significant repeated measures ANOVA (p<0.001). CONCLUSIONS: Patients with newly diagnosed hypertension remain longer in the initial stages of CKD, to later evolve and change more quickly.

Cost analysis of drug treatment in hypertensive patients at social security health care family medicine units.

OBJECTIVE: To estimate the increase of drug treatment costs associated with predictive factors of hypertensive patients in family medicine units. MATERIALS AND METHODS: A generalized linear model was employed to estimate costs with data from a microcosting costing study for a 1-year time horizon. Sources of dada were medical electronic files, phar-macy records and unitary prices updated to 2019. RESULTS: From a total of 864 patients older than 65 years were 67% and women 65%. Factors with most influence on mean drug treatment costs were diabetes, age and complications associ-ated with hypertension. Mean annual cost of antihypertensive treatment was 61 dollars (CI95% 55,67) and median were 32 dollars (IQR 30,35) per patient. Incremental costs for diabetes were 23 dollars (CI95% 13,33) and 25 dollars (CI95% 5,45) in the group of ≥ 65 years. CONCLUSION: Diabetes, age and complications were the factors with largest influence on hypertension pharmacological costs.

Cost analysis of drug treatment in hypertensive patients at social security health care family medicine units / Análisis de costo de tratamientos farmacológicos en pacientes hipertensos en unidades de medicina familiar de seguridad social en salud

Abstract: Objective: To estimate the increase of drug treatment costs associated with predictive factors of hypertensive patients in family medicine units. Materials and methods: A generalized linear model was employed to estimate costs with data from a microcosting costing study for a 1-year time horizon. Sources of dada were medical electronic files, pharmacy records and unitary prices updated to 2019. Results: From a total of 864 patients older than 65 years were 67% and women 65%. Factors with most influence on mean drug treatment costs were diabetes, age and complications associated with hypertension. Mean annual cost of antihypertensive treatment was 61 dollars (CI95% 55,67) and median were 32 dollars (IQR 30,35) per patient. Incremental costs for diabetes were 23 dollars (CI95% 13,33) and 25 dollars (CI95% 5, 45) in the group of ≥ 65 years. Conclusion: Diabetes, age and complications were the factors with largest influence on hypertension pharmacological costs.

Resumen: Objetivo: Estimar el aumento de costos de tratamiento farmacológico de hipertensión asociado con factores predictivos en pacientes de unidades de medicina familiar. Material y métodos: El análisis utilizó un modelo lineal generalizado alimentado con información de un estudio de microcosteo en 2016. Las fuentes de información fueron los registros médicos del expediente electrónico y de farmacia y los precios unitarios del cuadro básico de medicamentos transformados a dólares americanos correspondientes a 2019. Resultados: Las variables significativas con mayor influencia fueron diabetes, edad y complicaciones asociadas con hipertensión. El costo promedio anual de tratamiento antihipertensivo por paciente fue de 61 dólares (IC95% 55,67) Los resultados sugieren un costo incremental de 23 dólares (IC95% 13,33) cuando se tiene diabetes y de 25 dólares (IC95% 5, 45) en el grupo ≥ 65 años. Conclusiones: Diabetes, edad y complicaciones son los factores encontrados que más influyen en los costos farmacológicos de tratamiento de la hipertensión.