RESUMO
OBJECTIVE: Dermatomyositis (DM) and polymyositis (PM) are systemic autoimmune diseases that have been associated with high in-hospital mortality (IHM). The aim of this study was to use the National Inpatient Sample (NIS), a large US population database, to determine the reasons for hospitalization and IHM in patients with DM and PM. METHODS: We conducted a medical records review of adult DM/PM hospitalizations in 2016 and 2017 in acute care hospitals across the United States using the NIS. The reasons for IHM and reasons for hospitalization were divided into 19 broad categories based on their principal International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) diagnosis. RESULTS: A total of 27,140 hospitalizations carried either a principal or secondary ICD-10 code for DM or PM. The main reasons for hospitalization were rheumatologic (22%, n = 6085), cardiovascular (15%, n = 3945), infectious (13%, n = 3515), respiratory (12%, n = 3170), and gastrointestinal, (8%, n = 2150). A total of 3.5% of all patients experienced IHM. Infectious (34%, n = 325), respiratory (23%, n = 215), and cardiovascular (15%, n = 140) diagnoses were the most common reasons for IHM. Sepsis ICD-10 A41.9 was the most frequent specific principal diagnosis for both hospitalizations and IHM. CONCLUSIONS: Our analysis demonstrated that in the NIS the most common reasons for hospitalization in patients with DM/PM were rheumatologic diagnoses. However, IHM in these patients was most frequently from infectious diagnoses, highlighting the need for increased attention to infectious complications in these patients.
Assuntos
Dermatomiosite , Polimiosite , Adulto , Dermatomiosite/diagnóstico , Dermatomiosite/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Polimiosite/diagnóstico , Polimiosite/epidemiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The appropriate use of analgesia, sedation, neuromuscular blockade and the diagnosis and prevention of delirium (ASBD) are associated with better outcomes in critically ill patients at Intensive Care Unit (ICUs). AIM: To know the practices about analgesia, sedation, delirium, and neuromuscular blockade use among healthcare professionals working in adult ICUs in Chile. MATERIAL AND METHODS: An electronic survey was sent to 812 professionals working in ICUs using a previously published instrument, which was adapted and authorized by the author. RESULTS: We received 278 surveys. Fifty two percent of respondents were physicians, 34% nurses and 11% physical therapists. Their age ranged between 30 and 39 years in 43% and was over 50 years in 9%. Eighty four percent evaluated pain routinely, but only 26% use a validated scale. Sedation was routinely evaluated with a validated scale and 73% referred to have a protocol. Neuromuscular block is seldom used, and little monitoring occurs (43%). Delirium is routinely evaluated by 48% of respondents, usually using the CAM-ICU scale. CONCLUSIONS: There is a heterogeneous adherence to the ASBD recommended practices. The main gaps are in the assessment of pain, monitoring of neuromuscular blockade and diagnosis of delirium through validated instruments.
Assuntos
Analgesia , Delírio , Bloqueio Neuromuscular , Adulto , Chile , Cuidados Críticos , Delírio/diagnóstico , Delírio/prevenção & controle , Humanos , Hipnóticos e Sedativos , Unidades de Terapia Intensiva , Bloqueio Neuromuscular/efeitos adversos , DorRESUMO
Background: The appropriate use of analgesia, sedation, neuromuscular blockade and the diagnosis and prevention of delirium (ASBD) are associated with better outcomes in critically ill patients at Intensive Care Unit (ICUs). Aim: To know the practices about analgesia, sedation, delirium, and neuromuscular blockade use among healthcare professionals working in adult ICUs in Chile. Material and Methods: An electronic survey was sent to 812 professionals working in ICUs using a previously published instrument, which was adapted and authorized by the author. Results: We received 278 surveys. Fifty two percent of respondents were physicians, 34% nurses and 11% physical therapists. Their age ranged between 30 and 39 years in 43% and was over 50 years in 9%. Eighty four percent evaluated pain routinely, but only 26% use a validated scale. Sedation was routinely evaluated with a validated scale and 73% referred to have a protocol. Neuromuscular block is seldom used, and little monitoring occurs (43%). Delirium is routinely evaluated by 48% of respondents, usually using the CAM-ICU scale. Conclusions: There is a heterogeneous adherence to the ASBD recommended practices. The main gaps are in the assessment of pain, monitoring of neuromuscular blockade and diagnosis of delirium through validated instruments.
Assuntos
Humanos , Adulto , Bloqueio Neuromuscular/efeitos adversos , Delírio/diagnóstico , Delírio/prevenção & controle , Analgesia , Dor , Chile , Cuidados Críticos , Hipnóticos e Sedativos , Unidades de Terapia IntensivaRESUMO
La migraña es la cefalea más frecuente, afecta entre el 6-7% de los hombres y 15-18% de las mujeres en edad laboral. En el 2002 las perdidas por incapacidad se estimaron en 19,600 millones de dólares para EEUU en 1990 se estimó entre 250 millones y 611 millones de libras el costo anual de la enfermedad en UK. Tanto el tratamiento alopático recomendado por el NICE y la acupuntura han mostrado eficacia. El costo del tratamiento con acupuntura en Alemania es de 365,64 para el 2008 sin embargo a pesar de la relevancia económica y sobre la calidad de vida de este padecimiento no se ha estimado su costo en Colombia. Metodología: Se realizó un estudio basado en la prevalencia con metodología botton up para la estimación de los costos asociados a la prestación de servicios de salud, tanto para el tratamiento con acupuntura como para el tratamiento propuesto por el NICE. La probabilidad de las complicaciones se tomó de la literatura indexada. y una aproximación basada en la prevalencia tipo top down para la estimación de los costos directos diferentes a servicios de salud. Las frecuencias de uso para la acupuntura se estimaron mediante consenso formal de expertos y las frecuencias de uso para el protocolo propuesto por NICE se extrajeron de las recomendaciones del mismo, los costos unitarios para acupuntura se levantaron mediante un estudio de corte transversal de una muestra representativa a juicio de experto, los costos unitarios para los medicamentos alopáticos fueron tomados del PLM y el costo de los servicios de los manuales tarifarios vigentes. El horizonte temporal fue un año, la perspectiva usada fue la del tercer pagador. Resultados: El costo del tratamiento con acupuntura equivale a: (1801323/505627,20 (valor upc) 3.56 UPC frente al costo del tratamiento definido con medicina alopatica que fue de (2760110+2778258 /505627,20) 10.95 UPC. El costo directo de aspectos distintos a servicios de salud fue de (# de días de incapacidad por la enfermedad en Colombia * pacientes afectados por la enfermedad *PIB per capita promedio 2010/ 365)/ Valor UPC (3 *438590*5400*2159/ 365) =42.027.496.225 /505627,2 = 83120 UPC.
