El COVID-19 fue predominantemente más prevalente entre adultos mayores de 15 años en las primeras etapas del brote y la proporción de casos confirmados entre niños fue relativamente menor. Sin embargo, debido a la creciente propagación mundial del SARS-CoV-2, tenemos nuevos desafíos para la prevención y el control de la epidemia de COVID-19 entre los niños. Ya que en los más pequeños no se pueden emplear medidas de prevención (barbijos), la clínica inespecífica que presentan, las dificultades para el diagnóstico, la deficiente comunicación entre médico-paciente y familiar que han contribuido al desafío de desarrollar medidas para proteger a esta población, al igual que al personal de salud que manejan casos pediátricos. Al mismo tiempo, los niños con comorbilidades, s on vulnerables a la infección por SARS-CoV-2. La presente revisión intenta mostrar esta enfermedad desde el punto de vista pediátrico, para orientar en su diagnóstico y manejo.
Pediatric Intensive Care Units (PICUs) provide multidisciplinary care to critically ill children and their families. Grief is present throughout the trajectory of illness and can peak around the time of death or non-death losses. The objective of this study was to assess how PICUs around the world implement grief and bereavement care (GBC) as part of an integrated model of care. This is a multicenter cross-sectional, prospective survey study. Questionnaires with multiple-choice and open-ended questions focusing on unit infrastructure, personnel, policies, limited patient data, and practices related to GBC for families and health care professionals (HCPs) were completed by on-site researchers, who were HCPs on the direct care of patients. PICU fulfillment of GBC goals was evaluated using a custom scoring based on indicators developed by the Initiative for Pediatric Palliative Care (IPPC). We compared average total and individual items fulfillment scores according to the respective country's World Bank income. Patient characteristics and details of unit infrastructure were also evaluated as potential predictors of total GBC fulfillment scores. Statistical analysis included multilevel generalized linear models (GLM) with a Gaussian distribution adjusted by child age/gender and clustering by center, using high income countries (HICs) as the comparative reference. Additionally, we applied principals of content analysis to analyze and summarize open-ended answers to contextualize qualitative data. The study included 34 PICUs from 18 countries: high-income countries (HICs): 32.4%, upper middle-income countries (UMICs): 44.1%, low middle-income and low-income countries (LMI/LICs): 23.5%. All groups reported some compliance with GBC goals; no group reported perfect fulfillment. We found statistically significant differences in GBC fulfillment scores between HICs and UMICs (specifically, HCP grief support), and between HICs and LMICs (specifically, family grief support and HCP grief support). PICUs world-wide provide some GBC, independent of income, but barriers include lack of financial support, time, and training, overall unit culture, presence of a palliative care consultation service, and varying cultural perceptions of child death. Disparities in GBC for families and HCPs exist and were related to the native countries' income level. Identifying barriers to support families and HCPs, can lead to opportunities of improving GBC in PICUs world-wide.
Critical spare-parts stock optimization has become a relevant topic for academy and industry. In most articles, the problem has been stated as a trade-off between economic risks of shortages and financial costs. Risk optimization in this context has been mainly studied from a logistics point of view. The most common decision variables have been stock levels, stock location, and reorder points. In this context, buying insurance to cover shortage cost can be a complementary (or exclusive) measure for risk mitigation. Insurance optimization traditionally has been studied from a microeconomic and financial perspective. The main decision variable has been the indemnity function, and occasionally, the insurance premium. Its use in the context of physical asset management has not been observed to the best of our knowledge. This creates an opportunity to link inventory optimization techniques with insurance optimization for shortage losses. In this work, we present a novel approach to jointly manage the shortage risk of a critical non-repairable component in a unique critical system. We develop an original model to integrate critical spare-parts stock optimization with insurance optimization techniques. The result is a decision model to select the optimal stock and insurance policy that maximizes the decision maker's expected utility. This allows for a business-centered integrated perspective in critical parts decisions. We present a case study representative of the mining industry, illustrating the complementary nature of selecting optimal stock levels and contracting an optimal insurance. Our results show that contracting an insurance can lead to policies preferred by a risk-averse decision maker. The case study shows that this may even occur lowering stock levels and increasing profits. CopyrightAppl. Stochastic Models Bus. Ind. 2016, 32 90-98 A. MARTÍNEZ, R. PASCUAL AND S. MATURANA The coverage can help to compensate the client for lost production, equipment renting costs, and so on. From this point of view, an insurance is a complimentary and interrelated risk-management tool to the logistics-centered view.An example of such insurance contracts has been seen in the mining industry [1,2]. For example, in 2005, mining company Compañia minera Doña Inés de Collahuasi received $US 161m from two insurance contracts, after a semiautogenous mill failure that accounted for nearly half of its production process at the time. The insurance contract covered repair direct costs and lost production related to downtime and considered a deductible. The final reimbursement was agreed between the mining and insurance companies, in a process that took 4 years.In this work, we present an original model that integrates the use of insurance contracts with spare parts management. We propose a decision aid methodology to jointly decide the optimal stock level and insurance policy to be bought. The insurance is designed to mitigate unexpected shortage costs. The problem is studied in the context of a single nonrepairable critical component o...
La estenosis aórtica (EA) es actualmente una de las enfermedades valvulares más comunes en los países desarrollados 1 . Su prevalencia aumenta con la edad y se diagnostica en el 4,6% de los adultos mayores de 75 años. Tiene un curso insidioso, con un largo período de latencia; sin embargo, presenta una rápida progresión posterior al inicio de los síntomas. Sin tratamiento específico, se ha descrito una mortalidad promedio de 50% a 2 años 2 . El reemplazo valvular aórtico quirúrgico (RVAo) es el pilar del tratamiento de la estenosis aórtica avanzada, mejora los síntomas y aumenta la sobrevida. Sin embargo, existe un 30% de los pacientes con EA sintomática que por su riesgo no son "buenos" candidatos quirúrgicos. Aunque globalmente la mortalidad del RVAo se reporta por debajo del 3%, el riesgo de mortalidad y morbilidad aumentan significativamente cuando la estenosis aórtica se presenta en pacientes de edad avanzada con patologías concomitantes. Precisamente en estos casos riesgosos los clínicos han sido reacios para indicar la cirugía. Como alternativa, en el año 2002 se implantó por primera vez una prótesis aórtica por vía percutánea (TAVI: transcatheter aortic valve implantation) ( 3 ). Desde entonces, la seguridad y eficacia de este nuevo tratamiento se ha confirmado tanto con los resultados de múltiples registros multicéntricos, como también con estudios aleatorizados. Así, se ha establecido con los sistemas Sapien de Edwards y CoreValve de Medtronic, una tasa de éxito > 90% y una mortalidad a los 30 días del procedimiento < 10% en la mayoría de las series. Por su parte, en forma aleatorizada, el ensayo PARTNER confirmó tanto la superioridad de la TAVI sobre el tratamiento médico en pacientes no considerados aptos para el recambio valvular quirúrgico estándar 4 , como la no inferioridad de la TAVI comparada con el tratamiento quirúrgico en pacientes de alto riesgo 5 . De este modo se dispone en la actualidad de esta nueva alternativa de tratamiento en pacientes de alto riesgo quirúrgico y se discute su potencial indicación en un espectro más amplio de pacientes.
El búho bicolor (Aegolius harrisii) es un ave rapaz nocturna poco conocida, con distribución amplia y discontinua en Suramérica. Reportamos un nuevo registro de distribución de A. harrisii para Colombia, en el Parque Natural Regional Cerro Páramo de Miraflores, departamento del Huila. Este registro constituye una ampliación geográfica de la distribución conocida para esta especie hacia el sur de la cordillera Oriental. Corrobora la continuidad de su distribución a lo largo de los Andes, y también amplía 464 metros el límite superior de su rango altitudinal. Palabras clave. Cordillera de los Andes. Páramo de Miraflores. Strigidae.
The assessment of these patients needs to involve the combined use of ultrasound, clinical, genetic, cytogenetic and molecular testing. The present results indicate that the chromosome breakage test should always be performed to rule out Fanconi anemia in this group.
Basismaßnahmen und erweiterte Maßnahmen zur Wiederbelebung von Kindern COVID-19-Leitlinien des European Resuscitation Council Einführung Kinder sind anfällig für die Coronaviruskrankheit 2019 (COVID-19), scheinen jedoch häufig nur einen milden Krankheitsverlauf zu haben [1-7]. Sehr kleine Kinder und Kinder mit Komorbiditäten sind möglicherweise anfälliger für schwere Krankheitsverläufe. In der größten derzeit veröffentlichten pädiatrischen Fallserie (chinesische CDC 01/16-02/08; n = 2143) hatten 5,2 % der Kinder einen schweren Krankheitsverlauf (definiert als "Dyspnoe, zentrale Zyanose und eine Sauerstoffsättigung von weniger als 92 %"), 0,6 % der erkrankten Kinder hatten einen kritischen Krankheitsverlauf [9]. Jedoch können viele andere Krankheitserreger und/oder Ursachen bei Kindern zu respiratorischem Versagen führen und es kann schwierig sein, eine eindeutige Diagnose zu stellen [10]. In Anbetracht dessen ist sich die ERC Pediatric Guideline Writing Group Diese Leitlinie wurde am 24. April 2020 erstellt und unterliegt den sich weiterentwickelnden Kenntnissen und Erfahrungen über COVID-19. Da sich die Länder in verschiedenen Stadien der Pandemie befinden, kann es in der Praxis zu Abweichungen in einzelnen Ländern kommen.
Background A shared decision-making model is preferred for engaging prostate cancer patients in treatment decisions. However, the process of assessing an individual’s preferences and values is challenging and not formalized. The purpose of this study is to develop an automated decision aid for patient-centric treatment decision-making using decision analysis, preference thresholds and value elicitations to maximize the compatibility between a patient’s treatment expectations and outcome. Methods A template for patient-centric medical decision-making was constructed. The inputs included prostate cancer risk group, pre-treatment health state, treatment alternatives (primarily focused on radiation in this model), side effects (erectile dysfunction, urinary incontinence, nocturia and bowel incontinence), and treatment success (5-year freedom from biochemical failure). A linear additive value function was used to combine the values for each attribute (side effects, success and the alternatives) into a value for all prospects. The patient-reported toxicity probabilities were derived from phase II and III trials. The probabilities are conditioned on the starting state for each of the side effects. Toxicity matrices for erectile dysfunction, urinary incontinence, nocturia and bowel incontinence were created for the treatment alternatives. Toxicity probability thresholds were obtained by identifying the patient’s maximum acceptable threshold for each of the side effects. Results are represented as a visual. R and Rstudio were used to perform analyses, and R Shiny for application creation. Results We developed a web-based decision aid. Based on preliminary use of the application, every treatment alternative could be the best choice for a decision maker with a particular set of preferences. This result implies that no treatment has determinist dominance over the remaining treatments and that a preference-based approach can help patients through their decision-making process, potentially affecting compliance with treatment, tolerance of side effects and satisfaction with the decision. Conclusions We present a unique patient-centric prostate cancer treatment decision aid that systematically assesses and incorporates a patient’s preferences and values to rank treatment options by likelihood of achieving the preferred outcome. This application enables the practice and study of personalized medicine. This model can be expanded to include additional inputs, such as genomics, as well as competing, concurrent or sequential therapies.
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