Background: Malnutrition is highly prevalent in hospitalized patients but seldom recognized and treated. Malnutrition poses several adverse events, such as increased infection rates, length of hospital stay, and mortality, as well as costs. Early nutrition interventions have been shown to decrease the associated malnutrition burdens, leading to relevant savings. Thus, this study aims to evaluate the cost-effectiveness of nutrition therapy, including oral supplements to at-risk or malnourished adult inpatients admitted to the Brazilian Public System (SUS) hospitals. Method: A cost-effectiveness model, encompassing a 1-year period and regarding total costs, length of hospital stay, readmissions, and mortality related to malnutrition, was developed, having the provision of early nutrition therapy as the intervention variable. The number of avoided hospitalization days, prevented hospital readmissions, and prevented deaths defined the effectiveness of the model. All the costs were estimated based on the SUS database. Results: Early nutrition therapy provided to all at-risk or malnourished patients would represent cost-effectiveness of US $92.24, US $544.59, US $1848.12, and US $3698.92, for each day of hospitalization avoided, for additional patients having access to hospitalization, for preventing readmission, and for prevented death, respectively. The highest impact on savings was represented by the mean reduction in the length of hospital stay. Conclusion: Early oral nutrition intervention for patients malnourished or at risk of malnutrition resulted in overall reduced hospital costs. These findings provide a rationale to tackle the implementation of educational programs focusing on the care of inpatients with malnutrition or its risk.
Objective:To analyze the COVID-19 pandemic in Brazil, a continental-sized country, considered as an emerging economy but with several regional nuances, focusing on the availability of human resources, especially for intensive care units. Methods: The database of the National Registry of Health Facilities was accessed. Healthcare professionals in the care of COVID-19 were georeferenced. We correlated the number of professionals with the parameters used by the World Health Organization. According to the Brazilian Intensive Care Medicine Association, we correlated the data for adult intensive care unit beds in each state with the number of professionals for each ten intensive care unit beds. The number of professionals, beds, and cases were then organized by state. Results: The number of physicians per 100 thousand inhabitants followed the World Health Organization recommendations; however, the number of nurses did not. The number of intensivists, registered nurses, nurse technicians specialized in intensive care, and respiratory therapists, necessary for every ten intensive care beds, was not enough for any of these professional categories. A complete team of critical care specialists was available for 10% of intensive care unit beds in Brazil. Conclusion: There is a shortage of professionals for intensive care unit, as we demonstrated for Brazil. Intensive care physical resources to be efficiently used require extremely specialized human resources; therefore, planning human resources is just as crucial as planning physical and structural resources.
Objectives: To establish if the procalcitonin (PCT) test's diagnostic performance is more clinically and cost-effective than C reactive protein (CRP) and White Cell Count (WCC) tests for suspicion of prodomal stage Meningococcal disease (MD) in children presenting at emergency department (ED) with a fever without source. MethOds: A decision analytic model was designed to reflect realistic clinical pathways for a child presenting with non-specific fever to ED. Test accuracy was evaluated using data from independent studies carried out in developed countries identified through a systematic literature search. Studies were combined to determine the optimal cutoff value for the PCT, CRP and WCC tests, each as an indicator of MD. Summary Receiver Operator Curve (SROC) analysis was used to determine the inter-study and overall diagnostic performance of each test from the areas under the curve (AUC), with 95% confidence intervals (CIs). Components of each clinical pathway were costed in UK sterling using the National Schedule of Reference Costs 2010-2011. Hospital stays were costed using the appropriate Health Resource Group code. Results: Seven studies involving 881 children with non-specific fever provided data for inclusion. The PCT test was more accurate (sensitivity= 89%, 95%CI= 75-96; specificity= 71%, 95%CI= 37-91) for early MD compared to CRP (sensitivity= 84%, 95%CI= 74-90; specificity= 60%, 95%CI= 44-74) and WCC (sensitivity= 50%, 95%CI= 39-60; specificity= 68%, 95%CI= 54-79). PCT had the best PLR (3.0, 95%CI= 1.8-7.8) to be viable as a rule-in test for MD and a borderline NLR as a rule-out test, making it a better option to either CRP (2.1, 95%CI= 1.4-3.1) or WCC (1.5, 95%CI= 1.0-2.3). Outcomes from the decision analytic model indicated that the PCT test was the most cost-effective (£2547 per patient treated), followed by the combined CRP and WCC test (£3069 per patient treated). cOnclusiOns: The improved sensitivity and specificity of the PCT test provides a more cost-effective test than the currently recommended CRP and WCC tests.
history of breast or ovarian cancer than BRCAwt (55.6% vs. 14.7%), [P=0.003]. Numerically lower GHS scores were reported in patients with BRCAm (mean EQ-5D overall index score=0.7 [SD: 0.2], mean VAS score=53.6 [SD: 18.1]) relative to BRCAwt (mean EQ-5D overall index score=0.8 [SD: 0.2], mean VAS score= 58.7 [SD: 22.4]) and BRCAunk (mean EQ-5D overall index score=0.8 [SD: 0.2], mean VAS score=67.7 [SD: 20.5]) patients. Conclusions: In this study, adult females with HER2-ABC, patients with BRCAm vs. BRCAwt were significantly younger and more likely to have a family history of breast or ovarian cancer. Numerically worse GHS scores were observed in patients with BRCAm relative to BRCAwt/BRCAunk. Future larger studies are warranted to validate these conclusions.
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