Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.
Objetivo: El cáncer gástrico es la segunda causa de muerte por cáncer y la quinta neoplasia más frecuente en el mundo. En Colombia, es la primera causa de mortalidad por cáncer. La incidencia y mortalidad anuales son 16,3 y 14,2/100.000 habitantes respectivamente. El objetivo de este estudio fue estimar su carga de enfermedad, medida en años de vida ajustados por discapacidad (AVAD), en Colombia.Métodos: Se desarrolló un estudio con enfoque en prevalencia para el año 2014. Para estimar la prevalencia se realizó una búsqueda en los registros del Sistema de Información en Protección Social (SISPRO), y el Departamento Administrativo Nacional de Estadística (DANE). La duración promedio de los casos prevalentes y la sobrevida estimada se obtuvieron de la literatura local. Los AVAD fueron calculados sumando los años de vida perdidos por muerte prematura (AVPM) y los años de vida vividos con discapacidad (AVVD), según metodología de la Organización Mundial de la Salud (OMS).Resultados: las prevalencias estimadas para cinco años en población mayor de 15 años fueron 40,9/100.000 en mujeres y 62,5/100.000 en hombres. El total de AVAD fue 293.418, con una tasa de 623/100.000 habitantes; 97,4% corresponden a AVPM. La tasa de AVVD y AVPM para Colombia fue 16 y 607/100.000, respectivamente.Conclusiones: los datos obtenidos de SISPRO y el DANE estiman una alta carga de enfermedad en Colombia. Es necesaria la implementación de estrategias de detección temprana del cáncer para disminuir la carga de la enfermedad y mejorar el pronóstico de los pacientes.
49,9%, lipid-lowering 22,7% and Antidiabetics the 6,1% of the total annual follow up medication cost . For the patients were subjected to ICD initial implantation antiplatelet-anticoagulants represent 24,4 %, antiarrhythmic 2,2 %, cardiovascular 44,2 %, lipid-lowering 25,0% and antidiabetics 4,1% of the total annual follow up medication cost. For the patients were subjected to ICD replacement antiplatelet-anticoagulants represent the 28,7 %, antiarrhythmic the 7,7 %, Cardiovascular 58,1 %, Lipid-lowering 5,5% and Antidiabetics 0,0% of the total annual follow up medication cost . ConClusions: The present study provides unique data regarding the percentage of annual medication cost attributed to each kind of treatment of unselected patients subjected to CRMDs implantation in a real-world setting.
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