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Miami Beach, FL, United States

Perez C.,Hospital Universitario La Paz | Navarro A.,Care Angel | Saldana M.T.,Primary Care Health Center Raices | Wilson K.,Pfizer | Rejas J.,Pfizer
Clinical Journal of Pain | Year: 2015

OBJECTIVE: The aim of the present analysis was to model the association and predictive value of pain intensity on cost and resource utilization in patients with chronic peripheral neuropathic pain (PNP) treated in routine clinical practice settings in Spain. METHODS: We performed a secondary economic analysis based on data from a multicenter, observational, and prospective cost-of-illness study in patients with chronic PNP that is refractory to prior treatment. Pain intensity was measured using the Short-Form McGill Pain Questionnaire. Univariate and multivariate linear regression models were fitted to identify independent predictors of cost and health care/non-health care resource utilization. RESULTS: A total of 1703 patients were included in the current analysis. Pain intensity was an independent predictor of total costs ([total costs]=35.6 [pain intensity]+214.5; coefficient of determination [R]=0.19, P<0.001), direct costs ([direct costs]=10.8 [pain intensity]+257.7; R2=0.06, P<0.001), and indirect costs ([indirect costs]=24.8 [pain intensity]-43.4; R2=0.20, P<0.001) related to chronic PNP in the univariate analysis. Pain intensity remains significantly associated with total costs, direct costs, and indirect costs after adjustment by other covariates in the multivariate analysis (P<0.001). None of the other variables considered in the multivariate analysis were predictors of resource utilization. DISCUSSION: Pain intensity predicts the health care and non-health care resource utilization, and costs related to chronic PNP. Management of patients with drugs associated with a higher reduction of pain intensity may have a greater impact on the economic burden of that condition. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.

Navarro A.,Care Angel | Saldana M.T.,Primary Care Health Center Raices | Perez C.,Pain Clinics | Torrades S.,European Biometrics Institute | Rejas J.,Pfizer
BMC Neurology | Year: 2011

Background: Neuropathic pain (NeP) is a common symptom of a group of a variety of conditions, including diabetic neuropathy, trigeminal neuralgia, or postherpetic neuralgia. Prevalence of NeP has been estimated to range between 5-7.5%, and produces up to 25% of pain clinics consultations. Due to its severity, chronic evolution, and associated co-morbidities, NeP has an important individual and social impact. The objective was to analyze the effect of pregabalin (PGB) on pain alleviation and longitudinal health and non-health resources utilization and derived costs in peripheral refractory NeP in routine medical practice in primary care settings (PCS) in Spain.Methods: Subjects from PCS were older than 18 years, with peripheral NeP (diabetic neuropathy, post-herpetic neuralgia or trigeminal neuralgia), refractory to at least one previous analgesic, and included in a prospective, real world, and 12-week two-visit cost-of-illness study. Measurement of resources utilization included both direct healthcare and indirect expenditures. Pain severity was measured by the Short Form-McGill Pain Questionnaire (SF-MPQ).Results: One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB). Reductions of pain severity were higher in both PGBm and PGB add-on groups (54% and 51%, respectively) than in non-PGB group (34%), p < 0.001. Incremental drug costs, particularly in PGB subgroups [€34.6 (80.3), €160.7 (123.9) and €154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€1,045.3 (1,989.6),-€1,312.9 (1,543.0), and -€1,565.5 (2,004.1), for the three groups respectively (p = 0.03).Conclusion: In Spanish primary care settings, PGB given either add-on or in monotherapy in routine medical practice was associated with pain alleviation leading to significant longitudinal reductions in resource use and total costs during the 12-week period of the study compared with non-PGB-therapy of patients with chronic NeP of peripheral origin. The use of non-appropriate analgesic therapies for neuropathic pain in a portion of subjects in non-PGB group could explain partially such findings. © 2011 Navarro et al; licensee BioMed Central Ltd.

Implementing a nutrition support protocol in critical care is a complex and dynamic process that involves the use of evidence, education programs and constant monitoring. To facilitate this task we developed a mnemonic tool called the Nutritional FAST HUG (F: feeding, A: analgesia, S: stools, T: trace elements, H: head of bed, U: ulcers, G: glucose control) with a process also internally developed (both modified from the mnemonic proposed by Jean Louis Vincent) called MIAR (M: measure, I: interpret, A: act, R: reanalysis) showing an easy form to perform medical rounds at the intensive care unit using a systematic process. © 2015 Grupo Aula Medica S.A. All rights reserved.

Faisy C.,University of Paris Descartes | Llerena M.C.,Care Angel | Savalle M.,University of Paris Descartes | Mainardi J.-L.,University of Paris Descartes | Fagon J.-Y.,University of Paris Descartes
Chest | Year: 2011

Background: Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients'early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP). Methods: In this prospective, observational, cohort study conducted in a teaching hospital ICU, energy balance (energy delivered - calculated resting energy expenditure) was compared according to the microbiologic results of the fiber-optic BAL cultures of 76 consecutive patients receiving acute prolonged (≥ 96 h) mechanical ventilation who developed VAP during their ICU stay. Results: Among the 76 BAL cultures, 22 contained significant Staphylococcus aureus concentrations. The cumulated energy deficit of patients with S aureus VAP was greater than those with VAP caused by other pathogens (-10,275 ± 4,211 kcal vs -7,376 ± 4,013 kcal from ICU admission to day of BAL, P < .01). ICU admission, nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with S aureus VAP had lower prescribed and delivered energy, causing higher energy deficits. Multivariate analysis identified energy deficit as being independently associated with S aureus VAP. More-severe energy deficit and higher rate of S aureus -positive BAL cultures (P = .01 comparing quartiles) were observed. Conclusions: Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation. © 2011 American College of Chest Physicians.

Care Angel | Date: 2016-01-08

Interactive care monitoring of care receivers and notification system for care givers; interactive care monitoring of care receivers for monitoring of the mental, physical and emotional well-being and monitoring medication adherence of a care recipient; interactive care monitoring of the mental, physical and emotional well-being and monitoring medication adherence of a care recipient, namely, vitals including blood pressure, glucose, and blood oxygen for creating, storing, accessing and managing electronic personal health and medical records of a care recipient for caregivers through a communication network; interactive care monitoring of care receivers using artificial intelligence and interactive voice recognition algorithms and predictive analytics that allow for an audio and data communication bridge between a care recipient and one or more care giver or family member.

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