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Manjarres L.,Carlos Andrade Marin Hospital | Sanchez P.,Carlos Andrade Marin Hospital | Cabezas M.C.,Pontifical Catholic University of Ecuador | Cabezas M.C.,Health and Research Services | And 3 more authors.
BMC Health Services Research | Year: 2016

Background: Chronic kidney disease (CKD) is a disorder with high morbidity and mortality worldwide whose complications generate multiple costs. In Ecuador, only a few healthcare institutions have implemented management protocols aimed to reduce costs and to improve the quality of life of patients. The aim of this study is to evaluate the short-term (1-year) and long-term (5-year) costs and savings in the management of secondary hyperparathyroidism (SHPT) of hemodialyzed CKD patients by comparing calcitriol and paricalcitol in a large social security hospital in Quito, Ecuador. Methods: The estimation model assessed the resources used in the management of SHPT by comparing prospectively the cost savings within 1-year and 5-year time horizon with calcitriol and paricalcitol. Hospitalization, erythropoietin (EPO), treatment doses, intravenous iron consumption, and medical supplies were estimated according international references, based on the initial parathormone level (iPTH) of patients. The Ecuadorian National Reference costs (2014-2015) and institutional costs were used to calculate treatment costs. A statistical sensitivity analysis was also performed. Results: The study was based on data from 354 patients of whom 147 (41.4 %) had a value of iPTH in the range 300-600 pg/ml, 45 (12.8 %) in the range 601-800 pg/ml, and 162 (45.7 %) over 800 pg/ml. The 1-year estimated costs per patient for calcitriol and paricalcitol, respectively, were: medication, 63.88 USD and 1,123.44 USD; EPO, 19,522.95 USD and 16,478 USD; intravenous iron 143.21 USD and 187.76 USD. Yearly hospitalization costs per patient were 11,647.99 USD with calcitriol and 8,019.41 USD with paricalcitol. Total yearly costs per patient amounted to 31,378.02 USD with calcitriol and 25,809.50 USD with paricalcitol. Total savings using paricalcitol were 5,568.52 USD per patient compared with calcitriol. The 5-year cumulative medication costs were 319 USD for calcitriol and 2,403 USD for paricalcitol; EPO with calcitriol was 97,615 USD and with paricalcitol 82,394 USD; intravenous iron with calcitriol was 716 USD and paricalcitol 939 USD. Hospitalization costs for patients with calcitriol and paricalcitol were 43,095 USD and 62,595 USD, respectively. Total savings using paricalcitol amounted 32,414 USD per patient compared with calcitriol. Conclusions: Paricalcitol use generated more cost savings than calcitriol after 1 and 5 years. © 2016 The Author(s).


Ambrosio L.,University of Pamplona | Portillo M.C.,University of Southampton | Rodriguez-Blazquez C.,CIBER ISCIII | Martinez-Castrillo J.C.,Ramon y Cajal University Hospital | And 9 more authors.
Parkinsonism and Related Disorders | Year: 2016

Introduction: To explore the psychometric attributes of a new Satisfaction with Life Scale (SLS-6) in a wide Spanish-speaking population with Parkinson's disease (PD). Methods: This was an international, cross-sectional study. Several rater-based and patient-reported outcomes measures for evaluation of PD (e.g., Scales for Outcomes in Parkinson's Disease-Motor) and other constructs (e.g., Duke-UNC Functional Social Support Questionnaire, Scale for Living with Chronic Illness) were applied together with the SLS-6. Acceptability, scaling assumptions, reliability, precision, and construct validity were tested. Results: The study included 324 patients from five countries, with age (mean ± standard deviation) 66.67 ± 10.68 years. None of the SLS-6 items had missing values and all acceptability parameters fulfilled the standard criteria. Scaling assumptions allowed the calculation of a summary index from items 2 to 6, complementary to the global evaluation (item 1). For these five items, Cronbach's alpha was 0.85; the corrected item-total correlation 0.53-0.73; inter-item correlation, 0.45-0.70, with an item homogeneity index of 0.55. The standard error of measurement, based on Cronbach's alpha for a single observation, was 3.48. SLS-6 correlations were moderate to strong (rs ≥ 0.35) with the patient-reported outcomes and weak to moderate with the rater-based assessments used in the study. The SLS-6 total score was significantly different according to PD severity levels established according to Hoehn and Yahr staging, Clinical Impression of Severity Index, and Patient-Based Global Impression of Severity scale. Conclusion: The results suggest that SLS-6 is an easy, feasible, acceptable, consistent, precise and valid measure to evaluate satisfaction with life in PD patients. © 2016 Elsevier Ltd.


PubMed | JM Ramos Mejia Hospital, Carlos Andrade Marin Hospital, National Institute of Neurology and Neurosurgery, Vithas Xanit International Hospital and 5 more.
Type: | Journal: Parkinsonism & related disorders | Year: 2016

To explore the psychometric attributes of a new Satisfaction with Life Scale (SLS-6) in a wide Spanish-speaking population with Parkinsons disease (PD).This was an international, cross-sectional study. Several rater-based and patient-reported outcomes measures for evaluation of PD (e.g., Scales for Outcomes in Parkinsons Disease-Motor) and other constructs (e.g., Duke-UNC Functional Social Support Questionnaire, Scale for Living with Chronic Illness) were applied together with the SLS-6. Acceptability, scaling assumptions, reliability, precision, and construct validity were tested.The study included 324 patients from five countries, with age (mean standard deviation) 66.67 10.68 years. None of the SLS-6 items had missing values and all acceptability parameters fulfilled the standard criteria. Scaling assumptions allowed the calculation of a summary index from items 2 to 6, complementary to the global evaluation (item 1). For these five items, Cronbachs alpha was 0.85; the corrected item-total correlation 0.53-0.73; inter-item correlation, 0.45-0.70, with an item homogeneity index of 0.55. The standard error of measurement, based on Cronbachs alpha for a single observation, was 3.48. SLS-6 correlations were moderate to strong (rs 0.35) with the patient-reported outcomes and weak to moderate with the rater-based assessments used in the study. The SLS-6 total score was significantly different according to PD severity levels established according to Hoehn and Yahr staging, Clinical Impression of Severity Index, and Patient-Based Global Impression of Severity scale.The results suggest that SLS-6 is an easy, feasible, acceptable, consistent, precise and valid measure to evaluate satisfaction with life in PD patients.


Lopez-Cortes A.,University of the Americas in Ecuador | Jaramillo-Koupermann G.,University of the Americas in Ecuador | Munoz M.J.,University of the Americas in Ecuador | Cabrera A.,University of the Americas in Ecuador | And 4 more authors.
American Journal of the Medical Sciences | Year: 2013

INTRODUCTION:: The methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTR) and MTR reductase (MTRR) enzymes act in the folate metabolism, which is essential in methylation and synthesis of nucleic acids. The single nucleotide polymorphisms, MTHFR C677T, A1298C, MTR A2756G and MTRR A66G, cause alteration in the homocysteine levels and reduced enzymatic activity that generates deficiency in the assimilation of folates associated with DNA damage; that is, why it is important to know if the single nucleotide polymorphisms are associated with the pathological characteristics and development of prostate cancer, through a case-control retrospective study. METHODS:: DNA was extracted from 110 healthy and 104 affected men. The genotypes were determined by means of the polymerase chain reaction-restriction fragment length polymorphism and confirmed with genomic sequencing. RESULTS:: We found significant association between the genotypes of the MTHFR C677T polymorphism: C/T (odds ratio [OR] = 2.2; 95% confidence interval [CI] = 1.3-3.9; P = 0.008) and C/T + T/T (OR = 2.2; 95% CI = 1.3-3.9; P = 0.009) with the risk of prostate cancer development, and a slight association with MTRR A66G. Regarding pathological characteristics, we found significant risk between the C/T + T/T genotypes and the Gleason score (7-10) of poorly differentiated carcinoma (OR = 5.2; 95% CI = 1.7-16.2; P = 0.007). On the other hand, a significant association between A1298C, A66G, and A2756G with the pathological characteristics was not found (P > 0.05). CONCLUSIONS:: The MTHFR C677T polymorphism has significant effects on susceptibility to prostate cancer in Ecuadorian population, especially with the Gleason grade. © 2013 Lippincott Williams & Wilkins.


PubMed | University of Liège, Carlos Andrade Marin Hospital, University of the Americas in Chile and Pontifical Catholic University of Ecuador
Type: | Journal: BMC health services research | Year: 2016

Chronic kidney disease (CKD) is a disorder with high morbidity and mortality worldwide whose complications generate multiple costs. In Ecuador, only a few healthcare institutions have implemented management protocols aimed to reduce costs and to improve the quality of life of patients. The aim of this study is to evaluate the short-term (1-year) and long-term (5-year) costs and savings in the management of secondary hyperparathyroidism (SHPT) of hemodialyzed CKD patients by comparing calcitriol and paricalcitol in a large social security hospital in Quito, Ecuador.The estimation model assessed the resources used in the management of SHPT by comparing prospectively the cost savings within 1-year and 5-year time horizon with calcitriol and paricalcitol. Hospitalization, erythropoietin (EPO), treatment doses, intravenous iron consumption, and medical supplies were estimated according international references, based on the initial parathormone level (iPTH) of patients. The Ecuadorian National Reference costs (2014-2015) and institutional costs were used to calculate treatment costs. A statistical sensitivity analysis was also performed.The study was based on data from 354 patients of whom 147 (41.4%) had a value of iPTH in the range 300-600pg/ml, 45 (12.8%) in the range 601-800pg/ml, and 162 (45.7%) over 800pg/ml. The 1-year estimated costs per patient for calcitriol and paricalcitol, respectively, were: medication, 63.88 USD and 1,123.44 USD; EPO, 19,522.95 USD and 16,478 USD; intravenous iron 143.21 USD and 187.76 USD. Yearly hospitalization costs per patient were 11,647.99 USD with calcitriol and 8,019.41 USD with paricalcitol. Total yearly costs per patient amounted to 31,378.02 USD with calcitriol and 25,809.50 USD with paricalcitol. Total savings using paricalcitol were 5,568.52 USD per patient compared with calcitriol. The 5-year cumulative medication costs were 319 USD for calcitriol and 2,403 USD for paricalcitol; EPO with calcitriol was 97,615 USD and with paricalcitol 82,394 USD; intravenous iron with calcitriol was 716 USD and paricalcitol 939 USD. Hospitalization costs for patients with calcitriol and paricalcitol were 43,095 USD and 62,595 USD, respectively. Total savings using paricalcitol amounted 32,414 USD per patient compared with calcitriol.Paricalcitol use generated more cost savings than calcitriol after 1 and 5years.


Cardenas P.A.,San Francisco de Quito University | Cardenas P.A.,Imperial College London | Alarcon M.,Carlos Andrade Marin Hospital | Narvaez I.,Carlos Andrade Marin Hospital | And 4 more authors.
International Microbiology | Year: 2013

Staphylococcus aureus is a frequent cause of nosocomial pneumonia and bacteremia worldwide. Classical and molecular epidemiology approaches were used to study a S. aureus outbreak in the intensive care unit (ICU) of one of the largest public hospitals in Quito. Staphylococcus aureus isolates from 17 patients and 19 potential carriers from the staff were collected from March 2007 to February 2008 and analyzed by pulsed-field gel electrophoresis (PFGE) to determine their clonal relationships. During this period the hospital reported 16 cases of hospital-acquired staphylococcal pneumonia and an apparent outbreak occurred from June to September 2007. DNA from these isolates formed six different PFGE patterns: four clonal groups, and two groups of clonally related isolates. Molecular typing failed to identify any staphylococcal reservoir among staff members. The current study suggested that a staphylococcal outbreak that occurred in the summer of 2007 was caused by different bacterial clones, although some clones were shared by two patients. Historical analysis of the staphylococcal infections in the ICU showed a higher incidence during the summer months, which coincided with the programmed personnel shift. This observation suggests that outbreaks might be produced by the introduction of improperly trained personnel.


Serrano-Duenas M.,Carlos Andrade Marin Hospital | Serrano-Duenas M.,Pontifical Catholic University of Ecuador | Calero B.,Pontifical Catholic University of Ecuador | Serrano S.,Pontifical Catholic University of Ecuador | And 2 more authors.
Movement Disorders | Year: 2010

Parkinson's disease (PD) is a chronic neurodegenerative disorder that causes cognitive impairment and dementia in 30% of patients. Objective: Compare metric qualities of Mini-Mental Parkinson (MMP) and scales for outcomes in Parkinson's disease-cognition (SCOPA-COG) with respect to their relative reliability, validity and ability to predict symptoms (mobility, quality of life, social repercussions, and mood) in PD patients. Outpatients (n=123, 78 males/45 females) diagnosed with PD were included in the study. A multilevel (hierarchical) modeling analysis was performed along with tests of reliability and validity to ascertain which of the two models better predicts symptoms related to PD. Results: The MMP differed significantly between patients with Hoehn and Yahr (H&Y) stages 1, 2 or versus 4/5 (grouped together). The SCOPA-COG showed differences only between patients in H&Y stages 2 versus 4/5. Both scales were dependent on educational background and age. The SCOPA-COG had a higher coefficient of variation (0.303) than the MMP (0.184), indicating that it was the more discriminative of the two. Conclusions: The SCOPA-COG has some advantages over the MMP, the most important being a greater discriminative ability. Multilevel hierarchical analysis clarified the necessity of stratifying the PD population according to educational background, years of illness, and H&Y stage when using these scales. © 2010 Movement Disorder Society.


Serrano-Duenas M.,Carlos Andrade Marin Hospital | Serrano-Duenas M.,Pontifical Catholic University of Ecuador | Calero B.,Pontifical Catholic University of Ecuador | Serrano S.,Pontifical Catholic University of Ecuador | And 2 more authors.
Movement Disorders | Year: 2010

Background: The RSGE-PD-V2.0 is a specific measure for evaluation of gait impairment in PD. Objective: To check the RSGE-PD-V2.0 metrics attributes. Methods: In addition to demographic and historical data of PD, applied assessments were: Hoehn and Yahr staging (H&Y); impact in daily activities with Schwab and England scale (S&E); SCOPA Motor; mental status with Short portable mental status questionnaire (SPMSQ); quality of life with Parkinson's impact scale (PIMS), the Hamilton Depression Rating Scale-6 items (HDRS-6); and, the Clinical Impression of Severity Index-PD (CISI-PD). Results: 151 PD patients were included (n = 102 (67.5%) were male). Most patients were in H&Y stage 3 (n = 78 (51.6%)). Mean of age and duration of disease was 68.4 and 7.6 years respectively. Mean values of L-Dopa doses was 652.6 mg/day. Mean values of SCOPA Motor were 29.1; SPMSQ: 1.8; HADS-6: 9.2; PIMS: 18.7; RSGE-PD-V2.0: 25.4; and, CISI-PD were 10.8. Full computable scores were 100%; Guttman's lambda, 0.954; and the item-total correlation, 0.408-0.830. Correlation coefficients (Spearman's rho) between RSGE-PD-V2.0 and H&Y, S&E, SCOPA Motor, PIMS and CISI-PD, were: 0.62; -0.75; 0.74; 0.46; and, 0.78 respectively. RSGE-PDV2.0 scale significantly discriminated among PD severity levels (based on H&Y staging) Kruskal-Wallis (p < 0.000). Conclusions: Metric attributes of the RSGE-PD-V2.0 in this sample of study resulted in has sufficient and suitable satisfactory. We, therefore, believe that RSGE-PD-V2.0 is easy and a useful and recommendable specific tool for measuring gait disease in PD patients. © 2010 Movement Disorder Society.


PubMed | Carlos Andrade Marin Hospital
Type: Journal Article | Journal: Movement disorders : official journal of the Movement Disorder Society | Year: 2010

The RSGE-PD-V2.0 is a specific measure for evaluation of gait impairment in PD.To check the RSGE-PD-V2.0 metrics attributes.In addition to demographic and historical data of PD, applied assessments were: Hoehn and Yahr staging (H&Y); impact in daily activities with Schwab and England scale (S&E); SCOPA Motor; mental status with Short portable mental status questionnaire (SPMSQ); quality of life with Parkinsons impact scale (PIMS), the Hamilton Depression Rating Scale-6 items (HDRS-6); and, the Clinical Impression of Severity Index-PD (CISI-PD).151 PD patients were included (n = 102 (67.5%) were male). Most patients were in H&Y stage 3 (n = 78 (51.6%)). Mean of age and duration of disease was 68.4 and 7.6 years respectively. Mean values of L-Dopa doses was 652.6 mg/day. Mean values of SCOPA Motor were 29.1; SPMSQ: 1.8; HADS-6: 9.2; PIMS: 18.7;RSGE-PD-V2.0: 25.4; and, CISI-PD were 10.8. Full computable scores were 100%; Guttmans lambda, 0.954; and the item-total correlation, 0.408-0.830. Correlation coefficients (Spearmans rho) between RSGE-PD-V2.0 and H&Y, S&E, SCOPA Motor, PIMS and CISI-PD, were: 0.62; -0.75; 0.74; 0.46; and, 0.78 respectively. RSGE-PD-V2.0 scale significantly discriminated among PD severity levels (based on H&Y staging) Kruskal-Wallis (p < 0.000).Metric attributes of the RSGE-PD-V2.0 in this sample of study resulted in has sufficient and suitable satisfactory. We, therefore, believe that RSGE-PD-V2.0 is easy and a useful and recommendable specific tool for measuring gait disease in PD patients.

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