PubMed Health⌕ Search

Biomedical subjects

P de la Cuadra

Publications and source records attributed to P de la Cuadra.

5 recordsLinked to original sources
PubMed2006

Economic evaluation of adherence to treatment guidelines in nonintensive care pneumonia.

Guidelines have been developed to improve the treatment of community-acquired pneumonia (CAP) but information regarding their influence on costs is lacking. The aim of the present study was to conduct a cost-effectiveness analysis of CAP treatment from the hospital perspective when adhering to Spanish guidelines. A prospective cohort study was performed in 271 patients with CAP admitted to a tertiary-care hospital, not needing intensive care. Collected data included patients' characteristics, comorbidity, initial risk class, resource use (medication, blood and microbiological analyses, and radiology) and economic data. Antimicrobial treatment was recorded as adherent or nonadherent to Spanish guidelines. Outcome measures were mortality and readmission at 30 days. The median cost for adherent treatment was 1,665.5 versus 1,710.5 Euros for nonadherent treatment. Mortality and readmission were 10% and 2.1% for adherent treatment versus 13.6% and 6.2% for nonadherent treatment. The cost-effectiveness ratio was 2,277 Euros per expected cure for patients treated according to the guidelines and 2,567 Euros per expected cure for the nonadherence group. The incremental cost-effectiveness ratio showed that adherence to treatment guidelines saved 1,121 Euros per patient cured compared with nonadherence. The sensitivity analysis demonstrated that the findings were robust. An antimicrobial treatment according to guidelines is the dominant alternative due to its cost-effectiveness.

Aged↗
PubMed2000

Pediatric stress fractures.

Stress fractures in children are uncommon. This report describes the findings of 8 cases in 6 children. One patient had 3 stress fractures: 2 consecutive midshaft stress fractures of the same tibia associated with one of the fibula. Signs and symptoms may be misdiagnosed as malignant tumors or osteomyelitis. Serial radiographs and computed tomography scans are the key to the diagnosis, although bone scan and magnetic resonance imaging can be helpful. Biopsy is unnecessary and might even be misleading.

Adolescent↗
PubMed1999

[20210G/A mutation of prothrombin gene in a patient with deep venous thrombosis ad pulmonary embolism without other risk factors of thrombosis].

A new genetic anomaly predisposing to venous thrombosis was described in 1996, namely the transition of guanine (G) to adenine (A) at position 20210 in the 3-untranslated region of the prothrombin gene. This mutation is associated with high levels of plasma prothrombin and increased risk of thrombotic events in the venous system. We report the case of a man who, lacking known risk factors for thrombosis, suffered a massive pulmonary embolism and deep venous thrombosis in both lower legs. Thrombophilic analysis confirmed that the patient and close relatives were carriers of the heterozygotic 20210G/A variant of the prothrombin gene. Two relatives with the genetic defect had also suffered some type of deep venous thrombosis.

Adult↗
PubMed1997

[Treatment of asthmatic crises at a hospital emergency service. Are the protocols followed?].

Improper assessment and treatment of asthma attacks have been identified as causes of increased morbidity and mortality: several pneumological societies have therefore created and published guidelines for facilitating decision making and for preventing unnecessary failures of therapy. The objective of this study was to examine emergency department compliance with such guidelines in our hospital, comparing the performance of pneumologists and other specialists. We reviewed the records of 117 patients treated for acute asthma attacks in 1994 (87 women and 30 men, mean age 46 years); 37 patients were treated by pneumologists and 80 by other specialists. The two physician groups differed significantly with respect to initial assessment of severity, particularly in the recording of vital signs (p < 0.05) and in the examination of some signs such as the use of accessory musculature (38% versus 10%, for pneumologists and other specialists, respectively) or the presence of cyanosis (81% versus 55%). Other factors associated with risk of death were noted only occasionally. Peak flow meters were used with only 5 patients, all examined by pneumologists; on the other hand, arterial blood samples for gasometric measurements were taken from 97%, although only 24% met the criteria stipulated in the guidelines. Treatment evaluated against the guidelines was incorrect in 24%, with no significant differences between pneumologists and other specialists. We conclude that: 1) the emergency clinical assessment and treatment of patients presenting with acute asthma attack is inadequate for a large proportion of patients, as the recommendations of consensual guidelines are habitually ignored, and 2) although there are differences in the management of these patients by pneumologists and other emergency room specialists, the former do not generally do a better job of following the guidelines.

Adolescent↗