Hospital Universitario La Paz

About: Hospital Universitario La Paz is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Medicine. The organization has 8960 authors who have published 11499 publications receiving 191509 citations.

COVID-19 infection in children and adolescents with cancer in Madrid.

Abstract: To the Editor: The incidence of COVID-19 is remarkably less in the pediatric population than in the adult population, with children accounting for 1-5% of diagnosed cases,1-3 0.8% in Madrid.4 Although children with cancer are considered a high-risk population, data specifically addressing the pediatric oncology population are still limited.3,5 We present a case series of all pediatric oncology patients infected with COVID-19 in Madrid to date to provide updated epidemiological data and to describe the most relevant clinical features and outcomes. All pediatric oncology patients (0-18 years) with proven infection of COVID-19 inMadrid up toApril 15, 2020were identified and included. Approval was obtained by the local Ethics Committee. The total number of current pediatric oncology patients in the Madrid region was estimated through 2015-2019 data from the Madrid Tumor Registry “RTMAD.”6 The main patient (n = 15) characteristics are shown in Table 1. Median agewas 10.6 years (range 0.6-18.6). The cancer types included hematological malignancies (73%, 11) and solid tumors (27%, four). Four patients (27%) had received hematopoietic stem cell transplantation (median interval to COVID-19 infection: 209 days, range 113749). Most patients (60%, nine) had received chemotherapy in the 15 days prior to the COVID-19 infection. Chemotherapy had to be interrupted or delayed in six (40%). Seven (47%) patientswere hospitalized due to the COVID-19 infection, four (27%) were already hospitalized (nosocomial infection), and four (27%) were managed in the outpatient clinic. The most frequent symptoms were fever (67%, 10) and cough (40%, six). Two patients were asymptomatic. Chest radiographs were performed inmost patients (93%, 14), with pathological findings in 57% (8/14). Noteworthy laboratory findings includedmedianwhite blood cell count at diagnosis of 3195 (range 9010 690), median lymphocyte count of 580 (range 0-6310), and median D-dimer 291 ng/mL (range 0.7-2620). Most patients received hydroxychloroquine (73%, 11), three of them in different combinations (including azithromycin, tocilizumab, lopinavir-ritonavir, corticoids, remdesivir; Table 1). Four (29%) patients did not receive any treatment.NoCOVID-19 treatment-related severe adverse events were identified. Two patients required oxygen therapy (nasal cannula, <2 LPM), one of them still requiring support. All patients presented favorable clinical outcomes so far, although four of them remained hospitalized. Themedian hospital stay due to the infection was 8 days (range 3-26). Given that the estimated total number of pediatric oncology patients in theMadrid region is 1140, we observed a COVID-19 infection rate of 1.3% among this patient population over the first 2months of the pandemic. This study is particularly relevant for several reasons. First, it presents all pediatric oncology patients infected with COVID-19 in Madrid, one of the epicenters of the pandemic. Second, it provides an accurate estimation of the real incidence for this patient population, as both the total number of susceptible patients and the total number of infected patients are well known. For the former, the robustness of the local tumor registry (RTMAD)was the key; for the latter, the well-established collaboration network among pediatric oncologists in Madrid enabled the identificationof all infectedpatients. Furthermore, the fact that children with cancer are considered high-risk patients for the COVID-19 infection leads to thorough and repeated testing in this population, even in asymptomatic patients. This is not the case for the general pediatric population, as most healthy children are not being tested for COVID-19 unless they require hospitalization. Hence, we believe the accuracy of the calculated infection prevalence among pediatric oncology patients to be notably reliable, as opposed to estimations in the general pediatric population or in other subpopulations. Additionally, all patients were tested by polymerase chain reaction, which continues to be the gold standard and, in our opinion, should not be substituted by rapid serology-based testing in the pediatric oncology population.7 The COVID-19 infection prevalence among adult cancer patients has been reported to be higher than in the general population (1% vs 0.29%).8 No robust data exist to date regarding the infection prevalence in pediatric cancer patients. In our series, the estimated 1.3% is difficult to compare with the general pediatric population, estimated 0.8% inMadrid,4 since the latter is likely to be underestimated. In spite of these limitations, the incidence seems higher in children and adolescents with cancer. A worrisome finding is the high proportion of patients (27%) that presentedwith nosocomial infection. The infection rates of health care professionals in Spain have been among the highest in the world,9,10 whichmay explain the proportion of nosocomial infection. The clinical, radiological, and laboratory findings are similar to previously published data for the general pediatric population.1,3 Although there is no solid evidence for the treatment of the COVID19 infection beyond support therapy in children with cancer, hydroxychloroquine was the most frequently used drug in our series, with a good safety profile. Remarkably, all patients had favorable outcomes so

EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring

Abstract: Aim Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated. Methods and results A total of 312 patients with VVI- or DDD-ICD implants from 17 centres in six EU countries were randomised to HM ON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar- or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 ± 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 ± 1.67 vs. 5.53 ± 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 ± 1.50 vs. 0.62 ± 1.25; P < 0.005), more non-office-based contacts (1.95 ± 3.29 vs. 1.01 ± 2.64; P < 0.001), more Internet sessions (11.02 ± 15.28 vs. 0.06 ± 0.31; P < 0.001) and more in-clinic discussions (1.84 ± 4.20 vs. 1.28 ± 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 ± 1.18 vs. 0.85 ± 1.43, P = 0.23) and shorter length-of-stay (6.31 ± 15.5 vs. 8.26 ± 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): €204 (169–238) vs. €213 (182–243); range for difference (€−36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of €408 (327–489) vs. €400 (345–455); range for difference (€−104 to 88), NS], but there was heterogeneity among countries, with less profit for providers in the absence of specific remote FU reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different. Conclusion For all the patients as a whole, FU-related costs for providers are not different for remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on provider budget among different countries illustrates the need for proper reimbursement to ensure effective remote FU implementation.

Multisystem Inflammatory Syndrome in Children: An International Survey.

Abstract: OBJECTIVES: To describe presentation, hospital course, and predictors of bad outcome in multisystem inflammatory syndrome in children (MIS-C). METHODS: Retrospective data review of a case series of children meeting the published definition for MIS-C who were discharged or died between March 1, 2020, and June 15, 2020, from 33 participating European, Asian, and American hospitals. Data were collected through a Web-based survey and included clinical, laboratory, electrocardiographic, and echocardiographic findings and treatment management. RESULTS: We included 183 patients with MIS-C: male sex, 109 (59.6%); mean age 7.0 ± 4.7 years; Black race, 56 (30.6%); obesity, 48 (26.2%). Overall, 114 of 183 (62.3%) had evidence of severe acute respiratory syndrome coronavirus 2 infection. All presented with fever, 117 of 183 (63.9%) with gastrointestinal symptoms, and 79 of 183 (43.2%) with shock, which was associated with Black race, higher inflammation, and imaging abnormalities. Twenty-seven patients (14.7%) fulfilled criteria for Kawasaki disease. These patients were younger and had no shock and fewer gastrointestinal, cardiorespiratory, and neurologic symptoms. The remaining 77 patients (49.3%) had mainly fever and inflammation. Inotropic support, mechanical ventilation, and extracorporeal membrane oxygenation were indicated in 72 (39.3%), 43 (23.5%), and 4 (2.2%) patients, respectively. A shorter duration of symptoms before admission was found to be associated with poor patient outcome and for extracorporeal membrane oxygenation and/or death, with 72.3% (95% confidence interval: 0.56–0.90; P = .006) increased risk per day reduction and 63.3% (95% confidence interval: 0.47–0.82; P CONCLUSIONS: In this case series, children with MIS-C presented with a wide clinical spectrum, including Kawasaki disease–like, life-threatening shock and milder forms with mainly fever and inflammation. A shorter duration of symptoms before admission was associated with a worse outcome.

Lateral epicondylitis of the elbow

Abstract: Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients.The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment.The diagnosis is usually clinical but some patients may benefit from additional imaging for a specific differential diagnosis.The disease has a self-limiting course of between 12 and 18 months, but in some patients, symptoms can be persistent and refractory to treatment.Most patients are well-managed with non-operative treatment and activity modification. Many surgical techniques have been proposed for patients with refractory symptoms.New non-operative treatment alternatives with promising results have been developed in recent years. Cite this article: Vaquero-Picado A, Barco R, Antuna SA. Lateral epicondylitis of the elbow. EFORT Open Rev 2016;1:391-397. DOI: 10.1302/2058-5241.1.000049.

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Abstract: Purpose Recalibration and determining discriminative power, internationally, of the existing delirium prediction model (PRE-DELIRIC) for intensive care patients.