ABSTRACT: OBJECTIVE: To compare the estimated cost of treatment of spinal disorders to those of this treatment in a specialized center. METHODS: An evaluation of average treatment costs of 399 patients referred by a Health Insurance Company for evaluation and treatment at the Spine Treatment Reference Center of Hospital Israelita Albert Einstein. All patients presented with an indication for surgical treatment before being referred for assessment. Of the total number of patients referred, only 54 underwent surgical treatment and 112 received a conservative treatment with motor physical therapy and acupuncture. The costs of both treatments were calculated based on a previously agreed table of values for reimbursement for each phase of treatment. RESULTS: Patients treated non-surgically had an average treatment cost of US$ 1,650.00, while patients treated surgically had an average cost of US$ 18,520.00. The total estimated cost of the cohort of patients treated was US$ 1,184,810.00, which represents a 158.5% decrease relative to the total cost projected for these same patients if the initial type of treatment indicated were performed. CONCLUSION: Treatment carried out within a center specialized in treating spine pathologies has global costs lower than those regularly observed.
Einstein (Sao Paulo, Brazil). 03/2013; 11(1):102-107.
ABSTRACT: Little information exists on the epidemiology and patterns of treatment of patients admitted to Brazilian hospitals with stroke. Our objective was to describe the frequency of risk factors, patterns of management, and outcome of patients admitted with stroke in Fortaleza, the fifth largest city in Brazil.
Data were prospectively collected from consecutive patients admitted to 19 hospitals in Fortaleza with a diagnosis of stroke or transient ischemic attack from June 2009 to October 2010.
We evaluated 2407 consecutive patients (mean age, 67.7±14.4 years; 51.8% females). Ischemic stroke was the most frequent subtype (72.9%) followed by intraparenchymal hemorrhage (15.2%), subarachnoid hemorrhage (6.0%), transient ischemic attack (3%), and undetermined stroke (2.9%). The median time from symptoms onset to hospital admission was 12.9 (3.8-32.5) hours. Hypertension was the most common risk factor. Only 1.1% of the patients with ischemic stroke received thrombolysis. The median time from hospital admission to neuroimaging was 3.4 (1.2-26.5) hours. In-hospital mortality was 20.9% and the frequency of modified Rankin Scale score≤2 at discharge was less than 30%. Older age, prestroke disability, and having a depressed level of consciousness at admission were independent predictors of poor outcome; conversely, male gender was a predictor of good outcome.
The prevalence of stroke risk factors and clinical presentation in our cohort were similar to previous series. Treatment with thrombolysis and functional independency after a stroke admission were infrequent. We also found long delays in hospital admission and in evaluation with neuroimaging and high in-hospital mortality.
Stroke 11/2011; 42(12):3341-6. · 5.73 Impact Factor
ABSTRACT: The aim of this study was to evaluate the change in hyperemia and intraocular pressure (IOP) in patients who switch from prostaglandin or prostamide to a fixed combination of prostamide and timolol maleate.
A multicenter, longitudinal, noncontrolled, nonrandomized open trial was conducted.
One hundred forty-four patients (282 eyes) were selected: 60 (41.6%) were on travaprost, 51 (35.4%) on bimatoprost, and 33 (22.9%) on latanoprost. All patients included were unable to attain adequate IOP control with monotherapy and had no contraindications to β-blockers.
Patients were treated with a fixed combination of bimatoprost and timolol maleate. Hyperemia was evaluated using a referential table, and IOP was measured at 8:00, 12:00, and 16:00 h both before and after 4 months of treatment.
IOP and hyperemia were compared at 2 time points: pretreatment and after 4 months. The mean of the 3 IOP measurements taken at various points during the day was considered for analysis. Generalized estimating equations were used for repeated measures and intereye dependency adjustments.
Hyperemia and IOP were reduced in all 3 groups, with the same pattern for both eyes. The bimatoprost group had the highest levels of hyperemia before treatment when compared with the latanoprost as well as the travaprost group and had the greatest reduction in hyperemia after treatment (P < 0.01). Regarding IOP, all 3 groups had a significant reduction (P < 0.001), but the bimatoprost group had a lower pretreatment IOP when compared with the travaprost and latanoprost groups.
A significant reduction in hyperemia was found after switching from monotherapy with prostaglandins or prostamide to a fixed combination of prostamide and a β-blocker. IOP reduction was significant after the intervention in all 3 groups.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 10/2010; 26(6):611-5. · 1.46 Impact Factor