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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine if permanent pacemaker implants &#40;PPM&#41; interventions and change of generator are more efficient in small hospitals&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cost-effective analysis and retrospective&#44; cross-sectional and observational study of diagnostic related groups &#40;DRG&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The data was obtained from the national Minimum Basic Data Set &#40;MBDS&#41; for the year 2007 provided by the Health Ministry&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This includes the total number of patients who required treatment in all national hospitals for 5 DRG&#58; 115 - bradyarrhythmic complication during the acute coronary syndrome&#44; heart failure or shock&#59; 116 - symptomatic isolated conduction defects&#59; 117 - revisions&#44; but without changing the battery&#44; 118 - application of a new one&#44; 549 - implementation or revision but with serious complications&#46;</p> <span class="elsevierStyleSectionTitle">Principal variables of interest</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical &#40;number of secondary diagnoses &#40;NSD&#41; and procedures &#40;NP&#41;&#44; mortality&#41; and management &#40;total and preoperative length of stay &#40;LOS&#41;&#44; access&#44; discharge&#44; hospital size&#41;&#44; defining inefficient stays as those exceeding 2 days on the average&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">23&#44;154 episodes&#44; 5&#46;3&#37; small hospitals&#46; The comparative bivariate study between small hospitals and the rest&#44; not discriminated by DRG&#44; showed a mean LOS of 7&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;78 days vs 11&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;95 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#44; 95&#37; CI for mean difference &#91;0&#46;17&#44; 1&#46;65&#93;&#41; and also lower than preoperatively &#40;3&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;14 vs&#46; 4&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;68 days &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#93;&#41; without greater comorbidity&#44; as measured by proxy through the NSD &#40;5&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;88 vs 5&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;28 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;055&#93;&#41; and NP as proxy of diagnostic and therapeutic effort &#40;3&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;50 vs 3&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;69 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#93;&#41;&#46; A total of 24&#46;1&#37; were inefficient&#44; there being an association with preoperative stay&#44; NDS&#44; NP and emergency access&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pacemaker implantation and generator change in small hospitals is more efficient&#44; with internal consistency by subgroups&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Determinar si el implante de marcapasos permanentes &#40;MPP&#41; y cambio de generador resultan m&#225;s eficientes en hospitales peque&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de costeefectividad&#46; Estudio retrospectivo&#44; transversal y observacional de cinco GDR&#46;</p> <span class="elsevierStyleSectionTitle">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los datos son procedentes del conjunto m&#237;nimo b&#225;sico de datos &#40;CMBD&#41; nacional del a&#241;o 2007&#44; facilitado por el Ministerio de Sanidad&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Son el total de los pacientes que requirieron asistencia en alg&#250;n hospital nacional por 5 GRD&#58; 115&#44; complicaci&#243;n bradiarr&#237;tmica durante la fase aguda de un s&#237;ndrome coronario&#44; insuficiencia card&#237;aca o shock&#59; 116&#44; trastorno de conducci&#243;n sintom&#225;tico aislado&#59; 117&#44; revisi&#243;n pero sin cambio de bater&#237;a&#59; 118&#44; aplicaci&#243;n de una nueva&#44; y 549&#44; implantaci&#243;n o revisi&#243;n pero con complicaciones graves&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s principales</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se analizaron variables demogr&#225;ficas&#44; cl&#237;nicas &#40;n&#250;mero de diagn&#243;sticos secundarios &#91;NDS&#93;&#44; de procedimientos &#91;NP&#93;&#44; mortalidad&#41; y de gesti&#243;n &#40;estancia total y preoperatoria &#91;Epo&#93;&#44; forma de acceso y alta&#44; tama&#241;o de hospital&#41;&#44; definiendo ineficiente una estancia superior 2 d&#237;as a la media&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">23&#46;154 episodios &#40;5&#44;3&#37; en hospitales<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200 camas&#41;&#46; El estudio bivariado comparativo entre hospitales peque&#241;os y el resto&#44; no discriminado por GDR&#44; mostr&#243; estancia media 7&#44;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;01 d&#237;as vs&#46; 8&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;95 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#44; IC 95&#37; &#91;0&#44;17&#59; 1&#44;65&#93;&#41; y Epo 3&#44;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;14 vs&#46; 4&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;68 d&#237;as &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#93;&#41;&#44; sin mayor comorbilidad&#44; medida como proxy por NDS &#40;5&#44;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;88 vs&#46; 5&#44;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;28 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;055&#93;&#41;&#59; y NP como proxy de esfuerzo diagn&#243;stico-terap&#233;utico &#40;3&#44;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;50 vs&#46; 3&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;69 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#93;&#41;&#46; 24&#44;1&#37; fueron ineficientes&#44; encontr&#225;ndose asociaci&#243;n con Epo&#44; NDS&#44; NP y acceso urgente&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La implantaci&#243;n de marcapasos y cambio de generador en hospitales peque&#241;os es m&#225;s eficiente&#44; con consistencia interna por subgrupos&#46;</p>"
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Is the permanent pacemaker implant more efficient in level 1 hospital?
¿Es más eficiente el implante de marcapasos permanentes en hospitales de nivel I?
E. Moreno-Millána, J.M. García-Torrecillasb, J. Villegas-del Ojoa,
Corresponding author
jvdo76@hotmail.com

Corresponding author.
, F. Prieto-Valderreya
a. Servicio de Medicina Intensiva, Hospital «Santa Bárbara», Puertollano, Spain
b. Servicio de Cuidados Críticos y Urgencias, Complejo Hospitalario «Torrecárdenas», Almería, Spain
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine if permanent pacemaker implants &#40;PPM&#41; interventions and change of generator are more efficient in small hospitals&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cost-effective analysis and retrospective&#44; cross-sectional and observational study of diagnostic related groups &#40;DRG&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The data was obtained from the national Minimum Basic Data Set &#40;MBDS&#41; for the year 2007 provided by the Health Ministry&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This includes the total number of patients who required treatment in all national hospitals for 5 DRG&#58; 115 - bradyarrhythmic complication during the acute coronary syndrome&#44; heart failure or shock&#59; 116 - symptomatic isolated conduction defects&#59; 117 - revisions&#44; but without changing the battery&#44; 118 - application of a new one&#44; 549 - implementation or revision but with serious complications&#46;</p> <span class="elsevierStyleSectionTitle">Principal variables of interest</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical &#40;number of secondary diagnoses &#40;NSD&#41; and procedures &#40;NP&#41;&#44; mortality&#41; and management &#40;total and preoperative length of stay &#40;LOS&#41;&#44; access&#44; discharge&#44; hospital size&#41;&#44; defining inefficient stays as those exceeding 2 days on the average&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">23&#44;154 episodes&#44; 5&#46;3&#37; small hospitals&#46; The comparative bivariate study between small hospitals and the rest&#44; not discriminated by DRG&#44; showed a mean LOS of 7&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;78 days vs 11&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;95 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#44; 95&#37; CI for mean difference &#91;0&#46;17&#44; 1&#46;65&#93;&#41; and also lower than preoperatively &#40;3&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;14 vs&#46; 4&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;68 days &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#93;&#41; without greater comorbidity&#44; as measured by proxy through the NSD &#40;5&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;88 vs 5&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;28 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;055&#93;&#41; and NP as proxy of diagnostic and therapeutic effort &#40;3&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;50 vs 3&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;69 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#93;&#41;&#46; A total of 24&#46;1&#37; were inefficient&#44; there being an association with preoperative stay&#44; NDS&#44; NP and emergency access&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pacemaker implantation and generator change in small hospitals is more efficient&#44; with internal consistency by subgroups&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Determinar si el implante de marcapasos permanentes &#40;MPP&#41; y cambio de generador resultan m&#225;s eficientes en hospitales peque&#241;os&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de costeefectividad&#46; Estudio retrospectivo&#44; transversal y observacional de cinco GDR&#46;</p> <span class="elsevierStyleSectionTitle">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los datos son procedentes del conjunto m&#237;nimo b&#225;sico de datos &#40;CMBD&#41; nacional del a&#241;o 2007&#44; facilitado por el Ministerio de Sanidad&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Son el total de los pacientes que requirieron asistencia en alg&#250;n hospital nacional por 5 GRD&#58; 115&#44; complicaci&#243;n bradiarr&#237;tmica durante la fase aguda de un s&#237;ndrome coronario&#44; insuficiencia card&#237;aca o shock&#59; 116&#44; trastorno de conducci&#243;n sintom&#225;tico aislado&#59; 117&#44; revisi&#243;n pero sin cambio de bater&#237;a&#59; 118&#44; aplicaci&#243;n de una nueva&#44; y 549&#44; implantaci&#243;n o revisi&#243;n pero con complicaciones graves&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s principales</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se analizaron variables demogr&#225;ficas&#44; cl&#237;nicas &#40;n&#250;mero de diagn&#243;sticos secundarios &#91;NDS&#93;&#44; de procedimientos &#91;NP&#93;&#44; mortalidad&#41; y de gesti&#243;n &#40;estancia total y preoperatoria &#91;Epo&#93;&#44; forma de acceso y alta&#44; tama&#241;o de hospital&#41;&#44; definiendo ineficiente una estancia superior 2 d&#237;as a la media&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">23&#46;154 episodios &#40;5&#44;3&#37; en hospitales<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200 camas&#41;&#46; El estudio bivariado comparativo entre hospitales peque&#241;os y el resto&#44; no discriminado por GDR&#44; mostr&#243; estancia media 7&#44;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;01 d&#237;as vs&#46; 8&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;95 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#44; IC 95&#37; &#91;0&#44;17&#59; 1&#44;65&#93;&#41; y Epo 3&#44;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;14 vs&#46; 4&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;68 d&#237;as &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#93;&#41;&#44; sin mayor comorbilidad&#44; medida como proxy por NDS &#40;5&#44;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;88 vs&#46; 5&#44;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;28 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;055&#93;&#41;&#59; y NP como proxy de esfuerzo diagn&#243;stico-terap&#233;utico &#40;3&#44;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;50 vs&#46; 3&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;69 &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#93;&#41;&#46; 24&#44;1&#37; fueron ineficientes&#44; encontr&#225;ndose asociaci&#243;n con Epo&#44; NDS&#44; NP y acceso urgente&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La implantaci&#243;n de marcapasos y cambio de generador en hospitales peque&#241;os es m&#225;s eficiente&#44; con consistencia interna por subgrupos&#46;</p>"
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