Comparación de la calidad de vida en personas que viven con infección por VIH en seguimiento mediante atención farmacéutica según metodología capacidad motivación-oportunidad vs. seguimiento convencional. Proyecto MAS-VIH / Comparison of quality of life in patients living with HIV infection through pharmaceutical care according to CMO methodology vs. conventional follow-up. MAS-VIH project

Objetivo. Comparar la calidad de vida en personas que viven con infección por el Virus de la Inmunodeficiencia Humana según el modelo de Atención Farmacéutica que reciben en los Servicios de Farmacia Hospitalaria: CMO (capacidad, motivación y oportunidad), versus seguimiento convencional. Método. Estudio longitudinal, prospectivo, multicéntrico, realizado entre octubre-2019 y noviembre-2021 en 14 Servicios de Farmacia Hospitalaria de España. Se incluyeron pacientes mayores de 18 años, que recibían tratamiento antirretroviral y acudían a las consultas de Atención Farmacéutica durante ≥1 año. Se excluyeron aquellos pacientes sin autonomía para completar los cuestionarios previstos. Los centros fueron aleatorizados a seguir utilizando la misma sistemática de trabajo (seguimiento tradicional) o implementar el modelo CMO, utilizando la estratificación, establecimiento de objetivos farmacoterapéuticos, uso de entrevista motivacional, así como el seguimientolongitudinal con nuevas tecnologías. La variable principal fue la diferencia en el número de dimensiones afectadas negativamente, en cada rama, a las 24 semanas, según cuestionario MOS-HIV. En el brazo CMO se registraron las intervenciones más frecuentemente realizadas.Resultados. Se incluyeron 151 pacientes. La mediana de edad fue de 51,3 años. Se encontró mejora significativa de la calidad de vida al final del seguimiento en el grupo CMO, reduciéndose el número de pacientes con dimensiones afectadas negativamente (2/11 vs 8/11). Las intervenciones más frecuentes llevadas a cabo, según la taxonomía, fueron: Motivación (51,7%) y Revisión y validación del TAR (49,4%). Conclusiones. La calidad de vida de los pacientes es superior en aquellos centros que desarrollan Atención Farmacéutica basada en metodología CMO en comparación con el seguimiento tradicional. (AU)

Objective. To compare quality of life, in patients livingwith HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. Method. Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded. Results. 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%) Conclusions. The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up. (AU)

Fibrosis avanzada asociada a esteatohepatitis no alcohólica (NASH) en España: resultados de un estudio Delphi / Advanced fibrosis associated with non-alcoholic steatohepatitis (NASH) in Spain: results of a Delphi study

Objetivo: Describir de manera detallada la epidemiología, diagnóstico, manejo clínico, opciones de tratamiento, impacto en la calidad de vida y necesidades no cubiertas de los pacientes con fibrosis hepática avanzada (F3-F4) asociada a esteatohepatitis no alcohólica (NASH) en España. Metodología: Estudio Delphi de dos rondas de consulta con 41 hepatólogos expertos de 16 comunidades autónomas para recoger su experiencia en práctica clínica. Resultados: La prevalencia estimada de pacientes adultos diagnosticados de fibrosis F3-F4 asociada a NASH en España es de 0,019% (intervalo de confianza [IC] 95%: 0,019-0,020%). Aproximadamente 7.588 adultos con este padecimiento están actualmente diagnosticados y son manejados en los Servicios de Aparato Digestivo de los hospitales españoles, y alrededor de 1.881 nuevos pacientes son diagnosticados cada año. El manejo es multidisciplinar e incluye las especialidades de Aparato Digestivo, Endocrinología y Medicina interna, considerando las frecuentes comorbilidades metabólicas asociadas (obesidad, diabetes mellitus tipo 2 o sobrecarga férrica dismetabólica). A pesar del claro impacto en la calidad de vida, este no se evalúa rutinariamente en la práctica clínica. Las técnicas diagnósticas no invasivas más utilizadas son la elastografía de transición y el índice de fibrosis hepática 4 (FIB-4). La ausencia de tratamientos eficaces y seguros se presenta como la principal necesidad no cubierta para el manejo de estos pacientes. Conclusiones: Este estudio proporciona una representación de la situación actual de los pacientes diagnosticados con fibrosis F3-F4 asociada a NASH en España, incrementando la evidencia disponible y contribuyendo a la toma de decisiones informadas por parte de los profesionales y el sistema sanitario. (AU)

Objective: To describe in detail the epidemiology, diagnosis, clinical management, treatment options, impact on quality of life and unmet needs of patients with advanced liver fibrosis (F3-F4) associated with non-alcoholic steatohepatitis (NASH) in Spain. Methodology: Delphi study of two rounds of consultation rounds with 41 expert hepatologists from 16 autonomous communities to collect their experience in clinical practice. Results: The estimated prevalence of adult patients diagnosed with F3-F4 fibrosis associated with NASH in Spain is 0.019% (95% confidence interval [CI]: 0.019-0.020%). Approximately 7,588 adults with this condition are currently diagnosed and managed in the Digestive System Services of Spanish hospitals, and around 1,881 new patients are diagnosed each year. Management is multidisciplinary and includes the specialties of Digestive System, Endocrinology and Internal Medicine, considering the frequently associated metabolic comorbidities (obesity, type 2 diabetes mellitus or dysmetabolic iron overload). Despite a clear impact on quality of life, this it is not routinely evaluated in clinical practice. The most widely used non-invasive diagnostic techniques are transitional elastography and liver fibrosis index 4 (FIB-4). The absence of effective and safe treatments appears as the main unmet need for the management of these patients. Conclusions: This study provides a representation of the current situation of patients diagnosed with F3-F4 fibrosis associated with NASH in Spain, increasing the evidence available and contributing to informed decision-making by professionals and the health system. (AU)

Clonal relationship, virulence genes, and antimicrobial resistance of Morganella morganii isolated from community-acquired infections and hospitalized patients: a neglected opportunistic pathogen

Morganella morganii is a bacterium belonging to the normal intestinal microbiota and the environment; however, in immunocompromised individuals, this bacterium can become an opportunistic pathogen, causing a series of diseases, both in hospitals and in the community, being urinary tract infections more prevalent. Therefore, the objective of this study was to evaluate the prevalence, virulence profile, and resistance to antimicrobials and the clonal relationship of isolates of urinary tract infections (UTI) caused by M. morganii, both in the hospital environment and in the community of the municipality of Londrina-PR, in southern Brazil, in order to better understand the mechanisms for the establishment of the disease caused by this bacterium. Our study showed that M. morganii presents a variety of virulence factors in the studied isolates. Hospital strains showed a higher prevalence for the virulence genes zapA, iutA, and fimH, while community strains showed a higher prevalence for the ireA and iutA genes. Hospital isolates showed greater resistance compared to community isolates, as well as a higher prevalence of multidrug-resistant (MDR) and extended-spectrum beta lactamase (ESBL)-producing isolates. Several M. morganii isolates from both sources showed high genetic similarity. The most prevalent plasmid incompatibility groups detected were FIB and I1, regardless of the isolation source. Thus, M. morganii isolates can accumulate virulence factors and antimicrobial resistance, making them a neglected opportunistic pathogen. (AU)

La alimentación de los enfermos en los hospitales de la edad moderna, el caso de Vitoria (Álava, España) / A alimentação dos doentes nos hospitais na era moderna, o caso de Vitoria (Álava, Espanha) / Feeding the sick in hospitals in the modern age, the case of Vitoria (Álava, Spain)

El conocimiento sobre alimentación en los hospitales de laedad moderna en España está sustentado en documentaciónde muy pocos centros, mayoritariamente de grandes urbes,siendo necesarias nuevas aportaciones para ampliar la evidenciaexistente. A tal objeto se ha analizado la documentación delhospital Santiago de Vitoria, un hospital y una ciudad másrepresentativos de la mediana peninsular.Se ha hallado un inequívoco enfoque económico de ladocumentación sobre alimentos y la consignación de suadquisición solo recoge gastos extraordinarios, mayoritariamentealimentos destinados a la botica (80% de los asientos). Ladieta basal solo nos es conocida por su descripción teórica,anotándose su gasto por número de raciones o su fracción.Se evidencia una supervisión triple en su preparación yadministración, así como una cuidada prescripción médicade los alimentos en las dietas individualizadas.En conclusión, los gastos no evidencian el consumo efectivo nitampoco representan la dieta real, pues la inmensa mayoría delos alimentos consignados estuvieron destinados a la botica yno a la alimentación de los enfermos. Debe preguntarse si losestudios precedentes, que utilizan también datos de gastos,no han hecho una mala interpretación de estos extrapolandoerróneamente una dieta magnífica cuando, en el caso vitoriano,tuvo una composición de clases populares.

Knowledge of hospital food in modern-age hospitals in Spainis based on documentation from very few centers, mostlyin large cities, and new contributions are needed to expandthe existing evidence. To this end, the documentation of theSantiago de Vitoria hospital has been analysed, a hospital nd a city more representative of the peninsular median.An unequivocal economic focus has been found in thedocumentation on foodstuffs, and the record of their acquisitiononly includes extraordinary expenses, mainly foodstuffsdestined for the apothecary's shop (80% of the entries). Thebasal diet is only known to us by its theoretical description,and its expenditure is recorded by number of portions ortheir fraction. There is evidence of triple supervision in itspreparation and administration, as well as careful medicalprescription of the food in the individualised diets.In conclusion, the expenditures do not show the actualconsumption, nor do they represent the real diet, since thevast majority of the food items recorded were destined for thepharmacy and not for the feeding of the sick. It must be askedwhether previous studies, which also use expenditure data,have not misinterpreted these data by wrongly extrapolatinga magnificent diet when, in the case of Vitoria, it was madeup of the working classes.(AU)

O conhecimento da alimentação hospitalar nos hospitais daIdade Moderna em Espanha baseia-se na documentação deum número muito reduzido de centros, principalmente nasgrandes cidades, e são necessárias novas contribuições paraampliar a evidência existente. Para o efeito, analisámos adocumentação do hospital de Santiago de Vitoria, um hospitale uma cidade mais representativos da mediana peninsular.Na documentação relativa aos géneros alimentícios, encontramosum enfoque económico inequívoco, sendo que o registoda sua aquisição apenas inclui despesas extraordinárias,sobretudo géneros destinados à botica (80% das entradas).A dieta basal só nos é conhecida pela sua descrição teórica,e a sua despesa é registada pelo número de porções oupela sua fração. Há indícios de uma tripla vigilância na suapreparação e administração, bem como de uma cuidadosaprescrição médica dos alimentos nas dietas individualizadas.Em conclusão, as despesas não mostram o consumo real nemrepresentam a dieta real, uma vez que a grande maioria dosalimentos registados se destinava à farmácia e não à alimentaçãodos doentes. É de perguntar se estudos anteriores, que tambémutilizam dados de despesas, não terão interpretado mal estesdados, extrapolando erradamente uma dieta magnífica quando,no caso de Vitória, era constituída pelas classes populares.(AU)

Estudio observacional nacional sobre tratamiento quirúrgico de fístula anal: ¿tiene impacto en los resultados el tipo de hospital? / National observational study about the surgical treatment of anal fistula: does the kind of hospital modify the results?

Introducción: En algunos procedimientos quirúrgicos se ha demostrado que la centralización en hospitales de alto volumen mejora los resultados obtenidos. Sin embargo, este punto aún no ha sido estudiado en los pacientes que son intervenidos por una fístula anal (FA). Material y métodos: Se realizó un estudio multicéntrico retrospectivo en el que se incluyeron los pacientes operados de FA durante el año 2019 en 56 centros españoles. Se hizo un análisis uni y multivariante para analizar la relación entre el tamaño del lugar, el porcentaje de curación de la fístula y el desarrollo de incontinencia fecal (IF). Resultados: Se incluyeron en el estudio a 1.809 pacientes. La cirugía se llevó a cabo en un hospital pequeño en 127 usuarios (7,0%), uno mediano en 571 (31,6%) y uno grande en 1.111 (61,4%). Tras un seguimiento medio de 18,9 meses, 72,3% de los participantes (1.303) se consideraron curados y 132 (7,6%) presentaron IF. El porcentaje de los rehabilitados de la FA fue de 74,8, 75,8 y 70,3% (p = 0,045) en los centros pequeño, mediano y grande, respectivamente. En cuanto a la IF no se evidenciaron diferencias significativas según el tipo de lugar (4,8, 8,0 y 7,7%, respectivamente, p = 0,473). En el análisis multivariante no se observó relación entre el tamaño del hospital y la curación de la fístula o el desarrollo de IF. Conclusión: Los resultados de curación e IF posoperatoria en los pacientes sometidos a una cirugía por FA fueron independientes del volumen hospitalario.(AU)

Introduction: Performing the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an Anal Fistula (AF). Material and methods: A retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals. A univariate and multivariate analysis was performed to analyse the relationship between hospital volume and AF cure and Fecal Incontinence (FI). Results: 1809 patients were include. Surgery was performed in a low, middle, and high-volume hospitals in 127 (7.0%), 571 (31.6%) y 1111 (61.4%) patients respectively. After a mean follow-up of 18.9 months 72.3% (1303) patients were cured and 132 (7.6%) developed FI. The percentage of patients cured was 74.8%, 75.8% and 70.3% (p=0.045) for low, middle, and high-volume hospitals. Regarding FI, no statistically significant differences were observed depending on the hospital volume (4.8%, 8.0% and 7.7% respectively, p=0.473). Multivariate analysis didńt observe a relationship between AF cure and FI. Conclusion: Cure and FI in patients who underwent AF surgery were independent from hospital volume.(AU)

Look-alike sound-alike (LASA) medication errors in Thai hospitals / Errores de medicación por sonido similar (LASA) en hospitales tailandeses

Look-alike sound-alike (LASA) drugs cause a high proportion of medication errors in hospitals. Drug lists available in hospitals are diverse and complicated. Presently, each hospital has its own LASA drug list and unique management strategies to minimize and prevent LASA errors. Objective: This study aimed to explore the prevalence of LASA drug lists, types of LASA drugs, and categories of medication errors in hospitals in Thailand. Methods: For this crosssectional study, questionnaires were developed and distributed along with a letter to 500 government hospitals (selected from a total of 1,309 hospitals) in Thailand via mail from April to June 2021. Data were analyzed using descriptive statistics (frequencies and percentages). Results: A total of 128 hospitals participated in this study (response rate: 25.60%), including 12 tertiary hospitals (9.38%), 33 secondary hospitals (25.78%), 24 large primary hospitals (18.75%), 51 small primary hospitals (39.84%), and eight private hospitals (6.25%). A total of 2,510 pairs of LASA drugs were identified, which included 1,674 (66.69%) tablets/capsules (Simvastatin 10-Simvastatin 20 pair had the highest frequency), 427 injections (17.01%) (Ceftriaxone-Ceftazidime pair had the highest frequency), 85 liquid dosage forms (3.39%) (Milk of magnesia-alum milk pair had the highest frequency), 74 special techniques in medicine (2.95%) (Seretide evohaler®-Seretide accuhaler® pair had the highest frequency), 49 external used drugs (1.95%) (Clotrimazole cream-Clobetasol cream pair had the highest frequency), and 28 powder dosage forms (1.12%) (ORS for pediatrics-ORS for adult pair had the highest frequency). Conclusion: Despite relevant awareness among healthcare professionals, LASA medication errors occur in hospitals. The most frequent similarities among LASA drugs were detected in their names/pronunciations, and the most common errors belonged to Category B.(AU)

Prevalence and predictors of discharge polypharmacy in geriatric patients discharged from an Indonesian teaching hospital: a retrospective observational study / Prevalencia y predictores de polifarmacia al alta en pacientes geriátricos dados de alta de un hospital universitario de Indonesia: un estudio observacional retrospectivo

Objective: The study aimed to investigate the prevalence and risk factors for discharge polypharmacy in geriatric patients in Indonesia. Methods: The retrospective cohort study used the medical record profiles of geriatric patients aged ≥ 60 years admitted to the inpatient ward between July 2018 and October 2019. Using three logistic regression models, we assessed the association of the patient’s demographic, clinical characteristics, and disease condition with discharge polypharmacy. The use of five or more medications was defined as discharge polypharmacy. Results: A total of 1533 patients were included in the study. Most patients (78.21%) aged between 60 and 74 years. The male-to-female patient ratio was almost the same (50.16% versus 49.83%). Of the patients (52.51%) were discharged with polypharmacy. According to regression model I, patients who had a chronic condition, comorbidity, stayed in the hospital for ≥ seven days, had a Charlson comorbidity index score (3-4), and received excessive polypharmacy (≥ 10 drugs) during admission had significantly more risk (p< 0.05) to receive polypharmacy at discharge. The results of model II investigated myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes mellitus, diabetes with complications, renal disease, and high blood pressure as significant (p<0.05) predictors of discharge polypharmacy. The combined model III evaluated that comorbidity, length of hospital stay (7 or more days), excessive polypharmacy use in the hospital, myocardial infarction, and congestive heart failure were significantly (P < 0.05) associated with discharge polypharmacy. Conclusions: Polypharmacy is common in Indonesia and is linked to certain chronic conditions and other clinical factors. A particular plan that includes a pharmacist and physician collaborative relationship and awareness of the health outcomes of polypharmacy could be critical.(AU)

A qualitative study on the process of dietitians working in pharmacies to practice dietary habit improvement support in their daily work

Background: Recently in Japan, there have been some cases of pharmacies staffed with dietitians in an effort to improve their health support functions. However, there have been few reports on the effects of these efforts, and it has been pointed out that dietitians may not be fully exercising their professional abilities. We conducted a before-and-after comparison study in 2022 to confirm the effectiveness of collaboration between pharmacy dietitians and pharmacists in supporting patients with type 2 diabetes. Objective: This study aimed to investigate the process by which dietitians who participated in our research project became accustomed to providing continuous dietary counseling as a matter of habit. Methods: Semi-structured interviews were conducted with three dietitians and two pharmacists. The main questions asked were about 1) the nature of their work before they began providing the interventions, 2) the aspects they paid attention to while providing the interventions, 3) what they felt they had changed during the intervention period, and4) what they considered obstacles to providing nutritional guidance in their pharmacies. Results: The responses of the participants regarding the nature of their work before they began providing interventions were mostly related to their “work as a dispensing clerk.” The dietitians also indicated their desire for more continuous dietary support. The responses of the participants regarding what they felt had changed during the intervention period included numerous references to having an “opportunity for trial and error” and obtaining the “cooperation of staff.” In the responses regarding what the participants considered obstacles, the dietitians mentioned “recognition by patients” and “an environment in which they can consult with patients.”... (AU)

Análisis de eventos adversos en los servicios de cirugía general y aparato digestivo. Estudio multicéntrico / Analysis of adverse events in general surgery: A multicenter study

Introducción: El conocimiento de los eventos adversos (EA) en los hospitales de agudos es un aspecto de especial relevancia en la seguridad del paciente. Su incidencia oscila entre un 3-17% y la cirugía se relaciona con la aparición de entre un 46-65% de todos los EA. Material y métodos: Se realiza un estudio observacional, descriptivo, retrospectivo y multicéntrico, con la participación de 31 hospitales de agudos españoles, para la determinación y análisis de los EA en los servicios de cirugía general. Resultados: La prevalencia de EA fue del 31,53%. Los tipos de EA más frecuentes fueron de tipo infeccioso (35%). Los pacientes con mayores grados de ASA, mayor complejidad y un tipo de ingreso urgente son factores asociados a la presencia de EA. A la mayoría de los pacientes se les atribuyó una categoría de daño F (daño temporal al paciente que requiera iniciar o prolongar la hospitalización) (58,42%). El 14,69% de los EA son considerados graves. El 34,22% de los EA se consideraron evitables. Conclusiones: La prevalencia de EA en los pacientes de cirugía general y del aparato digestivo (CGAD) es elevada. La mayor parte de los EA fueron de tipo infeccioso. El EA más frecuente fue la infección de herida o sitio quirúrgico. Los pacientes con mayores grados de ASA, mayor complejidad y un tipo de ingreso urgente son factores asociados a la presencia de EA. La mayoría de los EA detectados han supuesto un daño leve o moderado sobre los pacientes. Alrededor de un tercio de EA fueron evitables.(AU)

Introduction: Knowledge of adverse events (AE) in acute care hospitals is a particularly relevant aspect of patient safety. Its incidence ranges from 3% to 17%, and surgery is related to the occurrence of 46%-65% of all AE. Material and methods: An observational, descriptive, retrospective, multicenter study was conducted with the participation of 31 Spanish acute-care hospitals to determine and analyze AE in general surgery services. Results: The prevalence of AE was 31.53%. The most frequent types of AE were infectious (35%). Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. The majority of patients (58.42%) were attributed a category F event (temporary harm to the patient requiring initial or prolonged hospitalization); 14.69% of AE were considered severe, while 34.22% of AE were considered preventable. Conclusions: The prevalence of AE in General and GI Surgery (GGIS) patients is high. Most AE were infectious, and the most frequent AE was surgical site infection. Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. Most detected AE resulted in mild or moderate harm to the patients. About one-third of AE were preventable.(AU)

Comparación de ambos criterios diagnósticos de malnutrición ESPEN y GLIM en pacientes institucionalizados / Comparison of both ESPEN and GLIM diagnostic criteria for malnutrition in institutionalized patients

Introducción: La malnutrición relacionada con la enfermedad es un problema de alta prevalencia que continúa provocando graves repercusiones clínicas sobre los pacientes institucionalizados. La falta de un acuerdo mundial sobre los criterios de diagnóstico nutricional que deben aplicarse en el entorno clínico compromete la detección y el abordaje nutricional. En este estudio se pretende evaluar el índice de malnutrición en la institución hospitalaria, definir la validez de los criterios GLIM y ESPEN y determinar el criterio de referencia para el diagnóstico nutricional en la práctica clínica. Metodología: Estudio transversal, descriptivo desarrollado en un hospital de larga estancia en una muestra de 314 pacientes. Se analizó el diagnóstico nutricional mediante los criterios ESPEN y GLIM. Se evaluó la sensibilidad, especificidad y concordancia entre ambos criterios para determinar la validez de su uso en la práctica clínica. Resultados: La prevalencia de malnutrición fue del 58% según ESPEN y 78% en base a GLIM, siendo severa en el 24% de los pacientes y moderada en el 76%. La concordancia entre ESPEN y GLIM fue moderada (I. kappa: 0,325). Los criterios GLIM mostraron una sensibilidad buena (93,75%) y una especificad deficiente (38,32%). Por el contrario, los criterios ESPEN definieron una sensibilidad regular (61,4%) y una buena especificidad (85,4%). Conclusiones: Ambos criterios diagnósticos ESPEN y GLIM serían adecuados para la evaluación del diagnóstico nutricional en la práctica clínica. Sin embargo, los criterios GLIM resultan de mayor validez al identificar precozmente individuos en proceso de malnutrición. (AU)

Introduction: Disease-related malnutrition is a problem of high prevalence that continues to cause serious clinical repercussions on institutionalized patients. The lack of global agreement on the nutritional diagnostic criteria to be applied in the clinical setting compromises the detection and nutritional approach. This study intends to evaluate the malnutrition index in the hospital institution, define the validity of the GLIM and ESPEN criteria and determine the reference criterion for nutritional diagnosis in clinical practice. Methods: Cross-sectional, descriptive study conducted in a long-stay hospital in a sample of 314 patients. Nutritional diagnosis was analyzed using ESPEN and GLIM criteria. The sensitivity, specificity and concordance between both criteria were evaluated to determine the validity of their use in clinical practice. Key results: The prevalence of malnutrition was 58% according to ESPEN and 78% based on GLIM, being severe in 24% of patients and moderate in 76%. The agreement between ESPEN and GLIM was moderate (I. kappa: 0.325). The GLIM criteria showed good sensitivity (93.75%) and poor specificity (38.32%). In contrast, the ESPEN criteria defined regular sensitivity (61.4%) and good specificity (85.4%). Conclusions: Both ESPEN and GLIM diagnostic criteria would be suitable for the evaluation of nutritional diagnosis in clinical practice. However, the GLIM criteria are more valid when identifying individuals in the process of malnutrition early. (AU)

Isolation of filamentous basidiomycetes from respiratory samples in a tertiary care Spanish hospital / Aislamiento de basidiomicetos filamentosos en muestras respiratorias en un hospital español de tercer nivel

Background The clinical significance of the filamentous basidiomycetes isolated from clinical samples is not always clear. Thus, these fungi have been considered environmental contaminants traditionally. Aims To review those clinical cases in which filamentous basidiomycetes from respiratory samples had been isolated. Methods The retrospective study was carried out in a single tertiary care hospital. We recovered all culture-confirmed isolations of filamentous basidiomycetes from respiratory samples (bronchial aspirate [BAS], bronchoalveolar lavage [BAL] and sputum) analyzed between the years 2020 and 2023. Isolates were identified by ITS region sequencing. Results In six patients a filamentous basidiomycete had been isolated from a respiratory sample. The species identified were all different: Fomitopsis sp. (BAS), Trametes ljubarskyi (BAL), Stereum gausapatum (BAS), Porostereum spadiaceum (BAS), Phlebia subserialis (sputum) and Inonotus levis (BAL). All the patients were immunosuppressed or had an underlying disease with pulmonary involvement. None of them received any specific antifungal treatment (in relation with the fungus isolated) and all six improved clinically and were discharged. Conclusions The isolation of filamentous basidiomycetes in these patients had uncertain clinical significance. However, the isolation of any filamentous basidiomycete in respiratory samples from immunosuppressed patients or patients with chronic pulmonary disease is an emerging situation that should be carefully assessed in the context of chronic allergic episodes or suspicion of invasive fungal infections. (AU)

Antecedentes La importancia clínica de los basidiomicetos filamentosos procedentes de muestras clínicas no siempre es clara. Por ello, estos hongos se han considerado tradicionalmente como contaminantes ambientales. Objetivos Describir las características de los pacientes con aislamientos de basidiomicetos filamentosos en muestras respiratorias para intentar aclarar el significado clínico de estos hallazgos. Métodos Se realizó un estudio retrospectivo en nuestro hospital de tercer nivel; fueron incluidos pacientes con el aislamiento de un basidiomiceto filamentoso confirmado en cultivo a partir de una muestra respiratoria (aspirados bronquiales [BAS], lavados broncoalveolares [BAL] y esputos) procesadas entre los años 2020 y 2023. Realizamos la identificación molecular del aislamiento mediante la secuenciación de la región ITS. Resultados En seis pacientes se obtuvo un aislamiento de basidiomiceto filamentoso de una muestra respiratoria, y los seis aislamientos pertenecían a diferentes géneros: Fomitopsis sp. (BAS), Trametes ljubarskyi (BAL), Stereum gausapatum (BAS), Porostereum spadiaceum (BAS), Phlebia subserialis (esputo) e Inonotus levis (BAL). Todos los pacientes sufrían inmunosupresión o alguna enfermedad de base con afectación pulmonar. Ninguno de ellos recibió tratamiento antifúngico específico (en relación con el aislamiento recuperado de la muestra) y finalmente fueron dados de alta tras la mejoría clínica. Conclusiones Los aislamientos de basidiomicetos filamentosos en nuestros pacientes tuvieron un significado clínico incierto. Sin embargo, en los pacientes inmunodeprimidos o con enfermedades pulmonares crónicas, el aislamiento de un basidiomiceto filamentoso en el tracto respiratorio inferior representa una situación emergente que debe evaluarse cuidadosamente en el contexto de un episodio alérgico crónico o ante la sospecha de una infección fúngica invasiva. (AU)

Los cuidados enfermeros de San Juan de Dios según el Modelo de las necesidades humanas de Henderson / Cuidados de enfermagem de São João de Deus segundo o modelo de necessidades humanas de Henderson / Nursing care of Saint John of God according to Henderson's model of human needs

Consulting manuals of the History of Nursing, it can be appreciated how it is from Nightingale when considering the birth of modern or professional Nursing. However, this belief could be a black legend, because before the 19th century there was already awareness of Nursing as a profession, being this initiated by Juan de Dios, the one from Granada, in the Spanish 16th century. For this reason, in this article we have set the objective of describing the care of Juan de Dios following the model of human needs described by Henderson, together with care in agony and post-mortem. To do this, we use the historiographical methodology following the current of the history of mentalities, so that we can go from the past to the present, and vice versa. In the documentary analysis we have been able to observe how what we find today systematized in a theoretical way was already carried out at the beginning of the nursing reform of the Spanish 16th century, being a valid model for current Nursing, since it is found in its being, knowing , and doing, the concepts of the current nursing metaparadigm, although not explicitly, since its intention, more than theoretical, was care, although behind it there was a corpus of doctrine independent of other socio-health disciplines.(AU)

Consultando manuales de Historia de la Enfermería, se puede apreciar cómo es a partir de Nightingale cuando se considera el nacimiento de la Enfermería moderna o profesional. Sin embargo, esta creencia podría ser leyenda negra, pues antes del S. XIX ya existía conciencia de Enfermería como profesión, siendo esta iniciada por Juan de Dios, el de Granada, en el S. XVI español. Por ello, en el presente artículo hemos marcado como objetivo el describir los cuidados de Juan de Dios siguiendo el modelo de necesidades humanas descritas por Henderson, junto con los cuidados en la agonía y post-mortem. Para ello, utilizamos la metodología historiográfica siguiendo la corriente de la historia de las mentalidades, de manera que podamos ir del pasado al presente, y viceversa. En el análisis documental hemos podido observar cómo lo que hoy encontramos sistematizado de manera teórica, ya se realizaba en el inicio de la reforma enfermera del S. XVI español, siendo un modelo válido para la Enfermería actual, pues se encuentra en su ser, saber, y hacer, los conceptos del metaparadigma enfermero actuales aunque no de manera explícita, puesto que su intención, más que teórica, era asistencial, aunque detrás de ella hubo un corpus doctrinal independiente a otras disciplinassocio-sanitarias.(AU)

Ao consultar os manuais da História da Enfermagem, podese apreciar como é a partir de Nightingale quando se considera o nascimento da Enfermagem moderna ou profissional. No entanto, esta crença pode ser uma lenda negra, pois antes do século XIX já existia a consciência da Enfermagem como profissão, sendo esta iniciada por Juan de Dios, o de Granada, no século XVI espanhol. Por isso, neste artigo estabelecemos o objetivo de descrever o cuidado de Juan de Dios seguindo o modelo de necessidades humanas descrito por Henderson, juntamente com o cuidado em agonia e post-mortem. Para isso, utilizamos a metodologia historiográfica seguindo a corrente da história das mentalidades, para que possamos ir do passado ao presente e vice-versa. Na análise documental pudemos observar como o que encontramos hoje sistematizado de forma teórica já foi realizado no início da reforma da enfermagem espanhola do século XVI, sendo um modelo válido para a Enfermagem atual, uma vez que se encontra em seu ser, saber e fazer, os conceitos do atual metaparadigma da enfermagem, ainda que não explicitamente, pois sua intenção, mais do que teórica, era o cuidado, embora por trás dele houvesse um corpus de doutrina independente de outras disciplinas sócio-sanitárias.(AU)

Post-traumatic Stress Disorder after the first wave of the Pandemic in Hospitalized COVID-19 Patients and Health Professionals in a Front-line Spanish Tertiary Hospital: a retrospective observational study / Trastorno por estrés postraumático tras la primera ola de la pandemia en pacientes hospitalizados por COVID-19 y profesionales sanitarios de primera línea en un hospital terciario español: un estudio observacional retrospectivo

The COVID-19 pandemic had a serious impact on mental health, associated with Post Traumatic Stress Disorder (PTSD) after infection and within healthcare professionals. We propose to compare the semiology, evolution and trauma-associated variables between both groups in a sample of patients. An observational retrospective study was performed, including 42 hospitalized COVID-19 patients and 31 health professionals, treated at the Mental Health Service of the Hospital 12 de Octubre, between June 2020/21, with a diagnosis of PTSD. Mental state evaluation was performed through a standard clinical interview. Additionally, the 8-item treatment-outcome post-traumatic stress disorder scale (TOP-8) was administered. Demographic data, variables related to hospital stay and pre/peri/post-trauma variables considered of interest were collected. All analyses were performed using the Stata 16 program. Health professionals showed higher levels of recovery, however no significant differences were found in the initial severity of the PTSD. Regarding the symptom pattern it was similar between both groups, except that professionals presented more dissociation during the traumatic event. In general, the subjects presented mainly intrusive symptoms, hyperarousal and sleep-related difficulties. Having witnessed suffering or death, and the gypsy ethnic group, were the variables with the greatest impact in the PTSD severity. These results suggest that the COVID-19 leaves important psychological sequelae such as PTSD, both in infection survivors and in health professionals. Differences found could be due to dissimilarities in coping resources and therapeutic adherence styles. We consider that knowing the variables involved can help improve intervention in these vulnerable groups.(AU)

La pandemia por COVID-19 ha tenido grave impacto sobre la salud mental, asociándose con Trastorno por estrés postraumático (TEPT) tras la infección y en profesionales sanitarios. Nos proponemos comparar la semiología, evolución y variables asociadas al trauma entre ambos grupos en una muestra de pacientes. Se realizó un estudio observacional retrospectivo, incluyendo 42 pacientes hospitalizados por COVID-19 y 31 profesionales sanitarios, tratados en el Servicio de Psiquiatría del Hospital 12 de Octubre, entre junio 2020/21, con diagnóstico de TEPT. Se realizó entrevista clínica estándar. Adicionalmente, se pasó la Escala de 8 ítems para los resultados del tratamiento del TEPT (TOP-8). Se recogieron datos demográficos, variables relacionadas con la estancia hospitalaria y variables pre/peri/post-trauma. Se analizaron los datos usando el programa Stata 16. Los profesionales sanitarios mostraron mayores niveles de recuperación, sin embargo, no hubo diferencias significativas en la severidad inicial del TEPT. El patrón sintomático fue similar entre ambos grupos, excepto que los profesionales presentaron más disociación durante el evento traumático. Todos presentaron principalmente síntomas intrusivos, hiperactivación y dificultades de sueño. Haber presenciado sufrimiento o muerte, y la etnia gitana, fueron las variables con mayor impacto en la severidad del TEPT. Estos resultados sugieren que la COVID-19 deja importantes secuelas psicológicas como el TEPT, tanto en supervivientes de la infección como en profesionales sanitarios. Las diferencias encontradas podrían ser debidas a disimilitudes en recursos de afrontamiento y estilos de adherencia terapéutica. Consideramos que conocer las variables involucradas puede ayudar a mejorar la intervención en estos grupos vulnerables.(AU)

Explorando la validez de constructo del índice de Barthel en una muestra de pacientes hospitalizados españoles / Exploring the construct validity of the Barthel index in a sample of Spanish hospitalised patients

Objetivo: Examinar la validez de constructo del índice de Barthel en unidades de hospitalización de adultos. Métodos: Se realizó un análisis secundario en una muestra de 1.342 pacientes adultos ingresados en unidades de hospitalización. El análisis factorial confirmatorio del índice de Barthel no confirma su estructura unidimensional (CFA-1). Se exploraron dos métodos para encontrar una solución con un mejor ajuste. Se realizó la secuencia de los métodos clásicos de análisis factorial exploratorio y confirmatorio (CFA-2). Se realizó un modelo gráfico gaussiano y un análisis factorial confirmatorio (CFA-3). Se compararon tres modelos sobre una base de varios indicadores de bondad de ajuste. Resultados: Los resultados del CFA-1 (χ2 = 161.616; p < 0,001; RMSEA = 0,183) indicaron un mal ajuste entre el modelo y los datos obtenidos. El análisis factorial exploratorio proporcionó un modelo con dos dimensiones que explicaba 86% de la varianza y mejoró el indicador de bondad de ajuste en CFA-2 (χ2 = 846; p < 0,001; RMSEA = 0,133). El modelo gráfico gaussiano ofreció una solución con tres dimensiones que mejoró la bondad de ajuste con respecto a los modelos anteriores al eliminar el ítem continencia vesical (χ2 = 493; p < 0,001; RMSEA = 0,09). Conclusiones: El índice de Barthel no es una medida unidimensional de la capacidad funcional cuando se aplica en unidades de hospitalización de adultos. El modelo que mejor se ajusta tiene una estructura tridimensional (higiene, alimentación y eliminación, movilidad) que se relaciona con los dominios de los cuidados básicos.(AU)

Objective: Examine the construct validity of the Barthel Index in adult inpatient units. Methods: A secondary analysis was performed on a sample of 1342 adult patients admitted to inpatient units. A confirmatory factor analysis of the Barthel Index did not confirm its unidimensional structure (CFA-1). Therefore, two methods were explored to find a solution with a better fit. The sequence of the classical exploratory and confirmatory factor analysis methods was carried out (CFA-2). In contrast, a Gaussian graphical model and confirmatory factor analysis (CFA-3) were performed. Three models were compared on the basis of several goodness-of-fit indicators. Results: CFA-1 results (χ2 = 161616; P < .001; RMSEA = .183) indicated a poor fit between the model and the data. Exploratory factor analysis provided a model with two dimensions that explained 86% of the variance and improved the goodness-of-fit in CFA-2 (χ2 = 846; P < .001; RMSEA = .133). The Gaussian graphical model, by removing the item ‘Bladder’, offered a solution with three dimensions that improved the goodness-of-fit compared to the previous models (χ2 = 492; P < .001; RMSEA = .09). Conclusions: The Barthel Index is not a unidimensional measure of functional capacity when applied to adult inpatient units. The best-fitting model has a three-dimensional structure (Hygiene; Feeding and disposal; Mobility) that relates to the domains of care needs.

Design and implementation of a “crisis resource management” training program for the initial assessment of polytrauma patients / Diseño e implementación de un programa de aprendizaje crisis resource management para la evaluación inicial del paciente politraumatizado

Introduction: To describe the design and implementation of a Crisis Resource Management (CRM) training program for the initial assessment of polytrauma patients. Methods: Prospectively implemented CRM training program in acute-care tertiary hospital by hospital personnel involved in the care of polytraumatisms. The program has a blended format and 23-h duration, including 11 h of online theoretical training followed by 12-h simulation modules and practical cases devoted to the roles of members of the trauma team, functioning of the polytrauma room, and key aspects of teamwork. The Human Factors Attitude Survey (HFAS) was used to assess attitudes related to non-technical skills, and the End-of-Course Critique (ECC) survey to evaluate satisfaction with training. We evaluated changes in the pre- and post-training assessments. Results: Eighty staff personnel (26% specialists, 16% residents, 29% nurses, 14% nursing assistant, 15% stretcher bearer) participated in three editions of the program. Theoretical knowledge improved from a mean (SD) of 5.95 (1.7) to 8.27 (2.1) (P < .0001). In the HFAS, statistically significant differences in 18 of 23 attitudinal markers were observed, with improvements in all items of “leadership” and “roles”, in 4 of 5 items of “situational awareness”, and in 4 of 8 items of “communication”. Mean values obtained in the ECC questionnaire were also very high. Conclusions: A CRM training model developed for the initial care of polytrauma patients improved theoretical knowledge and participants perceptions and attitudes regarding leadership, communication, roles, and situational awareness of members of the trauma team. (AU)

Introducción: Describir el diseño y la implementación de un programa de formación basado en Crisis Resource Management para la evaluación inicial de los pacientes con politraumatismos. Métodos: Implementación prospectiva de un programa CRM de formación en Hospital terciario con el personal del hospital involucrado en la asistencia de politraumatismos. El programa tenía un formato semipresencial de 23 horas de duración, incluyendo 11 horas de formación online de contenido teórico seguidas de 12 horas de módulos de simulación y casos prácticos referidos a los papeles de los miembros del equipo de trauma, funcionamiento del box de trauma y aspectos claves del trabajo en equipo. El Human Factors Attitude Survey (HFAS) se utilizó para evaluar las actitudes relacionadas con las habilidades no técnicas y el End-of-Course Critique (ECC) cuestionario para valorar la satisfacción con la formación. Se evaluaron los cambios antes y después de la formación. Resultados: Ochenta miembros del hospital (26% especialistas, 16% residentes, 29% enfermeras, 14% auxiliares de enfermería, 15% camilleros) participaron en tres ediciones del programa. El conocimiento teórico aumentó de una media (DE) de 5.95 (1.7) a 8.27 (2.1) (P < ,0001). En el HFAS, se observaron diferencias estadísticamente significativas en 18 de los 23 marcadores de actitud, con mejorías en todos los ítems de “liderazgo” y “roles”, en 4 de los 5 items de “consciencia situacional” y en 4 de los 8 ítems de “comunicación”. Los valores medios obtenidos en el cuestionario ECC tambien fueron muy altos. Conclusiones: Un modelo CRM de formación desarrollado para la atención inicial de los pacientes con politraumatismos mejoró el conocimiento teórico y las percepciones y actitudes de los participantes relacionadas con el liderazgo, la comunicación, los roles y la consciencia situacional de los miembros del equipo de trauma. (AU)

Farmacia hospitalaria ecológica: un enfoque sostenible del proceso de utilización de medicamentos en un hospital de tercer nivel / Green hospital pharmacy: A sustainable approach to the medication use process in a tertiary hospital

Background Sustainable management of healthcare waste has a positive impact on the global environment. In order to reduce it, the sustainable practice of the pharmacotherapeutic process in all its stages is essential. Objective To analyze the sustainability strategies proposed by the pharmacy service to reduce drug waste derived from the pharmacotherapeutic process. Secondary objectives: to analyze the stage of the pharmacotherapeutic process and the number and type of drugs involved. Methods The study was carried out in a tertiary level hospital. To coordinate the proposals, a referent pharmacist from every pharmacy department area was selected. Four stages of the process were evaluated (procurement, validation, dispensing and compounding), patients concerned were classified as outpatients or inpatients, and drugs potentially involved were analyzed by the administration route: into oral or parenteral. Results 28 ideas were proposed, which could affect more than 1200 drugs. 39.3% would affect the validation process, 17.9% the procurement management, 17.9% dispensing and 7.1% the compounding. Implementation feasibility and acceptability of these proposals were evaluated. Those with the greatest potential were: limiting the duration of treatments when possible, favoring the implementation of computer prescription order entry, favoring the use of the oral route over the parenteral route, and implementing computers in the preparation areas to avoid the use of paper guides. Discussion In our study, many ideas have been proposed by hospital pharmacists to improve the sustainability of the medication use process. When assessing these proposals by impact and feasibility, according to our results, shorten as much as possible the duration of treatments, computerization of the medication use process and oral administration over intravenous should be prioritized in order to reduce environmental impact. (AU)

Antecedentes La gestión sostenible de los residuos sanitarios tiene un impacto positivo en el medio ambiente mundial. Para reducirlo, es esencial la práctica sostenible del proceso farmacoterapéutico en todas sus etapas. Objetivo Analizar las estrategias de sostenibilidad propuestas por el servicio de farmacia para reducir los residuos de medicamentos derivados del proceso farmacoterapéutico. Objetivos secundarios: Analizar la etapa del proceso farmacoterapéutico y el número y tipo de medicamentos implicados. Métodos El estudio se realizó en un hospital de tercer nivel. Para coordinar las propuestas se seleccionó un farmacéutico referente de cada área del servicio de farmacia. Se evaluaron cuatro etapas del proceso (Adquisición, validación, dispensación y formulación), se clasificaron los pacientes afectados como ambulatorios u hospitalizados y se analizaron los fármacos potencialmente implicados según la vía de administración: oral o parenteral. Resultados Se propusieron 28 ideas, que podrían afectar a más de 1.200 medicamentos. El 39,3% afectarían al proceso de validación, el 17,9% a la gestión, el 17,9% a la dispensación y el 7,1% a la formulación. Se evaluó la viabilidad de la aplicación y la aceptabilidad de estas propuestas. Las de mayor potencial fueron: limitar la duración de los tratamientos cuando sea posible, favorecer la implantación de la entrada de órdenes de prescripción por ordenador, favorecer el uso de la vía oral frente a la parenteral e implantar ordenadores en las áreas de preparación para evitar el uso de guías en papel. Conclusiones En nuestro estudio, son muchas las ideas propuestas por los farmacéuticos de hospital para mejorar la sostenibilidad del proceso de utilización de medicamentos... (AU)

Estimating the direct costs of oral cancer in Spain: a retrospective hospital data analysis

Background: Studies on the costs incurred from cancer in Spain are scarce and have focused on the most prevalent types such as colorectal, breast, and lung cancer. The aim of this study was to calculate the direct costs associated with the diagnostic, treatment and follow-up procedures for oral cancer in Spain. Material and methods: Applying a bottom-up approach, we retrospectively analyzed the medical records of a cohort of 200 patients with oral cancer (C00-C10), diagnosed and treated in Spain between 2015 and 2017. For each patient, we collected their age, sex, degree of medical impairment (American Society of Anesthesiologists [ASA] classification), tumor extent (TNM classification), relapses and survival during the first 2 years of follow-up. The final calculation of the costs is expressed in absolute values in euros as the percentage of the gross domestic product per capita and in international dollars (I$). Results: The total cost per patient rose to €16,620 (IQR, €13,726; I$11,634), and the total direct cost at the national level was €136,084,560 (I$95,259,192). The mean cost for oral cancer represented 65.1% of the gross domestic product per capita. The costs for the diagnostic and therapeutic procedures were determined by the ASA grade, tumor size, lymph node infiltration and presence of metastases. Conclusions: The direct costs for oral cancer are considerable compared with other types of cancer. In terms of gross domestic product, the costs were similar to those of countries neighboring Spain, such as Italy and Greece. The main determinants of this economic burden were the patient's degree of medical impairment and tumor extent. (AU)