[Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave]. / Pacientes con EPOC hospitalizados por COVID-19 en España: comparación entre la primera y la segunda ola.

Objective: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. Material and methods: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. Results: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1,128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. Conclusions: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

[Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters]. / Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa.

Background: COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account. Methods: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group. Results: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group. Conclusion: When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease.

Patients with COPD hospitalized due to COVID-19 in Spain: a comparison between the first and second wave.

OBJECTIVE: This work aimed to compare the characteristics, progress, and prognosis of patients with COPD hospitalized due to COVID-19 in Spain in the first wave with those of the second wave. MATERIAL AND METHODS: This is an observational study of patients hospitalized in Spain with a diagnosis of COPD included in the SEMI-COVID-19 registry. The medical history, symptoms, analytical and radiological results, treatment, and progress of patients with COPD hospitalized in the first wave (from March to June 2020) versus those hospitalized in the second wave (from July to December 2020) were compared. Factors associated with poor prognosis, defined as all-cause mortality and a composite endpoint that included mortality, high-flow oxygen therapy, mechanical ventilation, and ICU admission, were analyzed. RESULTS: Of the 21,642 patients in the SEMI-COVID-19 Registry, 6.9% were diagnosed with COPD: 1128 (6.8%) in WAVE1 and 374 (7.7%) in WAVE2 (p = 0.04). WAVE2 patients presented less dry cough, fever and dyspnea, hypoxemia (43% vs 36%, p < 0.05), and radiological condensation (46% vs 31%, p < 0.05) than WAVE1 patients. Mortality was lower in WAVE2 (35% vs 28.6%, p = 0.01). In the total sample, mortality and the composite outcome of poor prognosis were lower among patients who received inhalation therapy. CONCLUSIONS: Patients with COPD admitted to the hospital due to COVID-19 in the second wave had less respiratory failure and less radiological involvement as well as a better prognosis. These patients should receive bronchodilator treatment if there is no contraindication for it.

Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: time matters.

BACKGROUND: COVID-19 shows different clinical and pathophysiological stages over time. The effect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19 prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospitalization and how other independent prognostic factors perform when taking this time elapsed into account. METHODS: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online data capture registry. Univariate and multivariate COX-regression were performed in the general cohort and the final multivariate model was subjected to a sensitivity analysis in an early presenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. RESULTS: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in the LP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortality in the multivariate Cox regression model along with other 9 variables. Each DEOS increment accounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93-0.98). Regarding variations in other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index only remained significant in the EP group while D-dimer only remained significant in the LP group. CONCLUSION: When caring for COVID-19 patients, DEOS to hospitalization should be considered as their need for early hospitalization confers a higher risk of mortality. Different prognostic factors vary over time and should be studied within a fixed timeframe of the disease.

[Potentially inappropriate prescriptions in the ambulatory treatment of elderly patients]. / Prescripciones potencialmente inapropiadas en el tratamiento ambulatorio de pacientes ancianos.

INTRODUCTION: The aim of this study was to establish the percentage of potentially inappropriate prescriptions, according to STOPP/START criteria, in the ambulatory treatments of patients over 65 years admitted to an internal medicine unit, and to identify the most common prescription errors. MATERIAL AND METHODS: A prospective, observational study was performed between October and December 2012. The variable recorded were,age, gender, Charlson comorbidity index, reason for hospitalisation and pharmacological ambulatory treatment. RESULTS: Data from 131 patients were collected (Mean age: 80.2 years; 58.8% male, mean Charlson comorbidity index: 2; mean number of medications per patient: 8.6). Main reasons for hospitalisation: decompensated heart failure, respiratory infection, exacerbated COPD, urinary tract infection, pneumonia, and unintended weight loss. There were 121 potentially inappropriate prescriptions detected in 73 patients (55.7%). The most common STOPP criteria were therapeutic duplicities. The most common START criteria were the omission of statins and antiplatelets in primary prevention for cardiovascular risk in patients with diabetes mellitus and at least one cardiovascular risk factor. CONCLUSIONS: The percentage of patients with inappropriate prescriptions was similar to those obtained in similar studies. Over 50% of elderly patients had at least one inappropriate prescription. This warrants a joint search for errors by excess and by default in the prescription of medications, with the aim of performing a more complete evaluation of prescription practice and to achieve optimization of therapy in elderly patients, especially the most fragile.

Seguridad del paciente

La seguridad del paciente es un factor esencial de la calidad asistencial y desde la publicación del informe \"Errar es humano\" es objeto de atención general. Las estrategias de mejora han estimulado el desarrollo de modelos que permiten un mejor conocimiento de los efectos adversos ligados a la asistencia sanitaria. Los sistemas de comunicación de efectos adversos generan información que permitirá adoptar medidas que incrementen la calidad asistencial. Los efectos adversos más comunes son los relacionados con el uso de medicamentos y con frecuencia son evitables. Para disminuirlos, detectarlos y mitigarlos cuando se producen, se pueden emplear estrategias dirigidas a reducir la complejidad, optimizar la información y la automatización de procesos. Aunque el progreso sea lento los cambios se están acelerando especialmente en la implantación de sistemas de prescripción electrónica y difusión de prácticas seguras.

[Drug-related interventions made through a computerized prescription order entry system in an Internal Medicine unit]. / Intervenciones farmacoterapéuticas realizadas mediante un programa de prescripción electrónica en una unidad de medicina interna.

INTRODUCTION: The objective of this article is to describe the drug-related interventions made in the prescriptions with a computerized order entry system and to determine their frequency and clinical relevance in order to propose improvement actions. MATERIAL AND METHOD: Observational descriptive study. Drug-related interventions made in the inpatient's prescriptions of an Internal Medicine unit from January to May of 2007 were analyzed and recorded. The frequency of the intervention causes and of the drugs involved was determined.The clinical significance and impact of the recommendations were also determined. RESULTS: A total of 441 interventions were recorded, 0.73 per patient. The most frequent was the proposal of intravenous to oral conversion (45%), mainly with acetaminophen (63%) and protons pump inhibitors (24%). This was followed by replacement of drugs not included in the guide (15% of interventions), mainly involving cardiovascular and central nervous system drugs (23% each one). Educational actions proposed included a campaign to promote intravenous to oral conversion and a program involving therapeutic equivalent replacement. The most clinically significant interventions were due to dosage errors, therapeutic duplicities, off label medications and adverse events. A proposal was made to include a new module in the medical order entry system that alerts on the established maximum doses for each drug, and new protocols for the treatment of certain conditions. Sixty percent of the interventions achieved an improvement in efficiency. DISCUSSION: We conclude that drug therapy intervention analysis can identify items that can be improved, set educational actions for physicians and new protocols for certain conditions. Innovative actions can be introduced into the medical order entry system in order to improve drug safety.

[Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service]. / Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna.

BACKGROUND AND OBJECTIVE: To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. MATERIAL AND METHOD: A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. RESULTS: Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. CONCLUSIONS: The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection.

[Patient safety and quality of care]. / Seguridad del paciente y calidad asistencial.

Adverse effects related to health care are common and partly avoidable. We need to identify how and why adverse events occur and how system defects may contribute to their occurrence. Systems and processes can be designed to help prevent errors and decrease harm that occurs when they are not intercepted. Tactics to reduce errors and mitigate their adverse effects include reducing complexity and optimizing information processing. Implementation of information technology may offer great promise but the most important is to make an effort to promote a culture of safety.

[Patient safety]. / Seguridad del paciente.

Ensuring patient safety is essential for better heath care. Safety have gripped public attention ever since the release of the report "To Err is Human". To find strategies of promotion of patient safety has stimulated models that improve knowledge of adverse events. Adverse drug events are the most common cause of injury to hospitalized patients and are often preventable. Many tactics are available to make system changes to reduce errors and adverse events; they fall into five categories: Reduce complexity, optimise information processing, automate wisely, use constraints, and mitigate the unwanted side effects of change. These tactics can be deployed to support any of the three strategic components of error prevention, detection, and mitigation. Although progress has been slow, the pace of change is likely to accelerate, particularly in implementation of electronic health records and diffusion of safe practices.

[Acute aortic dissection]. / Disección aórtica aguda.

OBJECTIVE: Acute aortic dissection is a medical emergency associated with high rates of mortality. Despite recent diagnostic advances, prompt and accurate diagnosis is difficult. We present a review of the a medical emergency service experience to diagnosis, factors associated to prompt diagnosis and inhospital evolution. MATERIAL AND METHOD: We studied 86 consecutive patients who had aortic dissections, to assess the presentation, management, and outcome. RESULTS: Mean age 61.9 +/- 12.5 years, 80% male. Hypertension was the most common predisposing factor (65% of patients overall). Chest pain was the most common initial complaint (58%). The initial clinical impression was aortic dissection in 56% of patients overall. Computed tomography was diagnostic in 96% when used. 62% underwent surgery. Overall in-hospital mortality was 28%. CONCLUSIONS: Acute aortic dissection presents with a wide range of manifestations. A high clinical index of suspicion and a prompt computed tomography should to improve recognition of aortic dissection.

[Diabetic ketoacidosis in an emergency department]. / Cetoacidosis diabética en un departamento de Urgencias.

OBJECTIVE: We study clinical data and differences in the patients with Diabetic Ketoacidosis (CAD) attended in an Emergency Department (ED). METHODS: We described 15 patients with criteria for diagnosis of CAD during a 12-month period. We value prospectively clinical data, precipitating factors, diagnosis associated, previous diagnosed diabetes, complications, mortality and use of and intensive care unit (UCI). We comparing groups according two characteristics: age group and prior diagnosis of diabetes mellitus.

[Fixed-dosage combinations in the treatment of hypertension]. / Combinaciones en dosis fija para el tratamiento de la hipertensión.

The antihypertensive treatment with a single agent is not useful for the arterial pressure control in a significant number of patients. In such cases, combined treatment or drug substitution are recommended (sequential or substitutive monotherapy). In the last years, the fixed dose combinations in one single pharmaceutical preparation have proliferated. These associations must fulfill a number of conditions in order to be considered rational, as for instance the compatibility of its pharmacokinetic features, properly dosing, the absence of new secondary effects and the high efficiency showed in most of patients. The advantages of these combinations are the comfort and easiness of the therapeutic schema, antihypertensive action strengthening, less secondary effects when dose is reduced, and perhaps a synergism in the protection of target organs. The most popular combinations are: potassium sparing diuretic plus thiazide, diuretic plus beta block, diuretic plus ACEI, or calcium antagonist plus ACEI.

[Dystomatosis produced by fasciola hepatica: three cases in Madrid]. / Distomatosis por fasciola hepática: a propósito de tres casos en la Comunidad de Madrid.

Three cases of hepatic fascioliasis diagnosed in the Department of Internal Medicine are presented. All of the patients live in Madrid, all were fed watercress in the last month and the diagnosis was established during the invasive phase and confirmed by serological testing. We emphasized the importance of the TC scan in the correct diagnosis, the ectopic location of the parasite presentation like subcutaneous thoracic nodule and the efficacy of bithionol in the treatment.

[Emergency department observation and short term unit]. / Unidad de Observación y Corta Estancia de Medicina en el Servicio de Urgencias.

BACKGROUND: An emergency department observation and short term unit is analyzed, and the conditions appropriate for it. METHODS: Four hundred patients admitted consecutively were evaluated. Demographic, and clinical data, complementary tests performed, diagnosis, destination and revisits to the emergency department were analyzed. RESULTS: The 57% of the patients were over 65 years. Complementary tests were performed in all patients. 42% were discharged home without hospitalization, being syncope, intoxication and epilepsy the most common diagnosis. The 1.8% of the patients no hospitalized revisted to emergency department during the next 72 hours. CONCLUSION: Emergency department observation and short term units can reduce hospitalization and health care costs and improve the quality of medical care through extended evaluation and treatment.