RESUMO
Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.
Assuntos
Qualidade de Vida , Vacinação , Idoso , Humanos , Espanha/epidemiologiaRESUMO
La evaluación de la intensidad del dolor en los pacientes con procesos accidentales continúa planteando un problema, así como las medidas analgésicas empleadas, citándose con frecuencia la baja utilización de procedimientos analgésicos. La limitación en la información es uno de los elementos que con frecuencia afectan la calidad asistencial en urgencias, la utilización de información estructurada podría mejorar la calidad percibida. Método: Estudio de intervención multicéntrico con dos fases en la primera no se modifica la pauta asistencial y en la segunda se introduce una información estructurada. Se realiza seguimiento mediante encuesta telefónica al 3er día. Se utiliza una escala numérica (0-10) para la valoración del dolor. Resultados: Los médicos infraestiman la intensidad del dolor tanto en reposo como al ser manipulada la lesión, en un 28,3% y en un 35,8% de los casos respectivamente. La predicción del dolor a los tres días también está infraestimada en un 24,1%. La capacidad para incorporarse a sus labores habituales está subestimada: se incorporan un 8% más que los estimados. La intervención mejora la calidad percibida aumentando en un 6,5% la valoración superior a la media tras el aporte de información estructurada. Conclusiones: En el estudio se confirma la infraestimación del dolor por parte del médico y las dificultades en la valoración de su evolución. La intervención informativa aplicada mejora la calidad percibida (AU)
Evaluation and management of pain is still one of the emergency department challenges. Often oligoanalgesia is refer with less than optimal care to traumatic patients. Information is one of the weakest part of the process of care provide to urgent cases, on quality assurance evaluation usually ranked as an area of improvement. To improve the quality perception structured information can be of help. Design: Multicenter intervention study, two phases where organized in the first one no modification on the process of care, in the second structured information was provided, and modifications on the patient quality perception was asses trough a telephone enquire. Pain was evaluated by doctors and patients using a numerical scale (0-10). Follow- up at 3º day was done using a phone interview. Results: Doctors underestimated pain evaluated at rest and with manipulation in 28,3% and 35,5% respectively. Third day pain prediction by doctors is also underestimated in 24%. Return to work is also underestimated by 8%. The structured information provided improves de quality perception of management in 6,5%. Conclusions: Underestimation of pain by doctors is confirmed, and difficulties on pain estimation are stress, structure information improves quality perception (AU)
Assuntos
Masculino , Feminino , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Medição da Dor , Dor/tratamento farmacológico , Dor/etiologia , Escala de Gravidade do Ferimento , Seguimentos , EspanhaRESUMO
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