Modelo de riesgo de crisis en acúmulos o estado epiléptico e intervención en servicios de urgencias / Risk model of seizure cluster or status epilepticus and intervention in the emergency department

Objetivos Identificar posibles factores predictores de crisis epilépticas en acúmulos o estado epiléptico (EE) y evaluar si estos pacientes reciben una mayor intervención en urgencias. Metodología Análisis secundario del Registro ACESUR el cual es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico de pacientes adultos con crisis epilépticas en 18 servicios de urgencias. Se recogen variables clínico-asistenciales. Se identifican factores y modelo de riesgo de presentar crisis en acúmulos o EE y se evalúa el efecto de intervención en servicios de urgencias extrahospitalarios y hospitalarios. Resultados Del registro ACESUR se analizan 186 (28%) con crisis en acúmulos (126; 19%) o EE (60; 9%) frente a 478 (72%) pacientes con crisis aislada. El modelo de riesgo de crisis en acúmulo o EE en urgencias incluyó la presencia de alta comorbilidad según índice de Charlson > 3 (OR: 1,60; IC95%: 1,05-2,46; p = 0,030), > 2 fármacos antiepilépticos habituales (OR: 2,29; IC95%: 1,49-3,51; p < 0,001) y crisis focal (OR: 1,56; IC95%: 1,05-2,32; p = 0,027). El ABC del modelo fue de 0,735 (IC95%: 0,693-0,777; p = 0,021). La intervención en pacientes con crisis en acúmulos y EE fue mayor en los servicios de urgencias extrahospitalarios (OR: 2,89; IC95%: 1,91-4,36; p < 0,001) y en los servicios de urgencias hospitalarios (OR: 4,41; IC95%: 2,69-7,22; p < 0,001). Conclusiones El modelo presentado podría ser una herramienta con valor predictivo de utilidad para identificar al paciente adulto con riesgo de presentar crisis en acúmulos o EE en urgencias. Estos pacientes recibieron una mayor intervención frente a pacientes con crisis epiléptica aislada por parte de los servicios de urgencias extrahospitalarios y más aún por los servicios de urgencias hospitalarios en nuestra muestra. (AU)

Objectives To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. Methodology We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. Results We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P = .030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P < .001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P = .027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P = .021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P < .001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P < .001). Conclusions This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department. (AU)

Modelo de riesgo de crisis en acúmulos o estado epiléptico e intervención en servicios de urgencias / Risk model of seizure cluster or status epilepticus and intervention in the emergency department

Objetivos Identificar posibles factores predictores de crisis epilépticas en acúmulos o estado epiléptico (EE) y evaluar si estos pacientes reciben una mayor intervención en urgencias. Metodología Análisis secundario del Registro ACESUR el cual es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico de pacientes adultos con crisis epilépticas en 18 servicios de urgencias. Se recogen variables clínico-asistenciales. Se identifican factores y modelo de riesgo de presentar crisis en acúmulos o EE y se evalúa el efecto de intervención en servicios de urgencias extrahospitalarios y hospitalarios. Resultados Del registro ACESUR se analizan 186 (28%) con crisis en acúmulos (126; 19%) o EE (60; 9%) frente a 478 (72%) pacientes con crisis aislada. El modelo de riesgo de crisis en acúmulo o EE en urgencias incluyó la presencia de alta comorbilidad según índice de Charlson > 3 (OR: 1,60; IC95%: 1,05-2,46; p = 0,030), > 2 fármacos antiepilépticos habituales (OR: 2,29; IC95%: 1,49-3,51; p < 0,001) y crisis focal (OR: 1,56; IC95%: 1,05-2,32; p = 0,027). El ABC del modelo fue de 0,735 (IC95%: 0,693-0,777; p = 0,021). La intervención en pacientes con crisis en acúmulos y EE fue mayor en los servicios de urgencias extrahospitalarios (OR: 2,89; IC95%: 1,91-4,36; p < 0,001) y en los servicios de urgencias hospitalarios (OR: 4,41; IC95%: 2,69-7,22; p < 0,001). Conclusiones El modelo presentado podría ser una herramienta con valor predictivo de utilidad para identificar al paciente adulto con riesgo de presentar crisis en acúmulos o EE en urgencias. Estos pacientes recibieron una mayor intervención frente a pacientes con crisis epiléptica aislada por parte de los servicios de urgencias extrahospitalarios y más aún por los servicios de urgencias hospitalarios en nuestra muestra. (AU)

Objectives To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. Methodology We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. Results We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P = .030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P < .001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P = .027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P = .021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P < .001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P < .001). Conclusions This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department. (AU)

Risk model of seizure cluster or status epilepticus and intervention in the emergency department.

OBJECTIVES: To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY: We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS: We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS: This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.

COVID-19 pneumonia: Relationship between initial chest X-rays and laboratory findings.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (P<.05 for platelets, P<.01 for lymphocytes, and P<.001 for the remaining parameters), as well as with the time from the onset of symptoms (P<.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings. / Neumonía COVID-19: relación entre la radiografía de tórax inicial y los datos analíticos.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (p<0.05 for platelets, p<0.01 for lymphocytes, and p<0.001 for the remaining parameters), as well as with the time from the onset of symptoms (p<0.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

Risk model of seizure cluster or status epilepticus and intervention in the emergency department. / Modelo de riesgo de crisis en acúmulos o estado epiléptico e intervención en servicios de urgencias.

OBJECTIVES: To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY: We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS: We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores≥3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS: This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.

Predictors of good visual outcomes in patients with neovascular age-related macular degeneration in daily practice.

PURPOSE: To report predictive factors for therapeutic response to anti-VEGF in patients with neovascular age-related macular degeneration (nAMD) in daily clinical practice in our patient population. METHODS: Retrospective cohort study including 56 patients (69 eyes) with nAMD treated with anti-VEGF, followed for at least two years between February 2012 and April 2018. Patients received three intravitreal anti-VEGF (bevacizumab) injections (loading dose) and were monitored and treated according to a PRN regimen. We analysed whether a gain in visual acuity of 15 or more ETDRS letters at the final visit was associated with demographic characteristics, presence of systemic comorbidities, fundus lesions or measurable improvement on Cirrus optical coherence tomography (OCT) between the first and last visit. RESULTS: After a mean follow-up of 15.5 months (4.7-27.8 interquartile range), central retinal thickness (CRT) (RR: 1.004; IC 95%: 1.001-1.007; P=0.011) and macular hemorrhage (RR: 0.30; IC 95%: 0.10-0.90, P=0.032) at baseline were found to be useful predictive factors for visual acuity improvement (≥15 letters) in patients treated for nAMD by anti-VEGF in a real world clinical setting. CONCLUSION: In the present series of patients with nAMD receiving a loading dose of bevacizumab and followed according to a PRN regimen for 24 months, the only predictable factors for a ≥15 letter gain in visual acuity were anatomical response as measured by OCT and macular hemorrhage at baseline.

Early markers of endocrinometabolic disease in newborns with delayed intrauterine growth.

INTRODUCTION: The adjustments to malnutrition in growth restricted fetus (GRF) that lead to obesity, insulin resistance, diabetes and cardiovascular disease in adulthood are not well known. The most feasible explanation for this association is the hypothesis of catch up. Some studies postulate a greater influence of catch up growth than the low birth weight itself in developing metabolic and cardiovascular disease. MATERIAL AND METHODS: This is a prospective cohort study of newborns with intrauterine growth restriction (defined as weight percentile at birth less than 10th) born during a one-year period. Clinical data of patients were recorded (gender, gestational age, data about breastfeeding and anthropometry during follow-up every 3 months). Some details of pregnancy and characteristics of the mother were also registered. Serum biochemical parameters (IGF-1, IGF-BP3, insulin, glucose, total cholesterol, HDL cholesterol, DLD cholesterol, triglycerides, HOMA) were collected at birth from cord blood, 9 and 12 months. Two main comparative groups were established: those GRF who made a catch-up growth (increase in weight Z score higher than 0,67) during the follow-up and those who did not get it. RESULTS: 126 GRF children were born in the study period. 125 accepted the inclusion in the study and 67 of them completed the full monitoring for a year; 47 of them made recovery growth and 20 did not. A significant difference between both groups was found in glucose in umbilical cord and triglycerides at 12 months: GRF children with catch up growth showed lower glucose levels (p = 0.03) and higher levels of triglycerides (p = 0.03). There were no statistically significant differences in the rest of laboratory parameters analyzed (IGF-1, IGF-BP3, insulin, glucose, total cholesterol, HDL cholesterol, DLD cholesterol, HOMA at 9 and 12 months or triglycerides at 9 months). CONCLUSIONS: Those GRF with catch up growth during the first year of life have early changes in the triglycerides at the end of that period with higher levels than those GRF children without catch up growth. This finding could be useful to develop a tool for early detection of GRF children with higher metabolic risk in order to prevent future pathology.

Prognostic value of metabolic tumour volume and total lesion glycolysis in 18F-FDG PET/CT scans in locally advanced breast cancer staging. / Papel pronóstico del volumen metabólico tumoral y de la glucólisis tumoral total en los estudios 18F-FDG PET/TC de estadificación del cáncer localmente avanzado de mama.

OBJECTIVE: To determine whether metabolic tumour volume (MTV) and total lesion glycolysis (TLG) are able to predict recurrence risk in locally advanced breast cancer (LABC) patients. MATERIAL AND METHODS: Retrospective study of LABC patients who undertook neoadjuvant, local and adjuvant treatment and follow up. A 18F-FDG PET/CT study for initial staging was performed analysing in this study different metabolic parameters (MTV, TLG, SUVmax and SUVmed) both in the primary tumour (T) as well as in axillary nodes (N) and whole-body (WB). RESULTS: Forty females were included between January 2010-2011; follow up until January 2015 was completed. The average follow-up was 46 months. Twenty percent presented recurrence: local disease (n=2) and distant metastasis (n=6); 3 patients died (38% of the patients which recurred and 7.5% from the total). SUVmax, MTV and TLG, in T, N and WB, were higher in those patients with recurrence. The MTV and TLG parameters in the tumour (T) were related to the recurrence rate (P=.020 and P=.028, respectively); whereas SUVmax in the lymph nodes (N) was significantly related (P=.008) to the recurrence rate. The best cut-off points to predict recurrence where: MTV T ≥19.3cm3, TLG T≥74.4g and SUVmax N≥13.8, being 10-12 times more likely to recidivate when these thresholds where exceeded. Tumour grade was the only clinical-pathological variable which was related to recurrence probability (p=.035). CONCLUSIONS: In this study of LABC patients the metabolic parameters which have a better relationship with recurrence rate are: MTV and TLG in the primary tumour, SUVmax in the regional lymph node disease and whole-body PET data.

Breslow thickness and (18)F-FDG PET-CT result in initial staging of cutaneous melanoma: Can a cut-off point be established?

AIM: To establish a Breslow Thickness (BT) cut-off point for indication of PET-CT of cutaneous melanoma in early stages and evaluate its prognostic value. MATERIAL AND METHODS: Retrospective analysis of 347 PET-CT studies with diagnosis of melanoma, of which 108 were performed for initial staging. Thirty-one patients were excluded, and a final sample of 77 patients remained. A ROC curve analysis was performed to establish an optimal cut-off point. A survival analysis was performed, considering death assignable to melanoma as the main event, for the evaluation of its prognostic value. RESULTS: Forty-seven (61.04%) of all 77 patients selected were men, and 11 (14.29%) had a positive PET-CT result. Mean age was 65.17±15.00 years. The median BT in patients with a negative PET-CT result was 2.75 mm (IQR 1.83-4.50) and in the positive group 6.25 mm (IQR 5.40-7.50) (P=.0013). In the ROC curve analysis (AUC 0.804, SE 0.054), an optimal value of 5 mm BT with the following values was obtained: sensitivity 90.91%, specificity 78.79%, negative predictive value (NPV) 98.1%, positive predictive value (PPV) 41.7%, diagnostic OR 37.1, and accuracy 80.52%. Mean follow-up was 18.66±14,35 months, detecting 2/53 (3.77%) deaths in the BT<5 mm group, and 7/24 (29.17%) in the BT≥5 mm group. Survival curves between both groups were significantly different (P=.0013). CONCLUSIONS: A 5 mm cut-off point correctly distinguishes those patients with positive PET-CT from those with negative results in the early stages of cutaneous melanoma; therefore it could be included in initial staging of this subgroup of patients.

[Axillary pathologic response after neoadjuvant chemotherapy in locally advanced breast cancer with axillary involvement]. / Respuesta patológica en la axila tras quimioterapia neoadyuvante en el cáncer de mama localmente avanzado con afectación axilar.

AIM: To compare axillary involvement (N+) at initial staging in locally advanced breast cancer (LABC) with axillary lymphadenectomy histologic results after neoadjuvant chemotherapy treatment (NeoChemo). MATERIAL AND METHODS: Retrospective study between November 2011 and September 2013 of LABC cases treated with neoadjuvant chemotherapy based on docetaxel (associated with trastuzumab in HER2 positive cases and carboplatin/adriamycin in HER2 negative cases). Those clinically or radiologically suspected cases of axillary involvement were histologically confirmed. When there was no suspicion of axillary involvement, sentinel lymph node radioguided biopsy (SLNRB) was performed using intradermal injection of (99m)Tc-nanocolloid albumin prior to neoadjuvant treatment. Axillary lymphadenectomy after NeoChemo was undertaken in all cases with positive axilla. Final pathologic response was classified as complete (pCR) when there was no evidence of tumoral disease and as non-pathologic complete response (no pCR) in the opposite case. RESULTS: A total of 346 patients treated with docetaxel were reviewed, identifying 105 LABC. Axillary involvement at initial staging was detected in 70 (67%) before starting NeoChemo. From these 70, 73% (n=51) were N+ (fine needle biopsy and/or biopsy) and the remaining 19 (27%) were occult N+ detected by SLNRB. Axillary lymphadenectomy detected pCR in 56% (39/70), increasing up to 84% pCR when initial N+ status was reached using SNLB. On the other hand, when N+ was detected using fine needle biopsy/lymph biopsy, pCR was only 45%. CONCLUSION: More than 50% of women affected by locally advanced breast cancer with tumoral axillary involvement at initial diagnosis present free metastatic axilla after therapeutic neoadjuvant chemotherapy effect. This increases up to almost 90% in case of occult metastatic axilla detected with sentinel node biopsy prior starting neoadjuvant chemotherapy.

[Differences in the management of epileptic seizures between the elderly and younger adults treated in an emergency department]. / Diferencias en el manejo de las crisis epilepticas entre los ancianos y los adultos mas jovenes atendidos en un servicio de urgencias.

AIM: To study the differences in the management and short-term outcomes of adult patients treated in an emergency service for epileptic seizures, depending on whether they are elderly or not. PATIENTS AND METHODS: This observational retrospective cohort study included all the patients over 15 years of age who were treated for epileptic seizures in the hospital emergency department of a tertiary and university hospital between 1 September and 31 December 2011. The variables collected were acute treatment and follow-up at 30 days after the index event in the emergency department. RESULTS: Altogether the sample included 114 patients with a mean age of 46.4 years (interquartile range: 32.6-74.3 years), of whom 34 (29.8%) were aged 65 years or over. The group of elderly persons presented a first epileptic episode (p = 0.001), with unknown precipitating factor (p = 0.02), structural causation (p < 0.001), a computerised tomography scan carried out in the emergency department (p < 0.001), establishment of preventive antiepileptic drug regime in the emergency department (p = 0.001) and a prolonged hospital stay (p = 0.002) more frequently than the younger adults. Following a multivariable analysis, being elderly was an independent factor associated to a greater need for specific complementary tests (odds ratio = 3.7; 95% confidence interval = 1.3-10.3) and pharmacological intervention in the emergency department (odds ratio = 3.3; 95% confidence interval = 1.4-8.1). There were no statistically significant differences in the results between the two groups at 30 days in terms of return visits (p = 0.316) and mortality (p = 0.087). CONCLUSIONS: The treatment of epileptic seizures in the elderly in the emergency department is complex, if compared with younger adults, thereby making it necessary to use a greater amount of hospital resources.

TITLE: Diferencias en el manejo de las crisis epilepticas entre los ancianos y los adultos mas jovenes atendidos en un servicio de urgencias.Objetivo. Estudiar las diferencias en el manejo y los resultados a corto plazo de los pacientes adultos atendidos en un servicio de urgencias por una crisis epileptica en funcion de ser anciano. Pacientes y metodos. Estudio observacional de cohorte retrospectivo que selecciono a todos los pacientes de 15 años o mas atendidos por una crisis epileptica en un servicio de urgencias de un hospital terciario y universitario desde el 1 de septiembre al 31 de diciembre de 2011. Se recogieron las variables de la atencion aguda y de seguimiento a los 30 dias del episodio indice de urgencias. Resultados. Se incluyeron 114 pacientes con una mediana de edad de 46,4 años (rango intercuartilico: 32,6-74,3 años), de los cuales 34 (29,8%) tenian 65 años o mas. El grupo de los mayores presento mas frecuentemente un primer episodio epileptico (p = 0,001), desencadenante desconocido (p = 0,02), etiologia estructural (p < 0,001), realizacion de tomografia computarizada en urgencias (p < 0,001), inicio de farmaco antiepileptico preventivo en urgencias (p = 0,001) y estancia prolongada (p = 0,002) que los adultos mas jovenes. Tras un analisis multivariable, el ser anciano fue un factor independiente asociado a un mayor requerimiento de pruebas complementarias especificas (Odds ratio = 3,7; intervalo de confianza al 95% = 1,3-10,3) e intervencion farmacologica en urgencias (odds ratio = 3,3; intervalo de confianza al 95% = 1,4-8,1). No hubo diferencias estadisticamente significativas en los resultados a 30 dias entre ambos grupos en terminos de revisita (p = 0,316) y mortalidad (p = 0,087). Conclusiones. La atencion de las crisis epilepticas del anciano en urgencias, en comparacion con adultos mas jovenes, es mas compleja, siendo necesario un mayor consumo de recursos hospitalarios.

Factores asociados a la satisfacción del residente con su formación como especialista / Factors associated with residents’ satisfaction with their training as specialists

Antecedentes y objetivos: No se conoce qué factores influyen en la percepción de la satisfacción de los residentes durante su formación. El objetivo del estudio fue analizar la satisfacción del especialista en formación y sus factores asociados. Material y métodos: Estudio transversal mediante encuestas autocumplimentadas a los residentes en formación del Hospital Clínico San Carlos en los cortes realizados en los años 2006, 2009, 2010 y 2012. La variable dependiente del estudio fue la satisfacción global con la formación, y como factores independientes se estudiaron características sociodemográficas y laborales, variables relacionadas con la actividad asistencial, docente e investigadora. Resultados: Porcentaje de participación total de un 83,7% (1.424/1.701). La edad media fue 28,4 (DE 3,2) años. El porcentaje de satisfacción global fue de un 75,2%. En el análisis multivariado, los factores asociados de manera estadísticamente significativa a la satisfacción global fueron: la implicación del personal docente (tutores y adjuntos) en la formación, mayor satisfacción en especialidades médicas frente a las quirúrgicas, el año de residencia, las facilidades para realizar la tesis, trabajar menos de 40h a la semana, el tiempo adecuado para la realización de las tareas diarias, la adecuación en el número de sesiones en el servicio y el no disponer de otra especialidad previa. Conclusiones: Las actividades relacionadas con la investigación y docencia están asociadas con la satisfacción global del residente. Los factores de la actividad rutinaria que más se asocian con la satisfacción fueron el tiempo disponible y las horas de trabajo. Son necesarios más estudios para conocer el impacto de la satisfacción del residente en la calidad asistencial y en su actividad como futuro especialista (AU)

Background and objectives: We do not know what factors influence residents’ perceived satisfaction during their training. The aim of this study was to analyze the satisfaction of specialists with their training and its associated factors. Material and methods: This was a cross-sectional study using self-completion surveys of residents in training at the Clinic Hospital San Carlos for the courses conducted in 2006, 2009, 2010 and 2012. The study's dependent variable was overall satisfaction with the training; the independent factors were demographic and occupational characteristics, variables related to healthcare, teaching and research activity. Results: The total participation percentage was 83.7% (1,424/1,701), and the mean age was 28.4 years (SD, 3.2 years). The overall satisfaction percentage was 75.2%. The factors statistically associated with overall satisfaction in the multivariate analysis were the involvement of the teaching staff (tutors and assistants) in the training, greater satisfaction in medical versus surgical specialties, the year of residence, the facilities for completing the thesis, working less than 40h a week, adequate time to perform daily tasks, appropriate number of department meetings and not having a previous specialty. Conclusions: the activities related to research and teaching are associated with the overall satisfaction of residents. The routine activity factors most closely associated with satisfaction were the time available and the work hours. More studies are necessary to understand the impact of resident satisfaction on care quality and in their activity as future specialists (AU)

Factors associated with residents' satisfaction with their training as specialists.

BACKGROUND AND OBJECTIVES: We do not know what factors influence residents' perceived satisfaction during their training. The aim of this study was to analyze the satisfaction of specialists with their training and its associated factors. MATERIAL AND METHODS: This was a cross-sectional study using self-completion surveys of residents in training at the Clinic Hospital San Carlos for the courses conducted in 2006, 2009, 2010 and 2012. The study's dependent variable was overall satisfaction with the training; the independent factors were demographic and occupational characteristics, variables related to healthcare, teaching and research activity. RESULTS: The total participation percentage was 83.7% (1,424/1,701), and the mean age was 28.4 years (SD, 3.2 years). The overall satisfaction percentage was 75.2%. The factors statistically associated with overall satisfaction in the multivariate analysis were the involvement of the teaching staff (tutors and assistants) in the training, greater satisfaction in medical versus surgical specialties, the year of residence, the facilities for completing the thesis, working less than 40 h a week, adequate time to perform daily tasks, appropriate number of department meetings and not having a previous specialty. CONCLUSIONS: the activities related to research and teaching are associated with the overall satisfaction of residents. The routine activity factors most closely associated with satisfaction were the time available and the work hours. More studies are necessary to understand the impact of resident satisfaction on care quality and in their activity as future specialists.

[Effectiveness of an intervention to improve the compliance of hand hygiene in a tertiary hospital]. / Efectividad de una intervención para la mejora del cumplimiento en la higiene de manos en un hospital de tercer nivel.

OBJECTIVE: The aim of the study is to assess the effectiveness of an intervention to improve the compliance with hand hygiene (HH) and the detection of factors associated with non-compliance. METHODS: A before and after intervention study with two cross-sectional and direct observations of HH compliance was performed. The intervention was targeted at all the health workers and hospital departments directly related with patients and their healthcare environment. One hundred and sixty observation periods were included in each cross-sectional observation, accounting for a total of 5,245 observed opportunities of HH among 947 health workers. RESULTS: Hand hygiene compliance showed a significant increase of 7.7% (95% CI: 5.5-9.9; P<.001) with a pre-intervention and post-intervention HH compliance of 17.4% (95% CI: 16.0-18.9) and 25.5% (95% CI: 23.5-26.9), respectively. The following variables showed an independent association with the non-compliance of HH: morning shift (0.32; 95% CI: 0.24-0.42), being a nurse (OR: 0.44; 95%CI: 0.29-0.65), working in an intensive care unit (OR: 0.14: 95%CI: 0.10-0.18), non-use of gloves (OR:0.58: 95% CI:0.48-0.69), observed opportunities of HH arising after high risk contact (OR:0.30: 95% CI: 0.22-0.41) and after low risk contact (OR:0.43: 95% CI:0.32-0.58). CONCLUSIONS: The intervention has independently and significantly improved hand hygiene in the hospital. Multimodal strategies need to be designed in healthcare settings in order to increase HH compliance among health workers.

Smoking cessation in HIV patients: rate of success and associated factors.

BACKGROUND: Smoking is the modifiable cardiovascular (CV) risk factor that contributes most to causing premature CV disease. Prevalence of smoking in patients with HIV infection is double that of the general population. OBJECTIVES: To determine the rate of patients succeeding in quitting smoking after 12 months, factors associated with this success, and the characteristics of tobacco consumption and nicotine dependence. METHODS: Longitudinal descriptive study. Three hundred and sixty-eight HIV-infected patients were interviewed. Smokers in Prochaska's stage of action began a programme to quit smoking. We registered the variables related to tobacco consumption and the level of success of cessation. RESULTS: 63.9% of the patients were active smokers and 14% of them began the cessation programme. Average motivation for cessation was 7.8 +/- 1.4 (Richmond) and nicotine dependence rate 5.5 +/- 3.0 (Fagerström). After 1 year, 25% had quit smoking. Those patients who stopped smoking presented a higher motivation level (8.8 +/- 1.3 vs. 7.5 +/- 1.5, P=0.048). Cessation significantly reduced their CV risk at 12 months [2.5 [interquartile range (IQR) 2.0-5.2] vs. 1.7 [IQR 1.0-3.5], P=0.026]. CONCLUSIONS: The prevalence of smokers in our population of HIV-infected patients was 63.9%. Only 14% began a smoking cessation programme. Twelve months after a programme to quit smoking, cessation rate was 25%; this was influenced mostly by the level of motivation of the patient.

[Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year]. / Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal.

BACKGROUND: In recent years, there has been an increase of drugs poisoning cases seen in the Emergency Department. This study has aimed to evaluate the characteristics of these cases in the Ramón and Cajal Hospital in Madrid. MATERIALS AND METHODS: A descriptive analysis about the drug poisonings diagnosed in 2004 was performed, using a retrospective search in the database of the electronic clinical records. The studied variables were gender, age, intention, drugs, admission into the hospital and relapse. RESULTS: There were 566 drug poisoning (47%) with a cumulative incidence of 0.1%, in which women (62.3%) were found to predominate, and the average patient age was 42.46+/-19.97 years (range 14-100 years). In 64.31% of the cases (566), only one kind of drug was used, benzodiazepine being the most common. This appeared at least once in 62% of the cases. Furthermore, 83% were cases of voluntary poisoning. Of the involuntary poisonings, digoxin was the most common drug with a frequency of 58.4%. A total of 28.6% of the cases were admitted into hospital, while the total number of patients who suffered a relapse in this period was 10%. DISCUSSION: Voluntary drug intoxications are caused mostly by psychoactive drugs, likely due to a high prevalence of underlying psychiatric disease in these patients. However, unintentional intoxications are mainly found in patients under chronic treatment with drugs such as digoxin and antiepileptics. More studies should be carried out to analyze which kind of preventive actions could reduce or avoid the high number of relapses.

Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal / Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year

un aumento de las intoxicaciones medicamentosasatendidas en los servicios de Urgencias. El objetivode este trabajo fue evaluar las características deéstas en el Hospital Ramón y Cajal de Madrid.Material y métodos. Se realizó un análisisdescriptivo de las intoxicaciones medicamentosasdiagnosticadas en el año 2004, a través de unabúsqueda retrospectiva, en la base de datos de lahistoria clínica electrónica. Las variables estudiadasfueron sexo, edad, intencionalidad, tipo de fármaco,ingreso hospitalario y reincidencia.Resultados. Se recogieron 566 intoxicacionesmedicamentosas con una incidencia acumulada del0,1%, en las cuales existía un predominio de mujeres(62,3%), y la media de edad de los pacientes fue de42,46±19,97 años (rango 14-100 años). En un64,31% de los casos se utilizó un solo tipo defármaco. Las benzodiacepinas, presentes en el 62%de los casos, fueron las de mayor frecuencia. Además,un 83% fueron voluntarias. En las intoxicaciones novoluntarias la digoxina fue el fármaco que apareciócon más frecuencia (58,4%). Un 28,6% del totalrequirieron ingreso hospitalario, mientras que lareincidencia en este periodo fue del 10%.Discusión. Los intentos autolíticos medicamentososson producidos en su mayoría por fármacospsicoactivos, debido probablemente a una altaprevalencia de patología psiquiátrica subyacente enestos pacientes. Las intoxicaciones no voluntarias,sin embargo, se presentan fundamentalmente enpacientes con tratamiento crónico, mediantefármacos como la digoxina o los antiepilépticos. Sedeberán realizar estudios para analizar qué tipo demedidas de prevención pueden disminuir o evitar elgran número de reincidencias

Background. In recent years, there has been anincrease of drugs poisoning cases seen in theEmergency Department. This study has aimed toevaluate the characteristics of these cases in theRamón and Cajal Hospital in Madrid.Materials and methods. A descriptive analysisabout the drug poisonings diagnosed in 2004 wasperformed, using a retrospective search in thedatabase of the electronic clinical records. Thestudied variables were gender, age, intention, drugs,admission into the hospital and relapse.Results. There were 566 drug poisoning (47%) witha cumulative incidence of 0.1%, in which women(62.3%) were found to predominate, and theaverage patient age was 42.46±19.97 years (range14-100 years). In 64.31% of the cases (566), onlyone kind of drug was used, benzodiazepine being themost common. This appeared at least once in 62%of the cases. Furthermore, 83% were cases ofvoluntary poisoning. Of the involuntary poisonings,digoxin was the most common drug with a frequencyof 58.4%. A total of 28.6% of the cases wereadmitted into hospital, while the total number ofpatients who suffered a relapse in this period was10%.Discussion. Voluntary drug intoxications are causedmostly by psychoactive drugs, likely due to a highprevalence of underlying psychiatric disease in thesepatients. However, unintentional intoxications aremainly found in patients under chronic treatmentwith drugs such as digoxin and antiepileptics. Morestudies should be carried out to analyze which kindof preventive actions could reduce or avoid the highnumber of relapses