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INTRODUCTION: Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS: The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS: A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS: This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.
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Clinical Medicine , Internal Medicine , Humans , Ultrasonography , Internal Medicine/education , Societies, MedicalABSTRACT
BACKGROUND: In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities. OBJECTIVE: To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia. DESIGN: Observational, cross-sectional, multicenter study using convenience sampling. SETTING: Six Spanish academic hospitals. PATIENTS: Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020. MEASUREMENTS: The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists. RESULTS: In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%. CONCLUSION: POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.
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La Esclerosis Lateral Amiotrófica (ELA) es una enfermedad neurodegenerativa caracterizada por una evolución rápida y mortal, produciendo un gran impacto emocional tanto en el paciente, como en su familia. El papel de la enfermera Gestora de Casos en el seguimiento, evaluación y control del paciente y su familia desde el diagnóstico de ELA, y como principal referente experta en cuidados, la posiciona como referente de nexo de unión del equipo multidisciplinar y la unidad familiar. Su papel dentro del equipo interdisciplinar ayuda a mejorar la asistencia que el cuidador familiar proporciona, evitando la sobrecarga del rol de cuidador, aumentando la seguridad del paciente, y por tanto la calidad de vida de ambos, mejorando así también la comunicación e información y la satisfacción familiar. En la práctica, resulta complicado mantener una continuidad de cuidados integrales a lo largo de todo el proceso de la enfermedad, desde el diagnóstico, hasta los últimos días. (AU)
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease characterized by rapid and fatal evolution, producing a great emotional impact on both the patient and their family. The role of the Nurse Case Manager in the monitoring, evaluation, and control of the patient and their family from the diagnosis of ALS, and as the main expert reference in care, positions her as a point of reference for the union of the multidisciplinary team and the family unit. Their role within the interdisciplinary team helps to improve the assistance that the informal caregiver provides, avoiding the overload of the caregiver role, increasing patient safety, and therefore the quality of life for both, thus also improving communication and information and family satisfaction. In practice, it is difficult to maintain a continuity of comprehensive care throughout the disease process, from diagnosis to the last days. (AU)
Subject(s)
Humans , Amyotrophic Lateral Sclerosis , Hospice Care , Nursing , Caregivers , Primary Health Care , Nurse-Patient RelationsABSTRACT
BACKGROUND: One hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data. RESULTS: Concerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/µL, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve. CONCLUSION: Age and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results.
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