ABSTRACT
Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as nursing workload or the level of dependency, are being incorporated. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. Methods: A multicentre prospective observational study design was used. Sampling was conducted between February 2015 and October 2017. Patients over 16 years, admitted to medical or surgical units at 11 public hospitals in Andalusia (Spain), with a foreseeable stay of at least 48 h were included. Multivariate regression analyses were performed to analyse the data. Results: The sample consisted of 3821 assessments conducted in 1004 patients. The mean profile was that of a male (52%), mean age of 64.5 years old, admitted to a medical unit (56.5%), with an informal caregiver (60%). In-hospital mortality was 4%. The INICIARE (Inventario del Nivel de Cuidados Mediante Indicadores de Clasificación de Resultados de Enfermería) scale yielded an adjusted odds ratio [AOR] of 0.987 (95% confidence interval [CI]: 0.97-0.99) and the nurse staffing level (NSL) yielded an AOR of 1.197 (95% CI: 1.02-1.4). Conclusion: Nursing care dependency measured by INICIARE and nurse staffing level was associated with in-hospital mortality.
Subject(s)
Hospital Mortality , Nursing Staff, Hospital , Personnel Staffing and Scheduling , Female , Hospitals , Humans , Male , Middle Aged , Prospective Studies , Spain/epidemiologyABSTRACT
In order to achieve significant improvements in quality, cost, and accessibility (the health "iron triangle"), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was 136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (2297 per QALY gained). At six months, the mean of WTP was 69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient.
Subject(s)
Ostomy , Quality of Life , Quality-Adjusted Life Years , Adult , Aged , Aged, 80 and over , Cost-Benefit Analysis , Female , Humans , Male , Middle Aged , Ostomy/economics , Ostomy/standards , Patient Care/standards , Prospective StudiesABSTRACT
Two new species of subterranean water amphipod crustaceans of the genus Pseudoniphargus (Pseudoniphargidae) are described from gypsum caves of Andalusia, southern Spain. Both species share the extreme elongation of the male third uropod, a striking feature frequently reported in the genus and that seems to have arisen independently in several lineages. These findings raise the number of species of Pseudoniphargus known from the area to 17.
Subject(s)
Amphipoda , Caves , Animals , Male , SpainABSTRACT
Objetivos: Determinar situaciones conflictivas con ciudadanos en un área específica de Atención Especializada de Madrid. Material y Métodos: Se realiza un análisis descriptivo, observacional y retrospectivo de incidentes con los ciudadanos en un Área Específica en Atención Especializada entre los años 2009 y 2013. Durante el periodo de estudio se analizaron 188 situaciones conflictivas incluyendo como variables a estudio, su edad y sexo, el tipo de agresión y agresor, el lugar de trabajo, la categoría laboral, la causa del incidente y las medidas propuestas. Los datos se obtuvieron del Sistema de Registro Madrileño de Agresiones y Conflictos (REMAC). Resultados: De las 188 situaciones conflictivas recogidas, predomina en el agresor con más de un 60% el sexo masculino. La mayoría, 25% ,se encuentran en edades comprendidas entre los 31 y 40 años. Predominó el tipo de agresión verbal con un 88,8%. Se identificó como el tipo de agresor más frecuente al familiar o acompañante con un 46,8%. Con un 31,3%, el lugar de trabajo en el que mayor número de situaciones ocurrieron fue hospitalización médica. Por categorías, la enfermería/ DUE con un 35,1% es la que presentó mayor porcentaje de incidente. Discusión: Las situaciones Conflictivas con usuarios en Atención Especializada han aumentado considerablemente en los últimos años, por lo que se ha hecho necesario establecer planes de prevención y actuación ante estas situaciones, (procedimiento de actuación, formación de los profesionales, asesoramiento jurídico, etc).; que contemplan medidas previstas en la Orden 212/2004 del 4 de Marzo del Consejero de Sanidad y Consumo de la Comunidad de Madrid (AU)
Objectives: Determine the conflictive situations that arise with citizens in a specific area of Specialized Care of Madrid. Material and Methods: A descriptive, observational and retrospective analysis of incidents with citizens in a Specific Area of Specialized Care that occurred between 2009 and 2013 was carried out. During the study period, 188 conflictive situations were analyzed including the following variables: level of education, age and sex, type of aggression and aggressor, workplace, job category, cause of the incident and proposed measures.The information was obtained from the Register of Aggressions and Conflicts of Madrid (REMAC, Registro Madrileño de Agresiones y Conflictos). Results: Of the 188 conflictive situations analyzed, more than 60% of them were committed by males. The majority, 25%, were between 31 and 40 years old. The predominant incident, 88.8%, was verbal aggression. The most frequent aggressor, 46.8%, was a relative or companion. The workplaces where more conflictive situations arose (AU)
Subject(s)
Female , Humans , Male , Labor Relations , Patient Care Management/ethics , Patient Care Management , Aggression/ethics , Aggression/psychology , Public Health/education , Public Health/ethics , Patient Care Management/classification , Patient Care Management/methods , Aggression/classification , Aggression/physiology , Public Health , Public Health/methodsABSTRACT
Objetivos: Conocer el procedimiento de actuación ante una exposición laboral a Tos ferina. Material y Métodos: Exposición laboral del personal sanitario ante un paciente trasplantado renal e inmunosuprimido, que ingresa en la urgencia de un Hospital terciario de la comunidad de Madrid, que posteriormente fue diagnosticado de Tos ferina. Notificación al SPRL e identificación de los Servicios en los cuales permaneció ingresado el paciente, para el posterior seguimiento del personal expuesto. Resultados: Acudieron 43 trabajadores, 39 de ellos recibieron quimioprofilaxis, se inició tratamiento con claritromicina, hasta disponer de azitromicina, por mejor cumplimiento por parte del personal. Se recomendó refuerzo vacunal anti Tos ferina (dTpa) a todos los expuestos. Conclusiones: La situación epidemiológica actual de la Tos ferina en España nos obliga a tener presente la actuación a realizar ante una exposición laboral a Tos ferina y la necesidad de incorporar nuevas estrategias vacunales para un mejor control de la infección (AU)
Objectives: To know the procedure of the performance in a workplace exposure to Pertussis. Material and Methods: Workpl ace exposure of medical staff, with a kidney-transplant patient and in-munosupressive who is admitted in an emergency terciary hospital of Madrid Community, who was diagnosed of Pertussis. Notification to the Laboral Risk Preventive Department (LRPD) and detection of all the departments where the patient remains admitted, for the subsequent tracing of the personal that was exposed from the LRPD. Results: 43 workers attended, 39 of them received prophylaxis, it was started treatment with Clarithromycin until was available Azithromycin for being ease of adherence. It was recommended Tetanus Toxoid and reduced Diphtheria Toxoid and Acellular Pertussis vaccines adsorbed (Tdap) to all the exposures. Conclusions: Actual epidemiological situation of Pertussis in Spain, force us having each day to have current performance in a workplace exposure to Pertussis and the requirement of incorporate new vaccination strategies (AU)
Subject(s)
Female , Humans , Whooping Cough/complications , Whooping Cough/metabolism , Whooping Cough/mortality , Spain/ethnology , Vaccination , Vaccination/mortality , Program of Risk Prevention on Working Environment , Health Benefit Plans, Employee/ethics , Health Benefit Plans, Employee/legislation & jurisprudence , Whooping Cough/prevention & control , Whooping Cough/transmission , Whooping Cough/virology , Vaccination/classification , Vaccination/methods , Health Benefit Plans, Employee/standards , Health Benefit Plans, EmployeeABSTRACT
El síndrome de apnea-hipopnea del sueño es el más frecuente de los trastornos respiratorios que se producen durante el sueño, afectando alrededor del 4% de los adultos, y a casi 2 millones de personas en España. Se presenta con episodios repetidos de obstrucción de la vía aérea superior provocando un colapso del flujo de aire hacia los pulmones y síntomas como somnolencia diurna, trastornos respiratorios, cardiovasculares, psicológicos e intelectuales. La somnolencia al conducir es común entre conductores profesionales, afectando su rendimiento y la seguridad de la población. Se llevó a cabo una revisión bibliográfica exploratoria, para conocer la prevalencia de la patología en conductores profesionales, los factores del riesgo implicados, los métodos utilizados en su diagnóstico y su relación con los accidentes de tránsito. Se seleccionaron nueve bases de datos, PUBMED, IBECS, LILACS, COCHRANE LIBRARY, EMBASE, SCOPUS, SCIELO, WOS y WOK, para llevar a cabo la búsqueda entre Octubre 2011 y Enero 2012. Luego de aplicados los criterios de inclusión/exclusión se analizaron 12 artículos. La prevalencia del síndrome es similar en la mayoría de los estudios pero superior a la población general. Los factores de riesgo de mayor estudio e impacto fueron la obesidad, la somnolencia excesiva, los ronquidos. No existe consenso entre los test diagnósticos utilizados y su eficacia. Sin embargo el más utilizado ha sido la escala de Epworth (ESE). La relación siniestralidad y apnea del sueño ha sido poco estudiada en conductores profesionales (AU)
The sleep apnea-hypopnea syndrome is the most common respiratory disorders that occur during sleep, affecting about 4% of adults, and nearly 2 million people in Spain. It occurs with repeated episodes of upper airway obstruction causing a flow of air collapse into the lungs and symptoms such as daytime sleepiness, respiratory, cardiovascular, psychological and intellectual disorders. Sleepiness while driving is common among professional drivers, affecting their performance and safety of the population. It was conducted an exploratory literature review to determine: the prevalence of the disease in professional drivers, the risk factors involved, the methods used in diagnosis and its relation with traffic accidents. There were selected nine databases, PubMed, IBECS, LILACS, Cochrane Library, EMBASE, Scopus, SciELO, WOS and WOK, to carry out the research between October 2011 and January 2012. After applying the criteria of inclusion / exclusion 12 articles were analyzed. The prevalence of the syndrome is similar in most studies but higher than general population. The most significant Risk factors and its impact were obesity, excessive sleepiness, snoring. There is no consensus among the diagnostic tests used and their effectiveness. However the most used is the Epworth Sleepiness Scale (ESS). The relationship between job accidents and sleep apnea has been not studied a lot in professional drivers (AU)
Subject(s)
Humans , Sleep Apnea, Obstructive/epidemiology , Automobile Driving/statistics & numerical data , Accidents, Traffic/prevention & control , Risk FactorsABSTRACT
Symptoms such as cough and hemoptysis in patients with lung cancer can be the consequence of local bronchopulmonary disease, tumor growth that leads to compression of surrounding structures, distant metastases, diverse systemic effects (anorexia, asthenia, weight loss), or paraneoplastic syndromes associated with tumor production of certain hormones. Approximately 10% of patients are asymptomatic at diagnosis. We report the case of a 77-year-old man with dyspnea, pleuritic chest pain, and lower limb edema. The patient died within a few days. The cause of the clinical picture was constrictive pericarditis secondary to metastases from lung carcinoma.
Subject(s)
Heart Neoplasms/secondary , Lung Neoplasms/diagnosis , Pericarditis, Constrictive/diagnosis , Aged , Diagnosis, Differential , Early Diagnosis , Fatal Outcome , Heart Neoplasms/diagnosis , Humans , Lung Neoplasms/pathology , Male , Neoplasms, Second Primary/diagnosis , Pericarditis, Constrictive/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Los síntomas que presentan los pacientes con cáncer de pulmón pueden ser la consecuencia de una enfermedad broncopulmonar local (tos, hemoptisis, etc.), deberse a la extensión del tumor hacia las estructuras circundantes, a metástasis a distancia, a efectos sistémicos inespecíficos (anorexia, astenia, pérdida de peso) o a síndromes paraneoplásicos secundarios a la producción de determinadas hormonas por el tumor. En torno al 10% de los pacientes se encuentran asintomáticos en el momento del diagnóstico. Presentamos el caso de un paciente varón de 77 años de edad, que presentaba disnea, dolor torácico de tipo pleurítico y edemas en los miembros inferiores. Su evolución fue fatal, falleciendo al cabo de pocos días. La causa de la clínica era la existencia de pericarditis constrictiva secundaria a metástasis de carcinoma pulmonar
Symptoms such as cough and hemoptysis in patients with lung cancer can be the consequence of local bronchopulmonary disease, tumor growth that leads to compression of surrounding structures, distant metastases, diverse systemic effects (anorexia, asthenia, weight loss), or paraneoplastic syndromes associated with tumor production of certain hormones. Approximately 10% of patients are asymptomatic at diagnosis. We report the case of a 77-year-old man with dyspnea, pleuritic chest pain, and lower limb edema. The patient died within a few days. The cause of the clinical picture was constrictive pericarditis secondary to metastases from lung carcinoma
Subject(s)
Male , Aged , Humans , Pericarditis, Constrictive/diagnosis , Heart Neoplasms/secondary , Lung Neoplasms/diagnosis , Neoplasms, Second Primary/diagnosis , Diagnosis, Differential , Fatal Outcome , Pericarditis, Constrictive , Tomography, X-Ray Computed , Early Diagnosis , Heart Neoplasms/diagnosis , Lung Neoplasms/pathologyABSTRACT
El empleo cada vez más generalizado de insecticidas anticolinesterásicos (organofosforados y carbamatos) de uso agrícola ha contribuido al aumento de intoxicaciones, muy importante en zonas de alta producción agrícola y dando lugar a pacientes que precisan de una estrecha vigilancia y gran cantidad de cuidados y técnicas de enfermería, dado lo florido de su clínica y su tratamiento. Tras analizar las vías de entrada, el mecanismo de acción y la clínica, en el artículo se estudia la actuación de enfermería que debe ser precoz y dirigida principalmente a disminuir la absorción del tóxico y administración de los antídotos así como tratamiento sintomático y una estrecha vigilancia (AU)
Subject(s)
Humans , Cholinesterase Inhibitors/poisoning , Insecticides, Organophosphate/poisoning , Poisoning/nursing , Insecticides/poisoning , Antidotes/administration & dosage , Nursing Care/methods , Security Measures , Fluid Therapy/methodsABSTRACT
Se revisan 13 hitorias clínicas de pacientes operados por tumores de intestino delgado en el hospital docente clinicoquirúrgico "10 de Octubre", en el período de tiempo comprendido entre los años 1976 y 1982, con una revisión del tema y el análisis particular de cada uno de ellos, orientado fundamentalmente por el estudio anátomo-patológico. Se señala la importancia del estudio radiológico con contraste, endoscopia y laparoscopia como valiosos medios de diagnóstico. Se insiste en el seguimiento de estos enfermos hasta los cinco años (AU)
Subject(s)
Adult , Middle Aged , Aged , Humans , Male , Female , Intestinal Neoplasms/surgery , Hospitals, Teaching , Intestine, Small , Intestinal Neoplasms/pathologyABSTRACT
Se revisan 13 hitorias clínicas de pacientes operados por tumores de intestino delgado en el hospital docente clinicoquirúrgico "10 de Octubre", en el período de tiempo comprendido entre los años 1976 y 1982, con una revisión del tema y el análisis particular de cada uno de ellos, orientado fundamentalmente por el estudio anátomo-patológico. Se señala la importancia del estudio radiológico con contraste, endoscopia y laparoscopia como valiosos medios de diagnóstico. Se insiste en el seguimiento de estos enfermos hasta los cinco años
