Routine Kidney Graft Ultrasound After Elective Ureteric Stent Removal: Does it Help?

Transplantation (KTx) is considered to be the best renal replacement therapy, and improving its outcomes remains a primary challenge. KTx ureteral stenting has been used to prevent urological complications, but there is no consensus on the timing of stent removal, and literature regarding routine ultrasonography after ureteric stent removal (RUSUS) to detect complications is lacking. Point-of-care ultrasound has been gaining drive in the medical community in recent years, including nephrologists. We aimed to define the incidence of urological complications diagnosed with RUSUS, if those findings changed patient's management and ultrasound utility. Contrary to previously published data, in our cohort RUSUS allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx point-of-care ultrasound is a cost-effective and reproducible test that provides relevant information to guide clinical decisions, seeming most efficient when performed approximately 2 weeks post ureteral stent removal. Interventional nephrologists can promptly perform these examinations, reducing waiting times and improving graft and patient's survival.

Impact of the COVID-19 Pandemic on Inappropriate Use of the Emergency Department.

Background: Inappropriate use of the emergency department (IEDU)-consisting of the unnecessary use of the resource by patients with no clinical need-is one of the leading causes of the loss of efficiency of the health system. Specific contexts modify routine clinical practice and usage patterns. This study aims to analyse the influence of COVID-19 on the IEDU and its causes. Methods: A retrospective, cross-sectional study conducted in the emergency department of a high-complexity hospital. The Hospital Emergency Suitability Protocol (HESP) was used to measure the prevalence of IEDU and its causes, comparing three pairs of periods: (1) March 2019 and 2020; (2) June 2019 and 2020; and (3) September 2019 and 2020. A bivariate analysis and multivariate logistic regression models, adjusted for confounding variables, were utilized. Results: In total, 822 emergency visits were included (137 per period). A total prevalence of IEDU of 14.1% was found. There was a significant decrease in IEDU in March 2020 (OR: 0.03), with a prevalence of 0.8%. No differences were found in the other periods. A mistrust in primary care was the leading cause of IEDU (65.1%). Conclusions: The impact of COVID-19 reduced the frequency of IEDU during the period of more significant population restrictions, with IEDU returning to previous levels in subsequent months. Targeted actions in the field of population education and an improvement in primary care are positioned as strategies that could mitigate its impact.

[Apropriateness of hospital admissions due to COVID-19 in the 2nd and 5th phase of the pandemic.] / Adecuación de ingresos hospitalarios por COVID-19 en la 2ª y 5ª fase de la pandemia.

OBJECTIVE: The increase in the demand for healthcare caused by COVID-19 implies a lower availability of health resources and influences the appropriateness of their use. Due to the variability of demand during the pandemic, the study aimed to compare the appropriateness of hospital admissions between the 2nd and 5th phases of the pandemic according to the criteria of the Hospital Emergency Service (CiHRyC). These results were compared with those obtained according to the Pneumonity Severity Index (FINE) and the Appropriateness Evaluation Protocol (AEP). As a secondary objective, the clinical and sociodemographic characteristics of the patients studied were described. METHODS: 80 patients hospitalized from the Emergency Department were randomly selected in two study periods (2nd and 5th pandemic phase) obtained from the registry of hospitalizations of the Preventive Medicine service of Hospital Ramon y Cajal. Prevalences of inappropriateness were estimated according to the CiHRyC, FINE and AEP and an analysis was performed using univariate logistic regression between epidemiological variables of both periods collected through the electronical medical records. RESULTS: Inappropriateness of admissions were 35% and 45% in the 2nd and 5th phase of the pandemic according with CiHRyC, 25% and 5/% according with FINE and 0% and 5% according with AEP. Median age was 71.4 and 50.0 years in 2nd and 5th phase (p=0.02). 72.5% and 17.5% of the patients in the 2nd and 5th phases had at least one risk factor for COVID-19 severe illness (p<0.01). CONCLUSIONS: The measurement tools used identified more inappropriately cases in the 5th phase of the pandemic than in the 2nd one. CiHRyC coincided with FINE and AEP in the result of their evaluation.

OBJETIVO: El aumento de la demanda asistencial hospitalaria producida por la COVID-19 supone una menor disponibilidad de recursos sanitarios e influye en la adecuación de su utilización. Debido a la variabilidad de la demanda durante la pandemia, el objetivo del estudio fue comparar la adecuación de los ingresos hospitalarios entre la 2ª y 5ª fase de la pandemia según los criterios del servicio de Urgencias del Hospital (CiHRyC). Se compararon estos resultados con los obtenidos según el Pneumonity Severity Index (FINE) y el Appropriateness Evaluation Protocol (AEP). Como objetivo secundario se describieron las características clínicas y sociodemográficas de los pacientes estudiados. METODOS: Se seleccionaron aleatoriamente 80 pacientes hospitalizados desde Urgencias en dos periodos de estudio (2ª y 5ª fase pandémica) obtenidos del registro de hospitalizaciones del servicio de Medicina Preventiva del Hospital Ramón y Cajal. Se estimaron las prevalencias de inadecuación según los CiHRyC, el FINE y el AEP para admisiones y se realizó un análisis mediante regresión logística univariante entre las variables epidemiológicas de ambos periodos recogidas mediante la Historia Clínica Electrónica (HCE). RESULTADOS: La inadecuación de la hospitalización fue del 35% y 45% en la 2ª y 5ª fase de la pandemia con los CiHRyC, del 25% y 57% con el FINE y del 0% y 5% con el AEP. La mediana de edad fue de 71,4 y 50 años en la 2ª y 5ª fase (p=0,02). El 72,5% y el 17,5% de los pacientes de la 2ª y 5ª fase tuvieron al menos un factor de riesgo de complicaciones de COVID-19 (p<0,01). CONCLUSIONES: Los instrumentos de medida empleados (CiHRyC, el FINE y el AEP) identificaron más casos inadecuadamente ingresados en la 5ª fase de la pandemia que en la 2ª, coincidiendo el CiHRyC con el FINE y el AEP en el resultado de su evaluación.

Adecuación de ingresos hospitalarios por COVID-19 en la 2ª y 5ª fase de la pandemia / Apropriateness of hospital admissions due to COVID-19 in the 2nd and 5th phase of the pandemic

Fundamentos: El aumento de la demanda asistencial hospitalaria producida por la COVID-19 supone una menor disponibilidad de recursos sanitarios e influye en la adecuación de su utilización. Debido a la variabilidad de la demanda durante la pandemia, el objetivo del estudio fue comparar la adecuación de los ingresos hospitalarios entre la 2ª y 5ª fase de la pandemia según los criterios del servicio de Urgencias del Hospital (CiHRyC). Se compararon estos resultados con los obtenidos según el Pneumonity Severity Index (FINE) y el Appropriateness Evaluation Protocol (AEP). Como objetivo secundario se describieron las características clínicas y sociodemográficas de los pacientes estudiados. Métodos: Se seleccionaron aleatoriamente 80 pacientes hospitalizados desde Urgencias en dos periodos de estudio (2ª y 5ª fase pandémica) obtenidos del registro de hospitalizaciones del servicio de Medicina Preventiva del Hospital Ramón y Cajal. Se estimaron las prevalencias de inadecuación según los CiHRyC, el FINE y el AEP para admisiones y se realizó un análisis mediante regresión logística univariante entre las variables epidemiológicas de ambos periodos recogidas mediante la Historia Clínica Electrónica (HCE). Resultados: La inadecuación de la hospitalización fue del 35% y 45% en la 2ª y 5ª fase de la pandemia con los CiHRyC, del 25% y 57% con el FINE y del 0% y 5% con el AEP. La mediana de edad fue de 71,4 y 50 años en la 2ª y 5ª fase (p=0,02). El 72,5% y el 17,5% de los pacientes de la 2ª y 5ª fase tuvieron al menos un factor de riesgo de complicaciones de COVID-19 (p<0,01). Conclusiones: Los instrumentos de medida empleados (CiHRyC, el FINE y el AEP) identificaron más casos inadecuadamente ingresados en la 5ª fase de la pandemia que en la 2ª, coincidiendo el CiHRyC con el FINE y el AEP en el resultado de su evaluación.(AU)

Background: The increase in the demand for healthcare caused by COVID-19 implies a lower availability of health resources and influences the appropriateness of their use. Due to the variability of demand during the pandemic, the study aimed to compare the appropriateness of hospital admissions between the 2nd and 5th phases of the pandemic according to the criteria of the Hospital Emergency Service (CiHRyC). These results were compared with those obtained according to the Pneumonity Severity Index (FINE) and the Appropriateness Evaluation Protocol (AEP). As a secondary objective, the clinical and sociodemographic characteristics of the patients studied were described. Methods: 80 patients hospitalized from the Emergency Department were randomly selected in two study periods (2nd and 5th pandemic phase) obtained from the registry of hospitalizations of the Preventive Medicine service of Hospital Ramon y Cajal. Prevalences of inappropriateness were estimated according to the CiHRyC, FINE and AEP and an analysis was performed using univariate logistic regression between epidemiological variables of both periods collected through the electronical medical records. Results: Inappropriateness of admissions were 35% and 45% in the 2nd and 5th phase of the pandemic according with CiHRyC, 25% and 5/% according with FINE and 0% and 5% according with AEP. Median age was 71.4 and 50.0 years in 2nd and 5th phase (p=0.02). 72.5% and 17.5% of the patients in the 2nd and 5 th phases had at least one risk factor for COVID-19 severe illness (p<0.01). Conclusions: The measurement tools used identified more inappropriately cases in the 5th phase of the pandemic than in the 2 nd one. CiHRyC coincided with FINE and AEP in the result of their evaluation.(AU)