Prevalencia de caídas en pacientes ingresados en un hospital universitario / Prevalence of falls in patients admitted to a University Hospital

Objetivo: analizar la prevalencia de caídas de los pacientes hos­pitalizados en un hospital universitario, así como los factores asociados con la asistencia sanitaria (motivos de las caídas, especialidad más prevalente, turno más frecuente, si estaban solos o acompañados, etc.) en los pacientes que se cayeron y las posibles consecuencias de las caídas. Métodos: estudio transversal. Se incluyeron a todos los pacientes adultos ingresados en 20 unidades de hospitalización del Hospital Universitario de Burgos, que habían sufrido una caída en 2019 y estaban incluidos en el registro de caídas del programa GACELA Care®. El formulario consta de 28 campos de en­trada de datos, que aportan información relevante sobre la caída. Se llevó a cabo análisis descriptivo y comparativo, usando los test estadísticos correspondientes. Resultados: se registraron 244 caídas (0,9%). La edad media fue 73,3 años. El 54,4% tenía edad igual o mayor a 75 años. El 57,8% era del sexo masculino. En Medicina Interna (29,1%) y Psiquiatría (11,1%) se registró el mayor porcentaje de caídas. El 44,2% se produjo en turno de noche, en pacientes que estaban solos (71,7%), sin protecciones (70,5%); y deambulando (36,1%). El motivo principal fue la inestabilidad motora (48,4%). El 62,7% de los pacientes resultó ileso. La especialidad y el turno de trabajo se asociaron significativamente con las caídas. Conclusiones: la prevalencia de caídas en el hospital fue baja. Los factores que se relacionaron con mayor porcentaje de caídas fueron ser mayor de 75 años, sexo masculino, estar ingresado en unidades de especialidad médica y turno de noche. Las caídas ocurrieron habitualmente cuando el paciente estaba solo, sin protección, al levantarse y caminar. La mayoría de los pacientes no presentó lesiones.(AU)

Objective: to analyse the prevalence of falls in patients admitted to a University Hospital, as well as to identify the characteristics of those patients who experienced falls, the factors associated with patient care (reasons for falls, the most prevalent specialty, the most frequent shift, whether they were alone or accompanied, etc.) among patients who fell down, and the potential consequences of said falls. Methods: a cross-sectional study, including all adult patients admitted to 20 hospitalization units from the Hospital Universitario de Burgos, who had experienced a fall in 2019 and were included in the register of falls from the GACELA Care® program. The form consisted of 28 data entry fields, and included information about date, time and place of the fall; reasons for falls; consequences of falls, and action by professionals. Descriptive and comparative analysis was conducted, using the relevant statistical tests. Results: in total, 244 (0.9%) falls were registered. The mean age was 73.3 years; 57.8% were male. The highest proportion of falls was recorded at Internal Medicine (29.1%) and Psychiatry (11.1%); 44.2% occurred during the night shift, in patients who were alone (71.7%); without protections (70.5%); and walking around (36.1%). The main reason was motor instability (48,4%); 62.7% of patients remained unharmed. There was a significant association between specialty and work shift and falls. Conclusions: there was a low prevalence of falls in the hospital. The factors associated with a higher proportion of falls were being >75-year-old, male gender, being admitted to medical specialty units, and night shift. Falls commonly occurred when the patient was alone, without protection, when getting up and walking. Most patients did not present any lesions.(AU)

A Low-Cost System Using a Big-Data Deep-Learning Framework for Assessing Physical Telerehabilitation: A Proof-of-Concept.

The consolidation of telerehabilitation for the treatment of many diseases over the last decades is a consequence of its cost-effective results and its ability to offer access to rehabilitation in remote areas. Telerehabilitation operates over a distance, so vulnerable patients are never exposed to unnecessary risks. Despite its low cost, the need for a professional to assess therapeutic exercises and proper corporal movements online should also be mentioned. The focus of this paper is on a telerehabilitation system for patients suffering from Parkinson's disease in remote villages and other less accessible locations. A full-stack is presented using big data frameworks that facilitate communication between the patient and the occupational therapist, the recording of each session, and real-time skeleton identification using artificial intelligence techniques. Big data technologies are used to process the numerous videos that are generated during the course of treating simultaneous patients. Moreover, the skeleton of each patient can be estimated using deep neural networks for automated evaluation of corporal exercises, which is of immense help to the therapists in charge of the treatment programs.

Assistive Devices for Personal Mobility in Parkinson's Disease: A Systematic Review of the Literature.

Background: Gait abnormalities are a hallmark of Parkinson's disease and contribute to falling risk. As disease symptoms progress, assistive devices are often prescribed. However, there are no guidelines for choosing appropriate ambulatory devices for gait impairment. Objective: To review the scientific evidence on assistive devices for gait impairment in Parkinson's disease. Methods: We performed a systematic literature review for articles relating to parkinsonian gait impairment and assistive devices. We assessed the studies' methodological quality and risk of bias using the PEDro scale. Results: Seventeen articles were reviewed. Four articles (23.53%) showed that canes and standard and two-wheeled walkers without visual cues decreased gait speed and stride length, with no significant effects on freezing of gait or falls. Instead, improvements were observed with the use of visual [seven articles (41.18%)] and auditory cues [three articles (17.65%)], including decreased number of freezing episodes and increased stride length. Conclusions: Although assistive devices seem to improve confidence, there is still limited information about the efficacy of assistive devices on gait parameters and functional disability in Parkinson's disease. Further, longitudinal, multicenter, randomized, blinded, and controlled studies using assistive devices in a free-living context are required to provide the best scientific evidence.

Evaluación del Informe de Cuidados de Enfermería en un hospital universitario / Assessment of nursing care reports in a university hospital

OBJETIVO: valorar la calidad de los Informes de Cuidados de Enfermería (ICE) realizados en las unidades de hospitalización de un complejo hospitalario universitario y determinar su mejoría en 2016 respecto a 2015. MÉTODO: se llevó a cabo un estudio descriptico longitudinal retrospectivo, con dos cortes en periodos similares, mayo de 2015 y mayo de 2016, en el Complejo Asistencial Universitario de Burgos. Para la recogida de datos se utilizó el programa de gestión de cuidados GACELA Care. Se analizó la calidad de los ICE en función a criterios estandarizados y consensuados por el equipo. Se realizó un análisis descriptivo de la calidad de los ICE. Para valorar los cambios entre 2015 y 2016 en su calidad global y de sus variables, se utilizó la prueba de Chi cuadrado o el test exacto de Fisher. RESULTADOS: se analizaron 666 informes. Los ICE efectuados aumentaron en el 2016 de 316 (79%) a 350 (85%). Los informes con calidad muy buena ascendieron del 1% (n= 4) al 17% (n= 60), disminuyendo los de calidad mala, del 53% (n= 169) al 42% (n= 146) con p< 0,00. Globalmente, las varibles de Observaciones (resumen) y Observaciones (dipositivos/continuidad de cuidados) mejoraron significativamente en 2016 respecto a 2015. La variable de Valoración activa alcanzó el 75% de cumplimentación, mientras que en el 13% de los ICE no se incluyeron recomendaciones al alta que precisaba el paciente CONCLUSIONES: la cumplimentación del ICE es bastante elevada, mejorando de un año a otro, aunque solo en el 25% de ellos se realiza con una calidad buena o muy buena. Sería recomendable planificar una intervención con el objeto de mejorar la calidad en la cumplimentación de estos informes

OBJECTIVE: to assess the quality of Nursing Care Reports (NCR) completed in the hospitalization units of a university hospital, and to determine their improvement in 2016 vs. 2015. METHOD: a retrospective longitudinal descriptive study was conducted, with two cut-off dates in similar periods: May, 2015 and May, 2016, in the Complejo Asistencia Universitario de Burgos. The care management program GACELA-Care was used for data collection. The quality of NCRs was analyzed based on standard criteria that were agreed upon by consensus of the team. There was a descriptive analysis of NCR quality. Chi-Square Test or Fisher's Exact Test was used in order to assess the changes between 2015 and 2016 in terms of overall quality and variables. RESULTS: there was an analysis of 666 reports. There was an increase in the number of NCRs conducted: from 316 (79%) to 350 (85%) in 2016. The reports with very good quality increased from 1% (n= 4) to 17% (n= 60), and there was a reduction in the number of reports with poor quality, from 53% (n= 169) to 42% (n= 146) with p< 0.00. Overall, the variables Observations (summary) and Observations (devices, continuity of care) improved significantly in 2016 vs. 2015. The Active Assessment variable reached 75% compliance, while 13% of NCRs did not include recommendations needed by the patient at discharge. CONCLUSIONS: NCR compliance is quite high, and improving from one year to another, though only 25% of these reports presented Good or Very Good quality. It would be advisable to plan an intervention with the aim to improve the quality in the completion of these reports

[Impact of rural or urban areas on disability after a stroke]. / Estudio del impacto del medio rural o urbano sobre la discapacidad residual tras un ictus.

OBJECTIVES: To assess the residual disability in a sample of patients after suffering a first episode of a stroke and to compare the disability of those patients who live in rural areas with those living in urban areas. METHODOLOGY: An observational, longitudinal study of a cohort of 89 patients from a Neurology Unit, affected by cerebrovascular accident. The following factors were assessed: sociodemographic and environmental factors, co-morbidity, functional status, disability, depression and anxiety, and quality of life. The different clinical and demographic variables were compared after admission to the unit, at hospital discharge, and 3 months afterwards. Regression analyses were also carried out in order to study the association between the clinical and sociodemographic factors, and post-stroke disability. RESULTS: Compared to their previous clinical state, after suffering a stroke patients showed a higher rate of co-morbidity (P<.0001), disability (P<.0001), depression (P=.002), and a poorer quality of life (P=.013). The difference between patients coming from rural and urban areas was not statistically significant in terms of disability, quality of life, anxiety, depression, or co-morbidity. CONCLUSIONS: The level of disability, depression and co-morbidity that patients showed after suffering a stroke was similar to the results obtained in other studies. As a novel feature, there were no differences between patients living in rural areas after suffering a stroke and those living in urban areas, as regards disability, depression, or co-morbidity.

Estudio del impacto del medio rural o urbano sobre la discapacidad residual tras un ictus / Impact of rural or urban areas on disability after a stroke

Objetivos: Evaluar la discapacidad residual en una muestra de pacientes tras un primer episodio de ictus y comparar dicha discapacidad entre los pacientes que viven en un medio rural y en un medio urbano. Metodología Estudio observacional, longitudinal, de una cohorte de 89 pacientes afectados por enfermedad cerebrovascular ingresados en el Servicio de Neurología. Se evaluaron factores sociodemográficos y medioambientales, comorbilidad, estado funcional, discapacidad, depresión y ansiedad y calidad de vida. Se realizaron comparaciones de las diferentes variables clínicas y sociodemográficas al ingreso, al alta del centro hospitalario y a los 3 meses, así como un análisis de regresión para estudiar la asociación entre factores clínicos y sociodemográficos con discapacidad postictus. Resultados Comparados con su situación clínica previa, los pacientes tras sufrir un ictus presentaron mayor frecuencia de comorbilidad (p < 0,0001), discapacidad (p < 0,0001), depresión (p = 0,002) y menor calidad de vida (p = 0,013). No hubo diferencias estadísticamente significativas cuando se compararon los pacientes procedentes de un área rural con los de un área urbana en términos de discapacidad, calidad de vida, ansiedad, depresión y comorbilidad. Conclusiones Los grados de discapacidad, depresión y comorbilidad que presentaron los pacientes tras un episodio de ictus fueron similares a los obtenidos en otros estudios. Como aspecto novedoso, no existieron diferencias en cuanto a discapacidad, depresión y comorbilidad al comparar los pacientes del medio rural y urbano tras sufrir un ictus (AU)

OBJECTIVES: To assess the residual disability in a sample of patients after suffering a first episode of a stroke and to compare the disability of those patients who live in rural areas with those living in urban areas. METHODOLOGY: An observational, longitudinal study of a cohort of 89 patients from a Neurology Unit, affected by cerebrovascular accident. The following factors were assessed: sociodemographic and environmental factors, co-morbidity, functional status, disability, depression and anxiety, and quality of life. The different clinical and demographic variables were compared after admission to the unit, at hospital discharge, and 3 months afterwards. Regression analyses were also carried out in order to study the association between the clinical and sociodemographic factors, and post-stroke disability. RESULTS: Compared to their previous clinical state, after suffering a stroke patients showed a higher rate of co-morbidity (P<.0001), disability (P<.0001), depression (P=.002), and a poorer quality of life (P=.013). The difference between patients coming from rural and urban areas was not statistically significant in terms of disability, quality of life, anxiety, depression, or co-morbidity. CONCLUSIONS: The level of disability, depression and co-morbidity that patients showed after suffering a stroke was similar to the results obtained in other studies. As a novel feature, there were no differences between patients living in rural areas after suffering a stroke and those living in urban areas, as regards disability, depression, or co-morbidity (AU)