[Prognostic factors on mortality in patients admitted to hospital with heart failure]. / Factores predictores de mortalidad en pacientes hospitalizados por insuficiencia cardíaca.

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization for aging populations in Western countries, and is showing an increasing mortality. The aim of this study was to assess the probable long-term mortality risk factors for patients admitted because of HF. METHODS: Retrospective study of a cohort of 202 patients consecutively hospitalized because of HF and followed up for a maximum period of 5 years. Clinical and epidemiological factors and their relationship to in-hospital and long-term mortality were analyzed. RESULTS: In-hospital mortality was 16%.The independent predictors were: age >75 years (HR?=?2.68, 95%?IC: 1.65-4.36, p?=?0.001); cognitive impairment (HR?=?2.77, 95%?IC: 1.40-5.48, p?=?0.004); Barthel index =60 (HR?=?0.54, 95%?IC: 0.37-0.78, p?=?0,009); creatinine levels >1.16 mg/dl at admission (HR?=?1.57, 95%?IC: 1.12-2.20, p?=?0.009); and number of diagnostics >10 on discharge (HR?=?1. 64, 95%?IC: 1.14-2.36, p?=?0.007). Accumulated mortality at 12, 24, 36 and 48 months after hospital discharge were 43%, 51%, 67% and 70%, respectively; the independent predictors for this were: age >75 years (HR?=?2.55, 95%?IC: 1.56-4.15, p?<0.001); cognitive impairment (HR?=?2.45, 95%?IC: 1.22-4.90, p?=?0.011); creatinine levels >1.16 mg/dl on admission (HR?=?1.59, 95%?IC: 1.12-2.24, p?=?0.009); systolic blood pressure >140 mm Hg on admission (HR?=?0.56, 95%?IC: 0.40-0.80, p?<0.001); and number of diagnostics >10 on discharge (HR?=?1. 49, 95%?IC: 1.03-2.16, p?=?0.033). CONCLUSIONS: Clinical and epidemiological factors related to in-hospital and long-term mortality could help to improve the management of patients with HF.

[Mortality and medical care of patients hospitalized during weekends]. / Mortalidad y atención a pacientes hospitalizados durante los fines de semana.

BACKGROUND AND OBJECTIVES: It has been shown that patients admitted to hospital during the weekends tend to have less favourable outcomes, including higher mortality rates, compared with those admitted during weekdays. The main objective of this study is to evaluate the impact of on the health outcomes of patients admitted during the weekend. MATERIAL AND METHODS: A retrospective observational study was conducted on all patients admitted to Montilla Hospital (Córdoba).. All hospitalised patients were attended to daily, including weekends and holidays. An analysis was performed on the epidemiological variables and health outcomes (total mortality). RESULTS: The study included a total of 2,565 hospital admissions, of whom 653 (25.6%) were discharged during the weekend. Patients discharged during the weekend were significantly younger [53 (27) versus 56 (27) years, P<.002], had fewer diagnoses on discharge [6.2 (3.7) versus 6.7 (3.9), P<.003], and had fewer procedures performed [(3 (1.9) versus 3.2 (1.8), P<.005]. The mean length of stay was shorter for weekend discharges than the weekday discharges [3 (2.6) days versus 3.7 (3.9) days, P<.001). The total mortality was 4%, and there were no differences between weekday and weekend admissions (4.3% versus 3.7%). Home discharges on the weekend were related to a reduction in the mean length of stay by 0.3 days (from 3.6 to 3.9 days, P<.001). CONCLUSIONS: Hospitalised patient care has led to the disappearance of increased mortality during weekends.

Impact of a do-not-do intervention on 12 laboratory measurements. / Impacto de una intervención de «no hacer¼ en 12 determinaciones de laboratorio.

OBJECTIVES: In recent years, various scientific societies and healthcare organisations have created recommendations aimed at decreasing the use of healthcare interventions that have shown no efficacy or effectiveness. The aim of this study was to assess the impact of an intervention on 12 do-not-do recommendations regarding the laboratory in 7 hospital centres. METHODS: Before-after study conducted in 7 hospital centres of Cordoba and Jaen during 2015 and 2016. Based on the recommendations of existing scientific societies, a consensus was reached on various actions regarding laboratory measurements. We analysed the number and cost of measuring 6 tumour markers (carcinoembryonic antigen, prostate-specific antigen, carbohydrate antigen [CA] 15.3, CA125, CA19.9 and alpha-fetoprotein), thyrotropin, T3, T4, glycated haemoglobin, urea, ferritin and antigliadin antibodies, before and after implementing the consensus. RESULTS: Compared with the previous year, there were 55,902 fewer laboratory measurements (-19%) in 2016, with an overall savings of €82,100. The reduction in the number of measurements occurred mainly in plasma urea (-50.3%) and in the tumour markers CA125 (-16%), CA19.9 (-11.6%) and CA15.3 (-10.5%). The most pronounced savings were achieved in the measurements of urea (-€21,002), thyroid hormones (-€12,716) and thyrotropin (-€7,638). CONCLUSIONS: The adoption and consensus of do-not-do recommendations among healthcare levels resulted in a significant reduction in unnecessary measurements.

[Clinical processes in a high resolution clinic of specialist outpatient clinics]. / Procesos médicos susceptibles de alta resolución en consultas ambulatorias.

OBJECTIVES: The high resolution clinic (HRC) is an outpatient care process by which treatment and diagnosis are established, recorded, and completed in a single day. The aim of this study was to assess the extent to which patients with medical conditions may benefit from a single consultation system. MATERIAL AND METHODS: A descriptive study of 795 first visit events, randomly selected as high-resolution consultations in cardiology, gastroenterology, internal medicine, and chest diseases. A discussion is presented on the percentage of patients who benefited from HRC and the complementary tests performed. RESULTS: A total of 559 (70%, 95% CI: 67-73%) of all first visits became HRCs, and 483 (61%, 95% CI: 57%-64%) required a diagnostic test that was reviewed on the same day. There were differences between medical consultations (86% in cardiology versus 44% in gastroenterology consultations, P<.001). Performing a test on the same day significantly increased the percentage of HRCs (49 versus 22%, P<.001). Ischaemic heart disease, dyspepsia, headache, and asthma were the conditions most commonly leading to HRC. The most common tests were cranial tomography, blood analysis, and ultrasound. CONCLUSIONS: Medical consultations may largely benefit from an HRC system, only requiring some organisational changes and no additional costs.

[Characteristics of patients with multiple disease hospitalized in Internal Medicine services]. / Características clínicas diferenciales de los enfermos pluripatológicos hospitalizadosen servicios de Medicina Interna.

INTRODUCTION: Know what proportion of patients hospitalized in the Internal Medicine services have multiple diseases. MATERIAL AND METHODS: We analyzed 400 clinical histories of a random sample of patients admitted to 24 Internal Medicine services of Andalusia. We assessed the diagnostic categories present that make it possible to classify patients as having multiple diseases. RESULTS: One hundred sixty eight patients (42%) were considered as having multiple diseases. The most prevalent diseases in these patients are cardiological and diabetes mellitus. The two main variables that determine that one is a multiple disease patient are age and disease causing the admission. DISCUSSION: A significant percentage of the patients admitted to the Medicine services of the Andalusia public hospitals have multiple diseases.

[Impact of automatized systems in a high resolution model of outpatients clinics]. / Impacto de los sistemas automatizados en un modelo de consulta de alta resolución.

OBJECTIVE: To analyse the impact of computerised systems in Radiology and Laboratory Departments on the reduction in the waiting time of the patients attending to an Internal Medicine outpatient consultation organised in a high resolution model. METHODS: For one year, we studied the delay in diagnostic explorations (laboratory test, simple radiology, ultrasonic diagnostics and brain scanner) that were all applied for and performed in a single day. We compared the traditional organization (n = 312 explorations), in which the results were handed in by hospital auxiliary staff, to a computerised method (n = 457 explorations), which was implemented via our intranet. RESULTS: The global delay decreased 10% in average, the differences being significant only for the variables "brain scanner" (12.7%) and "laboratory" (19%). The average reduction in the waiting time per patient was 11.7%, ranging from 7.8% (when only one exploration was performed) to 13.2% (when 2 explorations were carried out). The percentage of patients who needed to wait more than 3 hours to receive their results also diminished significantly. CONCLUSION: The implementation of computerised systems reduced the waiting time to receive the results of complementary explorations. However, our results were not homogeneous for the different explorations.

[Do women demand to be assisted at medical clinics more often than men?]. / Solicitan las mujeres más consultas al área médica que los hombres?

BACKGROUND: Different features of the users of the Spanish Public Health System have been previously assessed, specially in General Practice and Hospital Emergency Departments. Nevertheless, the epidemiological characteristics of those patients who attend to specialised clinics have not been so thoroughly evaluated. PATIENTS AND METHODS: The referee of the demand, the place of residence, the age and the sex of patients were all analysed for the ,first visits, at the Medical Department clinics (Internal Medicine, Cardiology, Gastroenterology, Pneumology) in our hospital, during 2002. RESULTS: A total of 7,486 demands for attention (53.3% were women) were asked for by 5,841 patients (52.8%) were women. When analysing the variable, place of residence, we find women asked for more frequently than men, in the categories of General Practice Department and age less than 60 years. Those patients coming from urban areas were more in percentage than those coming from rural areas. Whereas the, index of frequency, was higher in women than in men, however, there were no differences between urban and rural areas. CONCLUSION: In our targeted population we have observed a higher demand for medical clinics in women, though the actual demand will depend on factors such as age, place of residence and the referee.

[The practice of Internal Medicine in Andalusia follows the evidence-based medicine basic principles]. / La práctica de la Medicina interna en Andalucía se ajusta a la Medicina basada en la evidencia.

BASIS: To know the proportion of medical interventions carried out in the Services of Internal Medicine of the public hospitals of Andalusia based on randomized clinical trials. PATIENTS AND METHODS: We have analyzed the primary treatments prescribed in a random sample of 326 patients admitted to these Internal Medicine services during 1998. RESULTS: One hundred and forty-three of the 326 treatments analyzed (43.9%) were based in clinical trials and 135 (41.4%) were interventions unanimously accepted by the medical community without being based in clinical trials. CONCLUSIONS: Most of the primary Andalusian treatments prescribed in the Internal Medicine services are evidence-based.

Duodenal compression caused by superior mesenteric artery: study of 10 patients.

BACKGROUND: the compression of the third portion of the duodenum by the superior mesenteric artery (aorto-mesenteric clamp) is a rare cause of abdominal pain. Its clinical appearance may range between an asymptomatic and accidental radiological finding and an acute duodenal ileus (superior mesenteric artery syndrome), which requires urgent surgical intervention. METHODS: we revised all of the reports of upper gastrointestinal tract contrast-medium study (which included the duodenum) made in our hospital between May 1999 and April 2002. We analysed the case history of those patients with a radiological image compatible with aorto-mesenteric clamp. RESULTS: of the 1280 studies analysed, 10 of them (0,78%) were compatible with an aorto-mesenteric clamp. The 10 patients were females whose mean age was 25,7 years (range 9-77) that consulted for different abdominal discomfort. The symptoms of the 9 youngest patients were not typical of duodenal obstruction and their evolution was favourable. In the eldest patient, the clinical data were compatible with a mesenteric superior artery syndrome, although a subsequent study showed the presence of a colon adenocarcinoma. CONCLUSIONS: the aorto-mesenteric clamp is a rare radiological finding (<1 %) which does not always justify the supported clinical data. In our series, 9 cases were considered non-obstructive aorto-mesenteric clamps, although some of them showed pathogenical factors (scoliosis and thinness). The superior mesenteric artery syndrome should be considered as a diagnosis of exclusion after performing an adequate clinical study when the situation of the patient requires it.

[Gaucher's disease. Report of 4 cases]. / Enfermedad de Gaucher. Aportación de 4 casos.

Gaucher's disease is a rare condition caused by a deficiency in the lysosomal enzyme called beta-glucocerebrosidase (GBA). The objective of our work was to analyse the clinical, diagnostic and therapeutic characteristics in a group of four patients with Gaucher's disease type 1. The advantages of the new diagnostic and therapeutic techniques are stressed. In all cases the diagnosis was made by means of cyto-histological examination and enzymatic measurement of the beta-glucocerebrosidase activity. A genetic study and genotype determination was made in the four cases. A questionnaire was administered to patients to evaluate their life quality applying the SF36 questionnaire adapted to the Gaucher's disease. All subjects have received enzymatic replacement therapy with the recombinant enzyme imiglucerase (Cerezyme Corporation) with a satisfactory clinical course. Interestingly, eosinophilia was present in one patient, which disappeared after treatment.

[Factors that influence the non prescription of beta-blockers in patients with acute myocardial infarction]. / Factores que intervienen en la no prescripción de betabloqueantes en los pacientes con infarto agudo de miocardio.

OBJECTIVE: To study the factors that influence the non prescription of beta-blockers in patients discharged with a diagnosis of acute myocardial infarction (AMI). METHOD: A retrospective study was done of all patients discharged from our Service in the year 1998, with a diagnosis of AMI. The variables considered were age, sex, diabetes mellitus, peripheral vascular disease, left ventricle dysfunction and COPD. RESULTS: 60 patients with AMI were included in the study, 18 of whom (30%) were discharged without beta-blockers. The average age of these patients was 77 years, while the average age of those discharged with these pharmaceutical agents was 60 years (p < 0.0001). Likewise, left ventricle dysfunction (p < 0.031) and female gender (p < 0.016), also negatively influenced the use of these drugs. It was observed with multivariable regression analysis that age was the main predictor for the use of beta-blockers (p < 0.0001). CONCLUSION: Age is the main factor that influences the non prescription of beta-blockers in patients with AMI in our Service. In spite of the potential adverse effects of the drugs in the advanced age population, the data so far obtained demonstrates a clear benefit in the subgroups at risk (advanced age, heart failure,...). Therefore it's use should be extended to this group of population as long as there are no absolute contraindications.