ABSTRACT
Introducción Dada la creciente adopción de la ecografía clínica en medicina, es fundamental estandarizar su aplicación, su formación y su investigación. Objetivos y métodos El propósito de este documento es proporcionar recomendaciones de consenso para responder cuestiones sobre la práctica y el funcionamiento de las unidades de ecografía clínica. Participaron 19 expertos y responsables de unidades avanzadas de ecografía clínica. Se utilizó un método de consenso Delphi modificado. Resultados Se consideraron un total de 137 declaraciones de consenso, basadas en la evidencia y en la opinión experta. Las declaraciones fueron distribuidas en 10 áreas. Un total de 99 recomendaciones alcanzaron consenso. Conclusiones Este consenso define los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, con el objetivo de homogeneizar y promover este avance asistencial en sus diferentes vertientes. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna. (AU)
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. (AU)
Subject(s)
Point-of-Care Testing , Internal Medicine/education , Ultrasonography , Quality Control , Education, Medical , SpainABSTRACT
Introducción Dada la creciente adopción de la ecografía clínica en medicina, es fundamental estandarizar su aplicación, su formación y su investigación. Objetivos y métodos El propósito de este documento es proporcionar recomendaciones de consenso para responder cuestiones sobre la práctica y el funcionamiento de las unidades de ecografía clínica. Participaron 19 expertos y responsables de unidades avanzadas de ecografía clínica. Se utilizó un método de consenso Delphi modificado. Resultados Se consideraron un total de 137 declaraciones de consenso, basadas en la evidencia y en la opinión experta. Las declaraciones fueron distribuidas en 10 áreas. Un total de 99 recomendaciones alcanzaron consenso. Conclusiones Este consenso define los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, con el objetivo de homogeneizar y promover este avance asistencial en sus diferentes vertientes. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna. (AU)
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. (AU)
Subject(s)
Point-of-Care Testing , Internal Medicine/education , Ultrasonography , Quality Control , Education, Medical , SpainABSTRACT
OBJECTIVE: Hospital mortality is a leading indicator of quality of healthcare and a valuable tool for planning and management. Infectious diseases represent a substantial part of the activity of internal medicine.Our aim was to describe the characteristics of in-hospital mortality due to infectious diseases and associated risk factors in our environment. MATERIALS AND METHODS: A retrospective case-control study was designed. We reviewed deaths during 2012 from an Internal Medicine Department. 187 cases (infectious disease related mortality) and 224 controls were found. Clinical and demographic information was obtained from medical records. Comorbidity was evaluated with Charlson index (CI). Data were analyzed using SPSS 15.0 (p-value < 0.05). RESULTS: During 2012, of the 3193 discharge, 187 were exitus due to infectious disease (5.8%). Mean age was 85.7 ± 7.6, higher in women (88 ± 7 vs 83 ± 7.4, p < 0.001), and 55% were aged over 85 years. The CI mean was 4.2 ± 3, higher in younger than 85 years (5.3 ± 3.4 vs 3.6 ± 2.6, p < 0.001). Most frequent causes of death were respiratory sepsis (29%), severe pneumonia (23.5%) and urinary sepsis (16.6%) and risk factors were living in Nursing Home (55.6% vs 34%, p < 0.001), being dependent (73.8% vs. 44.6%, p < 0.001), dementia (59.4% vs 27.2%, p < 0.001) and cerebrovascular disease (25.7% vs 17.4%, p = 0.041). CONCLUSIONS: Dementia, cerebrovascular disease, living in Nursing Home and being dependent were risk factors for infectious disease in-hospital mortality in our study, but not comorbidity, age or length of stay. Our series, although limited by retrospective design, is the first qualitative study of in-hospital mortality due to infectious disease in an Internal Medicine Service in our environment. Most frequent cause of death in our setting was respiratory etiology.
Subject(s)
Communicable Diseases/mortality , Hospital Mortality , Internal Medicine/statistics & numerical data , Aged , Aged, 80 and over , Case-Control Studies , Comorbidity , Female , Hospital Departments , Humans , Male , Middle Aged , Pneumonia/mortality , Retrospective Studies , Risk Factors , Sepsis/mortalityABSTRACT
AIM: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. METHODS: Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. RESULTS: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004). CONCLUSIONS: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.
Subject(s)
Enterobacteriaceae Infections/epidemiology , Urinary Tract Infections/epidemiology , Aged , Enterobacteriaceae/enzymology , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Female , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Spain/epidemiology , Urinary Tract Infections/microbiology , beta-Lactam Resistance , beta-Lactamases/biosynthesisABSTRACT
BACKGROUND AND OBJECTIVES: Little is known about the impact of comorbid psychiatric symptoms in health related quality of life (HRQL) in patients with HIV infection. The aim of this investigation was to describe depressive symptoms and the impact in HRQL in HIV infected people. MATERIALS AND METHODS: A cross-sectional study over 150 HIV-outpatients in a tertiary hospital was designed. Depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. HRQL data were collected by disease-specific questionnaire MOS-HIV. Researchers' team designed a specific template to get rest of the data. RESULTS: Almost three-quarters of the population were men. After adjusting for gender and age, HIV-related symptoms and presence of depression were found to be negatively associated with all the Medical Outcomes Study HIV Health Survey (MOS-HIV) general domains and in the Physical Health Summary score and Mental Health Summary score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Quality of life and depression should be monitored in follow-up of HIV infected patients. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV.
Subject(s)
Depression/complications , HIV Infections/psychology , Health Status , Quality of Life/psychology , Adult , Age Factors , Cross-Sectional Studies/statistics & numerical data , Depression/diagnosis , Depression/psychology , Female , HIV Infections/complications , Humans , Male , Psychiatric Status Rating Scales , Sex CharacteristicsABSTRACT
OBJECTIVES: Health-related quality of life (HRQL) is used in the assessment of chronic illness. Regarding HIV infection, HRQL assessment is an objective for physicians and institutions since antiretroviral treatment delays HIV clinical progression. The aim of this study was to determine the factors with the most influence on HRQL in HIV-infected people and to create a predictive model. METHODS: We conducted a cross-sectional study in 150 patients in a tertiary hospital. HRQL data were collected using the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. The research team created a specific template with which to gather clinical and sociodemographic data. Adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. Logistic regression models were used to identify determinants of HRQL. RESULTS: HIV-related symptoms and presence of depression were found to be negatively associated with all the MOS-HIV domains, the Physical Health summary score and the Mental Health summary score. Patients receiving protease inhibitor (PI)-based treatment had lower scores in four of the 11 domains of the MOS-HIV questionnaire. Gender, hospitalization in the year before enrolment, depression and parenthood were independently related to the Physical Health Score; depression and hepatitis C virus coinfection were related to the Mental Health Score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV infection can be considered a chronic disease with the prospect of long-term survival. Quality of life should be monitored in follow-up of HIV-infected patients. The assessment of HRQL in this population can help us to detect problems that may influence the progression of the disease. This investigation highlights the importance of a multidisciplinary approach to HIV infection.
Subject(s)
HIV Infections/psychology , HIV Long-Term Survivors/psychology , Health Status Indicators , Hepatitis C, Chronic/psychology , Quality of Life , Adult , Anti-HIV Agents/therapeutic use , Attitude to Health , Child , Depressive Disorder/complications , Epidemiologic Methods , Female , HIV Infections/complications , HIV Infections/drug therapy , Hepatitis C, Chronic/complications , Hospitalization , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Socioeconomic FactorsABSTRACT
The human immunodeficiency virus (HIV) infection is a disease with great sociosanitary impact. Since 1981, when the first cases of AIDS were described, more than 60 million people have become infected. During these 25 years there have been a lot of advances in the infection management and we know that prevention and early diagnosis are crucial. Family Physician s role is essential since this is a privileged point of global attention, counseling and support for these patients. The main objective is to reduce the new HIV infections incidence. In addition, other objectives are: primary prevention and health promotion, early diagnosis, recruitment infected patients, monitoring and end-of-life caring. It is important to know that all of us are susceptible to contract the virus and, although the HIV testing is voluntary, there are screening recommendations from the CDC: persons with signs or symptoms that suggest infection, pregnant women, persons at high risk for infection and all patients aged 13-64 years, as a part of routine clinical care. The communication of the result is a key point in the therapeutic relation. If it is negative we must make intervention on risk attitudes. If it is positive we must inform and support the patient, to convince him about the need to be followed up by an specialized level. The AIDS terminal patient is a very immunodeficient one and needs palliative cares like other terminal disease. Another challenge is prevention and control of HIV infection among the immigrant community. In conclusion, Family Physicians must investigate risk practices, inform, prevent new cases and, in the infected people, monitor the evolution, supporting and comforting.
Subject(s)
HIV Infections/therapy , Physician's Role , Physicians, Family , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/therapy , Adolescent , Adult , Emigrants and Immigrants , Female , HIV Infections/diagnosis , HIV Infections/prevention & control , Health Promotion , Humans , Male , Middle Aged , Physician-Patient Relations , Pregnancy , Primary Prevention , Risk Factors , Terminal CareABSTRACT
La infección por el virus de la inmunodeficiencia humana (VIH) es una enfermedad con gran impacto sociosanitario. Desde 1981, cuando se describieron los primeros casos de sida, se han infectado más de 60 millones de personas. En estos 25 años se han realizado muchos avances en cuanto a su manejo y sabemos que la prevención y el diagnóstico precoz son fundamentales. El papel del médico de familia es esencial ya que es un punto privilegiado de atención global, counseling y apoyo para estos pacientes. El principal objetivo es disminuir la incidencia de nuevas infecciones por VIH. Además, otros objetivos son: prevención primaria y promoción de la salud, diagnóstico precoz, captación de pacientes infectados, seguimiento y cuidados al paciente terminal. Es importante conocer que todos somos susceptibles de contraer el virus y, aunque la realización de la serología de VIH es voluntaria, existen recomendaciones de los CDC: sujetos con signos o síntomas sugestivos de infección, mujeres embarazadas, sujetos con situaciones de riesgo y entre los 13 y 64 años de manera rutinaria. La comunicación del resultado es un punto clave en la relación terapéutica. Si es negativo se debe hacer intervención sobre las conductas de riesgo. Si es positivo debemos informar y apoyar al paciente, además es importante una buena captación y valoración para su derivación a la consulta especializada. El paciente terminal de sida está muy inmunodeprimido y necesita cuidados paliativos como otra enfermedad terminal. Otro reto es la prevención y control de la infección VIH en la población inmigrante. En conclusión, el médico de familia debe investigar prácticas de riesgo, informar, prevenir nuevos casos y, en la población infectada, seguimiento de la evolución, apoyando y confortando
The human immunodeficiency virus (HIV) infection is a disease with great sociosanitary impact. Since 1981, when the first cases of AIDS were described, more than 60 million people have become infected. During these 25 years there have been a lot of advances in the infection management and we know that prevention and early diagnosis are crucial. Family Physicians role is essential since this is a privileged point of global attention, counseling and support for these patients. The main objective is to reduce the new HIV infections incidence. In addition, other objectives are: primary prevention and health promotion, early diagnosis, recruitment infected patients, monitoring and end-of-life caring. It is important to know that all of us are susceptible to contract the virus and, although the HIV testing is voluntary, there are screening recommendations from the CDC: persons with signs or symptoms that suggest infection, pregnant women, persons at high risk for infection and all patients aged 13-64 years, as a part of routine clinical care. The communication of the result is a key point in the therapeutic relation. If it is negative we must make intervention on risk attitudes. If it is positive we must inform and support the patient, to convince him about the need to be followed up by an specialized level. The AIDS terminal patient is a very immunodeficient one and needs palliative cares like other terminal disease. Another challenge is prevention and control of HIV infection among the immigrant community. In conclusion, Family Physicians must investigate risk practices, inform, prevent new cases and, in the infected people, monitor the evolution, supporting and comforting
