Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) / Executive summary of the consensus document for the training and development of clinical ultrasound in internal medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI)

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)

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) / Executive summary of the consensus document for the training and development of clinical ultrasound in internal medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI)

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)

[Analysis of infectious diseases care in Spanish hospitals from 2016-2020, including the first year of the SARS-CoV-2 pandemic]. / Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2.

Aims: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2 / Analysis of infectious diseases care in Spanish hospitals from 2016–2020, including the first year of the SARS-CoV-2 pandemic

Objetivo Revisar los pacientes atendidos en los hospitales españoles dados de alta con un diagnóstico principal de infección en un periodo de 5 años, incluyendo el primer año de la pandemia por SARS-CoV-2. Material y métodos Se han analizado los datos del Conjunto Mínimo Básico de Datos (CMBD) de los pacientes dados de alta durante el periodo 2016-2020 de los hospitales del Sistema Nacional de Salud de España identificando aquellos que tuvieran un diagnóstico principal de enfermedad infecciosa según el código CIE-10-S. Se han incluido en el análisis todos los pacientes mayores de 14 años que hubieran ingresado en una planta convencional o de cuidados intensivos, excluyendo los partos, y se han evaluado las altas en función del servicio de alta. Resultados Los pacientes dados de alta con patología infecciosa han aumentado del 10% al 19% en los últimos años, y gran parte del crecimiento se debe a la epidemia por SARS-CoV-2. Los servicios de medicina interna atienden a más del 50% de estos pacientes, seguidos de neumología (9%) y cirugía general (5%). En el año 2020 el 57% de los pacientes con diagnóstico principal de infección fueron dados de alta por internistas, que atendieron al 67% de los pacientes con SARS-CoV-2. Conclusiones Actualmente más de la mitad de los pacientes que ingresan con diagnóstico principal de infección son dados de alta en medicina interna. Dada la complejidad creciente de las infecciones, abogamos por un abordaje en el que un área de capacitación permita una especialización, pero dentro de un contexto generalista, para el mejor manejo de estos pacientes (AU)

Aims This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients (AU)

Analysis of infectious diseases care in Spanish hospitals from 2016 to 2020, including the first year of the SARS-CoV-2 pandemic.

AIMS: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. MATERIALS AND METHOD: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016⬜2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. RESULTS: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. CONCLUSIONS: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

¿Has pensado alguna vez que ya no sirves como médico? / Have you ever thought that you are no longer fit to be a physician?

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Ecografía clínica en las enfermedades autoinmunes sistémicas / Clinical ultrasonography in systemic autoimmune diseases

La ecografía clínica se debe considerar, hoy por hoy, como una exploración complementaria que puede modificar la práctica clínica. Es una herramienta más de la historia clínica. Las enfermedades autoinmunes sistémicas (EAS) son enfermedades en las que se pueden ver implicados múltiples estructuras y órganos. La ecografía tiene utilidad aplicada de forma genérica para detectar complicaciones, como la presencia de líquido libre intraabdominal, pleural o pericárdico en las poliserositis, la presencia de disfunción sistólica del ventrículo izquierdo en pacientes con miocarditis o para confirmar la existencia de una trombosis venosa profunda en un paciente con síndrome antifosfolípido. También, de forma específica en las EAS, la ecografía nos permite explorar las glándulas salivales en pacientes con síndrome de Sjögren, determinar la presencia del signo del halo en la arteritis de células gigantes, la presencia de inflamación tendinosa o articular, cuantificar la hipertensión pulmonar en pacientes con esclerodermia o valorar la presencia de enfermedad pulmonar intersticial en una dermatomiositis. La ecografía clínica realizada por el internista es, por tanto, una técnica extremadamente útil en el diagnóstico y seguimiento de los pacientes con EAS

Clinical ultrasonography should be considered a complementary examination that can change clinical practice, as well as a tool to add to the medical history. Systemic autoimmune diseases (SAD) can involve numerous structures and organs. Ultrasonography has broad applied utility in detecting complications such as the presence of free intraabdominal, pleural and pericardial fluid in polyserositis, left ventricular systolic dysfunction in myocarditis and deep vein thrombosis in antiphospholipid syndrome. Specifically for SAD, ultrasonography helps examine the salivary glands in Sjögren's syndrome, determines the presence of the halo sign in giant cell arteritis and the presence of tendon or joint inflammation, quantifies pulmonary hypertension in scleroderma and assesses the presence of interstitial pulmonary disease in dermatomyositis. Clinical ultrasonography performed by internists is therefore an extremely useful technique in the diagnosis and follow-up of patients with SAD

Utility of lateral flow tests in SARS-CoV-2 infection monitorization.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. METHODS: We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. RESULTS: The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0).. CONCLUSIONS: Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection).

Clinical ultrasonography in systemic autoimmune diseases. / Ecografía clínica en las enfermedades autoinmunes sistémicas.

Clinical ultrasonography should be considered a complementary examination that can change clinical practice, as well as a tool to add to the medical history. Systemic autoimmune diseases (SAD) can involve numerous structures and organs. Ultrasonography has broad applied utility in detecting complications such as the presence of free intraabdominal, pleural and pericardial fluid in polyserositis, left ventricular systolic dysfunction in myocarditis and deep vein thrombosis in antiphospholipid syndrome. Specifically for SAD, ultrasonography helps examine the salivary glands in Sjögren's syndrome, determines the presence of the halo sign in giant cell arteritis and the presence of tendon or joint inflammation, quantifies pulmonary hypertension in scleroderma and assesses the presence of interstitial pulmonary disease in dermatomyositis. Clinical ultrasonography performed by internists is therefore an extremely useful technique in the diagnosis and follow-up of patients with SAD.

¿Le interesaría conocer cuáles son sus resultados asistenciales en términos de calidad? / Would you like to know your healthcare results in terms of quality?

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Análisis de las hospitalizaciones por enfermedad cardiovascular en población diabética en España / Analysis of hospitalizations by cardiovascular disease in the population with diabetes in Spain

Objetivos: Diabetes mellitus se asocia con un marcado incremento de enfermedad cardiovascular. En el presente estudio analizamos la prevalencia de diabetes mellitus en pacientes hospitalizados en España en 2015 y la carga de enfermedad cardiovascular asociada. Métodos: Mediante el análisis del conjunto mínimo básico de datos (CMBD) del Ministerio de Sanidad del año 2015, se incluyen todos los pacientes dados de alta con diagnóstico de diabetes mellitus. Se describen las características epidemiológicas, la distribución por los diferentes servicios hospitalarios y la presencia de enfermedad cardiovascular. Resultados: En el año 2015 hubo 3.727.583 altas en España; de ellas, 619.188 correspondían a diabéticos (16,7%); el 56,8% eran varones y la edad media era de 73,2años. La prevalencia de enfermedad cardiovascular fue del 40,8%, distribuida en insuficiencia cardiaca congestiva (20,1%), enfermedad cerebrovascular (10,3%), enfermedad coronaria (9,4%) y enfermedad arterial periférica (9,1%). La mayor parte de pacientes ingresaron en los servicios de medicina interna (34,2%), cardiología (9,5%) y cirugía general (8,9%). La estancia media global fue de 8,2días y los reingresos a 30días alcanzaron el 14%. La mortalidad fue del 6,8%. Los pacientes ingresados en medicina interna tienen un grado de severidad más alto (3-4), 41,9% vs 31,6%, que los ingresados en otros servicios médicos (p<0,01) y que los ingresados en servicios quirúrgicos (11,2%) (p<0,01). Conclusiones: La diabetes mellitus es una comorbilidad importante de los pacientes ingresados en medicina interna. Una proporción significativa de estos pacientes presenta enfermedad cardiovascular, y la más frecuente es la insuficiencia cardíaca

Objective: Diabetes mellitus is associated with a marked increase in cardiovascular disease. In this study, we analysed the prevalence of diabetes mellitus in hospitalised patients in Spain in 2015 and the burden of associated cardiovascular disease. Methods: By analysing the 2015 minimum basic data set (MBDS) of the Spanish Ministry of Health, we included all patients discharged with a diagnosis of diabetes mellitus. We describe the epidemiological characteristics, distribution by the various hospital departments and the presence of cardiovascular disease. Results: In 2015, there was 3,727,583 hospital discharges in Spain, 619,188 of which involved patients with diabetes (16.7%), 56.8% of whom were men and with a mean age of 73.2years. The prevalence of cardiovascular disease was 40.8%, distributed among congestive heart failure (20.1%), cerebrovascular disease (10.3%), coronary artery disease (9.4%) and peripheral arterial disease (9.1%). Most of the patients were admitted to internal medicine (34.2%), cardiology (9.5%) and general surgery (8.9%) departments. The mean overall stay was 8.2days, the readmission rate at 30days was 14%, and the mortality rate was 6.8%. The patients hospitalized in internal medicine had higher severity levels (3-4) than those hospitalized in other medical departments (41.9% vs. 31.6%, respectively; P<.01) and those hospitalized in surgical departments (11.2%; P<.01). Conclusions: Diabetes mellitus is a significant comorbidity for patients hospitalized in internal medicine. A significant proportion of these patients present cardiovascular disease, mostly heart failure

Analysis of hospitalizations by cardiovascular disease in the population with diabetes in Spain. / Análisis de las hospitalizaciones por enfermedad cardiovascular en población diabética en España.

OBJECTIVES: Diabetes mellitus is associated with a marked increase in cardiovascular disease. In this study, we analysed the prevalence of diabetes mellitus in hospitalised patients in Spain in 2015 and the burden of associated cardiovascular disease. METHODS: By analysing the 2015 minimum basic data set (MBDS) of the Spanish Ministry of Health, we included all patients discharged with a diagnosis of diabetes mellitus. We describe the epidemiological characteristics, distribution by the various hospital departments and the presence of cardiovascular disease. RESULTS: In 2015, there was 3,727,583 hospital discharges in Spain, 619,188 of which involved patients with diabetes (16.7%), 56.8% of whom were men and with a mean age of 73.2years. The prevalence of cardiovascular disease was 40.8%, distributed among congestive heart failure (20.1%), cerebrovascular disease (10.3%), coronary artery disease (9.4%) and peripheral arterial disease (9.1%). Most of the patients were admitted to internal medicine (34.2%), cardiology (9.5%) and general surgery (8.9%) departments. The mean overall stay was 8.2days, the readmission rate at 30days was 14%, and the mortality rate was 6.8%. The patients hospitalized in internal medicine had higher severity levels (3-4) than those hospitalized in other medical departments (41.9% vs. 31.6%, respectively; P<.01) and those hospitalized in surgical departments (11.2%; P<.01). CONCLUSIONS: Diabetes mellitus is a significant comorbidity for patients hospitalized in internal medicine. A significant proportion of these patients present cardiovascular disease, mostly heart failure.

Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna / Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments

Este documento de posicionamiento describe los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, desde sus indicaciones fundamentales hasta el período de formación recomendado. Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la práctica clínica habitual del internista en múltiples escenarios clínicos y ámbitos de actuación (urgencias, planta de hospitalización, consulta general y específica y atención domiciliaria). Su uso tiene un impacto relevante en la capacidad de resolución del profesional, al aumentar su fiabilidad y seguridad diagnóstica, además de proporcionar información pronóstica y evolutiva importante. Además, en los últimos años se ha incorporado como una herramienta en la enseñanza pregrado con excelentes resultados. Por tanto, es necesario generalizar su uso y para ello se debe fomentar la formación estructurada y la adquisición de equipos. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine

Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments. / Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna.

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

Dosis altas de corticoides sistémicos en pacientes ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Un estudio de cohortes / High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study

Objetivos. Evaluar el efecto de las dosis altas de corticoides en pacientes ingresados por exacerbación de una enfermedad pulmonar obstructiva crónica (EPOC). Pacientes y métodos. Estudio de cohortes prospectivo de enfermos hospitalizados con EPOC entre enero y marzo de 2015, agrupados en función de la dosis de glucocorticoides recibida (punto de corte: 40mg de prednisona/día). Se compararon los resultados de estancia hospitalaria, y de reingreso y mortalidad a los 3 meses del alta. Resultados. Se analizaron 87 pacientes. La mediana de la dosis diaria recibida fue de 60mg de prednisona/día (rango intercuartílico: 46,67-82,33mg/día); la vía de administración fue endovenosa en el 96,6% de los casos. Se estableció un riesgo relativo (RR) de estancia superior a 8 días de 1,095 [intervalo de confianza (IC) 95%: 0,597-2,007; p=0,765] cuando se usaban dosis de esteroides superiores a 40mg/día. Además, en estos pacientes la hazard ratio (HR) para el reingreso durante los 3 meses siguientes al alta fue de 0,903 [IC 95%: 0,392-2,082; p=0,811] y la mortalidad de 1,832 (IC 95%: 0,229-16,645; p=0,568]. Ni el RR ni las HR observadas variaron de forma estadísticamente significativa tras el ajuste por factores de confusión. Conclusiones. Una dosis superior a 40mg diarios de prednisona en pacientes ingresados por exacerbación de EPOC no se asocia a una menor estancia hospitalaria ni a una disminución del reingreso y de la mortalidad a los 3 meses (AU)

Objectives. To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD). Patients and methods. A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge. Results. We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors. Conclusions. A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months (AU)

RECALMIN II. Ocho años de hospitalización en las Unidades de Medicina Interna (2007-2014). ¿Qué ha cambiado? / RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed?

Objetivos. Analizar la evolución de la asistencia prestada en las Unidades de Medicina Interna (UMI) del Sistema Nacional de Salud en 2007 y 2014. Material y métodos. Análisis de todas las altas dadas por las UMI del Sistema Nacional de Salud en los años 2007 y 2014, utilizando el Conjunto Básico Mínimo de Datos. Se contrastaron los factores de riesgo por episodio, mortalidad y reingresos entre ambos períodos. Se elaboraron ajustes específicos de riesgo para la mortalidad y reingresos en la insuficiencia cardiaca, neumonía y enfermedad pulmonar crónica obstructiva, así como el índice de Charlson para el conjunto de la actividad. Resultados. Las altas dadas por las UMI entre ambos períodos aumentaron un 14%. La edad promedio creció en 2,8 años (71,2±17,1 vs. 74±16,2; p<0,001), con un notable incremento de la comorbilidad (índice de Charlson: 4±3,7 vs. 4,7±3,9; p<0,001; 24% más de factores de riesgo por episodio). Las tasas ajustadas de mortalidad se redujeron leve, pero significativamente, con un ligero aumento de los reingresos. Conclusiones. Durante el período analizado ha aumentado en casi tres años la edad media de los pacientes atendidos en las UMI del Sistema Nacional de Salud, con un notable aumento de la comorbilidad, lo que debería conllevar una asignación más adecuada de las cargas de trabajo de enfermería, así como una mayor implantación de buenas prácticas de gestión clínica (AU)

Objectives. To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. Material and methods. We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. Results. Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions. Conclusions. During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management (AU)

High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study. / Dosis altas de corticoides sistémicos en pacientes ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Un estudio de cohortes.

OBJECTIVES: To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge. RESULTS: We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors. CONCLUSIONS: A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months.