RESUMEN
OBJECTIVES: To evaluate the impact of specialized training for nurses on selective screening for undetected HIV infection in the emergency department. MATERIAL AND METHODS: The intervention group was comprised of 6 emergency departments that had been participating in a screening program (the "Urgències VIHgila" project) for at least 3 months. Nurses on all shifts attended training sessions that emphasized understanding the circumstances that should lead to suspicion of unidentified HIV infection and the need to order serology. Two studies were carried out: 1) a quasi-experimental pre-post study to compare the number of orders for HIV serology in each time period and measures of sensitivity, and 2) a case-control study to compare the changes made in the 6 hospitals where specialized training was provided (cases) vs 6 control hospitals in the HIV screening program where no training was given. RESULTS: A total of 280 HIV serologies were ordered for the 81015 patients (0.3%) attended during the period before training; 331 serologies were ordered for the 79620 patients in the period after training (0.4%). The relative increase in serologies was 20.3% (95% CI, 2.9% to 34.5%; P = .022). The relative increase in measures of sensitivity ranged between 19% and 39%, consistent with the main comparison. Serologies in the control group decreased between periods, from 0.9% to 0.8%, indicating a relative decrease of 15.7% (95% CI, -25.1% to -6.2%; P = .001). The absolute number of patients tested in the training group was 0.2% higher in the training hospitals (95% CI, 0.11% to 0.31%; P .001) than in the control hospitals. CONCLUSION: Training nurses to screen for undetected HIV infection in the emergency department increased the number of patients tested, according to the pre-post and case-control comparisons.
OBJETIVO: Evaluar el impacto de una formación específica para enfermería en el servicio urgencias (SU) sobre el despistaje selectivo de infección por VIH oculta. METODO: Participaron 6 SU adheridos al programa "Urgències VIHgila" con un mínimo de 3 meses y se realizaron sesiones formativas para los diferentes turnos. Las sesiones enfatizaban en qué circunstancias debía sospecharse infección oculta VIH y la necesidad de solicitar serología. Se realizaron dos estudios: 1) cuasiexperimental pre/post, que comparó la tasa de solicitudes VIH entre ambos periodos, con diversos análisis de sensibilidad; 2) caso-control, que comparó el cambio entre periodos de los 6 SU con formación (caso) con el cambio en otros 6 SU que no tuvieron formación (control). RESULTADOS: Se realizaron serologías de VIH a 280 de los 81.015 pacientes atendidos durante el periodo preintervención (0,3%) y a 331 de los 79.620 del periodo posintervención (0,4%). El incremento relativo fue del 20,3% (IC 95% de +2,9% a +34,5%; p = 0,022). Los análisis de sensibilidad mostraron incrementos relativos congruentes con el análisis principal (entre 19% y 39%). En el grupo control hubo descenso de solicitudes entre periodos, del 0,9% al 0,8% (descenso relativo del 15,7%, IC 95% de 25,1% a6,2%; p = 0,001). El grupo caso, en relación con el grupo control, tuvo un incremento absoluto de 0,2% (IC 95% de +0,11 a +0,31%, p 0,001) de pacientes testados. CONCLUSIONES: La formación de enfermería para despistaje de la infección VIH oculta en urgencias incrementa el número de pacientes investigados, tanto comparado con el periodo previo a la formación como comparado con SU sin formación específica para enfermería.
Asunto(s)
Enfermería de Urgencia , Servicio de Urgencia en Hospital , Infecciones por VIH , Humanos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Estudios de Casos y Controles , Femenino , Enfermería de Urgencia/educación , Masculino , Tamizaje Masivo/métodos , Adulto , Persona de Mediana Edad , Personal de Enfermería en Hospital/educación , España , Serodiagnóstico del SIDA , Estudios Controlados Antes y DespuésRESUMEN
OBJECTIVE: To describe other reasons for requesting HIV serology in emergency departments (ED) other than the 6 defined in the SEMES-GESIDA consensus document (DC-SEMES-GESIDA) and to analyze whether it would be efficient to include any of them in the future. METHODS: Review of all HIV serologies performed during 2 years in 20 Catalan EDs. Serologies requested for reasons not defined by the DC-SEMES-GESIDA were grouped by common conditions, the prevalence (IC95%) of seropositivity for each condition was calculated, and those whose 95% confidence lower limit was >0.1% were considered efficient. Sensitivity analysis considered that serology would have been performed on 20% of cases attended and the remaining 80% would have been seronegative. RESULTS: There were 8044 serologies performed for 248 conditions not recommended by DC-SEMES-GESIDA, in 17 there were seropositive, and in 12 the performance of HIV serology would be efficient. The highest prevalence of detection corresponded to patients from endemic countries (7.41%, 0.91-24.3), lymphopenia (4.76%, 0.12-23.8), plateletopenia (4.37%, 1.20-10.9), adenopathy (3.45%, 0.42-11.9), meningoencephalitis (3.12%, 0.38-10.8) and drug use (2.50%, 0.68-6.28). Sensitivity analysis confirmed efficiency in 6 of them: endemic country origin, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional disorder-agitation and fever of unknown origin. CONCLUSION: The DC-SEMES-GESIDA targeted HIV screening strategy in the ED could efficiently include other circumstances not previously considered; the most cost-effective would be origin from an endemic country, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional-agitation disorder and fever of unknown origin.
RESUMEN
BACKGROUND AND IMPORTANCE: The rates of hidden infection and late diagnosis of HIV still remain high in Western countries. Missed diagnostic opportunities represent the key point in changing the course of the epidemic. OBJECTIVE: To evaluate the feasibility and results of implementation of a selective strategy to test for HIV in the emergency department (ED) in patients with six pre-defined medical situations: sexually transmitted infections, herpes zoster, community-acquired pneumonia, mononucleosis syndrome, practice of chemsex (CS) or request of post-exposure prophylaxis. DESIGN: This quasi-experimental longitudinal study evaluated the pre- and post-implementation results of HIV testing in the six aforementioned clinical scenarios. SETTINGS AND PARTICIPANTS: Patients attended 34 Spanish EDs. INTERVENTION OR EXPOSURE: The intervention was an intensive educational program and pathways to facilitate and track orders and results were designed. We collected and compared pre- and post-implementation ED census and diagnoses, and HIV tests requested and results. OUTCOME MEASURES AND ANALYSIS: The main outcome was adherence to the recommendations. Secondary outcomes were to evaluate the effectiveness of the program by the rate of positive test and the new HIV diagnoses. Differences between first and second periods were assessed. The magnitude of changes (absolute and relative) was expressed with the 95% confidence interval (CI). MAIN RESULTS: HIV tests increasing from 7080 (0.42% of ED visits) to 13 436 (relative increase of 75%, 95% CI from 70 to 80%). The six conditions were diagnosed in 15 879 and 16 618 patients, and HIV testing was ordered in 3393 (21%) and 7002 (42%) patients (increase: 97%; 95% CI: 90-104%). HIV testing significantly increased for all conditions except for CS. The positive HIV test rates increased from 0.92 to 1.67%. Detection of persons with undiagnosed HIV increased from 65 to 224, which implied a 220% (95% CI: 143-322%) increase of HIV diagnosis among all ED comers and a 71% (95% CI: 30-125%) increase of positive HIV tests. CONCLUSION: Implementation of a strategy to test for HIV in selective clinical situations in the ED is feasible and may lead to a substantial increase in HIV testing and diagnoses.
Asunto(s)
Infecciones por VIH , Humanos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Estudios Controlados Antes y Después , Estudios de Factibilidad , Estudios Longitudinales , Tamizaje Masivo/métodos , Prueba de VIH , Servicio de Urgencia en HospitalAsunto(s)
Humanos , Masculino , Femenino , Servicios Médicos de Urgencia , VIH , Enfermedades Transmisibles , Salud Pública , Tamizaje MasivoAsunto(s)
Servicios Médicos de Urgencia , Hospitales , Humanos , Relaciones Interpersonales , Cuerpo Médico , EspañaRESUMEN
OBJECTIVES: To prospectively validate a model to predict hospital admission of patients given a low-priority classification on emergency department triage and to indicate the safety of reverse triage. MATERIAL AND METHODS: Single-center observational study of a prospective cohort to validate a risk model incorporating demographic and emergency care process variables as well as vital signs. The cohort included emergency visits from patients over the age of 15 years with priority level classifications of IV and V according to the Andorran-Spanish triage system (Spanish acronym, MAT-SET) between October 2018 and June 2019. The area under the receiver operating characteristic curve (AUC) of the model was calculated to evaluate discrimination. Based on the model, we identified cut-off points to distinguish patients with low, intermediate, or high risk for hospital admission. RESULTS: A total of 2110 emergencies were included in the validation cohort; 109 patients (5.2%) were hospitalized. The median age was 43.5 years (interquartile range, 31-60.3 years); 55.5% were female. The AUC was 0.71 (95% CI, 0.64-0.75). The model identified 357 patients (16.9%) at low risk of hospitalization and 240 (11.4%) at high risk. A total of 15.8% of the high-risk patients and 2.8% of the low-risk patients were hospitalized. CONCLUSION: The validated model is able to identify risk for hospitalization among patients classified as low priority on triage. Patients identified as having high risk of hospitalization could be offered preferential treatment within the same level of priority at triage, while those at low risk of admission could be referred to a more appropriate care level on reverse triage.
OBJETIVO: Validar prospectivamente un modelo predictivo de ingreso hospitalario para los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con baja prioridad de visita y determinar la capacidad predictiva del modelo para realizar con seguridad la derivación inversa. METODO: Estudio observacional unicéntrico de una cohorte prospectiva de validación de un modelo predictivo basado en variables demográficas, de proceso y las constantes vitales (modelo 3). Se incluyeron los episodios de pacientes >15 años con prioridades IV y V MAT-SET atendidos entre octubre 2018 y junio 2019. Se evaluó la discriminación mediante el área bajo la curva de la característica operativa del receptor (ABC). Para determinar la capacidad de discriminación se crearon 3 categorías de riesgo: bajo, intermedio y alto. RESULTADOS: Se incluyeron 2.110 episodios, de los cuales 109 (5,2%) ingresaron. La mediana de edad fue de 43,5 años (RIC 31-60,3) con un 55,5% de mujeres. El ABC fue de 0,71 (IC 95%: 0,64-0,75). Según el modelo predictivo, 357 episodios (16,9%) puntuaron de bajo riesgo de ingreso y 240 (11,4%) de alto riesgo. El porcentaje de ingreso observado de los pacientes clasificados de alto riesgo fue de 15,8% mientras que el de los pacientes de bajo riego fue de 2,8%. CONCLUSIONES: El modelo predictivo validado permite estratificar el riesgo de ingreso de los pacientes con baja prioridad de visita. Los pacientes con alto riesgo de ingreso se les podría ofrecer una atención preferente dentro del mismo nivel de prioridad, mientras que los de bajo riesgo podrían ser redirigidos al recurso asistencial más adecuado (derivación inversa).
Asunto(s)
Servicio de Urgencia en Hospital , Triaje , Adolescente , Adulto , Femenino , Hospitalización , Hospitales , Humanos , Masculino , Estudios ProspectivosRESUMEN
Objectives: To compare the communication skills shown by medical students during simulated patient interviews between those who received training in communication during the preclinical years and those who did not. Methods: A retrospective study was conducted to analyze the communication skills of several cohorts of fourth-year medical students from Universitat Internacional de Catalunya during simulated patient interviews. Out of a total of 477 students included in the study, 229 (48%) had received training in communication skills through a 60-hour elective course during the preclinical second year, while the remaining 248 (52%) had received none. Communication skills were assessed by an evaluation team using a numerical scale (0 to 10) that included eight categories: "verbal", "non-verbal", "empathy", "concreteness", "warmth", "message content", "assertiveness", and "respect". Scores obtained by trained and non-trained students were compared using the t-test. Results: A trend towards obtaining better results was observed among students who had received communication training (mean score: 6.98/10) versus none (6.83/10, t(1,869)=-1.95, p=0.05). Non-trained male students obtained significantly lower mean scores than non-trained females in the categories of "respect" (7.48/10 vs. 7.83/10, t(968)=-2.89, p<0.01), "verbal communication" (6.87/10 vs. 7.15/10, t(968)=-2.61, p=0.01), "warmth" (6.53/10 vs. 6.95/10, t(968)=-3.40, p<0.01), and "non-verbal communication" (6.49/10 vs. 6.79/10, t(968)=-2.48, p=0.01). Trained female and male students had similar scores. Conclusions: Training in communication skills during the preclinical years may improve fourth-year students' performance in simulated interviews with patients, particularly among males. These results demonstrate the importance of introducing specific training in communication skills early in the undergraduate medical curriculum.
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Educación de Pregrado en Medicina , Estudiantes de Medicina , Competencia Clínica , Comunicación , Curriculum , Educación de Pregrado en Medicina/métodos , Femenino , Humanos , Masculino , Relaciones Médico-Paciente , Estudios RetrospectivosRESUMEN
Objetivo. Validar prospectivamente un modelo predictivo de ingreso hospitalario para los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con baja prioridad de visita y determinar la capacidad predictiva del modelo para realizar con seguridad la derivación inversa. Método. Estudio observacional unicéntrico de una cohorte prospectiva de validación de un modelo predictivo basado en variables demográficas, de proceso y las constantes vitales (modelo 3). Se incluyeron los episodios de pacientes >15 años con prioridades IV y V MAT-SET atendidos entre octubre 2018 y junio 2019. Se evaluó la discriminación mediante el área bajo la curva de la característica operativa del receptor (ABC). Para determinar la capacidad de discriminación se crearon 3 categorías de riesgo: bajo, intermedio y alto. Resultados. Se incluyeron 2.110 episodios, de los cuales 109 (5,2%) ingresaron. La mediana de edad fue de 43,5 años (RIC 31-60,3) con un 55,5% de mujeres. El ABC fue de 0,71 (IC 95%: 0,64-0,75). Según el modelo predictivo, 357 episodios (16,9%) puntuaron de bajo riesgo de ingreso y 240 (11,4%) de alto riesgo. El porcentaje de ingreso observado de los pacientes clasificados de alto riesgo fue de 15,8% mientras que el de los pacientes de bajo riego fue de 2,8%. Conclusiones. El modelo predictivo validado permite estratificar el riesgo de ingreso de los pacientes con baja priori- dad de visita. Los pacientes con alto riesgo de ingreso se les podría ofrecer una atención preferente dentro del mismo nivel de prioridad, mientras que los de bajo riesgo podrían ser redirigidos al recurso asistencial más adecuado (derivación inversa).
Objectives. To prospectively validate a model to predict hospital admission of patients given a low-priority classification on emergency department triage and to indicate the safety of reverse triage. Methods. Single-center observational study of a prospective cohort to validate a risk model incorporating demographic and emergency care process variables as well as vital signs. The cohort included emergency visits from patients over the age of 15 years with priority level classifications of IV and V according to the AndorranSpanish triage system (Spanish acronym, MAT-SET) between October 2018 and June 2019. The area under the receiver operating characteristic curve (AUC) of the model was calculated to evaluate discrimination. Based on the model, we identified cut-off points to distinguish patients with low, intermediate, or high risk for hospital admission. Results. A total of 2110 emergencies were included in the validation cohort; 109 patients (5.2%) were hospitalized. The median age was 43.5 years (interquartile range, 31-60.3 years); 55.5% were female. The AUC was 0.71 (95% CI, 0.64-0.75). The model identified 357 patients (16.9%) at low risk of hospitalization and 240 (11.4%) at high risk. A total of 15.8% of the high-risk patients and 2.8% of the low-risk patients were hospitalized. Conclusions. The validated model is able to identify risk for hospitalization among patients classified as low priority on triage. Patients identified as having high risk of hospitalization could be offered preferential treatment within the same level of priority at triage, while those at low risk of admission could be referred to a more appropriate care level on reverse triage.
Asunto(s)
Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Triaje/organización & administración , Servicios Médicos de Urgencia , Hospitalización , Visita a Consultorio Médico , Urgencias Médicas , Estudios Prospectivos , Conducta de Reducción del RiesgoRESUMEN
La infección por Helicobacter pylori es muy frecuente entre la población española y representa la causa fundamental de gastritis crónica, úlcera péptica y cáncer gástrico. Previamente se han llevado a cabo cuatro reuniones de Consenso sobre el manejo de la infección por H. pylori en España, la última de ellas en 2016. Los cambios en los esquemas de tratamiento y la creciente evidencia disponible al respecto han justificado la organización de esta V Conferencia Española de Consenso en mayo de 2021, centrada en el tratamiento de esta infección. Participaron 14 expertos sobre el tema, que realizaron una búsqueda sistemática de la evidencia científica y elaboraron una serie de recomendaciones que fueron sometidas a un proceso de interacción de votaciones anónimas seriadas mediante metodología Delphi. Para clasificar la evidencia científica y la fuerza de las recomendaciones, se utilizó el sistema GRADE. Este consenso establece, como punto de partida, un aumento de la exigencia en la eficacia de los tratamientos recomendados, que deben alcanzar, o preferiblemente superar, el 90% de curación al ser administrados empíricamente. De este modo, tanto en primera como en segunda línea se recomiendan tratamientos cuádruples con o sin bismuto, generalmente prescritos durante 14 días. Como tratamiento de primera línea se recomienda una pauta cuádruple concomitante sin bismuto (inhibidor de la bomba de protones, claritromicina, amoxicilina y metronidazol) o una combinación cuádruple con bismuto (inhibidor de la bomba de protones, bismuto, tetraciclina y metronidazol). En el presente consenso se revisan también con detalle otras alternativas de tratamiento de rescate.(AU)
Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.(AU)
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Humanos , Masculino , Femenino , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Metronidazol/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , Gastroenterología , Enfermedades Transmisibles , Consenso , EspañaRESUMEN
Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.
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Infecciones por Helicobacter , Helicobacter pylori , Úlcera Péptica , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Bismuto/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Metronidazol/uso terapéutico , Úlcera Péptica/complicaciones , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.
Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Metronidazol/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéuticoAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Pandemias , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Hospitales de Aislamiento/organización & administración , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Ocupación de Camas/estadística & datos numéricos , EspañaAsunto(s)
COVID-19/prevención & control , Hospitales de Aislamiento/organización & administración , Pandemias , SARS-CoV-2 , Instalaciones Deportivas y Recreativas , Anciano , Ocupación de Camas/estadística & datos numéricos , COVID-19/terapia , Arquitectura y Construcción de Instituciones de Salud , Femenino , Sistemas de Información en Hospital/organización & administración , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Grupo de Atención al Paciente , Alta del Paciente/estadística & datos numéricos , Selección de Paciente , Transferencia de Pacientes/estadística & datos numéricos , EspañaRESUMEN
OBJECTIVES: To develop a model to predict hospital admission of patients in cases assessed as nonurgent or semiurgent on emergency department triage. MATERIAL AND METHODS: Single-center observational study of a retrospective cohort. We included cases of patients older than 15 years whose emergency was classified as level IV-V according to the Andorran-Spanish triage model (MAT-SET, the Spanish acronym). Fourteen independent variables included demographic and care process items as well as vital signs. The dependent variable was hospital admission. The regression models were based on generalized estimating equations. RESULTS: A total of 53 860 episodes were included; 3430 patients (6.4%) were admitted. The median (interquartile range) age was 44.5 (31.1-63.9) years, and 54.1% were female. Vital signs were recorded in 19.3% of the episodes. The model that best predicted admission included the following variables: age > 84 years (adjusted odds ratio [aOR], 6.72; 95% CI, 5.26-8.60); male sex (aOR, 1.46; 95% CI, 1.28-1.66); referral from a primary care center (aOR, 1.94; 95% CI, 1.64-2.29); referral from another acute-care hospital (aOR, 11.22; 95% CI, 4.42-28.51); arrival by ambulance (aOR, 3.72; 95% CI, 3.16-4.40); revisit 72 hours (aOR, 2.15; 95% CI, 1.60-2.87); systolic blood pressure $ 150 mmHg (aOR, 0.83; 95% CI, 0.71-0.97); diastolic blood pressure 60 mmHg (aOR, 1.57; 95% CI, 1.25-1.98); axillary temperature > 37°C (aOR, 2.29; 95% CI, 1.91-2.74); heart rate > 100 beats/min (aOR, 1.65; 95% CI, 1.40-1.96); baseline oxygen saturation in arterial blood (SaO2) 93% (aOR, 2.66; 95% CI, 1.86-3.81); and SaO2 93%-95% (aOR, 1.70; 95% CI, 1.42-2.05). The area under the receiver operating characteristic curve for the model was 0.82 (95% CI; 95% CI, 0.80-0.83). CONCLUSION: The model predicts which patients are more likely to be admitted after their cases were initially considered nonurgent or semi-urgent on triage. Patients found to be at risk can then be given greater attention than others in the same triage level.
OBJETIVO: Desarrollar un modelo predictivo de ingreso hospitalario desde triaje de los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con el nivel poco urgente-no urgente de prioridad de visita. METODO: Estudio observacional de cohortes retrospectivo unicéntrico. Se incluyeron los episodios de pacientes > 15 años con niveles IV-V MAT-SET atendidos en un SUH durante 2015. Se evaluaron 14 variables demográficas, datos de proceso y constantes vitales. La variable dependiente fue el ingreso hospitalario. Se utilizaron modelos de regresión basados en ecuaciones de estimación generalizadas. RESULTADOS: Se incluyeron 53.860 episodios, 3.430 (6,4%) ingresaron. La mediana de edad fue de 44,5 años (RIC 31,1-63,9), 54,1% mujeres. Un 19,3% de los episodios tenían registrados las constantes vitales (CV). El modelo con mayor capacidad predictiva incluía las siguientes variables: edad $ 85 años (ORa = 6,72; IC 95%: 5,26-8,60), sexo masculino (ORa = 1,46; IC 95% 1,28-1,66), procedencia de atención primaria (ORa = 1,94; IC 95% 1,64-2,29), de otro hospital de agudos (ORa = 11,22; IC 95% 4,42-28,51), llegada en ambulancia (ORa = 3,72; IC 95%:3,16-4,40), consulta previa a urgencias las 72 horas previas (ORa = 2,15; IC 95% 1,60-2,87), presión arterial sistólica $ 150 mmHg (ORa = 0,83; IC 95%:0,71-0,97), presión arterial diastólica 60 mmHg (ORa = 1,57; IC 95% 1,25-1,98), temperatura axilar > 37ºC (ORa = 2,29; IC 95% 1,91-2,74), frecuencia cardiaca > 100 latidos/minuto (ORa 1,65; IC 95% 1,40-1,96) y saturación basal de oxígeno 93% (ORa = 2,66; IC 95% 1,86-3,81) y 93-95% (ORa = 1,70; IC 95% 1,42-2,05). El área bajo la curva COR fue de 0,82 (IC 95% 0,80-0,83). CONCLUSIONES: Este modelo predictivo permitiría identificar desde el triaje a aquellos pacientes que, siendo poco urgentes o no urgentes, tienen mayor probabilidad de ingreso y darles una atención diferencial dentro del mismo nivel de prioridad.
Asunto(s)
Urgencias Médicas , Triaje , Adulto , Anciano de 80 o más Años , Femenino , Hospitalización , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJETIVOS: Desarrollar un modelo predictivo de ingreso hospitalario desde triaje de los pacientes atendidos en el servicio de urgencias hospitalario (SUH) con el nivel poco urgente-no urgente de prioridad de visita. MÉTODO: Estudio observacional de cohortes retrospectivo unicéntrico. Se incluyeron los episodios de pacientes > 15años con niveles IV-V MAT-SET atendidos en un SUH durante 2015. Se evaluaron 14 variables demográficas, datos de proceso y constantes vitales. La variable dependiente fue el ingreso hospitalario. Se utilizaron modelos de regresión basados en ecuaciones de estimación generalizadas. RESULTADOS: Se incluyeron 53.860 episodios, 3.430 (6,4%) ingresaron. La mediana de edad fue de 44,5 años (RIC31,1-63,9), 54,1% mujeres. Un 19,3% de los episodios tenían registrados las constantes vitales (CV). El modelo con mayor capacidad predictiva incluía las siguientes variables: edad ≥ 85 años (ORa = 6,72; IC 95%: 5,26-8,60), sexo masculino (ORa = 1,46; IC 95% 1,28-1,66), procedencia de atención primaria (ORa = 1,94; IC 95% 1,64-2,29), de otro hospital de agudos (ORa = 11,22; IC 95% 4,42-28,51), llegada en ambulancia (ORa = 3,72; IC 95%:3,16-4,40),consulta previa a urgencias las 72 horas previas (ORa = 2,15; IC 95% 1,60-2,87), presión arterial sistólica ≥ 150mmHg (ORa = 0,83; IC 95%:0,71-0,97), presión arterial diastólica < 60 mmHg (ORa = 1,57; IC 95% 1,25-1,98), temperatura axilar > 37ºC (ORa = 2,29; IC 95% 1,91-2,74), frecuencia cardiaca > 100 latidos/minuto (ORa 1,65; IC 95%1,40-1,96) y saturación basal de oxígeno < 93% (ORa = 2,66; IC 95% 1,86-3,81) y 93-95% (ORa = 1,70; IC 95%1,42-2,05). El área bajo la curva COR fue de 0,82 (IC 95% 0,80-0,83). CONCLUSIONES: Este modelo predictivo permitiría identificar desde el triaje a aquellos pacientes que, siendo poco urgentes o no urgentes, tienen mayor probabilidad de ingreso y darles una atención diferencial dentro del mismo nivel de prioridad
OBJECTIVE: To develop a model to predict hospital admission of patients in cases assessed as nonurgent or semi-urgent on emergency department triage. METHODS: Single-center observational study of a retrospective cohort. We included cases of patients older than 15 years whose emergency was classified as level IV-V according to the Andorran-Spanish triage model (MAT-SET, the Spanish acronym). Fourteen independent variables included demographic and care process items as well as vital signs. The dependent variable was hospital admission. The regression models were based on generalized estimating equations. RESULTS: A total of 53 860 episodes were included; 3430 patients (6.4%) were admitted. The median (interquartile range) age was 44.5 (31.1-63.9) years, and 54.1% were female. Vital signs were recorded in 19.3% of the episodes. The model that best predicted admission included the following variables: age > 84 years (adjusted odds ratio [aOR], 6.72; 95% CI,5.26-8.60); male sex (aOR, 1.46; 95% CI, 1.28-1.66); referral from a primary care center (aOR, 1.94; 95% CI, 1.64-2.29); referral from another acute-care hospital (aOR, 11.22; 95% CI, 4.42-28.51); arrival by ambulance (aOR, 3.72; 95% CI,3.16-4.40); revisit < 72 hours (aOR, 2.15; 95% CI, 1.60-2.87); systolic blood pressure ≥ 150 mmHg (aOR, 0.83; 95% CI,0.71-0.97); diastolic blood pressure < 60 mmHg (aOR, 1.57; 95% CI, 1.25-1.98); axillary temperature > 37°C (aOR, 2.29;95% CI, 1.91-2.74); heart rate > 100 beats/min (aOR, 1.65; 95% CI, 1.40-1.96); baseline oxygen saturation in arterialblood (SaO2) < 93% (aOR, 2.66; 95% CI, 1.86-3.81); and SaO293%-95% (aOR, 1.70; 95% CI, 1.42-2.05). The area under the receiver operating characteristic curve for the model was 0.82 (95% CI; 95% CI, 0.80-0.83). CONCLUSION: The model predicts which patients are more likely to be admitted after their cases were initially considered non urgent or semi-urgent on triage. Patients found to be at risk can then be given greater attention than others in the same triage level
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Hospitalización , Predicción/métodos , Triaje/organización & administración , Servicio de Urgencia en Hospital/normas , Estudios de Cohortes , Triaje/normas , Estudios Retrospectivos , Valor Predictivo de las Pruebas , Análisis MultivarianteRESUMEN
BACKGROUND: The current cure rates with triple therapy combining a proton-pump inhibitor, amoxicillin and clarithromycin are unacceptably low. AIMS: To evaluate the efficacy of a 14-day concomitant therapy as an empirical first-line treatment for curing Helicobacter pylori (Hp) infection in primary care. METHODS: Patients from six primary care centers in Catalonia -Spain- were included consecutively. Hp status pre and post treatment was assessed according to local clinical practice protocol. A 14-day concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus omeprazole 20 mg, all drugs administered twice daily) was prescribed. Adherence to therapy and adverse events were assessed by personal interview. RESULTS: 112 patients were enrolled. Mean age was 46.7 ± 16.1 years. Main indication for treatment was non-investigated dyspepsia (83%). Hp eradication was achieved in 100 of the 112 patients. Eradication rates were 89.3% (95% CI: 81.7-94.1) by intention-to-treat (ITT) analysis and 91.7% (95% CI; 84.6-95.9) per protocol (PP). No major side effects were reported; 104 (92.8%) patients complete the treatment. Forty-seven patients (42%) complained of mild side effects (metallic taste, nausea). Low adherence to treatment (p = 0.004) and significant adverse events (p = 0.004) were the variables associated with treatment failure. CONCLUSIONS: In primary care, a 14-day concomitant therapy is highly effective and well tolerated.
RESUMEN
Objetivo: Describir las principales características de todos los servicios de emergencias prehospitalarios (SEPH) existentes en Cataluña. Método: Una encuestadora profesional entrevistó a los responsables clínicos de todos los SEPH de Cataluña. La encuesta fue preparada por los autores, y abordaba diversos aspectos organizativos, profesionales, laborales, formativos, docentes y de investigación. Las preguntas contenidas en la encuesta solo permitían respuestas cerradas, y hacían referencia a la situación en 2015. Resultados: Se identificaron 13 SEPH (11 públicos, 2 privados), que recibieron 2.482.627 consultas (16,4% a SEPH privados) y realizaron 943.849 atenciones (11,8% por SEPH privados). Había 336 bases de soporte vital básico y 73 de avanzado, con instalaciones mayoritariamente consideradas de tamaño suficiente y calidad buena. Se contrataron 1.374.845 horas anuales (753.995 de médico y 620.850 de enfermero), el 23,4% de ellas por SEPH privados, que globalmente corresponderían a 815 puestos de trabajo a jornada completa (447 de médico, 368 de enfermero). La dotación de médicos/enfermeros era relativamente estable durante el día, pero decaía un 31%/9% de madrugada. La especialidad médica mayoritaria era medicina familiar y comunitaria (56,8%), el 21,3% no tenía formación especializada, y el 6,5% tenía título de doctor. Había médicos/enfermeros profesores universitarios de grado en el 61,5%/46,2% de los SEPH; y de postgrado en el 46,2%/84,6%. Recibían estudiantes de medicina/enfermería en prácticas de grado el 15,4%/15,4% de los SEPH, y de postgrado el 69,2%/76,9%. Conclusiones: La actividad de los SEPH en Cataluña es elevada; un 12% la desarrollan SEPH privados, y globalmente implica a un número alto de médicos y enfermeros, los cuales además desarrollan un rol docente y, en menor medida, investigador
Objective: To describe the main characteristics of all prehospital emergency services (SEPHs, the Catalan acronym) in Catalonia (the SEPHCAT study). Methods: A professional survey researcher interviewed the medical directors of all services in Catalonia, using a questionnaire prepared by the authors. Questions covered aspects related to organization, professional staffing and employment conditions, as well as the staffs training, instructional activity and research. Only closed answers were collected. The survey reflected the situation in 2015. Results: We identified 13 SEPHs (11 in the public health service and 2 private companies). Together they received 2 482 627 calls (16.4% to private services) and attended 943 849 emergencies (11.8% attended by private companies). Three hundred thirty-six basic life support units and 73 advanced life support units were reported. They were mostly considered to be of sufficient size and quality. The SEPHs contracted 1 374 845 person-hours/y (753 995 physician-hours and 620 850 nurse-hours; 23.4% in private companies). These figures correspond to 815 full-time staff positions (447 for physicians and 368 for nurses). The numbers of physicians and nurses working were relatively stable during the morning, afternoon and evening shifts but decreased during the midnight-to-early-morning shift (physicians, by 31%; nurses, by 9%). A majority of the physicians employed were trained in family and community medicine (56.8%), but 21.3% had no specialized training; 6.5% had PhD degrees. SEPH physicians (61.5%) and nurses (46.2%) also taught undergraduate medical students; 46.2% of physicians and 84.6% of nurses taught postgraduate medical courses. Both undergraduate medical and nursing students were received in the same measure for practical training by 15.4% of the SEPHs; 69.2% also offered practical training for physicians at the postgraduate level and 76.9% trained postgraduate nurses. Conclusions: SEPHs in Catalonia are very active, and private companies account for nearly 12% of the activity. Together the public and private sectors employ a large number of physicians and nurses. Staff members are involved in training others but are less involved in research
Asunto(s)
Humanos , Servicios Médicos de Urgencia/estadística & datos numéricos , Atención Prehospitalaria/clasificación , Médicos/estadística & datos numéricos , Enfermeras y Enfermeros/estadística & datos numéricos , Atención Prehospitalaria/estadística & datos numéricos , Encuestas y Cuestionarios , Distribución de Chi-Cuadrado , 16360 , Atención a la Salud/organización & administraciónRESUMEN
OBJECTIVES: To describe the main characteristics of all prehospital emergency services (SEPHs, the Catalan acronym) in Catalonia (the SEPHCAT study). MATERIAL AND METHODS: A professional survey researcher interviewed the medical directors of all services in Catalonia, using a questionnaire prepared by the authors. Questions covered aspects related to organization, professional staffing and employment conditions, as well as the staff's training, instructional activity and research. Only closed answers were collected. The survey reflected the situation in 2015. RESULTS: We identified 13 SEPHs (11 in the public health service and 2 private companies). Together they received 2 482 627 calls (16.4% to private services) and attended 943 849 emergencies (11.8% attended by private companies). Three hundred thirty-six basic life support units and 73 advanced life support units were reported. They were mostly considered to be of sufficient size and quality. The SEPHs contracted 1374845 person-hours/y (753995 physician-hours and 620 850 nurse-hours; 23.4% in private companies). These figures correspond to 815 full-time staff positions (447 for physicians and 368 for nurses). The numbers of physicians and nurses working were relatively stable during the morning, afternoon and evening shifts but decreased during the midnight-to-early-morning shift (physicians, by 31%; nurses, by 9%). A majority of the physicians employed were trained in family and community medicine (56.8%), but 21.3% had no specialized training; 6.5% had PhD degrees. SEPH physicians (61.5%) and nurses (46.2%) also taught undergraduate medical students; 46.2% of physicians and 84.6% of nurses taught postgraduate medical courses. Both undergraduate medical and nursing students were received in the same measure for practical training by 15.4% of the SEPHs; 69.2% also offered practical training for physicians at the postgraduate level and 76.9% trained postgraduate nurses. CONCLUSION: SEPHs in Catalonia are very active, and private companies account for nearly 12% of the activity. Together the public and private sectors employ a large number of physicians and nurses. Staff members are involved in training others but are less involved in research.
OBJETIVO: Describir las principales características de todos los servicios de emergencias prehospitalarios (SEPH) existentes en Cataluña. METODO: Una encuestadora profesional entrevistó a los responsables clínicos de todos los SEPH de Cataluña. La encuesta fue preparada por los autores, y abordaba diversos aspectos organizativos, profesionales, laborales, formativos, docentes y de investigación. Las preguntas contenidas en la encuesta solo permitían respuestas cerradas, y hacían referencia a la situación en 2015. RESULTADOS: Se identificaron 13 SEPH (11 públicos, 2 privados), que recibieron 2.482.627 consultas (16,4% a SEPH privados) y realizaron 943.849 atenciones (11,8% por SEPH privados). Había 336 bases de soporte vital básico y 73 de avanzado, con instalaciones mayoritariamente consideradas de tamaño suficiente y calidad buena. Se contrataron 1.374.845 horas anuales (753.995 de médico y 620.850 de enfermero), el 23,4% de ellas por SEPH privados, que globalmente corresponderían a 815 puestos de trabajo a jornada completa (447 de médico, 368 de enfermero). La dotación de médicos/enfermeros era relativamente estable durante el día, pero decaía un 31%/9% de madrugada. La especialidad médica mayoritaria era medicina familiar y comunitaria (56,8%), el 21,3% no tenía formación especializada, y el 6,5% tenía título de doctor. Había médicos/enfermeros profesores universitarios de grado en el 61,5%/46,2% de los SEPH; y de postgrado en el 46,2%/84,6%. Recibían estudiantes de medicina/enfermería en prácticas de grado el 15,4%/15,4% de los SEPH, y de postgrado el 69,2%/76,9%. CONCLUSIONES: La actividad de los SEPH en Cataluña es elevada; un 12% la desarrollan SEPH privados, y globalmente implica a un número alto de médicos y enfermeros, los cuales además desarrollan un rol docente y, en menor medida, investigador.