Patients With High Cardiovascular Risk as Candidates to Bempedoic Acid, After Treatment With Statins, Ezetimibe and PCSK9 Inhibitors: An Estimation and Cost-Effectiveness Analysis.

ABSTRACT: Low-density lipoprotein cholesterol (LDLc) is the lead effector of atherosclerosis and main treatment target. Bempedoic acid is a novel oral drug in the therapeutic armamentarium which is able to reduce LDLc. The objectives of this study were (1) to select the potential patients for administering bempedoic acid such as those with a very high cardiovascular risk in which objectives of LDLc were not achieved despite conventional treatment with PCSK9 inhibitors (PCSK9i) and/or statins and ezetimibe and (2) to estimate the cost-effectiveness of bempedoic acid in different scenarios. The methods used were a multicenter and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 17 different hospitals. Before and on-treatment LDLc cholesterol levels, medical treatments, clinical indication, and baseline characteristics were recorded. The results obtained from 443 subjects in secondary prevention were analyzed. The mean (±) LDLc level at baseline was 142.5 ± 46.4 mg/dL and 61.5 ± 40.5 mg/dL in the follow-up, with a reduction of 55.9% ( P < 0.0001); 71.6% of the patients reached the target of LDL < 55 mg/dL or >50% reduction. Of those patients treated with medium-intensity and low-intensity statins plus PCSK9 inhibitors (with or without ezetimibe), only 5.7% of them were able to reduce LDL below 55 mg/dL and the main LDLc reduction in this group was the lowest (42.9% on average). Patients with TG values >135 mg/dL represented 41.6% of the sample, of which approximately 10% of them were using fibrates. Assuming only LDLc reduction and the UK price, the incremental cost-effectiveness ratio was 88,359€; 83,117€; 82,378€; and 79,015€ for different discount rates. In conclusion, one-third of the patients could achieve the target LDL proposed in the 2019 ESC/EAS guidelines. Approximately 10% of them could also benefit from treating hypertriglyceridemia as indicated in the 2021 ESC guidelines on cardiovascular disease prevention. Patients with medium-intensity and low-intensity statins plus PCSK9i and ezetimibe would be the most benefited. Bempedoic acid could be a not cost-efficacy therapy in all the scenarios, but we need to wait for the CLEAR OUTCOMES Trial results.

Effect of PCSK9 inhibitors on remnant cholesterol and lipid residual risk: The LIPID-REAL registry.

BACKGROUND: Monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 55%, regardless of baseline treatments. Nonetheless, the effect of other lipid parameters, such as cholesterol remnants or, the so-called lipid residual risk, is unknown. METHODS: Multicenter and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals in Spain. Before and on-treatment lipid parameters were recorded. Residual lipid risk was estimated by (1) cholesterol remnants, (2) triglycerides/HDLc ratio (TG/HDL), (3) total cholesterol/HDLc (TC/HDL) and (4) the triglycerides-to-glucose index (TGGi). RESULTS: Six hundred fifty-two patients were analysed, mean age of 60.2 (9.63) years, 24.69% women and mean LDLc before treatment 149.24 (49.86) mg/dl. Median time to second blood determination was 187.5 days. On-treatment LDLc was 67.46 (45.78) mg/dl, which represented a 55% reduction. Significant reductions were observed for TG/HDL ratio, cholesterol remnants, TC/HDL ratio and TGGi. As consequence, 34.61% patients had LDLc <55 mg/dl and cholesterol remnants <30 mg/dl; additionally, 31.95% had cholesterol remnants <30 mg/dl but LDLc >55 mg/dl. Patients who had levels of cholesterol remnants >30 mg/dl before initiating the treatment with PCSK9 had higher reductions in cholesterol remnants, TG/HDL ratio, TC/HDL and TGGi. By contrast, no reduction differences were observed according to baseline LDLc (< or > the mean), age, gender or obesity. CONCLUSIONS: This multicenter and retrospective registry of real-world patients treated with PCSK9 inhibitors demonstrates a positive effect on cholesterol remnants and lipid residual risk beyond LDLc reductions.

Sex Differences in Low-Density Lipoprotein Cholesterol Reduction With PCSK9 Inhibitors in Real-world Patients: The LIPID-REAL Registry.

BACKGROUND: Previous evidence supports that monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 50%-65%, regardless of baseline treatments. We tested possible sex differences in a multicentre registry of real-world patients treated with PCSK9 inhibitors. METHODS: This is a multicentre and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 18 different hospitals. Before-treatment and on-treatment LDLc and medical treatments, clinical indication, and clinical features were recorded. RESULTS: Women represented 24.69% of the cohort. The use of statins was similar in both sexes, but women were receiving most frequently ezetimibe. Before-treatment median LDLc was 135 (interquartile range 115-166) mg, and it was higher in women. The median on-treatment LDLc was 57 (interquartile range 38-84) mg/dL, which represented a mean 54.5% reduction. On-treatment LDLc was higher in women, and the mean LDLc reduction was lower in women (47.4% vs. 56.9%; P = 0.0002) receiving evolocumab or alirocumab. The percentage of patients who achieved ≥50% LDLc reduction was higher in men (71.36% vs. 57.62%; P = 0.002). According to LDLc before-treatment quartiles, LDLc reduction was statistically lower in women in the 2 highest and a significant interaction of women and baseline LDLc >135 mg/dL was observed. Women were negatively associated with lower rates of LDLc treatment target achievement (odds ratio: 0.31). Differences were also observed in women with body mas index >25 kg/m2. Only 14 patients (2.14%) presented side effects. CONCLUSIONS: This multicentre and retrospective registry of real-world patients treated with PCSK9 inhibitors highlights significant gender differences in LDLc reduction.

La donación de órganos en asistolia controlada tipo iii de Maastricht: implicaciones éticas y cuidados al final de la vida / Organ donation after controlled cardiac death under Maastricht category iii: Ethical implications and end of life care

El descenso en la potencialidad de donación en muerte encefálica ha determinado la necesidad de valorar fuentes alternativas y la donación en asistolia representa una buena opción. Los objetivos del presente artículo han sido describir las características de la donación de órganos controlada tipo iii de Maastricht y determinar los cuidados al final de la vida y el papel de las enfermeras en el proceso de donación. En este tipo de donación, la parada cardiocirculatoria es previsible tras la limitación de tratamientos de soporte vital. Se trata de pacientes para los que no existen opciones de terapia efectivas y, en el contexto de una práctica organizada y planificada en la que participan cada uno de los profesionales implicados en el cuidado del paciente, se toma la decisión, de acuerdo con la familia, de retirar medidas de soporte vital. Esta limitación de tratamientos de soporte vital nunca se lleva a cabo con el objetivo de realizar una donación Maastricht iii, sino con el de evitar la prolongación del proceso de morir mediante intervenciones inútiles y posiblemente degradantes. La obligación del equipo de salud es proporcionar una muerte digna y ello no solo incluye la ausencia de dolor, sino que se debe garantizar al paciente y su entorno familiar una sensación de placidez y serenidad. Una vez tomada la decisión de no instauración o retirada de medidas, la enfermera tiene un papel importante en la implementación de un plan de cuidados paliativos en el que deben participar médicos, enfermeros y paciente/familiares, y cuyo foco debe ser la dignidad y el bienestar del paciente, considerando sus necesidades físicas, psicológicas y espirituales

The decrease in potential donation after brain death has resulted in a need to evaluate alternative sources. Donation after cardiac death is a good option. The objectives of this article are to describe the Maastricht type iii controlled organ donation characteristics and to determine end-of-life care and the role of nurses in the donation process. In this type of donation, cardiocirculatory arrest is predictable after the limitation of life sustaining treatments. These are patients for whom there are no effective therapy options and, in the context of an organised and planned practice involving all the professionals involved in the care of the patient, the decision is made, in consultation with the family, to withdraw life support measures. This limitation of life sustaining treatments is never carried out with the aim of making a Maastricht iii donation, but to avoid prolonging the dying process through useless and possibly degrading interventions. The obligation of the health team is to provide a dignified death and this not only includes the absence of pain, but the patient and their family must be guaranteed a feeling of calmness and serenity. Once the decision has been taken to withhold or withdraw measures, the nurse has an important role in the implementation of a palliative care plan in where physicians, nurses and patients/families should be involved and whose focus should be on patients' dignity and comfort, considering their physical, psychological and spiritual needs

Organ donation after controlled cardiac death under Maastricht category iii: Ethical implications and end of life care. / La donación de órganos en asistolia controlada tipo iii de Maastricht: implicaciones éticas y cuidados al final de la vida.

The decrease in potential donation after brain death has resulted in a need to evaluate alternative sources. Donation after cardiac death is a good option. The objectives of this article are to describe the Maastricht type iii controlled organ donation characteristics and to determine end-of-life care and the role of nurses in the donation process. In this type of donation, cardiocirculatory arrest is predictable after the limitation of life sustaining treatments. These are patients for whom there are no effective therapy options and, in the context of an organised and planned practice involving all the professionals involved in the care of the patient, the decision is made, in consultation with the family, to withdraw life support measures. This limitation of life sustaining treatments is never carried out with the aim of making a Maastricht iii donation, but to avoid prolonging the dying process through useless and possibly degrading interventions. The obligation of the health team is to provide a dignified death and this not only includes the absence of pain, but the patient and their family must be guaranteed a feeling of calmness and serenity. Once the decision has been taken to withhold or withdraw measures, the nurse has an important role in the implementation of a palliative care plan in where physicians, nurses and patients/families should be involved and whose focus should be on patients' dignity and comfort, considering their physical, psychological and spiritual needs.

Seguridad y calidad en la atención al paciente crítico / Safety and quality in critical patient care

La calidad asistencia ha ido situándose paulatinamente en el centro angular del sistema sanitario, alcanzando en los últimos años un mayor protagonismo la seguridad del paciente como una de las dimensiones clave de la calidad. La monitorización, medición y mejora de la seguridad y la calidad de la atención en la Unidad de Cuidados Intensivos representan un gran desafío para la comunidad de los cuidados críticos. Las intervenciones sanitarias conllevan un riesgo de que acontezcan eventos o acontecimientos adversos que pueden ocasionar en los pacientes lesiones, discapacidades e incluso la muerte. En las Unidades de Cuidados Intensivos, la gravedad del paciente crítico, las barreras de comunicación, la realización de un número elevado de actividades por paciente y día, la práctica de procedimientos diagnósticos y tratamientos invasivos, y la cantidad y complejidad de la información recibida, entre otros, convierten a estas unidades en áreas de riesgo para la aparición de acontecimientos adversos. En el presente artículo se abordan algunas de las estrategias e intervenciones propuestas y testadas internacionalmente para optimizar los cuidados en los pacientes críticos y mejorar la cultura de seguridad en la Unidad de Cuidados Intensivos

The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit

Safety and quality in critical patient care. / Seguridad y calidad en la atención al paciente crítico.

The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit.

Validez y confiabilidad de la escala de salud mental positiva / Validity and reliability based on the scale of possitive mental health

El objetivo del presente estudio consistió en demostrar la validez y confiabilidad de la Escala de Salud Mental Positiva en 400 trabajadores del Sector Salud de Michoacán, México. Para este propósito se realizaron los siguientes procesos: 1) De acuerdo a la teoría y a los indicadores, se definió lo que se requería medir; 2) Se revisaron los instrumentos existentes; 3) Se generó, revisó y decantó una serie de Ítems; 4) Se aplicó la Escala de Salud Mental a la muestra; 5) Se evaluaron los Ítems para obtener su validación y confiabilidad. La estructura factorial de la escala se evaluó mediante un análisis con el método de componentes principales y rotación Varimax. Los resultados muestran una confiabilidad de 0,862, considerándose adecuado para su aplicación en la población mexicana.

This paper focus on showing the validity and reliability based on the Scale of Positive Mental Health in 400 Health dpt workers from Michoacan, Mexico. For this purpose some procedures were performed as follow: 1. According to the indicators, it was defined what it was required measure; 2. Current instruments were reviewed; 3. Number of items were generated, decided and reviewed; 4. Mental health scale was applied for population sampled; 5. Items were assessed for its validation and reliability. Scale factorial structure was assessed using factor analysis and taking into account main components method and rotation. The results show 0.862 high reliability considered appropriate to be used for Mexican population.

Calidad de vida relacionada con la salud en pacientes con trasplante de progenitores hematopoyéticos / Quality of life related to health in patients with hematopoietic stem cell transplantation

El Trasplante de Progenitores Hematopoyéticos (TPH) es la primera opción de tratamiento en múltiples patologías. El análisis de la calidad de vida de estos pacientes es necesario para evaluar resultados y ofrecer información al paciente. Objetivo: Se analiza la evolución de la calidad de vida mediante estudio descriptivo longitudinal, en la Unidad Clínica de Hematología del Hospital Universitario Virgen del Rocío. Resultados: El análisis con SF36 rinde en las mediciones basal, 2 y 9 meses tras TPH, en escala física 43.5, 39.2 y 43.2 y en mental 48.7, 44.7 y 51.2. No se observaron diferencias por modalidad de trasplante (autólogo o alogénico) o tipo de acondicionamiento. Conclusión: La calidad de vida inicial de los pacientes con TPHes inferior a la población estándar, empeorando a los dos meses y produciéndose mejoría en funcionamiento mental a los 9. No hay evidencias de que influya la modalidad de TPH o el acondicionamiento previo

Hematopoietic Progenitor Transplantation (HSCT) is the first choice of treatment in many diseases. Analysis of quality of life for these patients is needed to evaluate results and provide information to the patient. Purpose: To analyze the evolution of quality of life through longitudinal study in the Hematology Unit Clinic of the University Hospital Virgen del Rocío. Results: The SF36 analysis yields on baseline measurements, 2 and 9 months after HSCT, in physical scale 43.5, 39.2 and 43.2and 48.7 in mental, 44.7 and 51.2. No differences were observed for type of transplant(autologous or allogeneic) or conditioning type. Conclusion: The initial quality of life of patients with HSCT is lower standard population, worsening two months and resulting improvement in mental functioning to 9. There is no evidence that influences the mode of HSCT or preconditioning

Guía de práctica clínica sobre terapia intravenosa con dispositivos no permanentes en adultos / Clinical practice guideline on intravenous therapy with temporary devices in adults

El objetivo principal de la guía es proporcionar a los profesionales sanitarios una herramienta que les permita tomar decisiones basadas en evidencia sobre aspectos de la atención al paciente adulto con indicación de terapia intravenosa con dispositivos no permanentes. Además, se señalan los objetivos secundarios siguientes: aumentar la calidad de las intervenciones, evitar complicaciones relacionadas con la terapia intravenosa y reducir la variabilidad existente entre los profesionales sanitarios.

The guideline includes recommendations for taking care of adult patients with intravenous therapy who are at primary care centres, hospitals and homes.

Prevención de úlceras por presión y lesiones musculoesqueléticas: paciente con ictus / Pressure ulcer prevention and muscular and skeletal injuries. Patient with stoke

Planteamos un caso clínico en el que enfermera y fisioterapeuta ponen en común procedimientos para mejorar la higiene postural de un paciente encamado con un accidente cerebrovascular y hemiplejia izquierda. Describimos analíticamente una intervención conjunta durante un mes. A pesar de que se ha mantenido el riesgo máximo de UPP objetivado inicialmente, durante este periodo no han aparecido úlceras, obteniendo un mantenimiento o aumento del rango de las articulaciones. Es importante un trabajo multidisciplinar que evite la aparición de úlceras por decúbito y de futuras lesiones musculoesqueléticas que dificultarían la posterior reeducación funcional del paciente (AU)

We propose a case in which both a nurse and a physiotherapist analyse different procedures to improve the postural hygiene of bedridden patients with stroke and left hemiplegia. We describe analitically a joint intervention for a month. Although the maximum risk of pressure ulcer (UP) as mentioned before, has remained, ulcers have not appeared during that period, obtaining an increasing articulation range. Multidisciplinary work is important to avoid the appearance of bedsores and future muscular and skeletal injuries that would hinder the future rehabilitation of the patient (AU)

Prevalencia de flebitis postcateterización / Prevalence of post-catheterization phlebitis

Objetivo: determinar la prevalencia de flebitis asociada a catéteres de inserción periférica en los centros de Hospitales Universitarios (HU) Virgendel Rocío de Sevilla y analizar los factores de riesgo asociados, así como las diferencias en la prevalencia en función de distintos momentos del año. Método: estudio descriptivo con tres cortes transversales en pacientes portadores de catéteres de inserción periférica ingresados en unidades de hospitalización en los que la permanencia del catéter es superior a 48 horas.Variables de estudio: tipo de catéter; tipo de conexiones; localización del catéter; tipo de infusión; Escala de Maddox para determinar la flebitis;edad y sexo del paciente.Resultados: se estudiaron 470 pacientes. Según la escala de Maddox, se encontró una prevalencia de flebitis del 8,5% (primer corte), del 17,1%(segundo corte) y del 11% (tercer corte). El riego de aparición de flebitisera mayor si había infusión intermitente (OR = 3,236), si no había llave de tres pasos (OR = 3,647), si existía conexión por bioconector(OR = 2,98) y si se era mujer (OR = 2,421).Conclusiones: la prevalencia de flebitis asociadas a catéter en los distintos cortes del presente estudio está consonancia con otros publicados.Los resultados del estudio han permitido conocer que los procesos aplicados se encuentran dentro de los márgenes de variabilidad deseables,detectando áreas de mejora sobre las que se deberá incidir (AU)

Objective: to determine the prevalence of phlebitis associated to peripherally inserted catheters at the Virgen del Rocío de Sevilla University Hospitals and to analyse associated risk factors, as well as differences in prevalence at different times of the year.Method: descriptive study with three cross-sections in patients who are carriers of peripherally inserted catheters admitted to hospitalization units in which the catheter is in place over 48 hours. Study variables: type of catheter; type of infusion; Maddox Scale to determine phlebitis; patientage and sex. Results: 470 patients were studied. According to the Maddox scale, a phlebitis prevalence of 8,5% (first cross section), 17,1% (second cross section)and 11% (third cross section) was found. The risk of phlebitis onset was greater if there was intermittent infusion (OR = 3,236), if there was no three-step key (OR = 3,647), if there was a connection via a bioconnector(OR = 2,98) or if the patient was a woman (OR = 2,421).Conclusions: the prevalence of catheter-related phlebitis in this study mirrors that of other published data. The results of the study have enabledus to discover that the applied processes are found within desirable variability margins, detecting areas of improvement which should be worked on (AU)

Influencia del apoyo social en el control de las personas con diabetes / Influence of the social support in the control of the diabetes

Introducción: El apoyo social es un proceso interactivo en donde se obtiene ayuda emocional, instrumental y afectiva de la red social que nos rodea, teniendo un efecto protector sobre la salud y amortiguador del estrés que supone una enfermedad. Las situaciones adversas que generan estrés en el individuo y se acompañan de un cambio vital, alcanzan la categoría de acontecimientos vitales estresantes siendo un obstáculo para el cumplimiento del régimen terapéutico. Objetivo: Determinar si el apoyo social que perciben los diabéticos influye en el control metabólico. Metodología: Estudio descriptivo transversal multicéntrico del ámbito de la Atención Primaria, en 246 diabéticos tipo 2, donde se midió el control metabólico (cifra de HbA1c) y percepción del apoyo social mediante el Cuestionario MOS. Para el análisis de datos se determinaron medias, desviaciones típicas y porcentajes mediante SPSS y para estudiar la relación de variables Chi-cuadrado, t-Student y regresión logística multivariante. Resultados: El 88.6% de los sujetos estudiados percibían buen apoyo social. La comparación de medias de HbA1c con Percepción de Apoyo Social no mostró asociación. Sin embargo en un primer corte con los primeros pacientes estudiados se apreciaba diferencias estadísticamente significativas de 1 punto en la cifra media de HbA1c con un IC 95% (0.2 - 1.75) p=0.01 y tras someter a regresión logística multivariante a la percepción de apoyo social se obtuvo un modelo que representa asociación significativa de HbA1c (p=0.02 y OR=2.3) e IMC (p= 0.04 y OR= 1.15). Discusión: El cuestionario MOS requieren un clima favorecedor para que las respuestas del paciente sean fiables y este clima lo puede crear el tiempo de relación profesional (AU)

Introduction: The social support is an interactive process in where emotional aid is obtained, instrumental and affective of the social network that surrounds to us, having a protective effect on the health and shock absorber of the stress that supposes a disease. The adverse situations that generate stress in the individual and accompany by a vital change, reach the category of stressful life events being an obstacle after the fulfilment of the therapeutic regime. Objective: To determine if the social support that perceive the diabetics influence in the metabolic control. Methodology: Multicentric cross-sectional descriptive study of the scope of the Primary Care, in 246 diabetics type 2, where they will be moderate the metabolic control (number of HbA1c), and perception of the social support, by questionnaire MOS. For the analysis of the data, it determined averages, standard deviations and percentage by means of SPSS and to study the relation of variables Test of Chi-square, Test t-Student, and multivariant logistic regression. Results: The 88.6 % of the studied subjects perceived good social support. The comparison of averages of HbA1c with Perception of Social Support did not show association. Nevertheless in a first cut with the first studied patients it was appraised statistically significant differences of 1 point in the average number of HbA1c with an IC 95% (0.2 - 1.75) p=0.01 and after putting under multivariant logistic regression to the perception of social support obtained a model that significant association of HbA1c represents (p=0.02 and OR=2.3) and IMC (p= 0.04 and OR= 1.15). Discussion: Questionnaire MOS requires an enhancing climate so that the answers of the patient are trustworthy and this climate it can create the time of professional relation (AU)

[Informal caretakers in Spain, their profile and care provided]. / Los cuidadores informales en España. Perfil y cuidados prestados.

The authors carried out a systematic search in main data bases and a methodological content review by paired authors about selected publications. The authors reviewed and analyzed 332 articles about informal caretakers and they chose 182 which complied with their selection criteria. The profile for informal caretakers of persons aged over 65 in Spain is identified as well as the type of care he/she provides. It is worth highlighting the introduction of a new factor in caretaking for the elderly during recent years at a national Spanish level, and since the 1990s on an international level: paid non-professional immigrant caretakers. This phenomenon makes the different traits which ethnic minority caretakers have reflect on the dynamics and the results of this study.

Adecuación de las estancias hospitalarias en un servicio de neumología / Appropriateness of hospital stays in a pulmonology department

Objetivo: Establecer la tasa de inadecuación de estancias en un servicio de neumología a lo largo de un año, así como conocer las causas que motivan dicha inadecuación y las variables predictoras de ésta. Pacientes y métodos: Se ha analizado una muestra representativa de las estancias hospitalarias generadas por los pacientes ingresados en el Servicio de Neumología del Hospital de Valme durante el año 2004, utilizando como instrumento de evaluación el Appropriateness Evaluation Protocol (AEP) de forma retrospectiva. Realizaron la evaluación 2 investigadores no neumólogos. Se efectuó una regresión lineal múltiple para determinar qué variables eran predictoras de inadecuación. Resultados: Se analizó un total de 1.166 estancias, en las que se obtuvo una tasa de adecuación del 89% (n = 1.038) y de inadecuación del 11% (n = 128). La causa principal de inadecuación fue la espera de pruebas diagnósticas o resultados (64%), mientras que los criterios que con mayor frecuencia justificaron la estancia fueron los tratamientos respiratorios (59,6%) y el tratamiento parenteral (46,1%). El modelo predictivo obtenido tras la regresión lineal múltiple incluyó las siguientes variables: estancia en una planta diferente de la de neumología, diagnóstico de ingreso y estación del año. Conclusiones: La tasa de inadecuación de estancias fue baja en comparación con otros estudios, y debida sobre todo a la espera de resultados o realización de pruebas diagnósticas. Las variables predictoras de inadecuación fueron el diagnóstico de ingreso, la estación del año y que el paciente estuviese ingresado en una planta diferente de la de neumología

Objective: To analyze the number of inappropriate stays generated by patients admitted through a pulmonology department over a 1-year period and to identify the causes and predictors of those stays. Patients and methods: A representative sample of hospital stays corresponding to patients admitted by the pulmonology department at Hospital de Valme, Seville, Spain, in 2004 was analyzed retrospectively using the Appropriateness Evaluation Protocol. The review was conducted by 2 physicians who did not belong to the pulmonology department. Multiple linear regression analysis was performed to identify predictors of inappropriate stay. Results: Of the 1166 stays analyzed, 1038 (89%) were judged to be appropriate and 128 (11%) inappropriate. The most common reason for inappropriate stay was the delay in performing diagnostic tests and receiving results (64%). The main justification for appropriate stay was the need for respiratory treatment (59.6%) and parenteral treatment (46.1%). The predictive model generated by multiple linear regression analysis identified the following predictors of inappropriate stay: stay on a ward other than the pulmonology ward, diagnosis on admission, and season of the year. Conclusions: The rate of inappropriate stay was low in comparison with other studies. The majority of inappropriate stays were attributed to delays in performing diagnostic tests and receiving results. Diagnosis on admission, season of the year, and stay on a ward other than the pulmonology ward were the strongest predictors of inappropriate stay

[Appropriateness of hospital admissions to a pulmonology department]. / Adecuación de los ingresos hospitalarios en un servicio de neumología.

OBJECTIVES: To analyze the rate of inappropriate admissions to a pulmonology department over the period of a year and to establish the reasons for such admission and predictors. PATIENTS AND METHODS: All 2004 admissions to the pulmonology department of the Hospital de Valme were analyzed using a version of the Appropriateness Evaluation Protocol (AEP) developed for concurrent review. Two physicians who were not directly involved in admitting the patients performed the review. A logistic regression analysis was performed in order to identify the independent predictors of inappropriate hospital admission. RESULTS: Of the 633 admissions analyzed, 92.1% (n = 583) were appropriate and 7.9% (n = 50) were inappropriate. The main reason for considering an admission to be inappropriate was that the patients in question could have been managed as outpatients (70%), whereas appropriate admissions were most frequently justified by the need for parenteral treatment (76.3%) or respiratory therapy (62%). In the logistic regression analysis, the variables that were independently associated with inappropriate admission were nonurgent admission (odds ratio, 2.82; 95% confidence interval, 1.28-6.21; P = .01), and a neoplasia diagnosis as the reason for admission (odds ratio, 8.57; 95% confidence interval, 2.69-27.24; P < .0005). CONCLUSIONS: The rate of inappropriate hospital admissions was lower than that reported in other studies. Most inappropriate admissions were of patients who could have been managed as outpatients. An admission diagnosis of neoplasm and nonurgent admission were independent predictors of inappropriateness.

Adecuación de los ingresos hospitalarios en un servicio de neumología / Appropriateness of hospital admissions to a pulmonology department

Objetivos: Analizar la tasa de inadecuación de ingresos en un servicio de neumología a lo largo de un año y conocer las causas que motivan dicha inadecuación, así como las variables predictoras de ésta. Pacientes y métodos: Se analizaron todos los ingresos del Servicio de Neumología del Hospital de Valme durante 2004 aplicando una versión concurrente del Appropriateness Evaluation Protocol (AEP). Realizaron la evaluación 2 facultativos no implicados en el ingreso de los pacientes. Se efectuó un análisis de regresión logística para determinar las variables que predecían la inadecuación de forma independiente. Resultados: Se analizaron 633 ingresos, de los que el 92,1% (n = 583) fueron adecuados y el 7,9% (n = 50) inadecuados. La causa principal de inadecuación fue el ingreso de pacientes que podrían haber sido manejados ambulatoriamente (70%), mientras que los criterios que con más frecuencia justificaron la adecuación del ingreso fueron la necesidad de tratamiento parenteral (76,3%) y las terapias respiratorias (62%). Las variables que se relacionaron de forma independiente con la inadecuación en la regresión logística fueron el ingreso no urgente (odds ratio = 2,82; intervalo de confianza del 95%, 1,28-6,21; p = 0,01) y el diagnóstico de neoplasia como motivo de ingreso (odds ratio = 8,57; intervalo de confianza del 95%, 2,69-27,24; p < 0,0005). Conclusiones: La tasa de inadecuación de ingresos fue baja en comparación con otros estudios y se debió sobre todo al ingreso de pacientes que podían haber sido manejados ambulatoriamente. La neoplasia como diagnóstico de ingreso y los ingresos no urgentes fueron predictores independientes de inadecuación

Objectives: To analyze the rate of inappropriate admissions to a pulmonology department over the period of a year and to establish the reasons for such admission and predictors. Patients and methods: All 2004 admissions to the pulmonology department of the Hospital de Valme were analyzed using a version of the Appropriateness Evaluation Protocol (AEP) developed for concurrent review. Two physicians who were not directly involved in admitting the patients performed the review. A logistic regression analysis was performed in order to identify the independent predictors of inappropriate hospital admission. Results: Of the 633 admissions analyzed, 92.1% (n=583) were appropriate and 7.9% (n=50) were inappropriate. The main reason for considering an admission to be inappropriate was that the patients in question could have been managed as outpatients (70%), whereas appropriate admissions were most frequently justified by the need for parenteral treatment (76.3%) or respiratory therapy (62%). In the logistic regression analysis, the variables that were independently associated with inappropriate admission were nonurgent admission (odds ratio, 2.82; 95% confidence interval, 1.28-6.21; P=.01), and a neoplasia diagnosis as the reason for admission (odds ratio, 8.57; 95% confidence interval, 2.69-27.24; P<.0005). Conclusions: The rate of inappropriate hospital admissions was lower than that reported in other studies. Most inappropriate admissions were of patients who could have been managed as outpatients. An admission diagnosis of neoplasm and nonurgent admission were independent predictors of inappropriateness

Atención de Enfermería al dolor provocado por procedimientos cruentos / Nursery attention to the pain caused by brutal procedures

INTRODUCCIÓN: En la práctica profesional se ejecutan a diario procedimientos que provocan dolor al enfermo, existiendo en la literatura evidencia científica sobre diferentes métodos de control de este dolor. Con el objetivo de valorar la actitud y conocimientos de los enfermeros hacia el dolor provocado por los Procedimientos Cruentos de Enfermería (PCE) se ha realizado un estudio observacional descriptivo transversal en 33 hospitales del SAS. PARTICIPANTES Y MÉTODO: Cuestionario autoadministrado de preguntas cerradas dicotómicas, en baterías y sustantivas, de información y directas, pasado a 522 enfermeros. RESULTADOS: La mayoría de los profesionales consideran que se provoca dolor al ejecutar los procedimientos, conocen métodos de control, pero no los ponen en práctica (AU)

[General principles for scientific reading and writing]. / Principios generales en escritura y lectura científica.

OBJECTIVE: To present an introduction to scientific writing and reading. METHODS/RESULTS: To analyse the most frequently used different formats of scientific-technical documents as reported by UNESCO (1983) including Scientific journals, books, monographs, presentations to congresses, technical reports, yearbooks and bulletins. We describe the main characteristics of each one. CONCLUSIONS: To emphasize the importance of written communication, in its different formats, in health sciences, for health care professionals formation and information.

[Types, structure, and function of scientific articles]. / Tipos, estructura y funciones de los artículos científicos.

OBJECTIVE: To define the importance of the scientific article as a source of original information. METHODS: To describe the fundamental contents of the scientific article and its three different formats: original scientific article, review article and case reports. CONCLUSIONS: The contents and structure of the different documents vary depending on the type of article considered as a result of the goal pursued with its publication.