RESUMEN
El uso de la ecografía clínica, entendida como una extensión de la exploración física que ayuda a la toma de decisiones clínicas en tiempo real, se ha generalizado en diversas especialidades médicas y quirúrgicas. En los últimos años, los avances tecnológicos han permitido disponer de ecógrafos de bolsillo, económicamente asequibles, que pueden ser utilizados en el propio domicilio del paciente. En esta revisión se describen las principales aplicaciones de la ecografía clínica en cuidados paliativos, un escenario de potencial utilidad tanto para mejorar la certeza en el diagnóstico de procesos agudos intercurrentes, que producen un impacto en la calidad de vida del paciente, como para guiar la realización de procedimientos invasivos sin necesidad de desplazamientos al medio hospitalario. Para la implantación de la ecografía clínica en cuidados paliativos son necesarios programas formativos con objetivos concretos, definiendo curvas de aprendizaje y estableciendo alianzas con sociedades científicas de reconocida trayectoria docente, asistencial e investigadora para la acreditación de competencias (AU)
Combined with a physical examination, clinical ultrasound offers a valuable complement that can help guide clinical decision-making. In various medical and surgical specialties, it is increasingly used for diagnostic and therapeutic purposes. Due to recent technological advances, smaller and more affordable ultrasound machines are now being developed for use in home hospice care. The purpose of this paper is to describe how clinical ultrasound may be applied in Palliative Care, where it can be a valuable tool to assist the clinician in making better clinical decisions and to assist in accurately guiding palliative procedures. Furthermore, it can be used to identify unnecessary hospitalizations and prevent them from occurring. Training programs with specific objectives are necessary to implement clinical ultrasound in Palliative Care, as well as defining learning curves and promoting alliances with scientific societies that recognize the teaching, care and research trajectory for accreditation of competencies (AU)
Asunto(s)
Humanos , Ultrasonografía/métodos , Cuidados Paliativos/métodos , Sistemas de Atención de PuntoRESUMEN
OBJECTIVE: To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain. METHODS: Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros. RESULTS: We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was 7,326 (95% confidence interval: 6,316-8,416). CONCLUSIONS: Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission.
Asunto(s)
Antibacterianos , Pacientes Ambulatorios , Adulto , Masculino , Femenino , Humanos , Estudios Retrospectivos , Estrés Financiero , Hospitales , Bacterias Grampositivas , Atención Ambulatoria/métodosRESUMEN
Objetivo: Analizar la eficacia y seguridad del tratamiento antibiótico domiciliario endovenoso (TADE) en infecciones de pacientes procedentes del servicio de urgencias. Método: Estudio prospectivo de los pacientes ingresados para TADE en la unidad de hospitalización a domicilio (HaD) del Hospital de Sabadell entre enero del 2008 a junio del 2011. Se comparan dos grupos: pacientes derivados desde urgencias frente a pacientes procedentes de otros dispositivos asistenciales. Las variables analizadas fueron edad, sexo, estancia media, índice de Barthel, vía y forma de administración del antibiótico, tipo de infección, microorganismo aislado, antibiótico utilizado, índices de reingreso precoz y tardío y complicaciones médicas y asociadas al acceso venoso. El TAD Ese autoadministró por parte del cuidador y/o el paciente mediante dispositivos de infusión elastoméricos. Resultados: Se reclutaron 409 pacientes que generaron 492 episodios de TADE, 92 (..) (AU)
Objective: To analyze the safety and efficacy of home intravenous antibiotic therapy (HIVAT) for patients with infections discharged from the emergency department and referred to the home hospital program. Methods: Prospective study of patients referred to the home hospital program of Hospital de Sabadell for HIVAT between January 2008 and June 2011. We compared 2 groups: patients referred by the emergency department and patients referred by any other department or service. Variables analyzed included age, sex, mean stay in the program, Barthel index, route and method for administering the antibiotic, type of infection, microorganism isolated, antibiotic prescribed, early and late readmission rates, and complications (medical and those associated with venous access). HIVAT was self-administered by the patient (or home caregiver) through an elastomeric infusion device. Results: We studied 409 patients and 492 courses of HIVAT; 92 patients were referred by the emergency department and400 came from other care units. Emergency patients were older, had greater functional impairment, a shorter stay in the (..) (AU)
