[Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. / Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria.

OBJECTIVE: To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN: A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE: The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS: Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS: Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES: To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS: Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS: The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.

[Influence of medical outliers in patients with femoral neck fracture]. / Influencia del ingreso hospitalario ectópico en pacientes con fractura del cuello femoral.

OBJECTIVES: The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD: A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS: Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS: Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.

Impacto del abandono de la lactancia materna exclusiva sobre la salud de los lactantes / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: El abandono de la lactancia materna es uno de los problemas que enfrenta el Sistema Nacional de Salud en Cuba por las consecuencias desfavorables que representa para la salud de los lactantes. Objetivo: Identificar la relación entre el abandono de la lactancia materna exclusiva y las afectaciones en la salud de los lactantes. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en 105 lactantes del Policlínico Aleida Fernández Chardiet nacidos en 2019, cuyas madres dejaron de utilizar la lactancia materna exclusiva antes del sexto mes. Las variables utilizadas fueron edad materna, tiempo de duración de la lactancia materna exclusiva, las enfermedades más frecuentes diagnosticadas en el niño y la necesidad de ingresos hospitalarios. Se aplicó la prueba no paramétrica de independencia Chi Cuadrado para demostrar la relación entre variables. Resultados: Predominó el abandono de la lactancia materna exclusiva antes de los 3 meses y no se encontró relación estadísticamente significativa entre esta y las afecciones más frecuentes de los lactantes (las IRA en 40 por ciento y las EDA en 23,8 por ciento). El 55,2 por ciento necesitó ingreso hospitalario antes del sexto mes y la relación con el abandono precoz de la lactancia materna exclusiva fue estadísticamente significativa. Conclusiones: El abandono precoz de la lactancia materna exclusiva afecta la salud de los lactantes y aunque las afecciones no tuvieron una relación estadísticamente significativa con aquella sí tienen una elevada frecuencia en estos niños de tan corta edad(AU)

Introduction: Breastfeeding withdrawal is one of the challenges faced by the Cuban National Health System due to its adverse consequences on the health of babies. Objective: To identify the relationship between exclusive breastfeeding withdrawal and health disorders in babies. Material and Methods: A descriptive, retrospective, cross-sectional study was carried out on 105 breastfed babies from "Aleida Fernández Chardiet" Policlinic who were born in 2019 and were precociously weaned from exclusive breastfeeding before the sixth month. The variables used were: maternal age, duration of exclusive breastfeeding, most frequent diseases diagnosed in the child, and need for hospital admission. The chi-squared non-parametric independence test was used to show the relationship among variables. Results: Exclusive breastfeeding withdrawal before the third month was predominant (71, 4 percent); the most frequent diseases diagnosed were respiratory diseases and diarrheas (40 percent and 23,8 percent, respectively); about half the babies required hospital admission (55,2 percent) before the sixth month; the relationship with early withdrawal of breastfeeding was statistically significant. Conclusions: Early withdrawal of breastfeeding has negative effects on the health of babies. Although the illnesses did not have a statistically significant relationship with it, a high frequency of their incidence was found in such young babies(AU)

Utilidad de una unidad de diagnóstico rápido en mayores de 69 años / Usefulness of a quick diagnosis unit in older than 69 years

Introduction: Quick Diagnosis Units (QDU) have demonstrated their importance as an alternative to conventional hospitalization in the study of potentially serious pathologies. The aim of the present study is to demonstrate itsusefulness also in the elderly population.Methods: A retrospective observational study of the patients admitted to theQDU of the Palencia University Health Complex (PUHC) from 2008 to 2020.Different variables were compared between the group ≥70 years and thegroup <70 using Student's t-test, Mann-Whitney U test or Chi-square tests.Results: The study included 9.090 patients (41.6% ≥70 years), with delayuntil the first visit of 1±2 days, and until diagnosis of 14±21 days, withoutdifferences between the two groups. Significant differences were found between the group ≥70 and the group <70 in the origin of the request (fromprimary care 58,1% and 50%), reasons for consultation (deterioration ofgeneral condition 28,5% and 16,1%, anemia 15,6% and 6,5%, lymphadenopathy 3,8% and 9,8% and abdominal pain 6,8% and 8,8%), percentage ofneoplasms (25% and 13,7%) and final destination (hospitalization 6,4% and2,9%, return to primary care 38% and 45,9% and palliative care 3,3% and 0%)Conclusions: QDU of PUHC prevents the admission of 93,6% of elderly patients, with a diagnostic delay similar to that of young people, reduces discontinuity with the socio-family environment and the loss of autonomy of thepatient, and contributes to contain health spending. QDUs are useful in thestudy of potentially serious pathologies regardless of age. (AU)

Introduction: Las Unidades de Diagnóstico Rápido (UDR) han demostradosu importancia como alternativa a la hospitalización convencional en el estudio de patologías potencialmente graves. El objetivo del presente estudio esdemostrar su utilidad también en la población anciana.Métodos: Estudio observacional retrospectivo de los pacientes atendidosen la UDR del Complejo Asistencial Universitario de Palencia (CAUPA), entre2008 y 2020. Se compararon distintas variables entre el grupo de ≥70 años yel de <70 mediante t de Student, U de Mann-Whitney o Chi-cuadrado.Resultados: Fueron estudiados 9.090 pacientes (41,6% de ≥70 años), condemora hasta la primera consulta de 1±2 días, y hasta el diagnóstico de14±21 días, sin diferencias entre ambos grupos. Se encontraron diferenciasentre el grupo de ≥70 y el de <70 en el origen de la solicitud (desde atenciónprimaria 58,1% y 50%), motivos de consulta (alteración del estado general28,5% y 16,1%, anemia 15,6% y 6,5%, adenopatías 3,8% y 9,8% y abdominalgia 6,8% y 8,8%), porcentaje de neoplasias (25% y 13,7%) y destino final(ingresaron 6,4% y 2,9%, regresaron a atención primaria 38% y 45,9% y acuidados paliativos 3,3% y 0%).Conclusiones: La UDR del CAUPA evita el ingreso del 93,6% de los pacientesancianos, con una demora diagnóstica similar a la de los jóvenes. Reduce ladiscontinuidad con el entorno socio-familiar y la pérdida de autonomía delpaciente, y contribuye a la contención del gasto sanitario. Las UDR son útilesen el estudio de patologías potencialmente graves independientemente dela edad. (AU)

Implicaciones pronósticas de la hipo e hiperpotasemia en la insuficiencia cardíaca aguda con fracción de eyección reducida. Análisis de la mortalidad cardiovascular y reingresos hospitalarios / Prognostic implications of hypo and hyperkalaemia in acute heart failure with reduced ejection fraction. Analysis of cardiovascular mortality and hospital readmissions

Antecedentes y objetivos:Las alteraciones del potasio constituyen un problema clínico de gran magnitud en la insuficiencia cardíaca (IC) descompensada. Este estudio pretende valorar las implicaciones pronósticas de la hipo e hiperpotasemia al ingreso por IC aguda en la mortalidad cardiovascular y reingresos hospitalarios.Material y método:De enero de 2016 a junio de 2020 fueron ingresados 1.397 casos con diagnóstico de IC aguda. Se excluyeron ingresos programados para estudio, terapias electivas y pacientes con fracción de eyección del ventrículo izquierdo>40%. El estudio se realizó sobre 689 pacientes, 45 con potasio (K+)<3,5 mmol/l, 49K+>5,0mmol/l y 595K+=3,5-5,0 mmol/l. Se analizaron los antecedentes, perfil clínico basal, terapia farmacológica y niveles de potasio obtenidos al ingreso.Resultados:La mortalidad anual por hipopotasemia (K+

Background and objectives: Potassium alterations constitute a major clinical problem in decompensated heart failure (HF). This study aims to assess the prognostic implications of hypo and hyperkalaemia on admission for acute HF in cardiovascular mortality and hospital readmissions.Material and method:From January 2016 to June 2020, 1,397 cases with a diagnosis of acute HF were admitted. Admission programmed for study, elective therapies, and patients with LVEF> 40% were excluded. The study was carried out on 689 patients, 45 with K+ <3.5 mmol/L, 49K +>5.0 mmol/L and 595K+3.5-5.0 mmol/L. Medical history, baseline clinical profile, drug therapy, and potassium levels obtained upon admission were analysed.Results:Annual mortality due to hypokalaemia (K+<3.5mmol/L) was 37.8% (HR 2.4; 95% CI: 1.3-4.7; P<.007); for hyperkalaemia 40.8% (HR: 1.9; 95% CI: 0.98-3.51; P<.055). Creatinine level and age were variables associated with mortality in both the hyperkalaemic and hypokalaemic cohorts. Hospital readmissions did not show statistical association with these electrolyte disorders.Conclusions:In patients admitted for decompensated HF, both hyperkalaemia and hypokalaemia determined at admission have a negative prognostic impact on survival. Creatinine and age are other independent factors associated with mortality. The effect on the probability of hospital readmission at one year is not demonstrated in this study. (AU)

[Prognostic implications of hypo and hyperkalaemia in acute heart failure with reduced ejection fraction. Analysis of cardiovascular mortality and hospital readmissions]. / Implicaciones pronósticas de la hipo e hiperpotasemia en la insuficiencia cardíaca aguda con fracción de eyección reducida. Análisis de la mortalidad cardiovascular y reingresos hospitalarios.

BACKGROUND AND OBJECTIVES: Potassium alterations constitute a major clinical problem in decompensated heart failure (HF). This study aims to assess the prognostic implications of hypo and hyperkalaemia on admission for acute HF in cardiovascular mortality and hospital readmissions. MATERIAL AND METHOD: From January 2016 to June 2020, 1,397 cases with a diagnosis of acute HF were admitted. Admission programmed for study, elective therapies, and patients with LVEF> 40% were excluded. The study was carried out on 689 patients, 45 with K+ <3.5 mmol/L, 49K +>5.0 mmol/L and 595K+3.5-5.0 mmol/L. Medical history, baseline clinical profile, drug therapy, and potassium levels obtained upon admission were analysed. RESULTS: Annual mortality due to hypokalaemia (K+<3.5mmol/L) was 37.8% (HR 2.4; 95% CI: 1.3-4.7; P<.007); for hyperkalaemia 40.8% (HR: 1.9; 95% CI: 0.98-3.51; P<.055). Creatinine level and age were variables associated with mortality in both the hyperkalaemic and hypokalaemic cohorts. Hospital readmissions did not show statistical association with these electrolyte disorders. CONCLUSIONS: In patients admitted for decompensated HF, both hyperkalaemia and hypokalaemia determined at admission have a negative prognostic impact on survival. Creatinine and age are other independent factors associated with mortality. The effect on the probability of hospital readmission at one year is not demonstrated in this study.

Características y resultados de los pacientes ingresados por COVID-19 durante la pandemia / Characteristics and results of patients admitted with COVID-19 during the pandemic

Objetivos: Describir la situación de los pacientes y de sus ingresos hospitalarios a causa de infección por SARS-CoV-2.Métodos: Estudio observacional retrospectivo de más de un mes de duración (marzo-abril) en el que se incluyeron pacientes ingresados en un hospital secundario con diagnóstico de infección por SARS-CoV-2. Los criterios de inclusión fueron: más de 18 años de edad en el momento de ingreso y diagnóstico de infección por SARS-CoV-2. Se recogieron datos demográficos y comorbilidades, datos clínicos al ingreso, fármacos recibidos durante el ingreso, datos analíticos y procedencia.Resultados: Se incluyeron 224 pacientes. La mediana de edad fue de 74 años (rango: 63-81) y 60,7% eran hombres. El 53,1% presentaba más de una comorbilidad. Las manifestaciones clínicas más frecuentes al ingreso fueron disnea (62,9%) y tos (62,5%), y el 25% tenía fiebre. De los tratamientos utilizados, destacan la hidroxicloroquina y azitromicina que han sido utilizados en el 91,5% y 73,2% de los pacientes, respectivamente. El 41,7% de los pacientes tenían linfopenia, y el 41,1% presentaba un dímero D >1.000 ng/ml. Conclusiones: Nuestro estudio muestra que las características predominantes en los pacientes hospitalizados por infección por SARS-CoV-2 en nuestro departamento durante la etapa temprana de la pandemia, han sido: hombres, pacientes mayores de 65 años, con más de una comorbilidad. Linfopenia y elevaciones del dímero D resultaron las alteraciones analíticas más típicas. Hidroxicloroquina y azitromicina fueron los dos fármacos que más han utilizado. (AU)

Objectives: Describe the situation of patients and their hospital admissions due to SARS-CoV-2 infection.Methods: Retrospective observational study lasting more than one month (March-April) including patients admitted to a secondary hospital with a diagnosis of SARS-CoV-2 infection. The inclusion criteria were: over 18 years of age at the time of admission and diagnosis of infection by SARS-CoV-2. Demographic data and comorbidities, clinical data on admission, drugs received during admission, analytical data and origin are collected.Results: 224 patients were included. The median age was 74 years (range: 63-81) and 60.7% were men. 53.1% had more than one comorbidity. The most frequent clinical manifestations on admission were dyspnea (62.9%) and cough (62.5%), and 25% had fever. Of the treatments used, hydroxy- chloroquine and azithromycin stand out, which have been used in 91.5% and 73.2% of patients, respectively. 41.7% of the patients had lymphopenia, and 41.1% had a D-dimer >1,000 ng/ml.Conclusions: Our study shows that the predominant characteristics in patients hospitalized for SARS-CoV-2 infection in our department during the early stage of the pandemic have been: men, patients over 65 years of age, with more than one comorbidity. Lymphopenia and D-dimer elevations were the most typical laboratory abnormalities. Hydroxychloroquine and azithromycin were the two drugs that have been used the most. (AU)

Alternativas a los internamientos en salud mental: hospitalización domiciliaria desde la perspectiva española y anglosajona / Alternatives to admissions in mental health: home treatment from the Spanish and Anglo-Saxon perspective

En España, los internamientos por motivo de trastorno mental suelen implicar una pérdida de libertades, ya que en general se realizan en unidades de puertas cerradas o bajo condiciones de carácter restrictivo. En este artículo se revisan las características de estos internamientos y la legislación española al respecto. Se realiza una comparativa con Reino Unido, donde se dispone de una ley exclusivamente dedicada a la salud mental, y se analiza el modelo anglosajón de hospitalización domiciliaria como alternativa al ingreso hospitalario. En conclusión, existe una mayor protección legislativa de los derechos fundamentales de los usuarios de salud mental en Reino Unido respecto a España. Es necesaria una reforma legislativa y el desarrollo de políticas sanitarias dirigidas a reducir los internamientos y fomentar otras alternativas de tratamiento. La hospitalización domiciliaria ha demostrado ser una alternativa eficaz al ingreso hospitalario, permitiendo tratar a la persona en el ambiente menos restrictivo posible y un mayor respeto de su autonomía (AU)

In Spain, most of the admissions in mental health units imply a lack of freedom since they are carried out in facilities with closed doors or under restrictive conditions. This article analyzes the characteristics of those admissions and its legislation in Spain; then, it is compared with the United Kingdom model, where there is a specific law for mental health. We describe their model of home treatment, which is implemented as an alternative to hospital admissions. In conclusion, there is a better legislative protection of mental health users' fundamental rights in the United Kingdom than Spain. Legislative reform and the development of health policies to reduce hospitalizations and promote other treatment alternatives are necessary. Home treatment has proven to be an effective alternative to hospital admission, allowing the person to be treated in the least restrictive environment possible and greater respect for their autonomy (AU)

A Espanya, els internaments per motiu de trastorn mental solen implicar una pèrdua de llibertats, ja que en general es realitzen en unitats de portes tancades o sota condicions de caràcter restrictiu. En aquest article es revisen les característiques d'aquests internaments i la legislació espanyola sobre aquest tema. Es realitza una comparativa amb Regne Unit, on es disposa d'una llei exclusivament dedicada a la salut mental, i s'analitza el model anglosaxó d'hospitalització domiciliària com a alternativa a l'ingrés hospitalari. En conclusió, existeix una major protecció legislativa dels drets fonamentals dels usuaris de salut mental a Regne Unit respecte a Espanya. És necessària una reforma legislativa i el desenvolupament de polítiques sanitàries dirigides a reduir els internaments i fomentar altres alternatives de tractament. L'hospitalització domiciliària ha demostrat ser una alternativa eficaç a l'ingrés hospitalari, permetent tractar a la persona en l'ambient menys restrictiu possible i un major respecte de la seva autonomia (AU)

[Incidence of genitourinary pathology in the emergency department.] / Incidencia de la patología genitourinaria en urgencias.

OBJECTIVE: The increase of healthcare pressure in Emergency Departments compels us to have a better understanding of patients' characteristics and the pathology they consult for. This is the first study that estimates the waiting time in the emergency room and the factors that are independently related with hospital admission. METHODS: Descriptive and retrospective study of 2.741 patients who were admitted to the Emergency Department with genitourinary symptoms in 2011. Clinical and epidemiological features were reviewed. A multivariable study was performed to identify the factors related with the final resolution of patients, recurrence emergency attendance, and waiting time in the emergency room. RESULTS: Most of the patients were male (60.3%), being diagnosed with hematuria, acute urinary retention and genital pathology. Females complained more frequently for pyelonephritis, urinary tract infection and low-back pain. Male were hospitalized in greater proportion. Age, diagnosis of infection/sepsis or low-back pain, and yellow or orange MTS level were independent features for hospital admission. Also, in the univariate and multivariate study, age > 60 years (311 vs 220 min.), UTI/sepsis related diagnoses (300 vs 250 min.), and hospital admission as final resolution (440 vs 240 min.) had a significant influence in the waiting time in the Emergency Department. CONCLUSIONS: Age over 60 years, hospital admission as final resolution and infection/sepsis diagnosis were independent features for further waiting time in the Emergency Department. Persistent pain and symptoms of infection/sepsis behaved as independent features for hospital admission.

OBJETIVO: El aumento de la presión asistencial de los servicios de urgencias hospitalarios obliga a conocer las características de los pacientes y de los procesos por los que acuden. Este estudio es el primero que calcula tiempo de permanencia en urgencias y factores que se relacionan de manera independiente con ingreso hospitalario.MÉTODOS: Estudio descriptivo y retrospectivo de 2.741 pacientes que acudieron a Urgencias por sintomatología genitourinaria en el año 2011. Se examinaron rasgos clínicos y epidemiológicos. Se realizó un análisis multivariable para conocer los factores relacionados con la resolución final de los pacientes, recurrencia en la asistencia a urgencias y tiempo en urgencias. RESULTADOS: La mayoría de pacientes fueron varones (60,3%), con diagnósticos de hematuria, RAO y patología genital. Las mujeres, presentaron pielonefritis, ITU y dolor lumbar de manera más frecuente. Los varones ingresaron en mayor proporción. La edad, el diagnóstico de infección/sepsis o dolor lumbar y un nivel MTS amarillo o naranja, resultaron ser factores independientes de ingreso. Tanto en el estudio univariable como multivariable, la edad mayor de 60 años (311 vs 220 min), los diagnósticos relacionados con ITU y sepsis (300 vs 250 min) y el ingreso hospitalario como resolución final (440 vs 240 min) influyeron de forma significativa en el tiempo de estancia en Urgencias. CONCLUSIONES: La edad > 60 años, el resultado de ingreso y el diagnóstico de infección/sepsis fueron factores independientes de mayor tiempo en Urgencias. La presencia de dolor persistente y de infección/sepsis se comportaron como factores independientes de ingreso.

Impact of first year renal replacement therapy on the hospital admissions of a regional public health system. / Impacto del primer año de tratamiento sustitutivo renal en la hospitalización de una comunidad autónoma.

INTRODUCTION AND OBJECTIVES: Chronic kidney disease has a high prevalence and economic impact, and an increased risk of hospitalization. Although there are public regional and country registries, we have not found references to estimate the impact of renal replacement therapy (RRT) on hospital admissions. METHODS: We obtained authorization from the ethics committee and health authorities to integrate the REMER [Madrid Kidney Disease Registry] (2013-2014) and Minimum Basic Data Set (2013-2015) databases and to analyze the admissions during the first year of RRT. RESULTS: 767 patients started RRT in all the hospitals of our region across all RRT modalities. More than a third of the patients start dialysis during a hospital admission. This unplanned start, more common in HD than PD, shows relevant differences in patient profile or admission characteristics. Without considering this initial episode, almost 60% of patients were admitted during their first year. The hospitalization rate was 1.2admissions/patient, higher in HD than in TX or PD; the mean length of stay was 8.6days. The estimated cost of admissions during the first year is €12,006/patient. Our analysis ensures the exhaustive inclusion of all episodes and accurate estimation based on the discharge form. CONCLUSION: The impact of RRT on hospitals has been underestimated and is very relevant when calculating the total cost of RRT. Results from other countries cannot be extrapolated due to differences in the health system and patient profile. The integration of clinical databases could open up an opportunity that needs only institutional support for its development.

First hospital admission due to heart failure: In-hospital mortality and patient profile. / Primera hospitalización por insuficiencia cardiaca: mortalidad hospitalaria y perfil del paciente.

OBJECTIVES: We evaluated the patient profile and outcomes of first heart failure (HF) related hospital admission patients in the 2010-2014 period. DESIGN: Retrospective, single-centre, cohort study. SETTING: We used administrative data from a tertiary care hospital (Hospital Universitari de Bellvitge, Barcelona, Spain). PARTICIPANTS: All patients with primary diagnosis of HF registered at the hospital discharge database from 2010 to 2014 were included, ruling out that HF was present 10 years prior to the current episode. INTERVENTION: Primary care HF diagnosis status was assessed in order to distinguish new onset from no-new onset patients. MAIN MEASURES: Descriptive, bivariate and multivariate analysis were performed using age, previous primary care HF diagnosis and in-hospital death as grouping variables. Significant variables were fitted into a Linear logistic regression model for each outcome. RESULTS: We selected 3,868 first HF-related admissions (56.8% of all HF episodes). In 1,220 patients (31.7%) HF was diagnosed by their primary care physician. Main pattern was a woman (OR=2.4), with higher prevalence of hypertension (OR=1.7), atrial fibrillation (OR=1.3), chronic kidney disease (OR=1.6) and mortality rate (9.8%). In-hospital death rate was 5.8%, age over 85 (OR=5.57), chronic kidney disease (OR=1.44) and length of stay over 7 days (OR=1.90) being the main contributors. CONCLUSIONS: First HF related admissions account for 56.7% of all HF episodes. Roughly one third of patients were already diagnosed by the time of their first hospital admission. Elderly women were the most frequent, but not the only, group of patients. Age, hospital stay and chronic kidney disease were the main contributors for in-hospital death.

Factores asociados al fracaso del tratamiento en pacientes hipertensos que requieren ingreso hospitalario / Factors associated to treatment failure in hypertensive patients requiring hospital admission

RESUMEN Introducción: La hipertensión es una enfermedad muy frecuente que, a pesar de los múltiples adelantos terapéuticos, sigue siendo mal controlada y frecuentemente lleva a descompensaciones que requieren hospitalización o atención en los servicios de emergencia. Objetivos: Identificar los factores relacionados con el fracaso terapéutico en los pacientes hipertensos que requirieron ingreso hospitalario a causa de afectaciones relacionadas con el control de la presión arterial. Método: Se estudiaron los 40 pacientes hipertensos ingresados en el área de salud Marta Abreu durante el año 2016, se tomaron los datos de las historias clínicas y se entrevistaron los pacientes y familiares para identificar las causas que influyeron en el fracaso del tratamiento. Resultados: Predominaron los pacientes del sexo masculino y mayores de 60 años, los factores de riesgo más frecuentes fueron: el hábito de fumar, la diabetes mellitus y la cardiopatía isquémica, y se encontraron como principales causas del mal control de la presión arterial los tratamientos inadecuados (45%) y la no adherencia al tratamiento (30%). Las tres primeras causas de ingreso fueron: accidentes cerebrovasculares (40%), síndrome coronario agudo (27,5%) y crisis hipertensiva (7,5%). Después de corregir la estratificación de riesgo la coincidencia con la estratificación previa fue solo del 10%, y el 95% de los pacientes fueron de alto riesgo. Conclusiones: Las causas de ingreso más frecuentes fueron de origen cardiovascular. Los tratamientos fracasaron por ser inadecuados o por la falta de adherencia de los pacientes. La mayoría de ellos tenían una estratificación incorrecta, por lo que los tratamientos fueron en su mayoría inadecuados y el control deficiente.

Abstract Introduction: High blood pressure is a very frequent disease that, in spite of multiple advances in therapy, continues to be poorly controlled and frequently leads to decompensation requiring hospitalization or emergency services. Objectives: To identify the factors associated to treatment failure in hypertensive patients requiring hospital admission, due to disturbances related to blood pressure control. Method: There were studied 40 hypertensive patients who were admitted in the Marta Abreu health area, during 2016; the data of clinical histories were taken into account and patients and relatives were interviewed in order to identify the causes that influenced the treatment failure. Results: Admissions of males and patients over 60 years predominated. The most frequent risk factors were smoking, diabetes mellitus and ischemic heart disease, and the main causes of poor control of blood pressure were the inadequate treatments (45%) and non-adherence to treatment (30%). The first three causes of admission were stroke (40%), acute coronary syndrome (27.5%) and hypertensive crisis (7.5%). After correcting the risk stratification, the coincidence with the previous stratification was only 10% and 95% of the patients were at high risk. Conclusions: The most frequent causes of admission were of cardiovascular origin. Treatments failed for being inadequate or the lack of patient adherence. Most of them had incorrect stratification, thus, treatments were mostly inadequate and the control was poor.

Paro cardíaco extrahospitalario. Presentación y supervivencia al ingreso hospitalario en algunos centros urbanos y suburbanos del departamento de Maldonado, Uruguay. Análisis de 12 años / Out-of-hospital cardiac arrest. Presentation and survival at hospital admission in some urban and suburban centers of the department of Maldonado, Uruguay. 12 year analysis

Resumen: Introducción: no se dispone de un registro de muerte súbita en Uruguay. Extrapolando datos de otros países se estima que fallecen súbitamente entre 2.000 y 3.000 personas cada año, entre cinco y seis veces más que en los accidentes de tránsito. Objetivo: describir la presentación y la supervivencia al ingreso hospitalario (SIH) de los pacientes asistidos por una emergencia médica móvil (EMM) por paro cardíaco extrahospitalario no traumático (PCEH) en algunos centros urbanos y suburbanos del departamento de Maldonado; analizar variables que se asocian a mayor SIH. Material y método: estudio retrospectivo, descriptivo-analítico, de todos los PCEH en pacientes mayores de 14 años asistidos en el período comprendido entre enero de 2005 y agosto de 2017 en el departamento de Maldonado por una EMM. Para el análisis de asociación de variables se realizó test de chi cuadrado para las variables categóricas y test de t para las variables continuas. Resultados: se asistieron 347 pacientes; 242 hombres (69,7%), edad media 66 años (DE±12,5 años) y 105 mujeres (30,3%), edad media 71,6 años (DE±13,5 años), p=0,002. La mediana del tiempo recepción del llamado-arribo fue de 7 minutos. El PCEH se presentó en 82,4% en el hogar. Diez pacientes fueron asistidos con desfibrilador externo automático (DEA). Los ritmos al arribo fueron: asistolia 56,2%, fibrilación ventricular (FV) 29,4%, actividad eléctrica sin pulso (AESP) 13,5% y taquicardia ventricular sin pulso (TVSP) 0,9%. El 44,6% recibió desfibrilación con un promedio de 3,5 descargas por paciente. La SIH fue 21,9%. En el análisis univariado las variables que se asociaron a mayor SIH fueron: vía pública (VP) como lugar del evento (p<0,001), ritmo desfibrilable al arribo (p<0,001) y las edades menores (p<0,001). Conclusiones: el ritmo más frecuente al arribo del equipo de salud fue la asistolia seguido de la FV. La menor edad, la VP como lugar del evento y la presencia de ritmos desfibrilables al arribo de la EMM se asociaron a mayor SIH.

Summary: Introduction: currently there is not a registry of sudden death in Uruguay. Extrapolating data from other countries it is estimated that between 2.000 and 3.000 people die suddenly every year, five or six times more than in traffic accidents. Objective: to describe the presentation of patients with out-of-hospital cardiac arrest (OHCA) assisted by a Mobile Medical Emergency (MME) in some urban and suburban centers in Maldonado; and to analize variables associated with greater survival at hospital admission (SHA). Material and method: a retrospective, descriptive-analytical study of all OHCA in patients older than 14 years assisted in the period between January 2005 and August 2017, in Maldonado department, by a MME was performed. For analysis, the chi-square test was performed for the categorical variables and the t-test for the continuous variables. Results: 347 patients were recruited in the study period. 69,7% were men, with a mean age of 66 years old (SD±12,5 years) and 30,3% were women, mean age 71,6 years old (SD±13,5 years), p=0,002. The median time of call reception-arrival was 7 minutes. The OHCA presented in 82,4% of cases at home. Ten patients were assisted with automatic external defibrillator (AED). The rhythms at arrival were: asystole 56,2%, ventricular fibrillation 29,4%, pulseless electrical activity 13,5% and ventricular tachycardia without pulse 0,9%. 44,6% received defibrillation with an average of 3,5 discharges per patient. SHA was 21,9%. In the univariated analysis, the variables that were associated with higher SHA were: public settings as the site of the event (p <0,001), shockable rhythm at arrival (p <0,001), and younger age (p <0,001). Conclusions: the most frequent rhythm at the arrival of the health team was asystole followed by ventricular fibrillation. Younger age, public settings as the place of the event and the presence of shockable rhythms at the arrival of the MME, were associated with higher SHA.

Substance abuse and gender differences in first episode psychosis: Impact on hospital readmissions. / Consumo de sustancias y diferencias de género en personas afectas de un primer episodio psicótico: impacto en los porcentajes de reingreso.

INTRODUCTION: There have been controversial results in the study of gender differences in first episode psychosis (FEP). Substance abuse is the main existing comorbidity in FEP, and has been associated with worse prognosis and greater symptom severity. OBJECTIVES: To explore gender differences in FEP in relation to drug abuse, and their relationship with hospital readmissions. METHODOLOGY: Descriptive and prospective study (18 months). RESULTS: We included 141 patients (31.2% women), aged 26.1 years on average, mostly diagnosed with schizophreniform disorder (32.6%). A percentage of 58.9 had problematic use of drugs. Gender significant differences were found in age of onset, age at entry to the programme, marital status and cohabitation, and percentage differences were revealed in current drug abuse and frequency of consumption. Gender, duration of untreated psychosis, psychiatric history, age of onset and previous drug use were not predictors of re-entry. Hospital readmission rate was 24.8%, with no gender differences. The most common reasons for admission were abandonment of treatment (66.7%) and drug abuse (44.4%). Drug abuse was higher in the men than in the women as a reason for re-admission. CONCLUSIONS: There are gender differences in FEP. Men have an earlier onset of symptoms and have worse functional outcomes. Drug abuse in men is higher and represents a major cause of hospital readmission. Therapeutic interventions to prevent the effects of drug abuse are necessary from the early stages of the illness.

Tuberculosis Costs in Spain and Related Factors. / Costes de la tuberculosis en España: factores relacionados.

OBJECTIVE: To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. PATIENTS AND METHODS: Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. CONCLUSION: Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required.

[Medication reconciliation at admission and discharge. A consolidated experience]. / Conciliación de la medicación al ingreso y alta hospitalaria. Una experiencia consolidada.

UNLABELLED: Medication reconciliation is currently one of the main strategies to reduce medication errors related to transitional care. OBJECTIVE: To describe a method that would ensure continuity of patient care as regards drug therapy from admission to discharge. METHODS: A description is presented on the methodology implemented in a tertiary hospital and the main results of medication reconciliation at admission and discharge of patients older than 75 years in the Trauma Unit during 2014. RESULTS: The phases of the methodology were: 1. Obtain medication history (at least two sources of information); 2. Analysis of discrepancies and validation of medication on admission: A checklist was made to standardise the process, 3. Report on the pharmacotherapeutic profile: a form was designed in electronic medical records, and 4. Medication reconciliation at discharge and patient information: presenting the dosing schedule and recommendations to the patient. The medication of 318 patients admitted to Trauma was reconciled (294 at admission and discharge) by applying this methodology during the study period. There was at least one medication reconciliation error in 35% of cases. The mean error per patient reconciled was 0.69. Written discharge information was given to 74.1% of patients. CONCLUSIONS: This methodology has allowed a workflow to be established that facilitates coordination between healthcare providers, in order to reduce medication errors and to respond to one of the main problems of continuity of care.

Abandono del hábito tabáquico tras un primer ingreso en el Servicio de Neumología / Smoking cessation after first admission in a respiratory unit

Some authors suggest that hospitalization is an ideal moment to stop smoking. It is unknown the outcome of smokers admitted for the first time in the pulmonology department, which interventions are carried out to achieve smoking cessation and which are the dropout rates once they are discharged. The purpose of this study is to analyze the impact of a first hospital admission in a service of Pneumology on smokers. Epidemiological variables, smoking habit, specialized interventions carried out on these subjects and rate of withdrawal after discharge were studied. It is necessary to train specialists to diagnose and treat the patient in the process, so that on every hospitalized smoker a cessation intervention should be carried out.

Algunos autores defienden que el ingreso hospitalario constituye un marco ideal para dejar de fumar. Se desconoce lo que sucede con los fumadores que ingresan por primera vez en el Servicio de Neumología, sobre las intervenciones que en ellos se lleva a cabo, así como sus tasas de abandono una vez que son dados de alta. El objetivo de este estudio es analizar el impacto que tiene un primer ingreso hospitalario en el Servicio de Neumología en sujetos fumadores. Conocer sus variables epidemiológicas, el hábito de tabáquico, las intervenciones que el personal médico especializado realiza sobre estos sujetos y las tasas de abstinencia posteriores al alta. Es necesario formar a los especialistas para diagnosticar y tratar al paciente en dicho proceso, de tal forma que sobre todo sujeto fumador hospitalizado se realice alguna intervención.

Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital. / Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario.

INTRODUCTION: Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. METHODS: A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. RESULTS: The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). CONCLUSIONS: For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor.

Evaluación económica de la atención a pacientes en la epidemia de dengue / Economic evaluation of patient care in the epidemic of dengue

Se realizó un estudio descriptivo y retrospectivo para la evaluación económica parcial, del tipo descripción de costos, de la atención hospitalaria y vigilancia de laboratorio de 22 196 pacientes con presunto diagnóstico de dengue, ingresados en 3 hospitales del municipio de Santiago de Cuba durante la epidemia ocurrida en el bienio 2006-2007. Se determinaron los costos directos e indirectos de hospitalización y vigilancia de laboratorio, y se revisó detalladamente la documentación económica existente en los diferentes centros de costes. De la población santiaguera, 2,3 % estaba afectada por dengue, con preponderancia de la forma clásica y confirmación en 50 % de los que ingresaron. Predominaron los costos totales por concepto de hospitalización ($ 11 246 037,18), que representaron 95,1 %, de los cuales 79,8 % provenían de gastos directos y eran superiores a los originados por la vigilancia de laboratorio. Se recomendó realizar una estimación de los gastos generados por la lucha antivectorial y las campañas educativas durante esta epidemia, como complemento de esta investigación.

A descriptive and retrospective study was carried out for the partial economic evaluation, of cost description type, of the hospital care and laboratory monitoring of 22 196 patients with presumptive diagnosis of dengue, admitted in 3 hospitals of Santiago de Cuba municipality during the epidemic occurred in 2006 - 2007. The direct and indirect costs of hospitalization and laboratory monitoring were determined, and the existing economic data were reviewed in detail in different cost centers. Of the Santiago population, 2.3% were affected by dengue, with a predominance of the classic form and confirmation in 50% of those admitted The total expenses for hospitalization ($11 246 037,18) prevailed, representing 95.1%, of which 79.8% came from direct expenses and were higher than those arising from laboratory monitoring. It was recommended to estimate the expenses incurred by the vector control and educational campaigns during this epidemic as a complement of this study.

Evaluación económica de la atención a pacientes en la epidemia de dengue / Economic evaluation of patient care in the epidemic of dengue

Se realizó un estudio descriptivo y retrospectivo para la evaluación económica parcial, del tipo descripción de costos, de la atención hospitalaria y vigilancia de laboratorio de 22 196 pacientes con presunto diagnóstico de dengue, ingresados en 3 hospitales del municipio de Santiago de Cuba durante la epidemia ocurrida en el bienio 2006-2007. Se determinaron los costos directos e indirectos de hospitalización y vigilancia de laboratorio, y se revisó detalladamente la documentación económica existente en los diferentes centros de costes. De la población santiaguera, 2,3 por ciento estaba afectada por dengue, con preponderancia de la forma clásica y confirmación en 50 por ciento de los que ingresaron. Predominaron los costos totales por concepto de hospitalización ($ 11 246 037,18), que representaron 95,1 por ciento, de los cuales 79,8 por ciento provenían de gastos directos y eran superiores a los originados por la vigilancia de laboratorio. Se recomendó realizar una estimación de los gastos generados por la lucha antivectorial y las campañas educativas durante esta epidemia, como complemento de esta investigación(AU)

A descriptive and retrospective study was carried out for the partial economic evaluation, of cost description type, of the hospital care and laboratory monitoring of 22 196 patients with presumptive diagnosis of dengue, admitted in 3 hospitals of Santiago de Cuba municipality during the epidemic occurred in 2006 - 2007. The direct and indirect costs of hospitalization and laboratory monitoring were determined, and the existing economic data were reviewed in detail in different cost centers. Of the Santiago population, 2.3 percent were affected by dengue, with a predominance of the classic form and confirmation in 50 percent of those admitted The total expenses for hospitalization ($11 246 037,18) prevailed, representing 95.1 percent, of which 79.8 came from direct expenses and were higher than those arising from laboratory monitoring. It was recommended to estimate the expenses incurred by the vector control and educational campaigns during this epidemic as a complement of this study(AU)