Tópicos y reflexiones sobre la reducción de ingresos hospitalarios: de la evidencia a la práctica / Topics and considerations on reducing hospital admission: From evidence to practice

Los cambios demográficos y la realidad económica de los últimos años han condicionado una reorientación de las políticas sanitarias priorizando la atención a la cronicidad. Dada la concentración de costes en la atención hospitalaria de los pacientes con enfermedades crónicas, la reducción de las hospitalizaciones ha pasado a ser un objetivo preferente. Mientras tanto, constatamos que entre el objetivo paradigmático de abordaje eminentemente comunitario propuesto para estos pacientes y la realidad asistencial vigente, queda aún un largo recorrido que valdría la pena realizar paso a paso. Con la evidencia científica de la que disponemos en el momento actual: ¿Es razonable dar por sentado que hay un nivel adecuado de ingresos o que reducir el número de ingresos es necesariamente mejor para los pacientes? ¿Es posible definir operativamente y con la suficiente fiabilidad cuáles de los ingresos hospitalarios son evitables? ¿Es perjudicial para un paciente y para el sistema que una persona con enfermedades crónicas con altas necesidades de atención ingrese en un hospital? ¿No serán los ingresos hospitalarios evitables y los reingresos, indicadores de fragmentación de los sistemas de salud? Ante esta situación, un abordaje razonable requiere en primer lugar de un análisis crítico de las distintas realidades asistenciales (microsistemas) y de la revisión sistemática de la evidencia científica –rompiendo algunos tópicos si es preciso–. En segundo lugar es indispensable llevar este conocimiento a la práctica asistencial, con la necesidad absoluta de conciliar el «qué» y el «cómo», la visión individual con la visión poblacional, la enfermedad única con la multimorbilidad y, finalmente, el abordaje clínico con la planificación sanitaria (AU)

Demographic changes and the economic situation of the recent years have conditioned a turning point in health policies, which have decided to progressively prioritize chronicity care programs. Given that hospital costs were concentrated in attention to patients with chronic diseases, reduction on admissions is now a priority target.Meanwhile, we state that among the obviously community handling paradigmatic aim for those patients and the current care situation, there is a long way to do that should be done gradually. According to the current scientific evidence: Is it sensible to assume that there is a proper level of admissions or is it better for the patients to reduce the number of admissions? Is it possible to operationally and reliably define which hospital admissions are avoidable? Is it harmful to a patient and to the health care system to admit a patient with multiple chronic disease? Maybe are hospital admissions are avoidable and readmissions are indicators of a fragmented health care system?Given that situation, a reasonable approach requires firstly a critical analysis of the various realities of care (microsystems) and a systematic review of the scientific evidence-breaking, and rejecting some topics if necessary. Secondly, we should bring all this knowledge to clinical practice, conciliating «what» and the know-how, individual and population view, sole disease and multimorbidity, and finally clinical approach and health planning (AU)

[Topics and considerations on reducing hospital admission: from evidence to practice]. / Tópicos y reflexiones sobre la reducción de ingresos hospitalarios: de la evidencia a la práctica.

Demographic changes and the economic situation of the recent years have conditioned a turning point in health policies, which have decided to progressively prioritize chronicity care programs. Given that hospital costs were concentrated in attention to patients with chronic diseases, reduction on admissions is now a priority target. Meanwhile, we state that among the obviously community handling paradigmatic aim for those patients and the current care situation, there is a long way to do that should be done gradually. According to the current scientific evidence: Is it sensible to assume that there is a proper level of admissions or is it better for the patients to reduce the number of admissions? Is it possible to operationally and reliably define which hospital admissions are avoidable? Is it harmful to a patient and to the health care system to admit a patient with multiple chronic disease? Maybe are hospital admissions are avoidable and readmissions are indicators of a fragmented health care system? Given that situation, a reasonable approach requires firstly a critical analysis of the various realities of care (microsystems) and a systematic review of the scientific evidence-breaking, and rejecting some topics if necessary. Secondly, we should bring all this knowledge to clinical practice, conciliating «what¼ and the know-how, individual and population view, sole disease and multimorbidity, and finally clinical approach and health planning.

Characterization of a putative fusogenic sequence in the E2 hepatitis G virus protein.

With the aim of better understanding the fusion process mediated by the envelope proteins of the hepatitis G virus (HGV/GBV-C), we have investigated the interaction with model membranes of two overlapping peptides [(267-284) and (279-298)] belonging to the E2 structural protein. The peptides were compared for their ability to perturb lipid bilayers by means of different techniques such as differential scanning calorimetry and fluorescence spectroscopy. Furthermore, the conformational behaviour of the peptides in different membrane environments was studied by Fourier-transform infrared spectroscopy and circular dichroism. The results showed that only the E2(279-298) peptide sequence was able to bind with high affinity to negatively charged membranes, to permeabilize efficiently negative lipid bilayers, to induce haemolysis, and to promote inter-vesicle fusion. This fusogenic activity could be related to the induced peptide conformation upon interaction with the target membrane.