Evaluación de las estrategias formativas digitales para profesionales sanitarios implementadas durante la pandemia por COVID-19 / Evaluation of the digital educational strategies for healthcare professionals implemented during the COVID-19 pandemic

Objetivo: evaluar la implementación de la estrategia educativa de microaprendizaje mediante el uso de una aplicación móvil para los profesionales sanitarios de un hospital universitario durante la pandemia por COVID-19. Método: se realizó una encuesta a trabajadores del hospital. Se monitorizaron las visualizaciones de las píldoras formativas. El cuestionario permitió recoger información del perfil sociodemográfico de los participantes, el uso de aplicaciones móviles formativas y el de las píldoras creadas ad hoc durante la pandemia por COVID-19. El número de usuarios registrados en la aplicación era de 4.572. Los datos obtenidos se analizaron mediante un análisis descriptivo, utilizándose la prueba T de Student y el test ANOVA para análisis bivariantes. Resultados: participaron 633 profesionales, edad media (DE) 44,8 (11,1) años. El 81,7% (n= 517) era mujer. El 93,5% (n= 592) era trabajador sanitario. Las enfermeras representaron el 41,2% (n= 261) y los médicos el 22,3% (n= 141). Durante la pandemia, el 55,8% (n= 353) de los sujetos del estudio había trabajado dando asistencia directa a pacientes COVID (+). El 94% (n= 595) utilizó la visualización de vídeos para formarse/informarse para su ámbito profesional. El 94,9% refirió conocer las píldoras formativas de la app Formación SanidadMadrid. Las 22 píldoras formativas recibieron 25.539 visualizaciones en total. Se registró alta satisfacción de los participantes en el uso de este método para su formación durante la pandemia. Conclusiones: la estrategia formativa de microlearning basada en píldoras formativas disponibles en una aplicación móvil demostró ser un elemento clave para el desarrollo de nuevas metodologías formativas digitales en el entorno hospitalario durante una situación pandémica.(AU)

Objective: to evaluate the implementation of the microlearning educational strategy through the use of a mobile application for the healthcare professionals of a university hospital during the COVID-19 pandemic. Methods: a survey was conducted on hospital staff. The visualizations of knowledge pills were monitored. The questionnaire allowed to collect information about the sociodemographic profile of participants, the use of educational mobile applications, and of the pills created ad hoc during the COVID-19 pandemic. The number of users registered in the application was of 4,572. The data obtained were analysed through descriptive analysis, using the Student’s T test and the ANOVA test for bivariate analyses. Results: the study included 633 professionals, with a mean age (SD) of 44.8 (11.1) years; 81.7% (n= 517) were female and 93.5% (n= 592) were healthcare professionals. Nurses represented 41.2% (n= 261) of the sample, and doctors 22.3% (n= 141). During the pandemic, 55.8% (n= 353) of the study subjects had worked providing direct assistance to COVID (+) patients; 94% (n= 595) visualized videos for training / getting information for their professional setting; and 94.9% reported awareness of the knowledge pills by the Formación SanidadMadrid App. The 22 knowledge pills received 25,539 visualizations in total. There was high satisfaction by participants regarding the use of this method for their training during the pandemic. Conclusions: the microlearning educational strategy, based on knowledge pills available at a mobile application, demonstrated being a key element for the development of new digital training methodologies in the hospital setting during a pandemics scenario.(AU)

General Characteristics and Activity of Emergency Department Short-Stay Units in Spanish Hospitals.

BACKGROUND: Emergency Department (ED) overcrowding mainly due to the lack of access to inpatient beds negatively affects safety and quality of care. Implementation of ED short-stay units (EDSSUs) may help to mitigate this situation. OBJECTIVES: To describe the general characteristics and evaluate the activity of EDSSUs in Spanish hospitals. METHODS: This is a cross-sectional study. A questionnaire was sent to coordinators responsible for the EDSSUs identified among Spanish hospitals appearing on the Ministry of Health Web page. Data regarding structure, caseloads, and clinical management practices were collected. RESULTS: Among the 591 hospitals surveyed, 35 EDSSUs (5.9%) were identified and 23 participated in the study. Admissions to EDSSUs over different periods in 2011 were assessed: 12-month activity in 17 EDSSUs and between 5 and 10.5 months in six EDSSUs. A total of 25,568 patients with a mean age of 67.2 ± 9.8 years were admitted, representing between 6% and 16.3% of hospital admissions from the ED. The most frequent diagnoses were acute heart failure, chronic obstructive pulmonary disease exacerbation, and urinary and respiratory tract infections. The average length of stay (LOS) was 2.6 ± 1.1 days (range 1.2-5.3), in-hospital mortality 0.59% (range 0-2.68), and the 30-day readmission rate after discharge was 6.7% (range 0-14.6). CONCLUSIONS: To date, only a few Spanish hospitals have implemented EDSSUs. Prevalent infections and exacerbation of chronic conditions are the most frequent causes for admission. Considering LOS, 30-day readmission rate and mortality, EDSSUs appear to be safe and effective and might be considered a tool to alleviate ED overcrowding.

Two Case Reports of Benign Testicular Mesothelioma and Review of the Literature.

Mesothelioma is usually diagnosed in people over the age of 50 with large history of asbestos-related exposure. It is frequently located in pleural cavity, peritoneum, and pericardium. At the testicles the mesothelioma had been reported first in 1957 like a malignant non-germ-cells tumor. The objective is to present two case reports of benign testicular mesothelioma and review of the literature.

La estancia media de los pacientes con insuficiencia cardiaca aguda en las unidades de corta estancia / Mean stay of patients with acute heart failure in short-stay units

No disponible

Absorb bioresorbable vascular scaffold versus everolimus-eluting metallic stent in ST-segment elevation myocardial infarction: 1-year results of a propensity score matching comparison: the BVS-EXAMINATION Study (bioresorbable vascular scaffold-a clinical evaluation of everolimus eluting coronary stents in the treatment of patients with ST-segment elevation myocardial infarction).

OBJECTIVES: The purpose of this study was to compare the 1-year outcome between bioresorbable vascular scaffold (BVS) and everolimus-eluting metallic stent (EES) in ST-segment elevation myocardial infarction (STEMI) patients. BACKGROUND: The Absorb BVS (Abbott Vascular, Santa Clara, California) is a polymeric scaffold approved for treatment of stable coronary lesions. Limited and not randomized data are available on its use in ST-segment elevation myocardial infarction (STEMI) patients. METHODS: This study included 290 consecutive STEMI patients treated by BVS, compared with either 290 STEMI patients treated with EES or 290 STEMI patients treated with bare-metal stents (BMS) from the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-segment Elevation Myocardial Infarction) trial, by applying propensity score matching. The primary endpoint was a device-oriented endpoint (DOCE), including cardiac death, target vessel myocardial infarction, and target lesion revascularization, at 1-year follow-up. Device thrombosis, according to the Academic Research Consortium criteria, was also evaluated. RESULTS: The cumulative incidence of DOCE did not differ between the BVS and EES or BMS groups either at 30 days (3.1% vs. 2.4%, hazard ratio [HR]: 1.31 [95% confidence interval (CI): 0.48 to 3.52], p = 0.593; vs. 2.8%, HR: 1.15 [95% CI: 0.44 to 2.30], p = 0.776, respectively) or at 1 year (4.1% vs. 4.1%, HR: 0.99 [95% CI: 0.23 to 4.32], p = 0.994; vs. 5.9%, HR: 0.50 [95% CI: 0.13 to 1.88], p = 0.306, respectively). Definite/probable BVS thrombosis rate was numerically higher either at 30 days (2.1% vs. 0.3%, p = 0.059; vs. 1.0%, p = 0.324, respectively) or at 1 year (2.4% vs. 1.4%, p = 0.948; vs. 1.7%, p = 0.825, respectively), as compared with EES or BMS. CONCLUSIONS: At 1-year follow-up, STEMI patients treated with BVS showed similar rates of DOCE compared with STEMI patients treated with EES or BMS, although rate of scaffolds thrombosis, mostly clustered in the early phase, was not negligible. Larger studies with longer follow-up are needed to confirm our findings.

Modificación de parámetros de salud en trabajadores expuestos a frío / Modificación of health parameters in workers exposed to cold

Objetivos: El trabajo en ambientes fríos puede provocar daños a la salud de los trabajadores y ser causa de cuadros de incapacidad temporal. El propósito de este trabajo fue hallar alteraciones en diferentes parámetros de salud (analíticos, tensión arterial y número de infecciones). Sujetos y método: Estudio de cohortes comparando dos poblaciones de 75 trabajadores que realizaban tareas similares en sus puestos de trabajo (principalmente corte y envasado de productos perecederos), en unas condiciones parecidas a excepción de la exposición laboral a frío del primer grupo, realizando el cálculo de tres parámetros para cada efecto de la exposición al frío: Riesgo relativo, Límites de Confianza y grado de significación estadística (p). el nivel de significación se estableció para un valor de p menor de 0,05. Resultados: se hallaron diferencias estadísticamente significativas entre expuestos y no expuestos para las variables presión arterial diastólica (RR=1,12; I. C (95%)= 1,01-1,23; y P = 0,03) y número de infecciones padecidas (P= 0,0486). No hubo diferencias estadísticamente significativas en el resto de variables. Conclusiones:; En este estudio , la exposición a temperaturas de 5 a 10 ºC ocasiona en el grupo de trabajadores expuestos una disminución de las cifras de presión arterial diastólica y un aumento en el número de infecciones padecidas con respecto al grupo control no expuesto (AU)

Objective: working in a cold environment can cause damage to the health of workers. The objective was to find changes in health parameters (analytical, blood pressure and number of infections). Subject and methods: Cohort study comparing two populations of 75 workers performing similar tasks in their jobs (mainly cutting and packaging of perishable products), in similar conditions except for occupational exposure to cold in the first group. It was obtained three parameters calculated for each effect on cold exposure: relative risk, confidence limits and level of statistical significance (p). The significance level was set to a value of p<0,05. Results: Statistically significant differences were found between exposed an unexposed workers in diastolic blood pressure variables (RR = 1.12, CI (95%) = 1,01-1,23; and P=0,03) and number of infections suffered (P=0,0486). There was no statistically significant differences in other variables. Conclusion: In this study, the exposure to temperatures from to 10ºC causes in the group of workers exposed a decrease in diastolic blood pressure levels and an increase in the number of suffered infections compared to the unexposed control group (AU)

Experiencia acerca del traslado de un hospital general y su repercusión en la actividad asistencial / Experience of the moving day of a general hospital and effect on clinical activity

Objetivos Describir el proceso del día del traslado de un hospital general. Analizar el impacto en la actividad asistencial en los primeros meses después del traslado. Método Hospital general de ámbito comarcal, en Cataluña, que se traslada a un nuevo edifico. Se describe el proceso del traslado de los pacientes y se analiza el impacto en la actividad (se comparan 3 meses a partir del traslado [período 2] con los mismos meses del año anterior [período1]).Resultados Se trasladaron 37 pacientes sin incidencias. Se atendieron 18.786 urgencias en el período 1 y 21.266 en el período 2 (+13,2%). El número de ingresos urgentes/programados fue de 1314/803 en el período 1 y de 1427/979 en el período 2 (+8,59%/+21,91%). Las visitas realizadas en consultas externas fueron 32.116 en el período 1 y 30.777 en el período 2 (-4,16%)Conclusiones Una adecuada planificación y coordinación permitió realizar un traslado de hospital sin incidencias y sin reducir la actividad asistencial(AU)

Objectives To describe the moving day of a general hospital and to analyze the impact on clinical activity in the first few months after the move. Methods We describe the process of patient transfer and analyze the impact on activity of moving a regional general hospital in Catalonia (Spain) to a new building. Activity was compared in two periods: the first 3 months after the move (period 2) and the same 3 months in the previous year (period 1).Results We moved 37 patients without incidents. A total of 18,786 patients were admitted to the emergency room in period 1 and 21,266 were admitted in period 2 (+13.2%). The number of admissions from the emergency room vs elective admissions was 1,314/803 in period 1 and 1,427/979 in period 2 (+8.59%/ +21.91%). The number of outpatient visits in period 1 was 32,116 and 30,777 in period 2 (-4.16%).Conclusions Proper planning and coordination allowed the hospital to be moved without incidents and without decreasing activity(SU)

[Experience of the moving day of a general hospital and effect on clinical activity]. / Experiencia acerca del traslado de un hospital general y su repercusión en la actividad asistencial.

OBJECTIVES: To describe the moving day of a general hospital and to analyze the impact on clinical activity in the first few months after the move. METHODS: We describe the process of patient transfer and analyze the impact on activity of moving a regional general hospital in Catalonia (Spain) to a new building. Activity was compared in two periods: the first 3 months after the move (period 2) and the same 3 months in the previous year (period 1). RESULTS: We moved 37 patients without incidents. A total of 18,786 patients were admitted to the emergency room in period 1 and 21,266 were admitted in period 2 (+13.2%). The number of admissions from the emergency room vs elective admissions was 1,314/803 in period 1 and 1,427/979 in period 2 (+8.59%/ +21.91%). The number of outpatient visits in period 1 was 32,116 and 30,777 in period 2 (-4.16%). CONCLUSIONS: Proper planning and coordination allowed the hospital to be moved without incidents and without decreasing activity.

Impacto de la implementación de medidas de gestión hospitalaria para aumentar la eficiencia en la gestión de camas y disminuir la saturación del servicio de urgencias / Impact of hospital management measures on improving the efficiency of bed allocation and reducing emergency department overcrowding

Objetivo: Analizar el impacto de la implementación de medidas para reducir el número de pacientes ubicados en urgencias en es pera de cama de hospitalización. Método: Tipo de estudio: comparativo con un análisis retrospectivo. Se compararon dos periodos: periodo 1 (nov 06-oct 07) y periodo 2 (nov 07-oct 08). Ámbito: Hospitalde Sant Boi, hospital general de 126 camas, en Sant Boi de Llobregat (Barcelona). Medidas implementadas: disminución de la estancia prequirúrgica, incremento de la cirugía mayor ambulatoria (CMA) y potenciación del ingreso en una unidad de corta estancia médica (UCE). Variables estudiadas: admisiones en el SUH, ingresos hospitalarios, ingresos de CMA, el número de días en que hay al menos 1 paciente pendiente de cama hospitalaria en el SUH a las 8:00 horas, estancia promedio hospitalaria, actividad y estancia promedio en la UCE. Resultados: El total de admisiones en el SUH fue de 57.140 en el periodo 1, y 71.280 en el periodo 2, con 4.840 (8,4%) y 5.385 (7,5%) ingresos, respectivamente. La estancia media de hospitalización disminuyó de 5,2 días a 4,5 días (p < 0,001). En 86 días del periodo 1, uno o más pacientes permanecían en el SUH pendientes de cama (307 pacientes/año), frente a 11 días en el período 2 (26 pacientes/año). Conclusiones: En nuestra experiencia, las medidas de gestión aplicadas fueron eficaces en la disminución del número de pacientes pendientes de cama en urgencias (AU)

Objective: To analyze the impact of hospital management measures to reduce the number of patients held in an emergency department while awaiting admission. Methods: Type of study: retrospective, comparing 2 periods, November 2006 to October 2007 and November 2007 to October 2008. Setting: Hospital de Sant Boi, a 126-bed general hospital in Sant Boi de Llobregat in the province of Barcelona. Management measures: decreased presurgical stay, increased use of ambulatory surgical procedures, and increased use of a medical short-stay unit. Variables studied: emergency department admissions, hospital ward admissions, admissions for ambulatory surgical procedures, number of days in which at least 1 patient was in the emergency department at 8 A.M. while waiting for a bed, mean hospital stay, and admissions and average time spent in the short-stay unit. Results: A total of 57140 patients were admitted to the emergency department in the first period and 71280 in the second period; 4840 (8.4%) were admitted to hospital in the first period and 5385 (7.5%) in the second. The average length of stay was 5.19 days in the first period and 4.54 days in the second (P<.001). At least 1 patient was waiting in the emergency department for a hospital bed to become available on 86 days in the first period (307 patients/year) and11 days in the second period (26 patients/year). Conclusions: The management measures applied in this case were effective in reducing the number of patients held in the emergency department while waiting for admission (AU)

High mortality rates from medical problems of frequent emergency department users at a university hospital tertiary care centre.

BACKGROUND: Frequent emergency department (ED) users are a nebulous group of patients. A high degree of psychiatric problems and higher than expected mortality from medical illness have been reported in this population. STUDY OBJECTIVES: We sought to examine the pattern of ED use by adult patients identified as being heavy users of the ED, to examine their demographic characteristics and describe their clinical profile during a one-year period at one institution. METHODS: This was a descriptive, retrospective study that took place in the ED of a 1000-bed teaching hospital in Barcelona, Spain, with a population in the metropolitan area of 1.5 million, which attends approximately 110,000 emergency visits per year, excluding paediatrics and obstetrics. The ED computer registration database was used to identify all patients presenting to the hospital ED more than 10 times in a one-year period from 1 January to 31 December 2000. A cohort composed of 86 patients fitting these inclusion criteria was identified as making 1263 (1.1%) of the total 109,857 ED visits. All medical records for each patient were reviewed to determine the primary reason for repeated ED visits. RESULTS: Of the 86 patients enrolled, 58 were men (67.4%). The mean age was 55 years (range 18-91), but only six patients (6.9%) were older than 80 years. The median number of ED visits per patient was 14 throughout the year. Forty-five of the patients (52.3%) were classified as having primarily medical reasons for presenting to the ED, with diagnoses such as shortness of breath and chest pain being the chief symptoms. Seventeen patients (19.7%) had a surgical problem as the cause of their ED visits, and eight (9.3%) had psychiatric problems contributing to the ED visits. Other major reasons for presentation to the ED were as follows: ophthalmic, eight patients (9.3%); otolaryngological, four patients (4.6%); and trauma, four patients (4.6%). A total of 982 (77.8%) of the total ED visits resulted in home discharge. Hospital emergency admissions and outpatient clinics diversions occurred in 106 (8.3%) and 71 (5.6%) ED visits, respectively. The mortality rate was as high as 18.6% (16 frequent ED users died). CONCLUSION: These data show that there is a high incidence of medical problems in frequent ED users and a high incidence of mortality in patients with heavy ED use.

Tratamiento combinado de la esquizofrenia aplicado en el ámbito domiciliario / Combined treatment of the schizophrenia applied in the home setting

En el presente estudio se describen ocho casos de esquizofrenia paranoide a los que se aplica un tratamiento combinado (farmacológico-psicológico) en su ámbito domiciliario. Dentro de la intervención se lleva a cabo un entrenamiento en habilidades de la vida diaria tanto básicas como instrumentales y un módulo de formación para la adhesión al tratamiento farmacológico. El diseño utilizado es de caso único con 8 réplicas (N= 8) y diseño ABAB. Finalizados los períodos de intervención en sus domicilios, los resultados indican que el entrenamiento aumenta el número de habilidades y la adherencia al tratamiento farmacológico y que se produce una mejora en la sintomatología general de los pacientes (AU)

In the present study eight cases of paranoid schizophrenia are described in which a combined treatment is applied (pharmacological-psychological) in the home setting. During the intervention, it is also carried out a training in skills of the daily life as basic as instrumental and a formation module for the adhesion to the pharmacological treatment. The used design is the only example with eight replies (N= 8) and a ABAB design. After the periods of intervention in their homes, the results show that the training increases the number of skills and the adherence to the pharmacological treatment and that they produce an improvement in the general symptomatology of the patients (AU)

Tratamiento de la psoriasis con infliximab / Treatment of recalcitrant psoriasis with infliximab

Introducción: La psoriasis y la artropatía psoriásica responden habitualmente a los tratamientos inmunosupresores convencionales. Infliximab es un anticuerpo monoclonal quimérico que bloquea la actividad del factor de necrosis tumoral alfa (TNF- ) y ha mostrado gran eficacia frente a psoriasis y artropatía psoriásica resistentes. Presentación de casos: Dos varones de 37 y 58 años de edad que padecían psoriasis y artropatía psoriásica invalidante fueron tratados con 3 dosis de 5 mg/kg de infliximab (semanas 0, 2, 6). Los pacientes mantuvieron su medicación previa de metotrexato 25 mg/semana, prednisona 20 mg/día y fentanilo parche de 50 mg/día en el primer caso y flurbiprofeno 200 mg/día y ciclosporina 3,5 mg/kg en el segundo. El PASI mejoró un 90% en ambos pacientes en la semana 10. La artropatía psoriásica mejoró en ambos pacientes (disminución BASDAI 7 a 4,2 en el caso 1 y ACR 50 caso 2). La medicación inmunosupresora pudo ser suspendida en ambos pacientes. No se ha apreciado ningún efecto adverso durante el tratamiento y en las 10 semanas después de finalizarlo. Conclusiones: Infliximab parece ser un fármaco eficaz y seguro a la dosis de 5 mg/kg en pacientes con psoriasis y artropatía psoriásica resistente a los tratamientos inmunosupresores convencionales (AU)