Resultados tras la aplicación de una vía clínica en el proceso de atención al paciente geriátrico con fractura de cadera osteoporótica en un hospital de segundo nivel / Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital

Objetivo. Evaluar la eficiencia de una vía clínica en el manejo del paciente geriátrico con fractura de cadera por fragilidad en un hospital de segundo nivel, en términos de estancia total, prequirúrgica y morbimortalidad intrahospitalaria y resultado funcional. Material y métodos. Estudio comparativo prospectivo entre dos grupos de pacientes (2010, n = 216 y 2013, n = 196) con fractura de cadera ≥ 75 años, antes y después de la puesta en marcha de un plan de mejora, consistente en la aplicación de medidas multidisciplinares actualizadas de acuerdo con la evidencia científica reciente. Se registra el grado de cumplimiento de las medidas implantadas. Resultados. Las características de los pacientes de ambos grupos fueron similares en edad, sexo, situación funcional (Índice de Barthel) y comorbilidad (Charlson). En 2013 disminuyó la estancia media un 45% (16,61 días en 2010 vs. 9,08 días en 2013, p = 0,000) y la estancia prequirúrgica un 29,4% (6,23 vs. 4,4 días, p = 0,000). Se registraron mayores tasas de complicaciones médicas (delirium, desnutrición, anemia y trastornos electrolíticos) con una menor mortalidad intrahospitalaria posquirúrgica (5,10% vs. 2,87, p > 0,005). La incidencia de infección de herida quirúrgica (p = 0,031) y la eficiencia funcional (p = 0,001) también mejoraron en 2013. Mayor número de pacientes iniciaron tratamiento para la osteoporosis (14,80 vs. 76, 09%, p = 0,001) tras la vía clínica. Conclusión. La aplicación de una vía clínica en el manejo del paciente anciano con fractura de cadera proporciona una reducción de la estancia hospitalaria global y prequirúrgica, sin repercusión clínica y funcional negativa (AU)

Purpose. To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. Material and methods. A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n = 216), and after a quality improvement intervention in 2013 (n = 196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. Results. The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p = .000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p = .000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p > .005). The incidence of surgical wound infection (p = .031) and functional efficiency (p = .001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p = .001) after implementing the clinical pathway. Conclusion. The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes (AU)

[Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital]. / Resultados tras la aplicación de una vía clínica en el proceso de atención al paciente geriátrico con fractura de cadera osteoporótica en un hospital de segundo nivel.

PURPOSE: To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. MATERIAL AND METHODS: A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. RESULTS: The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway. CONCLUSION: The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes.

Mejora de calidad en la asistencia hospitalaria del paciente anciano con fractura de cadera / Improved quality of hospital care of elderly patients with hip fracture

Objetivo: Mejorar la atención de pacientes de 75 o más años hospitalizados por fractura de cadera. Pacientes y método: Estudio comparativo entre dos cohortes de pacientes ingresados por fractura de cadera antes (año 2010) y después de una intervención de mejora de calidad (año 2013). La intervención consistió en la implantación de medidas de mejora multidisciplinares durante el ingreso por fractura de cadera según la evidencia científica actual. Se realizó una evaluación de las medidas implementadas, así como su repercusión clínica y asistencial. Resultados: Las características de los pacientes ingresados por fractura de cadera en 2010 (216 pacientes) y 2013 (196 pacientes) fueron similares en edad, sexo, índices de Barthel y de Charlson abreviado. En 2013, los pacientes tenían más comorbilidad, con diferencias significativas solo en el caso de insuficiencia renal. No se observaron diferencias entre los grupos en relación con el tipo de fractura registrado. Se logró una importante reducción de la estancia preoperatoria y de la estancia global en la cohorte de 2013. Se incrementó la detección de delirio, desnutrición, anemia y trastornos electrolíticos y menor incidencia de infección, alcanzándose mejor eficiencia funcional en el periodo de 2013. Conclusión: La introducción de medidas de mejora sobre el proceso de fractura de cadera reduce la estancia hospitalaria, con la consiguiente reducción de costes y complicaciones (AU)

Objective: To improve the care of patients of 75 or older hospitalized for hip fracture. Patients and method: A comparative study of two cohorts of patients admitted for hip fracture before (2010) and after a quality improvement intervention (2013). The intervention consisted of the implementation of multidisciplinary improvement measures during hospitalization for hip fracture according to current scientific evidence. An evaluation of the implemented measures was performed, and their clinical and health care impact. Results: The characteristics of patients admitted for hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel index and the Charlson abbreviated index. In 2013 patients had more comorbidity, with significant differences only in the case of renal insufficience. No differences between groups in relation to the registered type of fracture were observed. A significant reduction of preoperative stay and overall stay in the cohort of 2013 was achieved. Detection of delirium, malnutrition, anemia and electrolyte disturbances was higher in 2013, and a reduced incidence of infection and a better functional efficiency was achieved in this last period. Conclusion: The introduction of measures to improve on the process of hip fracture reduces hospitalization with consequent cost reduction. It has managed to unify criteria among professionals and identify opportunities for improvement and complications (AU)

Prescripción inadecuada de medicamentos en ancianos hospitalizados según criterios de Beers / Inadequate prescription of medications in hospitalised elderly patients according to Beers criteria

Objetivo: Estimar la prevalencia de utilización de medicamentos potencialmente inadecuados en la población anciana ingresada en el Hospital Nuestra Señora de Sonsoles de Ávila según criterios de Beers y describir el impacto sobre su prescripción tras una intervención educacional sobre los prescriptores. Método Estudio observacional antes y después, con 2 periodos de 28 días cada uno (P1 en 2008 y P2 en 2009) entre los cuales se realizaron actividades de difusión de los criterios de Beers. Se incluyeron todos los pacientes>65 años ingresados durante ambos periodos en unidades con sistema de distribución de medicamentos en dosis unitaria recogiendo los datos de aquellos con prescripción inadecuada. Resultados El número total de pacientes ingresados fue de 1.276: el 18,5% tenía al menos un medicamento inadecuado en el P1 y 20,5% en P2, sin diferencias significativas (χ2=0,56; p=0,45). Se identificaron un total de 295 medicamentos inadecuados (163 en P1 y 132 en P2) en 249 pacientes. El 70% de las prescripciones inadecuadas contienen: sulfato ferroso, digoxina, meperidina y doxazosina. No se modificó la prevalencia de prescripción inadecuada de medicamentos entre los períodos. Conclusión La prevalencia de utilización de medicamentos potencialmente inadecuados encontrada es el estudio es del 23% sin modificarse tras la intervención realizada (AU)

Objectives: To estimate the prevalence of using potentially inadequate drugs in the elderly population admitted to the Nuestra Señora de Sonsoles Hospital in Ávila according to Beerscriteria, and to describe the impacts on these prescriptions following an educational seminar for prescribers. Method: Before and after observational study, with two periods of 28 days each (P1 in 2008, P2in 2009), with educational seminars on Beers criteria provided between them. All patients >65years that were admitted during both time periods in health centres with a single dose drug system were included, taking data on those with inadequate prescriptions. Results: The total number of hospitalised patients was 1276. Of these, 18.5% had at least one inadequate medication at P1 and 20.5% at P2, with no significant differences ( 2 = 0.56, P=.45).We identified a total of 295 inadequate medications (163 in P1 and 132 in P2) in 249 patients. Iron sulfate, digoxin, meperidine, and doxazosine were present in 70% of inadequate prescriptions. The prevalence of inadequate medication prescriptions did not vary between the two periods. Conclusion: The prevalence of using potentially inadequate medications observed in this study was 23%, with no changes produced by the intervention provided (AU)

[Inadequate prescription of medications in hospitalised elderly patients according to Beers criteria]. / Prescripción inadecuada de medicamentos en ancianos hospitalizados según criterios de Beers.

OBJECTIVES: To estimate the prevalence of using potentially inadequate drugs in the elderly population admitted to the Nuestra Señora de Sonsoles Hospital in Ávila according to Beers criteria, and to describe the impacts on these prescriptions following an educational seminar for prescribers. METHOD: Before and after observational study, with two periods of 28 days each (P1 in 2008, P2 in 2009), with educational seminars on Beers criteria provided between them. All patients >65 years that were admitted during both time periods in health centres with a single dose drug system were included, taking data on those with inadequate prescriptions. RESULTS: The total number of hospitalised patients was 1276. Of these, 18.5% had at least one inadequate medication at P1 and 20.5% at P2, with no significant differences (χ2=0.56, P=.45). We identified a total of 295 inadequate medications (163 in P1 and 132 in P2) in 249 patients. Iron sulfate, digoxin, meperidine, and doxazosine were present in 70% of inadequate prescriptions. The prevalence of inadequate medication prescriptions did not vary between the two periods. CONCLUSION: The prevalence of using potentially inadequate medications observed in this study was 23%, with no changes produced by the intervention provided.

Lung cancer incidence in the province of Avila, Spain in 2002 and decade-long trends.

OBJECTIVES: To determine lung cancer incidence in the province of Avila, Spain, in the year 2002 and compare it with incidences reported in 2 previous studies (for 1992-1993 and 1997). PATIENTS AND METHODS: Patients diagnosed in 2002 were evaluated prospectively by the method used in the previous studies. The reference population was obtained from the municipal records for 2001. RESULTS: In 2002, 87 patients (74 men and 13 women) were diagnosed with lung cancer. The crude incidence rate was 53.09 cases per 100 000 population (men: 89.92/100 000; women: 15.93/100 000). Of these, 87.3% had been smokers. Squamous cell carcinomas were the most frequent type overall (38.1%) and in men (42.4%). Adenocarcinomas were the most frequent type in women (60%). The most frequent treatment was chemotherapy (35.6%). Between the 1992-1993 study and our 2002 study, significant increases were found in crude incidence rates of lung cancer and the use of chemotherapy, as well as significant decreases both in squamous cell carcinomas and the use of radiotherapy alone. CONCLUSIONS: Between 1992 and 2002 the lung cancer incidence in men and women in the province of Avila increased significantly.