Clinical characterization of patients with anal fistula during follow-up of anorectal abscess: a large population-based study.

PURPOSE: Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study was to determine the incidence of anorectal abscess and development of a fistula in a specific population area and to identify potential risk factors associated with demographic, socioeconomic and pre-existing disease (e.g. diabetes and inflammatory bowel disease). METHODS: A longitudinal observational study was designed including a large cohort study in an area with 7,553,650 inhabitants in Spain 1st january 2014 to 31st december 2019. Adults who attended for the first time with an anorectal abscess and had a minimum of 1-year follow-up were included. The diagnosis was made using ICD-10 codes for anorectal abscess and anal fistula. RESULTS: During the study period, we included 27,821 patients with anorectal abscess. There was a predominance of men (70%) and an overall incidence of 596 per million population. The overall incidence of anal fistula developing from abscesses was 20%, with predominance in men, and a lower incidence in the lowest income level. The cumulative incidence of fistula was higher in men and in younger patients (p < 0.0001). On multivariate analysis, patients aged 60-69 years (hazard ratio 2.0) and those with inflammatory bowel disease (hazard ratio 1.8-2.0) had a strong association with fistula development (hazard ratio 2.0). CONCLUSIONS: One in five patients with an anorectal abscess will develop a fistula, with a higher likelihood in men. Fistula formation was strongly associated with inflammatory bowel disease.

Evolución del gasto en servicios sanitarios antes y después del ictus isquémico: análisis de base poblacional / Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study

Introducción: A pesar del aumento de la supervivencia, el ictus representa una carga en salud y socioeconómica creciente. Mediante el uso de bases de datos poblacionales describimos las características principales de los pacientes con ictus isquémico y comparamos el uso de recursos y el gasto asociado un año antes y 3 años después del evento. Métodos: Se identificaron en los sistemas de Información del Servicio Catalán de la Salud todos los pacientes con ictus isquémico entre los años 2012 y 2016. Se relacionaron todos los contactos con el sistema sanitario desde un año antes del episodio índice hasta 3 años después. Se describió el uso de recursos y el gasto sanitario mensual y anual por paciente en los distintos recursos. Resultados: Se identificaron 36.044 pacientes con ictus isquémico, edad media (DE) de 74,7 (13,3) años. La supervivencia a los 3 años fue del 63%. El gasto medio por paciente en el año previo fue de 3.230€, de 11.060€ el primer año desde el ictus, de 4.104€ el segundo y 3.878€ el tercero. Los mayores determinantes de gasto en el primer año fueron las hospitalizaciones (incluyendo la hospitalización inicial), representando el 45% de la diferencia con respecto al año previo al ictus, y en segundo lugar el gasto en convalecencia y rehabilitación (un 33%). Después del primer año, los mayores determinantes del incremento en el gasto respecto al año previo fueron las nuevas hospitalizaciones y el tratamiento farmacológico. Conclusión: Después de un ictus isquémico, el gasto en atención sanitaria aumenta principalmente por las necesidades iniciales de hospitalización y después del primer año se reduce, aunque manteniéndose por encima de los valores previos al ictus. La información derivada de bases de datos poblacionales es útil para mejorar la organización de los servicios de atención al ictus. (AU)

Introduction: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. Methods: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. Results: We identified 36,044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3,230 the year before stroke, €11,060 for year one after stroke, €4,104 for year 2, and €3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. Conclusion: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services. (AU)

Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study.

INTRODUCTION: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS: We identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3230 the year before stroke, €11 060 for year 1 after stroke, €4104 for year 2, and €3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.

Carga de la psoriasis en Cataluña: datos epidemiológicos, comorbilidades asociadas, uso de recursos sanitarios e incapacidad laboral / Burden of Psoriasis in Catalonia: Epidemiology, Associated Comorbidities, Health Care Utilization, and Sick Leave

Antecedentes y objetivo: Disponer de datos epidemiológicos y de carga de una enfermedad es crucial para su control y óptima planificación. El objetivo es estimar la carga de la psoriasis en términos epidemiológicos, las comorbilidades asociadas, el uso de recursos sanitarios y la incapacidad laboral. Material y método: Se han analizado los datos de la encuesta de salud de Cataluña (ESCA) del 2016, el registro de morbilidad y utilización de servicios sanitarios de Cataluña (MUSSCAT) del 2016 y los datos recopilados entre el 2012 y el 2016 del sistema integrado de gestión de la incapacidad temporal (IT) del Instituto Catalán de Evaluaciones Médicas. Resultados:La prevalecía de la psoriasis en Cataluña con base en los datos de la ESCA se sitúa en el 1,8%. Los datos del MUSSCAT muestran que el número de casos incidentes se ha mantenido estable en los últimos años. Las comorbilidades más frecuentes en el paciente con psoriasis son la hipertensión arterial (35%) y la diabetes (15%). La estratificación de la población con psoriasis por niveles de riesgo situó al 40% en riesgo moderado-alto. El uso anual de recursos sanitarios de las personas con psoriasis es elevado (8,7 visitas de atención primaria; 2,8 consultas externas; 0,5 de urgencias y hospital de día; 0,2 de salud mental y 6,1 medicamentos). Los procesos de IT asociados con la psoriasis o artropatía psoriásica representaron el 0,04% del total de registros. Conclusiones: La prevalencia de la psoriasis en Cataluña es del 1,8%. La carga de la enfermedad es elevada, tanto en términos de comorbilidades del paciente como en el requerimiento del uso de recursos (AU)

Background and objectives: Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave. Material and methods: We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012–2016). Results: The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases. Conclusions:The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization (AU)

Burden of Psoriasis in Catalonia: Epidemiology, Associated Comorbidities, Health Care Utilization, and Sick Leave. / Carga de la psoriasis en Cataluña: datos epidemiológicos, comorbilidades asociadas, uso de recursos sanitarios e incapacidad laboral.

BACKGROUND AND OBJECTIVES: Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave. MATERIAL AND METHODS: We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012-2016). RESULTS: The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases. CONCLUSIONS: The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.

Multimorbidity as a predictor of health service utilization in primary care: a registry-based study of the Catalan population.

BACKGROUND: Multimorbidity is highly relevant for both service commissioning and clinical decision-making. Optimization of variables assessing multimorbidity in order to enhance chronic care management is an unmet need. To this end, we have explored the contribution of multimorbidity to predict use of healthcare resources at community level by comparing the predictive power of four different multimorbidity measures. METHODS: A population health study including all citizens ≥18 years (n = 6,102,595) living in Catalonia (ES) on 31 December 2014 was done using registry data. Primary care service utilization during 2015 was evaluated through four outcome variables: A) Frequent attendants, B) Home care users, C) Social worker users, and, D) Polypharmacy. Prediction of the four outcome variables (A to D) was carried out with and without multimorbidity assessment. We compared the contributions to model fitting of the following multimorbidity measures: i) Charlson index; ii) Number of chronic diseases; iii) Clinical Risk Groups (CRG); and iv) Adjusted Morbidity Groups (GMA). RESULTS: The discrimination of the models (AUC) increased by including multimorbidity as covariate into the models, namely: A) Frequent attendants (0.771 vs 0.853), B) Home care users (0.862 vs 0.890), C) Social worker users (0.809 vs 0.872), and, D) Polypharmacy (0.835 vs 0.912). GMA showed the highest predictive power for all outcomes except for polypharmacy where it was slightly below than CRG. CONCLUSIONS: We confirmed that multimorbidity assessment enhanced prediction of use of healthcare resources at community level. The Catalan population-based risk assessment tool based on GMA presented the best combination of predictive power and applicability.

Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis / Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis

La sepsis es una entidad sindrómica de elevada prevalencia y mortalidad. Su manejo está estandarizado y tiene una eficacia dependiente del tiempo. Sin embargo, el manejo de los pacientes con sepsis es complejo. La heterogeneidad de las formas de presentación puede dificultar su detección y manejo, así como las diferencias en formación, competencias o disponibilidad de recursos sanitarios. La Comisión Asesora para la Atención al PAciente con Sepsis (CAAPAS), formada por 7 sociedades científicas, el Sistema de Emergencias Médicas (SEM) y el Servei Català de la Salut (CatSalut), han desarrollado en Catalunya el Código Sepsis Interhospitalario (CSI). El objetivo general del CSI es facilitar la detección precoz, la atención inicial y la coordinación interhospitalaria para optimizar el tratamiento de los pacientes con sepsis o shock séptico en formato código de riesgo vital, de forma homogénea a lo largo de todo el territorio catalán

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia

Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis. / Código Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atención inicial al paciente con sepsis.

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study. / Evolución del gasto en servicios sanitarios antes y después del ictus isquémico: análisis de base poblacional.

INTRODUCTION: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS: We identified 36,044 patients with ischaemic stroke (mean age, 74.7±13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3,230 the year before stroke, €11,060 for year one after stroke, €4,104 for year 2, and €3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.

The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma.

Little is known about the role in ongoing risk stratification of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) performed early after radioactive iodine (RAI) ablation in differentiated thyroid carcinoma (DTC). The aim of the study is to investigate whether 18F-FDG PET/CT performed early after RAI ablation is useful to detect disease and to influence therapy and ongoing risk stratification. Patients with high/intermediate risk of recurrent DTC were included. 18F-FDG PET/CT scan was performed within 6 months after RAI ablation. We confirmed results with other imaging techniques, pathology reports, or follow-up. We classified the patient response as excellent, acceptable, or incomplete. Modified Hicks criteria were used to evaluate clinical impact. We included 81 patients with high/intermediate risk of recurrent DTC. Forty-one (50.6%) had positive uptake in 18F-FDG PET/CT, with negative (131)I whole-body scan ((131)I WBS). Sensitivity, specificity, and diagnostic accuracy of 18F-FDG PET/CT were 92.5, 90.2, and 91.4%, respectively. 18F-FDG PET/CT results had an impact on therapy in 38.3% of patients. One year after initial therapy, 45.7% showed excellent response, 8.6% acceptable response, and 45.7% incomplete response. A statistically significant relationship was found between negative 18F-FDG PET/CT and excellent response (80 vs. 12.2%, p < 0.001; OR 52.8). 18F-FDG PET/CT scan performed early in surveillance of patients with high/intermediate-risk thyroid carcinoma provides important additional information not available with conventional follow-up methods and had a high impact on therapy. A negative 18F-FDG PET/CT predicts an excellent response to therapy in the new ongoing risk stratification.

[Factors associated with a significant functional gain and new institutionalisation in rehabilitated patients admitted to a long term care unit]. / Factores asociados a mejoría funcional y nueva institucionalización en enfermos con intervención rehabilitadora en una unidad de media-larga estancia.

BACKGROUND AND OBJECTIVES: To determine which factors are associated with a functional gain above 19 on Barthel's index (CSFG) and also factors associated with a new post-discharge institutionalisation (NPDI) in patients who a underwent rehabilitation intervention whilst admitted to a medium long term care unit. PATIENTS AND METHODS: Prospective study of patients admitted between 2000 and 2005 who underwent a rehabilitation intervention. Demographic, mind-body and laboratory data were collected. RESULTS: 153 patients were selected for the first aim and 148 for the second. 53.3% of the patients achieved a CSFG. The incidence of NPDI was of 23.7%. The following factors were associated with a CSFG in the multivariate analysis: age (OR: 0.95), female gender (OR: 0.35), rehabilitation objective at admission (OR: 7.43), infectious disease as primary diagnosis (OR: 10.35), mild dependence at admission (OR: 0.09), absence of malnutrition (OR: 3.12), high comorbidity (OR: 0.31), need of wound care (OR: 0.36) and ansiolitic intake at admission (OR: 9.11). Likewise, the following factors were associated with the occurrence of a NPDI: age (OR: 1.12), long-term care objective at admission (OR: 7.84), chronic lung disease (OR: 0.29), number of drug prescriptions at admission (OR: 0.82), neuroleptic intake at admission (OR: 7.42), living with relatives (OR: 0.29) and nosocomial infection during the hospital stay (OR: 2.99). CONCLUSIONS: Several factors have been associated to CSFG and NPDI and they would be useful to optimise rehabilitation resources and to plan post-discharge institutional transfer.

Factores asociados a mejoría funcional y nueva institucionalización en enfermos con intervención rehabilitadora en una unidad de media-larga estancia / Factors associated with a significant functional gain and new institutionalisation in rehabilitated patients admitted to a long term care unit

Fundamento y objetivoDeterminar qué factores se asocian con una ganancia funcional clínicamente relevante (GFCR) superior a 19 en el índice de Barthel y con nueva institucionalización al alta (NIA) en pacientes con intervención rehabilitadora.Pacientes y métodoEstudio prospectivo en pacientes con intervención rehabilitadora ingresados entre 2000 y 2005 en una unidad de media-larga estancia. Se recogieron datos demográficos, biopsicosociales y de laboratorio.ResultadosParticiparon en el estudio 153 pacientes para el primer objetivo y 148 para el segundo. Alcanzó una GFCR el 53,3% de los pacientes. La incidencia de NIA fue del 23,7%. En el análisis multivariante se relacionaron con una GFCR los siguientes factores: edad (OR: 0,95), sexo femenino (OR: 0,35), objetivo de remisión rehabilitador (OR: 7,43), diagnóstico principal infeccioso (OR: 10,35), dependencia moderada al ingreso (OR: 0,09), ausencia de desnutrición (OR: 3,12), alta comorbilidad (OR: 0,31), necesidad de curas al ingreso (OR: 0,36) y uso de ansiolíticos al ingreso (OR: 9,11). Asimismo, se relacionaron con NIA: edad (OR: 1,12), remisión para larga estancia (OR: 7,84), enfermedad pulmonar crónica (OR: 0,29), número de fármacos al ingreso (OR: 0,82), neurolépticos al ingreso (OR: 7,42), vivir con familiares (OR: 0,29) e infección nosocomial (OR: 2,99).ConclusionesSe ha detectado un conjunto de variables asociadas a una GFCR y al riesgo de NIA, que podrían ser utilizadas tanto para optimizar los recursos rehabilitadores como para planificar la necesidad de un recurso residencial al alta(AU)

Background and objectivesTo determine which factors are associated with a functional gain above 19 on Barthel's index (CSFG) and also factors associated with a new post-discharge institutionalisation (NPDI) in patients who a underwent rehabilitation intervention whilst admitted to a medium long term care unit.Patients and methodsProspective study of patients admitted between 2000 and 2005 who underwent a rehabilitation intervention. Demographic, mind-body and laboratory data were collected.Results153 patients were selected for the first aim and 148 for the second. 53.3% of the patients achieved a CSFG. The incidence of NPDI was of 23.7%. The following factors were associated with a CSFG in the multivariate analysis: age (OR: 0.95), female gender (OR: 0.35), rehabilitation objective at admission (OR: 7.43), infectious disease as primary diagnosis (OR: 10.35), mild dependence at admission (OR: 0.09), absence of malnutrition (OR: 3.12), high comorbidity (OR: 0.31), need of wound care (OR: 0.36) and ansiolitic intake at admission (OR: 9.11). Likewise, the following factors were associated with the occurrence of a NPDI: age (OR: 1.12), long-term care objective at admission (OR: 7.84), chronic lung disease (OR: 0.29), number of drug prescriptions at admission (OR: 0.82), neuroleptic intake at admission (OR: 7.42), living with relatives (OR: 0.29) and nosocomial infection during the hospital stay (OR: 2.99).ConclusionsSeveral factors have been associated to CSFG and NPDI and they would be useful to optimise rehabilitation resources and to plan post-discharge institutional transfer(AU)

[Usefulness of implementing a dysphagia care programme at an intermediate and long stay hospital]. / Utilidad de implantar un programa de atención a la disfagia en un Hospital de Media y Larga Estancia.

OBJECTIVES: To describe the initial results of the implementation of a dysphagia assessment and intervention programme and to know which variables showed significant differences between patients with and without dysphagia detected by this way at an intermediate and long stay hospital. METHODS: Descriptive and retrospective study on the assessment performed to patients suspected of having dysphagia and of the subsequent intervention done on those in whom it was confirmed. A standardized clinical method using different viscosities and volumes was used. After confirming the condition, different dietary, postural, and educational cares were undertaken. Demographical, clinical, and analytical variables were registered. RESULTS: 146 patients were included, 110 of them presenting dysphagia of whom the corresponding assessments and interventions were described. This represented a dysphagia prevalence of 14.8% among all admitted patients. The univariate analysis between patients with and without dysphagia showed that the former presented at the time of admission a higher prevalence of a feeding tube (p = 0.011) and a lower proportion of mild cognitive impairment (p = 0.048); and at the time of hospital discharge, lower functional recovery (p < 0.01) and higher presence of a feeding tube (p = 0.028), hyponutrition(p < 0,01), and mortality (p = 0.02). CONCLUSIONS: Given its frequent presentation and important clinical repercussion, and in order to improve health care quality at ILSH, the implementation of a dysphagia care programme is advisable. The dysphagia detected was correlated with the presence of a feeding tube and had clear implications on the clinical course at a functional and nutritional level and vital prognosis.

Utilidad de implantar un programa de atención a la disfagia en un hospital de media y larga distancia / Usefulness of implementing a dysphagia care programme at an intermediate and long stay hospital

Objetivos: Describir en un Hospital de Media y Larga Estancia (HMLE) los resultados iniciales tras la implantación de un programa de valoración e intervención sobre la disfagia y conocer que variables mostraban diferencias significativas entre los enfermos con y sin disfagia así detectados. Métodos: Estudio descriptivo retrospectivo de la valoración realizada a los pacientes con sospecha de disfagia y de la intervención posterior en los que esta se confirmó. Se usó para dicha valoración un método clínico estandarizado que utiliza diferentes viscosidades y volúmenes. Tras su confirmación se llevaron a cabo cuidados dietéticos, posturales y formativos. Se recogieron variables demográficas, clínicas y de laboratorio. Resultados: Se incluyó a 146 pacientes, describiéndose sus correspondientes valoraciones y las intervenciones en los 110 que presentaron disfagia. Esto representó una prevalencia de disfagia del 14,8% de los pacientes ingresados. En el análisis univariante entre los pacientes con y sin disfagia, los primeros presentan al ingreso mayor presencia de sonda de alimentación (p 0,011) y menor proporción de deterioro cognitivo leve (p 0,048); y al alta menor recuperación funcional (p < 0,01) y mayor presencia de sonda de alimentación (p 0,028), de desnutrición (p < 0,01) y de mortalidad (p 0,02). Conclusiones: Para mejorar la calidad asistencial en HMLE es recomendable la implantación de un programa de atención a la disfagia, dada su frecuente presencia e importantes repercusiones clínicas. La disfagia detectada se relacionó con la presencia de sonda de alimentación y tuvo claras implicaciones evolutivas a nivel funcional, nutricional y de pronóstico vital (AU)

Objectives: To describe the initial results of the implementation of a dysphagia assessment and intervention programme and to know which variables showed significant differences between patients with and without dysphagia detected by this way at an intermediate and long stay hospital. Methods: Descriptive and retrospective study on the assessment performed to patients suspected of having dysphagia and of the subsequent intervention done on those in whom it was confirmed. A standardized clinical method using different viscosities and volumes was used. After confirming the condition, different dietary, postural, and educational cares were undertaken. Demographical, clinical, and analytical variables were registered. Results: 146 patients were included, 110 of them presenting dysphagia of whom the corresponding assessments and interventions were described. This represented a dysphagia prevalence of 14.8% among all admitted patients. The univariate analysis between patients with and without dysphagia showed that the former presented at the time of admission a higher prevalence of a feeding tube (p = 0.011) and a lower proportion of mild cognitive impairment (p = 0.048); and at the time of hospital discharge, lower functional recovery (p < 0.01) and higher presence of a feeding tube (p = 0.028), hyponutrition(p < 0,01), and mortality (p = 0.02). Conclusions: Given its frequent presentation and important clinical repercussion, and in order to improve health care quality at ILSH, the implementation of a dysphagia care programme is advisable. The dysphagia detected was correlated with the presence of a feeding tube and had clear implications on the clinical course at a functional and nutritional level and vital prognosis (AU)

Hidratación en el contexto de sedación paliativa en agonía: una perspectiva multidimensional / No disponible

Antecedentes: los médicos se enfrentan a aspectos éticos en su práctica clínica que producen perplejidad, exigen mucho tiempo y les implican emocionalmente. No sólo la vertiente clínica influye en la decisión, sino que interactúan otros factores como las creencias religiosas derivadas de la doctrina católica, en nuestro caso, y los aspectos legales. Las convicciones religiosas influyen en la forma de ver la vida y la muerte. Algunas familias, basándose en la creencia de que la doctrina católica apoya la hidratación hasta el final de la vida, demandan el mantenimiento de la misma a pesar de que ello puede prolongar el sufrimiento de su familiar agónico. Los aspectos legales de la cuestión preocupan sobre todo en relación a la problemática del encarnizamiento terapéutico, que puede derivarse del temor del personal sanitario a hipotéticas demandas legales. Todo ello plantea una disyuntiva. Este trabajo surge como una reflexión acerca del dilema ético planteado a los sanitarios en la toma de decisiones sobre la práctica de la hidratación en la sedación paliativa en agonía. Objetivo: revisar la literatura especializada relacionada con aspectos clínicos, antropológicos, doctrinales de la Iglesia Católica y médico-legales, según la legislación española e internacional, sobre la hidratación en el contexto de la sedación paliativa en la agonía. Material y método: una revisión narrativa de la literatura utilizando el buscador general Google y la base de datos Pubmed. Capítulos de libros sobre temas de medicina paliativa, antropología y legislación, los números anteriores de Medicina Paliativa y documentos tanto de la Sociedad Española de Cuidados Paliativos (SECPAL) como de la Iglesia Católica. La revisión se hizo en los idiomas español e inglés. Se seleccionaron aquellos artículos en los que la hidratación y/o la sedación paliativa en la agonía se trataban de manera relevante o aportaban algún dato significativo al tema. Resultados: se seleccionaron 8 capítulos de 7 libros de texto, 10 artículos, 11 documentos, compendios de legislación, 1 Acta del Senado, 1 sentencia judicial y 1 artículo de un periódico de información general. Se eligieron por sus referencias a la valoración de aspectos: a) clínico-antropológicos; b) doctrinales católicos; y c) médico-legales respecto a la hidratación en los últimos días de vida, con especial énfasis en las consideraciones éticas de cada apartado. Conclusión: desde el punto de vista clínico existe controversia sobre la hidratación en la agonía, siendo necesario individualizar cada situación y conjugarla con las creencias, actitudes y valores del paciente y su familia. Aunque la doctrina católica propugna la hidratación y la nutrición como cuidados debidos a todos los enfermos, considera lícito suprimirlas o no iniciarlas si resultan gravosas para el paciente. Desde el punto de vista legal, la hidratación parenteral en la agonía es opcional, siendo aconsejable razonar el proceso de toma de decisiones en la historia clínica

Background: physicians have to face ethical issues in their clinical practice that may induce perplexity, be time-consuming, and emotionally involve them. Not only clinical aspects influence decision making, but also other factors like religious beliefs (in our setting, mainly the Catholic point of view) or even Legal regulations. The way of perceiving life and death is influenced by religious faith; some families request hydration for their terminally ill relatives, even though this may lengthen their suffering. That is because they believe that Catholic doctrine endorses hydration to the end of life. The legal aspects of these questions derive from the fear of healthcare professionals to hypothetic claims, which could drive them to therapeutic obstinacy. This paper attempts to reflect on the ethical dilemma that we often face up in palliative care regarding decision making on sedation and hydration for terminally-ill patients. Objective: a review of the specialized literature related to clinical, anthropological, Catholic Church, and medico-legal aspects (domestic and international legislation) concerning hydration in the context of palliative sedation at the end of life. Material and method: a narrative review of the literature using Google and the Pubmed database. Book chapters on palliative medicine, anthropology and legislation, former issues of Medicina Paliativa, and documents from not only Sociedad Española de Cuidados Paliativos (SECPAL), but also the Catholic Church. The review was carried out in both Spanish and English. Papers dealing with hydration and/or palliative sedation at the end of life, or providing any significant information thereupon, were selected. Results: eight chapters from 7 textbooks, 10 articles, 11 documents and legislation compendia, 1 Senate committee decision, 1 judicial sentence, and 1 general newspaper’s opinion article were selected. They were chosen because of their references to clinical-anthropological, Catholic doctrinal, and medical-legal aspects about hydratation at the end of life, with special emphasis in the ethical regards of each source. Conclusion: from a clinical point of view there is controversy about hydration at the end of life, and decisions should be made on an individual basis considering patient and family attitudes and values. While the Catholic doctrine endorses hydration and nutrition for all patients, it also allows their discontinuation or absence should these measures be ultimately grievous. From a legal point of view, artificial hydration at the end of life is optional, but the rationale of a decision for or against it should be included in the patient’s medical record

Development of a predictive model for early death in diabetic patients entering hemodialysis: a population-based study.

The aim of this study was to investigate whether early death following the start of dialysis treatment can be explained by predialysis comorbid conditions, and to develop a prognostic model to predict early death in these patients. All patients with diabetes mellitus (DM) over 19 years of age entering hemodialysis in Catalonia in the 1997-2002 period (n = 1,365) were assessed from prospectively obtained data in the Catalan Renal Registry. Logistic regression was used to identify the risk factors associated with mortality at 3, 6 and 12 months of hemodialysis. Mortality at 3 months was found to be associated with age (RR: 1.53/10 years), low grades of functional autonomy, defined as "limited" (RR: 2.28) or "special care" (RR: 4.60), heart disease (RR: 2.23), and use of a catheter as the first vascular access (RR: 2.45). Malignant conditions and malnutrition were found to be additional significant risk factors for mortality at 12 months (RR: 1.68 and 1.74, respectively). Based on the multivariate analysis results, an individual prognostic model was formulated. This study confirms previous data suggesting that predialysis comorbid conditions are significantly associated with mortality in DM patients on dialysis and provides a prognostic model to help clinicians focus on various factors that may require attention before initiating this treatment.

[Why renal transplant from living donors gives better results than cadaver renal transplant?]. / Por qué el trasplante renal de donante vivo da mejores resultados que el trasplante renalde donante cadáver?

BACKGROUND: According to literature, patient and graft survival is better in living donor renal transplants (LRT) than in cadaver renal transplants (CRT). OBJECTIVE: To study factors that determine the best results in LRT related to those of CRT, found in univariate studies. PATIENTS AND METHODS: Renal transplants (RT) done in Catalonia during the 1990-2004 period, performed in patients over 17 years (135 LRT and 3.831 CRT), have been analyzed (retransplants were not included). The data come from the Renal Patients Transplant Registry (RMRC). Student's t-test and chi2 test have been used for mean and for proportions comparisons, respectively. To analyze univariate and multivariate survival, actuarial method and Cox regression have been used, respectively. Estimated creatinine clearance has been studied and its data have been showed through Selwood modified Analysis. RESULTS: As it happens with other great RT patients series, the RMRC analysis, globally and without any adjustment, shows that patient and graft survival in LRT is better than that obtained with CRT. When we studied which variables explain these results, we found that main factors were smaller recipient age and the short time on dialysis. The great influence of both factors has been published in a large number of papers, explaining the differences obtained on the transplanted renal patient survival. CONCLUSIONS: Once adjusted the analysis by the different factors that influence the survival of the patient and the graft, there are no differences in the obtained results, since the best outcomes of the TRV are due to factors like the smaller recipient age and the advanced TR.

Living donor kidney transplantation in catalonia: comparison with cadaveric kidney donors.

INTRODUCTION: We studied the renal transplantation results of living donor compared with cadaveric donor kidney transplantations. PATIENTS AND METHODS: One hundred thirty-six living donor transplantations performed during the period of 1990 to 2003 (group 1) were compared with a control group of 4304 cadaveric donor transplantations (group 2), paired 1:1 with group 1 patients, according to the period of transplantation, the primary renal disease, the transplant number, as well as the recipient and donor ages. RESULTS: There were no differences regarding patient or graft survival during a 10-year follow-up. CONCLUSIONS: The benefit of performing living donor kidney transplantations is the possibility of having the donor available even before beginning dialysis treatment.

Informe de situación de diálisis y trasplante en España, 2004 / Dialysis and transplant situation, Spain 2004

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