A magnetic massive star has experienced a stellar merger.

Massive stars (those ≥8 solar masses at formation) have radiative envelopes that cannot sustain a dynamo, the mechanism that produces magnetic fields in lower-mass stars. Despite this, approximately 7% of massive stars have observed magnetic fields, the origin of which is debated. We used multi-epoch interferometric and spectroscopic observations to characterize HD 148937, a binary system of two massive stars. We found that only one star is magnetic and that it appears younger than its companion. The system properties and a surrounding bipolar nebula can be reproduced with a model in which two stars merged (in a previous triple system) to produce the magnetic massive star. Our results provide observational evidence that magnetic fields form in at least some massive stars through stellar mergers.

Approach to COVID-19 pandemic management in Madrid. Chronic of a year.

After more than a year of pandemic, the international medical community has changed the perception of fear to one of respect for SARS-COV-2. This has been the consequence of the integral study of all the dimensions of the disease, from viral recombinant capacity to transmissibility, diagnosis, care and prevention. This document summarizes the main strategic lines of study and approach to the pandemic in Madrid.

Consensus statement of the Spanish Society of Internal Medicine and the Spanish Society of Medical Oncology on secondary thromboprophylaxis in patients with cancer

Up to 20% of cancer patients will develop some manifestation of venous thromboembolic disease (VTD) during their clinical course. VTD greatly impacts morbidity, mortality, quality of life and pharmaceutical expenditure. In addition, both thrombotic relapse and major haemorrhages derived from VTD treatment are more likely in oncological patients. To make the decision to establish secondary thromboprophylaxis as an indefinite treatment in these patients, it is important to review all the risk factors involved, whether related to the disease, the patient or the prior thrombotic event. The objectives of this consensus of the Spanish Society of Internal Medicine (Sociedad Española de Medicina Interna—SEMI) and the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM) are to establish recommendations that help assess the risk of recurrence of VTD and haemorrhagic risk in patients with cancer, as well as to analyse the evidence that exists on the currently available drugs, which will allow the establishment of a protocol for shared decision-making with the informed patient (AU)

Temporary hospitals in times of the COVID pandemic. An example and a practical view.

We describe the most widely used temporary hospital in Europe during the first pandemic wave, its structure, function, and achievements. Other models of care developed during the pandemic around the world were reviewed including their capacity, total bed/ICU bed ratio and time of use. We particularly analyzed the common and differential characteristics of this type of facilities. IFEMA Exhibition Center was transformed into a temporary 1,300-bed hospital, which was in continuous operation for 42 days. A total of 3,817 people were treated, generally patients with mild to moderate COVID-19, 91% of whom had pneumonia. The average length of stay was 5 to 36 days. The most frequent comorbidities were hypertension (16.5%), diabetes mellitus (9.1%), COPD (6%), asthma (4.6%), obesity (2.9%) and dementia (1.6%). A total of 113 patients (3%) were transferred to another centers for aggravation, 19 (0.5%) were admitted to ICU and 16 patients (0.4%) died. An element of great help to reducing the overload of care in large hospitals during peaks of health emergencies could be these flexible structures capable of absorbing the excess of patients. These must be safe, breaking domestic transmission and guarantee social and emotional needs of patients. The success of these structures depends on delimitation in admission criteria taking into account the proportion of patients who may require, during admission, assistance in the critical care area.

Consensus statement of the Spanish Society of Internal Medicine and the Spanish Society of Medical Oncology on secondary thromboprophylaxis in patients with cancer.

Up to 20% of cancer patients will develop some manifestation of venous thromboembolic disease (VTD) during their clinical course. VTD greatly impacts morbidity, mortality, quality of life and pharmaceutical expenditure. In addition, both thrombotic relapse and major haemorrhages derived from VTD treatment are more likely in oncological patients. To make the decision to establish secondary thromboprophylaxis as an indefinite treatment in these patients, it is important to review all the risk factors involved, whether related to the disease, the patient or the prior thrombotic event. The objectives of this consensus of the Spanish Society of Internal Medicine (Sociedad Española de Medicina Interna-SEMI) and the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica-SEOM) are to establish recommendations that help assess the risk of recurrence of VTD and haemorrhagic risk in patients with cancer, as well as to analyse the evidence that exists on the currently available drugs, which will allow the establishment of a protocol for shared decision-making with the informed patient.

Atención aguda a pacientes ancianos en una unidad de prevención del deterioro funcional / Acute care for elderly patients in a functional impairment prevention unit

OBJETIVO: Determinar si el cuidado de los pacientes con un moderado grado de dependencia ingresados en una unidad de prevención del deterioro funcional (UPDF) era superior al cuidado en una unidad convencional (UC) en términos de deterioro funcional y estancia media. MÉTODOS: Estudio retrospectivo, controlado, de intervención en un solo centro, que compara el tratamiento agudo en una UPDF y en plantas convencionales. Se incluyeron 466 pacientes ancianos con un grado moderado de dependencia (Barthel 30-70), mayores de 75 años. De estos, 280 pacientes formaron parte del grupo de intervención y 186 del grupo control. Los resultados primarios fueron la pérdida de funcionalidad achacable al ingreso (medida por pérdida de deambulación y continencia urinaria) y las diferencias en la duración de la estancia. RESULTADOS: Los pacientes ingresados en la UPDF presentaron un menor deterioro funcional determinado por la pérdida de la continencia urinaria (2,1% de pacientes en UPDF vs. 9,7% en UC; p < 0,01) y la pérdida de la capacidad de deambular (2,1% de pacientes en UPDF vs. 25,3% en UC; p < 0,01). Los pacientes ingresados en la UPDF tuvieron una estancia media más corta (7,4 vs. 8,5; p < 0,05), con un día menos de estancia que los pacientes en la UC. CONCLUSIÓN: La atención aguda de pacientes ancianos con un grado moderado de dependencia en una UPDF se asoció de forma independiente con un menor deterioro funcional y una menor estancia

AIM: To determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay. METHODS: We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30-70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay. RESULTS: The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1% of the FIPU patients vs. 9.7% of the CU patients; p<.01) and the loss of walking ability (2.1% vs. 25.3%; p<.01). The patients hospitalised in the FIPU had a shorter mean stay (7.4 vs. 8.5 days; p<.05), with 1 day less of stay than the CU patients. CONCLUSION: The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays

Características de los adultos con síndrome de Down ingresados en los servicios de medicina interna españoles en el periodo 2005-2014 / Characteristics of adults with Down syndrome hospitalised in Spanish internal medicine departments during 2005-2014

INTRODUCCIÓN Y OBJETIVOS: Los problemas clínicos de los adultos con síndrome de Down parecen diferir de los de la población general. Para entender mejor estas diferencias describimos las características demográficas y clínicas de los adultos con síndrome de Down que ingresaron en los servicios de Medicina Interna españoles en el periodo de 2005-2014. PACIENTES Y MÉTODOS: Estudio observacional retrospectivo sobre datos recogidos en el conjunto mínimo básico de datos de los episodios de ingreso de adultos con síndrome de Down en los servicios de Medicina Interna del Sistema Nacional de Salud desde 2005 hasta 2014. Se analizaron variables epidemiológicas, clínicas y sociales. RESULTADOS: Se registraron 7.548 episodios de ingreso de 3.786 pacientes. El 56,6% eran varones con una edad media (± DE) de 47±13 años. Fallecieron 715 pacientes (18,9%). La mortalidad ajustada a la edad fue 26,6% y su estancia media fue de 9,6±12 días. En 3.684 episodios (48,8%) el ingreso fue por enfermedad respiratoria y en 760 (10%), de origen cardiológico. Las comorbilidades más frecuentes fueron el hipotiroidismo (27,1%; 2.043 episodios), la epilepsia (24,1%; 1.819 episodios) y la demencia (15,4%; 1.162 episodios). CONCLUSIONES: Los ingresos de adultos con síndrome de Down en los servicios de Medicina Interna han aumentado en la última década. Si bien los motivos de ingreso, estancia media y coste por episodio de esta población son similares a los de la población general atendida en Medicina Interna, la mortalidad intrahospitalaria ajustada por edad fue significativamente mayor

INTRODUCTION AND OBJECTIVES: The clinical problems of adults with Down syndrome seem to differ from those of the general population. To better understand these differences, we list the demographic and clinical characteristics of adults with Down syndrome admitted to Spanish internal medicine departments during 2005-2014. PATIENTS AND METHODS: We conducted an observational retrospective study using data collected from the minimum basic data set on hospitalisation episodes of adults with Down syndrome in the internal medicine departments of Spain's National Health System from 2005 to 2014. We analysed the patients' epidemiological, clinical and societal data. RESULTS: A total of 7548 hospitalisation episodes from 3786 patients were recorded. Some 56.6% of the patients were male with a mean age (±SD) of 47±13 years, and 715 of the patients died (18.9%). The age-adjusted mortality was 26.6%, and the mean stay was 9.6±12 days. The hospitalisation was for respiratory disease in 3684 episodes (48.8%) and for cardiac origin in 760 (10%). The most common comorbidities were hypothyroidism (27.1%, 2043 episodes), epilepsy (24.1%, 1819 episodes) and dementia (15.4%, 1162 episodes). CONCLUSIONS: The hospitalisation of adults with Down syndrome in internal medicine departments has increased in the past decade. Although the reasons for hospitalisation, mean stay and cost per episode for this population are similar to those of the general population treated by internal medicine departments, the age-adjusted hospital mortality was significantly greater

Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings.

The high transmissibility of SARS-CoV-2 before and shortly after the onset of symptoms suggests that only diagnosing and isolating symptomatic patients may not be sufficient to interrupt the spread of infection; therefore, public health measures such as personal distancing are also necessary. Additionally, it will be important to detect the newly infected individuals who remain asymptomatic, which may account for 50% or more of the cases. Molecular techniques are the "gold standard" for the diagnosis of SARS-CoV-2 infection. However, the massive use of these techniques has generated some problems. On the one hand, the scarcity of resources (analyzers, fungibles and reagents), and on the other the delay in the notification of results. These two facts translate into a lag in the application of isolation measures among cases and contacts, which favors the spread of the infection. Antigen detection tests are also direct diagnostic methods, with the advantage of obtaining the result in a few minutes and at the very "pointof-care". Furthermore, the simplicity and low cost of these tests allow them to be repeated on successive days in certain clinical settings. The sensitivity of antigen tests is generally lower than that of nucleic acid tests, although their specificity is comparable. Antigenic tests have been shown to be more valid in the days around the onset of symptoms, when the viral load in the nasopharynx is higher. Having a rapid and real-time viral detection assay such as the antigen test has been shown to be more useful to control the spread of the infection than more sensitive tests, but with greater cost and response time, such as in case of molecular tests. The main health institutions such as the WHO, the CDC and the Ministry of Health of the Government of Spain propose the use of antigenic tests in a wide variety of strategies to respond to the pandemic. This document aims to support physicians involved in the care of patients with suspected SC2 infection, in the context of a growing incidence in Spain since September 2020, which already represents the second pandemic wave of COVID-19.

El hospital del futuro en 10 puntos / The hospital of the future in 10 points

La Sociedad Española de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario español la reflexión que abordó el Royal College of Physicians en el Reino Unido sobre la organización de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades científico-médicas y entidades profesionales del sector salud y asociaciones de pacientes. Este artículo tiene por objeto destacar en 10 puntos las previsiones que consideramos más relevantes derivadas de este proyecto, dedicando el último a los retos que para la Medicina Interna se deducen de estas propuestas

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals

The Hospital of the Future in 10 points. / El hospital del futuro en 10 puntos.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

Significant differences between verbal and non-verbal intellectual scales on a perinatally HIV-infected cohort: from pediatrics to young adults.

Delayed neurodevelopment is a common outcome in perinatally HIV-infected children. Our aim was to assess the intellectual profile of our cohort, considering both the infection and socio-environmental related variables. A cross-sectional cohort study was undertaken at seven major hospitals in Spain belonging to the CoRISpeS cohort (n = 97). Patients were followed up according to a standard protocol. Intellectual measures, psychosocial profile and HIV infection-related data have been analysed. The average patient age was 15 years. The median CD4 cell percentage was 35% (1,59). Viral load was undetectable in 80% of the patients and 27% were on AIDS category; 38% of whom had encephalopathy. The average composite score of both crystallized intelligence (CI) and intelligence quotient (IQ) for the cohort was lower than that of the general population (p < 0.001). Results revealed a significant difference of 38% between crystallized and fluid intelligence. There was a clear association between IQ and age of diagnosis (p = 0.022); CI and CDC classification (p = 0.035), CD4 count (p = 0.011) and CD4 nadir (p = 0.001). Higher parental education was associated with better performance across all intelligence scales (p < 0.002). A regression model showed that CI was influenced by the academic level of caregivers (p = 0.002), age at start of cART (p = 0.050) and primary language (p = 0.058). Findings revealed significant differences in verbal and non-verbal intellectual scales resulting in a misleading IQ Composite score. Crystallized intelligence demonstrated the highest level of impairment despite adequate treatment and good immunovirological status, while fluid intelligence results were average. Caregiver level of education was the strongest factor across all intelligence measures.

Psychophysiological Correlates of Emotional- and Alcohol-Related Cues Processing in Offspring of Alcohol-Dependent Patients.

AIMS: To determinate if offspring of alcohol-dependent patients (OA) process affective stimuli and alcohol-related cues in a different manner than control subjects do. METHODS: Event-related potentials (early posterior negativity [EPN]/ late positive potential [LPP]) and event-related oscillations (Theta) were obtained by electroencephalographic (EEG) recording during the viewing of International Affective Picture System (IAPS) images with positive, negative and neutral valence, as well as alcohol-related cues. The total sample was comprised of 60 participants, divided into two groups: one group consisted of OA (30) and the control group of participants with negative family history of alcohol use disorders (30). RESULTS: Theta power analysis implies a significant interaction between condition, region and group factors. Post-hoc analysis indicates an increased theta power for the OA at different regions, during pleasant (frontal, central, parietal, occipital, right temporal); unpleasant (frontal, central, occipital); alcohol (frontal, central, parietal, occipital, right and left temporal) and neutral (occipital) cues. There are no group differences regarding any of the event-related potential measurements (EPN/LPP). CONCLUSIONS: There is evidence of alterations in the processing of affective stimuli and alcohol-related information, evidenced by changes in theta brain oscillations. These alterations are characterized by an increased emotional reactivity, evidenced by increased theta at posterior sites. There is also an increased recruitment of emotion control, which could be a compensation mechanism, evidenced by increased theta power at anterior sites during affective stimuli and alcohol cues.

Characteristics of adults with Down syndrome hospitalised in Spanish internal medicine departments during 2005-2014. / Características de los adultos con síndrome de Down ingresados en los servicios de medicina interna españoles en el periodo 2005-2014.

INTRODUCTION AND OBJECTIVES: The clinical problems of adults with Down syndrome seem to differ from those of the general population. To better understand these differences, we list the demographic and clinical characteristics of adults with Down syndrome admitted to Spanish internal medicine departments during 2005-2014. PATIENTS AND METHODS: We conducted an observational retrospective study using data collected from the minimum basic data set on hospitalisation episodes of adults with Down syndrome in the internal medicine departments of Spain's National Health System from 2005 to 2014. We analysed the patients' epidemiological, clinical and societal data. RESULTS: A total of 7548 hospitalisation episodes from 3786 patients were recorded. Some 56.6% of the patients were male with a mean age (±SD) of 47±13 years, and 715 of the patients died (18.9%). The age-adjusted mortality was 26.6%, and the mean stay was 9.6±12 days. The hospitalisation was for respiratory disease in 3684 episodes (48.8%) and for cardiac origin in 760 (10%). The most common comorbidities were hypothyroidism (27.1%, 2043 episodes), epilepsy (24.1%, 1819 episodes) and dementia (15.4%, 1162 episodes). CONCLUSIONS: The hospitalisation of adults with Down syndrome in internal medicine departments has increased in the past decade. Although the reasons for hospitalisation, mean stay and cost per episode for this population are similar to those of the general population treated by internal medicine departments, the age-adjusted hospital mortality was significantly greater.

Acute care for elderly patients in a functional impairment prevention unit. / Atención aguda a pacientes ancianos en una unidad de prevención del deterioro funcional.

AIM: To determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay. METHODS: We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30-70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay. RESULTS: The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1% of the FIPU patients vs. 9.7% of the CU patients; p<.01) and the loss of walking ability (2.1% vs. 25.3%; p<.01). The patients hospitalised in the FIPU had a shorter mean stay (7.4 vs. 8.5 days; p<.05), with 1 day less of stay than the CU patients. CONCLUSION: The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays.

Análisis del tratamiento del prolapso de órganos pélvicos mediante colposacropexia mínimamente invasiva con 24 horas de ingreso / Analysis of minimally invasive sacrocolpopexy with 24-hour hospital stay for the treatment of pelvic organ prolapse

Objetivos: El objetivo del presente estudio es analizar el resultado de la implementación de una vía clínica para la corrección del prolapso de órganos pélvicos mediante colposacropexia mínimamente invasiva (CSMI) con 24 horas de ingreso en términos de seguridad y ahorro de costes de hospitalización. Material y métodos: Estudio observacional prospectivo de los primeros 78 procedimientos de CSMI realizados de forma consecutiva. Cuarenta y seis procedimientos (59%) se realizaron con estancia hospitalaria de 24 horas, mientras que 32 (41%) precisaron más de 24 horas. Para cada grupo se determinaron las complicaciones postoperatorias, visitas al servicio de urgencias, reintervenciones y el coste medio por procedimiento en términos de estancia hospitalaria y atención en el Servicio de Urgencias. El modelo de costes se estableció según los datos del Sistema de Contabilidad Analítica del Hospital Fundación Jiménez Díaz y del Boletín oficial de la Comunidad de Madrid. Resultados: No se encontraron diferencias entre ambos grupos respecto a las complicaciones intraoperatorias o postoperatorias. Las consultas en el servicio de urgencias, reintervenciones o reingresos hospitalarios fue menor en el grupo de 24 horas de ingreso, sin alcanzar la significación estadística. Mediante la implementación de la vía clínica de CSMI con 24 horas de ingreso se objetivó un ahorro de 607,91 € por procedimiento en estancia hospitalaria. Conclusiones: La corrección del prolapso de órganos pélvicos mediante CSMI con política de alta hospitalaria de 24 horas es factible y segura en al menos el 59% de las pacientes, sin objetivarse un mayor número de complicaciones, visitas al servicio de urgencias o reingresos hospitalarios

Objectives: The objective of this study is to analyze the impact (in terms of safety and saving of hospital costs) of the implementation of a new protocol for the correction of pelvic organ prolapse (POP) by minimally invasive sacrocolpopexy (MISC) with 24-hour hospital stay. Material and methods: Prospective observational study of the first 78 MISC procedures performed consecutively. 46 procedures (59%) were performed with 24-hour hospital stay, and 32 (41%) required more than 24 hours. The postoperative complications were determined for each group: visits to the Emergency Department, reoperations, and the average cost per procedure regarding hospital stay and ER visits. The cost model was established according to the data of the Analytical Accounting System of the Jiménez Díaz Foundation Hospital and of the Official State Gazette of Madrid. Results: There were no differences regarding intraoperative or postoperative complications between both groups. The number of visits to the Emergency Department, reinterventions or hospital re-admissions was lower in the 24-hour hospital stay group, without reaching statistical significance. The implementation of the MISC protocol with 24-hour hospital stay represented a saving of 607.91 € per procedure in hospital costs. Conclusions: Correction of the POP with MISC with a 24-hour hospital discharge policy was feasible and safe in at least 59% of the patients, with similar complications, visits to the Emergency Department or hospital readmission rates

Características clínicas del delirio y sus implicaciones pronósticas en los servicios de medicina interna españoles: análisis de una gran base de datos clínico-administrativa / Clinical characteristics and prognosis for delirium in Spanish internal medicine departments: an analysis from a large clinical-administrative database

OBJETIVOS: Investigar la prevalencia del delirio reportado, los factores asociados y los costes. DISEÑO: Análisis retrospectivo y descriptivo de una base de datos clínico-administrativa nacional que incluye todos los pacientes ingresados en España en los servicios de medicina interna desde enero de 2007 a diciembre de 2014. MATERIAL Y MÉTODO: Se incluyen datos sociodemográficos y clínicos (sexo, edad, diagnóstico y procedimientos), entre otros. RESULTADOS: La prevalencia del delirio reportado fue del 2,5% (114.343 de 4.628.397 informes de alta). El delirio fue más frecuente en el grupo de 81 a 90 años (48%) y en pacientes institucionalizados (4,5% vs 2,9%; p < 0,001). Los diagnósticos más asociados al delirio fueron demencia (14% vs 7% en los sujetos sin delirio), enfermedad cerebrovascular (17% vs 11%), desnutrición (4% vs 2%), úlceras por presión (4% vs 2%), disfagia (2% vs 0,2%) e hiponatremia (5% vs 2%); p < 0,001 en todos los casos. También tuvieron una estancia media más larga: 11,85 (DE: 13,15) días vs 9,49 (DE: 11,17) días, y mortalidad intrahospitalaria más elevada (OR: 1,41; IC95%: 1,39-1,43; p = 0,0001). El coste atribuible al delirio en 8años supera los 100 millones de euros (casi 1.000€ por ingreso/paciente). Elaboramos un modelo predictivo del riesgo de desarrollar delirio sin sensibilidad suficiente pero útil para identificar pacientes de bajo riesgo. CONCLUSIONES: Los pacientes que desarrollan delirio durante su ingreso en medicina interna tienen una estancia más prolongada, mayor mortalidad y mayor riesgo de ser institucionalizados al alta. El delirio está probablemente poco reportado en los informes de alta que elaboran los internistas

OBJECTIVES: To investigate the prevalence of reported delirium and its associated factors and costs. DESIGN: Retrospective and descriptive analysis of a national clinical-administrative database that includes all patients hospitalised in Spain in internal medicine departments from January 2007 to December 2014. MATERIAL AND METHOD: The study included the patients' sociodemographic and clinical data (sex, age, diagnosis and procedures). RESULTS: The prevalence of reported delirium was 2.5% (114,343 of 4,628,397 discharge reports). Delirium was most common in the 81-90-year age group (48%) and in institutionalised patients (4.5% vs.2.9%; P<.001). The diagnoses most associated with delirium were dementia (14% vs.7% for patients without delirium), cerebrovascular disease (17% vs.11%), malnutrition (4% vs.2%), pressure ulcers (4% vs.2%), dysphagia (2% vs.0.2%) and hyponatraemia (5% vs.2%) (P<.001 in all cases). Patients with delirium also had longer mean stays (11.85+/-13.15days vs.9.49+/-11.17) and higher hospital mortality (OR: 1.41; 95%CI: 1.39-1.43; P=.0001). The costs attributable to delirium in 8years exceeded €100 million (almost €1,000 per hospitalisation/patient). We developed a predictive model for the risk of developing delirium, which has insufficient sensitivity but is useful for identifying low-risk patients. CONCLUSIONS: Patients who develop delirium during their hospitalisation in internal medicine have a longer stay, greater mortality and an increased risk of being institutionalised at discharge. Delirium is probably poorly reported in the discharge reports prepared by internists

Analysis of minimally invasive sacrocolpopexy with 24-hour hospital stay for the treatment of pelvic organ prolapse. / Análisis del tratamiento del prolapso de órganos pélvicos mediante colposacropexia mínimamente invasiva con 24horas de ingreso.

OBJECTIVES: The objective of this study is to analyze the impact (in terms of safety and saving of hospital costs) of the implementation of a new protocol for the correction of pelvic organ prolapse (POP) by minimally invasive sacrocolpopexy (MISC) with 24-hour hospital stay. MATERIAL AND METHODS: Prospective observational study of the first 78 MISC procedures performed consecutively. 46 procedures (59%) were performed with 24-hour hospital stay, and 32 (41%) required more than 24hours. The postoperative complications were determined for each group: visits to the Emergency Department, reoperations, and the average cost per procedure regarding hospital stay and ER visits. The cost model was established according to the data of the Analytical Accounting System of the Jiménez Díaz Foundation Hospital and of the Official State Gazette of Madrid. RESULTS: There were no differences regarding intraoperative or postoperative complications between both groups. The number of visits to the Emergency Department, reinterventions or hospital re-admissions was lower in the 24-hour hospital stay group, without reaching statistical significance. The implementation of the MISC protocol with 24-hour hospital stay represented a saving of 607.91€ per procedure in hospital costs. CONCLUSIONS: Correction of the POP with MISC with a 24-hour hospital discharge policy was feasible and safe in at least 59% of the patients, with similar complications, visits to the Emergency Department or hospital readmission rates.

Clinical characteristics and prognosis for delirium in Spanish internal medicine departments: An analysis from a large clinical-administrative database. / Características clínicas del delirio y sus implicaciones pronósticas en los servicios de medicina interna españoles: análisis de una gran base de datos clínico-administrativa.

OBJECTIVES: To investigate the prevalence of reported delirium and its associated factors and costs. DESIGN: Retrospective and descriptive analysis of a national clinical-administrative database that includes all patients hospitalised in Spain in internal medicine departments from January 2007 to December 2014. MATERIAL AND METHOD: The study included the patients' sociodemographic and clinical data (sex, age, diagnosis and procedures). RESULTS: The prevalence of reported delirium was 2.5% (114,343 of 4,628,397 discharge reports). Delirium was most common in the 81-90-year age group (48%) and in institutionalised patients (4.5% vs. 2.9%; P<.001). The diagnoses most associated with delirium were dementia (14% vs. 7% for patients without delirium), cerebrovascular disease (17% vs. 11%), malnutrition (4% vs. 2%), pressure ulcers (4% vs. 2%), dysphagia (2% vs. 0.2%) and hyponatraemia (5% vs. 2%) (P<.001 in all cases). Patients with delirium also had longer mean stays (11.85±13.15days vs. 9.49±11.17) and higher hospital mortality (OR: 1.41; 95%CI: 1.39-1.43; P=.0001). The costs attributable to delirium in 8years exceeded €100 million (almost €1,000 per hospitalisation/patient). We developed a predictive model for the risk of developing delirium, which has insufficient sensitivity but is useful for identifying low-risk patients. CONCLUSIONS: Patients who develop delirium during their hospitalisation in internal medicine have a longer stay, greater mortality and an increased risk of being institutionalised at discharge. Delirium is probably poorly reported in the discharge reports prepared by internists.

Venous thromboembolism in patients with liver diseases.

Essentials Emerging evidence shows that patients with liver disease are not protected from thrombotic events. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. The presence of VTE resulted in an increase in mortality for patients with liver disease. Hospitalized patients with moderate-severe liver disease had low risk of VTE during admission. SUMMARY: Background and Aims Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. Methods Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate-severe or no liver disease, and the impact on in-hospital mortality and length of stay was calculated. Results The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate-severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in-hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate-severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14-1.18) and moderate-severe liver disease (OR, 1.63; CI 95%, 1.42-1.88). Conclusions Patients with moderate-severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in-hospital mortality.