RECALMIN. La atención al paciente en las unidades de Medicina Interna del Sistema Nacional de Salud / RECALMIN. Patient care in the internal medicine units of the Spanish national health system

Objetivos. Elaborar un diagnóstico de situación sobre la asistencia en las unidades de medicina interna (UMI) en España y desarrollar, basándose en el análisis anterior, propuestas de mejora de calidad en dichas unidades. Material y métodos. Estudio descriptivo transversal entre las UMI de hospitales generales de agudos del Sistema Nacional de Salud (SNS), con datos referidos a 2013. Las variables de estudio fueron recogidas mediante un cuestionario ad hoc. Resultados. De un total de 260hospitales identificados en el SNS español, se han obtenido 142respuestas de 139hospitales de toda España, que representan el 53,5% de las UMI del SNS. La media de internistas por UMI fue de 14±8, siendo la tasa media de internistas por cada 100.000 habitantes de 7,2±3,3. El promedio de altas hospitalarias de las UMI en 2013 fue de 2.987±2.066 y las altas anuales por internista 232±107. El 61% de las UMI ha desarrollado una unidad de interconsulta y el 41% un programa de atención sistemática al paciente crónico complejo. En el 33% de las UMI se realiza un pase de visita multidisciplinar y un 60% de las mismas planifica el alta. Conclusiones. La encuesta RECALMIN 2013 desvela aspectos relevantes sobre la organización, estructura y gestión de las UMI. La notable variabilidad hallada en los indicadores de estructura, actividad y gestión probablemente refleja diferencias notables en eficiencia y productividad y, por tanto, propicia un amplio margen de mejora (AU)

Objectives. To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units. Material and methods. A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire. Results. Of the total 260hospitals identified in the SNHS, 142responses were obtained from 139hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14±8, with a mean rate of 7.2±3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2,987±2,066, and those discharged by internists was 232±107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge. Conclusions. The 2013 RECALMIN survey revealed a number of important aspects of the organisation, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement (AU)

[RECALMIN. Patient care in the internal medicine units of the Spanish national health system]. / RECALMIN. La atención al paciente en las unidades de Medicina Interna del Sistema Nacional de Salud.

OBJECTIVES: To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units. MATERIAL AND METHODS: A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire. RESULTS: Of the total 260hospitals identified in the SNHS, 142responses were obtained from 139hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14±8, with a mean rate of 7.2±3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2,987±2,066, and those discharged by internists was 232±107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge. CONCLUSIONS: The 2013 RECALMIN survey revealed a number of important aspects of the organisation, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement.

[Cerebral malaria and multiple organ failure. A case report]. / Paludismo cerebral y fallo multiorgánico. Presentación de un caso.

It is discussed the case of cerebral paludism due to Plasmodium falciparum in a patient who travelled frequently to Ivory Coast and who had done an incorrect prophylaxis of paludism. It is underlined the relationship of cerebral presentation with the presence of multisystemic failure, which was characterized by respiratory distress, hyperdynamic shock, acute renal failure and hematological and digestive disorders. Shock forced the administration of vasoactive drugs (such as dopamine, dobutamine and methoxamine), respiratory failure to establish mechanical ventilation and coagulation disorders to transfuse platelets and plasma. Clinical evolution was favorable in few days thanks to an early symptomatic and etiology therapy.

[The characteristics of arterial hypertension in the population of a preventive medicine service]. / Características de la hipertensión arterial en la población de un servicio de medicina preventiva.

Of 2,115 persons who were submitted to a voluntary check-up, we found 10.6% suffering from hypertension and 16.2% with borderline hypertension, the latter group having been followed and the condition subsequently confirmed in 45.9% of the case. The prevalence increases with age. There were no prevailing differences found between rural and city populations. The prevalence is greater in self-employed persons that in salary workers and we would bring to the fore the higher prevalence in housewives (p less than 0.0005). 74.8% of the hypertensive patients knew of their situation but only 15.6% of them showed normal blood pressure at the following-up. Rarely 0.85% had severe hypertension and 3% had moderate hypertension.