CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC study.

OBJECTIVE: This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. METHODS: This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. RESULTS: A total of 247 patients were included (mean age 60 ± 14 years, 70% men, overall mortality 41.3%). Patients with CURB-65 ≥ 2 had a higher mortality rate (57 vs. 17%, p < .001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. CONCLUSIONS: CURB-65  ≥ 2 was associated with higher 30-day mortality on the univariate (Kaplan-Meier estimator) and multivariate (Cox regression) analysis.

CURB-65 como predictor de mortalidad a 30 días en pacientes hospitalizados con COVID-19 en Ecuador: estudio COVID-EC / CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC study

Objetivo: Valorar la utilidad del CURB-65 para predecir la mortalidad a 30 días en pacientes adultos hospitalizados con COVID-19. Métodos: Cohorte realizada entre el 1 de marzo y el 30 de abril de 2020 en Ecuador. Resultados: Se incluyeron 247 pacientes (edad media 60±14 años, 70% varones, mortalidad global 41,3%). Los pacientes con CURB-65≥2 presentaron mayor mortalidad (57 vs. 17%, p<0,001), en asociación con otros marcadores de riesgo: edad avanzada, hipertensión arterial, sobrepeso/obesidad, fracaso renal, hipoxemia, requerimiento de ventilación mecánica o desarrollo de distrés respiratorio.Conclusiones: En el análisis univariado (Kaplan-Meier) y multivariado (regresión de Cox) el CURB-65≥2 se relacionó con una mayor mortalidad a 30 días (AU)

Objective: This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. Methods: This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. Results: A total of 247 patients were included (mean age 60±14 years, 70% men, overall mortality 41.3%). Patients with CURB-65≥2 had a higher mortality rate (57 vs. 17%, p<.001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. Conclusions: CURB-65≥2 was associated with higher 30-day mortality on the univariate (Kaplan-Meier estimator) and multivariate (Cox regression) analysis (AU)

[CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC study]. / CURB-65 como predictor de mortalidad a 30 días en pacientes hospitalizados con COVID-19 en Ecuador: estudio COVID-EC.

OBJECTIVE: This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. METHODS: This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. RESULTS: A total of 247 patients were included (mean age 60 ± 14 years, 70% men, overall mortality 41.3%). Patients with CURB-65 ≥ 2 had a higher mortality rate (57 vs. 17%, p < .001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. CONCLUSIONS: CURB-65 ≥ 2 was associated with higher 30-day mortality on the univariate (Kaplan-Meier estimator) and multivariate (Cox regression) analysis.

«Do Not Do¼ recommendations for retinopathies: A mixed consensus study.

PURPOSE: Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do¼ recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence. MATERIALS AND METHODS: Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records. RESULTS: A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's¼ occurred in a range between 0.6% and 31.4% of the cases included in the study. CONCLUSIONS: This study identified «Do Not Do¼ recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved.

Recomendaciones «no hacer» para retinopatías: estudio mixto de consenso / «Do Not Do» recommendations for retinopathies: A mixed consensus study

Antecedentes y objetivos Entre las principales causas de ceguera y de pérdida severa de la visión se encuentran la degeneración macular asociada a la edad, el edema macular diabético y la oclusión venosa de la retina. Las recomendaciones «no hacer» son estrategias para mejorar la calidad asistencial y optimizar los costes sanitarios. Este estudio tuvo por objetivo definir por consenso prácticas de escaso valor en las enfermedades mencionadas, además de estimar su ocurrencia. Materiales y métodos Estudio de métodos mixtos. En una primera fase se buscó el consenso de un panel multidisciplinar de expertos a través de la técnica del grupo nominal. En una segunda fase, se realizó un estudio observacional retrospectivo, mediante el cual se revisaron los registros de historias clínicas. Resultados Fueron establecidas 7 recomendaciones para degeneración macular asociada a la edad, 4 para edema macular diabético y 5 para oclusión venosa de la retina. En total, 1.012 registros de pacientes fueron revisados por los 4 hospitales participantes. La revisión de historias clínicas reveló que los «no hacer» consensuados ocurrían en un rango entre 0,6 y 31,4% de los casos incluidos en el estudio. Conclusión Este estudio identificó recomendaciones «no hacer» en estas enfermedades que ocurren con relativa frecuencia en la práctica clínica. Es necesario revisar el proceso asistencial para erradicar estas prácticas y mejorar la calidad asistencial (AU)

Background and objective Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do» recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence. Materials and methods Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records. Results A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's» occurred in a range between 0.6% and 31.4% of the cases included in the study. Conclusions This study identified «Do Not Do» recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved (AU)

The Study on Safety in Hospitals in the Region of Madrid (ESHMAD) design: Screening and analysis of incidents and adverse events.

BACKGROUND: A Study related to Safety in Hospitals in the Region of Madrid (ESHMAD) was carried out in order to determine the prevalence, magnitude and characteristics of adverse events in public hospitals. This work aims to define a useful methodology for the multicenter study of adverse events in the Region of Madrid, to set out the preliminary results of the hospital enrollment and to establish a model of a strategy of training of trainers for its implementation. METHODS: ESHMAD was a multicenter, double phase study for the estimation of adverse events and incidents prevalence across the Region of Madrid. First phase comprehended a 1-day cross-sectional prevalence study, in which it was collected, through a screening guide, information about admission, patient characteristics, intrinsic and extrinsic risk factors, and the possibility of an adverse event or incident had happened during the hospitalization. Second phase was a retrospective nested cohort study, in which it was used a Modular Review Form for reviewing the positive screenings of the first phase, identifying in each possible adverse event or incident the classification of the patient safety event, clinical onset, root, and associated causes and factors, impact, and preventability. A pilot study was performed in an Internal Medicine Unit of a tertiary hospital. RESULTS: 34 public hospitals participated, belonging to 6 healthcare categories and with more than 10,000 hospitalisations aggregate capacity. 72 coordinators were enrolled in the strategy of training of trainers, which was performed through five on-site training workshops. In the pilot study, 45.2% patients were identified with at least one positive event of the screening. Of them, 48.1% (25 positive events) were identified as truly AE, with a result of 0.29 EA per analyzed patient. CONCLUSIONS: The ESHMAD protocol allows to estimate the prevalence of adverse events, and the strategy of training of trainers facilitated the spread of the research methodology among the participants.

«Do Not Do¼ recommendations for retinopathies: A mixed consensus study. / Recomendaciones «no hacer¼ para retinopatías: estudio mixto de consenso.

BACKGROUND AND OBJECTIVE: Among the main causes of blindness and severe vision loss are age-related macular degeneration, diabetic macular oedema, and retinal vein occlusion. The «Do Not Do¼ recommendations are strategies to improve quality of care and optimise healthcare costs. The aim of this study was to establish, by consensus, practices of low value in the above-mentioned pathologies, in addition to estimating their occurrence. MATERIALS AND METHODS: Mixed methods study including a first phase of consensus of a multidisciplinary panel of experts using the Nominal Group technique. In the second phase, a retrospective observational study was conducted, by conducting a review of medical records. RESULTS: A total of 7 recommendations were established for age-related macular degeneration, 4 for diabetic macular oedema, and 5 for retinal vein occlusion. A total of 1,012 medical records were reviewed by the 4 participating hospitals. The review of medical records revealed that agreed «Do Not Do's¼ occurred in a range between 0.6% and 31.4% of the cases included in the study. CONCLUSIONS: This study identified «Do Not Do¼ recommendations in these pathologies that occur relatively often in clinical practice. It is necessary to review the healthcare processes that will enable these practices to be eradicated, and the quality of care to be improved.

[Specialised headache units, a feasible alternative in Spain]. / Unidades especializadas de cefalea, una alternativa viable en España.

INTRODUCTION: Visits due to headaches are the most frequent cause of demand for neurological treatment in primary care and neurology services. Headache units improve the quality of care, reduce waiting lists, facilitate access to new treatments of proven efficacy and optimise healthcare expenditure. However, these units have not been implemented on a widespread basis in Spain due to the relatively low importance attributed to the condition and also the assumption that such units have a high cost. AIM: To define the structure and minimum requirements of a headache unit with the intention of contributing to their expansion in hospitals in Spain. SUBJECTS AND METHODS: We conducted a consensus study among professionals after reviewing the literature on the structure, functions and resources required by a headache unit designed to serve an area with 350,000 inhabitants. RESULTS: Eight publications were taken as a reference for identifying the minimum resources needed for a headache unit. The panel of experts was made up of 12 professionals from different specialties. The main resource required to be able to implement these units is the professional staff (both supervisory and technical), which can mean an additional cost for the first year of around 107,287.19 euros. CONCLUSIONS: If we bear in mind the direct and indirect costs due to losses in labour productivity per patient and compare them with the estimated costs involved in implementing these units and their expected results, everything points to the need for headache units to become generalised in Spain.

TITLE: Unidades especializadas de cefalea, una alternativa viable en España.Introducción. Las consultas por cefalea son el motivo más frecuente de demanda de atención de causa neurológica en la atención primaria y en los servicios de neurología. Las unidades de cefalea mejoran la calidad asistencial, reducen las listas de espera, facilitan el acceso a nuevos tratamientos de eficacia contrastada y optimizan el gasto sanitario. No obstante, la implantación de estas unidades no está extendida en España debido a la relativa importancia atribuida a la patología y a la suposición de que su coste es elevado. Objetivo. Definir la estructura y los requerimientos mínimos de una unidad de cefalea con la intención de contribuir a su extensión en los hospitales de España. Sujetos y métodos. Estudio de consenso entre profesionales tras la revisión de la bibliografía sobre la estructura, las funciones y los recursos de una unidad de cefalea para un área de 350.000 habitantes. Resultados. Se tomaron como referencia ocho publicaciones para la identificación de recursos mínimos necesarios de una unidad de cefalea. El panel de expertos estuvo integrado por 12 profesionales de diferentes especialidades. El principal recurso para la implementación de estas unidades son profesionales (superiores y técnicos), lo que puede suponer un coste adicional para el primer año de alrededor de 107.287,19 euros. Conclusiones. Si consideramos los costes directos e indirectos debidos a las pérdidas por productividad laboral por paciente y los comparamos con los costes estimados de implantación de estas unidades y su expectativa de resultados, todo apunta a que es necesaria la generalización de unidades de cefalea en España.

[Outcome of complaints by patients due to the refusal of Primary Care Physicians to agree to a treatment request]. / Reclamaciones por la negativa del médico de primaria a aceptar una petición del paciente.

OBJECTIVE: To analyse the frequency of complaints due to the refusal of Primary Care Physicians to indicate a diagnostic test, treatment, or referral requested by a patient. METHODS: Observational, retrospective study was conducted by analysing the complaints filed in a Primary Care Area during the years 2016, 2017, and 2018. RESULTS: A total of 378 complaints were included. Of these, 30 (8%) were justified in the refusal by the doctors to a request of the patient (28 addressed to general practitioners and 2 to paediatricians). The most frequent related to the request was for a treatment (18 [60%]) followed by the request for diagnostic tests (9 [30%]). While the total number of claims increased by 151%, the relative weight of the claims for not responding to a patient's request was reduced (2016, 8/70, 11.4%; 2017, 11/132, 8.3%; and 2018, 11/176, 6.3%). No professional liability claims were filed. CONCLUSIONS: Complaints for rejecting patient requests increased slightly, but tends to decrease their relative weight when considering the volume of complaints.

Bed 13 is not worse than any other. A retrospective cohort study.

INTRODUCTION: Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS: A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS: A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS: Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.

CURB-65 como predictor de mortalidad a 30 días en pacientes hospitalizados con COVID-19 en Ecuador: estudio COVID-EC / CURB-65 as a predictor of 30-day mortality in patients hospitalized with COVID-19 in Ecuador: COVID-EC study

OBJETIVO: Valorar la utilidad del CURB-65 para predecir la mortalidad a 30 días en pacientes adultos hospitalizados con COVID-19. MÉTODOS: Cohorte realizada entre el 1 de marzo y el 30 de abril de 2020 en Ecuador. RESULTADOS: Se incluyeron 247 pacientes (edad media 60 ± 14 años, 70% varones, mortalidad global 41,3%). Los pacientes con CURB-65 ≥ 2 presentaron mayor mortalidad (57 vs. 17%, p < 0,001), en asociación con otros marcadores de riesgo: edad avanzada, hipertensión arterial, sobrepeso/obesidad, fracaso renal, hipoxemia, requerimiento de ventilación mecánica o desarrollo de distrés respiratorio. CONCLUSIONES: En el análisis univariado (Kaplan-Meier) y multivariado (regresión de Cox) el CURB-65 ≥ 2 se relacionó con una mayor mortalidad a 30 días

OBJECTIVE: This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. METHODS: This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. RESULTS: A total of 247 patients were included (mean age 60±14 years, 70% men, overall mortality 41.3%). Patients with CURB-65 ≥ 2 had a higher mortality rate (57 vs. 17%, p <.001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. CONCLUSIONS: CURB-65 ≥ 2 was associated with higher 30-day mortality on the univariate (Kaplan-Meier estimator) and multivariate (Cox regression) analysis

Aspectos diagnósticos y terapéuticos de las lesiones de mama no palpables. Estudio en 160 biopsias / Diagnostic and therapeutic aspects of nonpalpable breast lesions. A study of 160 biopsies

Introducción. La prevención del cáncer de mama se realiza mediante el diagnóstico precoz detectando mamográficamente lesiones no palpables que deben ser valoradas para determinar la precocidad diagnóstica y el tipo de tratamiento.Pacientes y método. Tras seleccionar a los pacientes con criterios mamográficos y citológicos se realizaron 160 biopsias (0,65 por ciento de 24.500 mamografías de detección) utilizando aguja-guía de Kopans y Homer, en general de forma ambulatoria, con sedación y anestesia local. Se empleó el diagnóstico histológico de cáncer como patrón-base de los datos estadísticos.Resultados. El 46,87 por ciento de las lesiones biopsiadas fueron microcalcificaciones. La sensibilidad y la especificidad del sistema diagnóstico fue de 0,73 y 0,60, respectivamente. Se detectaron 84 cánceres (valor predictivo positivo: 52,5 por ciento; relación benigna/maligna de las biopsias: 0,9/1); 67 (79,76 por ciento) infiltrantes y 17 (20,24 por ciento) in situ, de los que 68 (80,94 por ciento) se encon traban en estadios 0 y I y 16 (19,96 por ciento) en estadio II. Fueron tratados con tumorectomía ampliada más axilectomía 50 pacientes (59,52 por ciento) y 12 (14,28 por ciento) con quimioterapia.Conclusiones. El impacto del diagnóstico precoz de las lesiones de mama no palpables disminuye la necesidad de tratamientos oncológicos y permite la terapia conservadora, promoviendo la aceptación a la detección y mejorando la calidad de vida de la mujer (AU)

Laparoscopic reconstruction of intestinal continuity following Hartmann's procedure.

Laparoscopy-guided reversal of Hartmann's procedure was performed in eleven patients who had been treated surgically for inflammatory disease or cancer of the colon. Restoration of intestinal continuity was achieved in ten of them. There were no postoperative complications. The mean surgical time was 144 minutes and the mean duration of postoperative ileus was 48 hours (range: 30 to 60 hours). The mean hospital stay was 7 days. Our results suggest that laparoscopic reversal of Hartmann's procedure is safer than and as effective as open surgery.

[Venous reservoirs: the late complications according to the route of implantation. The Interhospital Group of Valencia (GIHV)]. / Reservorios venosos: complicaciones tardías según la vía de implantación. Grupo Interhospitalario Valenciano (GIHV).

UNLABELLED: The aim of the study which we present is to analyze the incidence of late complications, clinical and sub-clinical, of venous reservoirs implanted through two access routes, subclavian (group A), and brachial (group B). It is a multi-centric clinical study, initiated in 1992, in which the general surgery departments of three general hospitals of the Valencian Community were involved. It is made up of 87 patients, 48 men and 39 women, with a mean age (SD) of 57.1 (12.6) years, of whom we made a late review of 41 patients (29 from group A and 12 from group B). They were subjected to a physical examination, bacterial cultures of the entrance, and phlebograms of the upper extremities through the dorsal veins of the hands. RESULTS: The incidence of clinical complications was 39% in group A and 77% in group B (p = 0.0507). The main clinical complications were minimally symptomatic venous thrombosis, catheter thrombosis, infection, and miscellaneous (migration, paresthesias, articular movement alterations, etc.). And the prevalence of phlebographic venous thrombosis was 18% in group A and 40% in group B (p = 0.051). CONCLUSIONS: The subclavian access for the implantation of venous reservoirs has a lower incidence (with a tendency towards clinical significance) of clinical complications and subclinical venous thrombosis (Phlebogram) than the brachial access.

[Surgical trauma from laparoscopic cholecystectomy]. / Traumatismo quirúrgico de la colecistectomía laparoscópica.

UNLABELLED: The authors present a prospective study whose objective is to estimate the degree of injury from laparoscopic cholecystectomy, by means of the determination of the neuroendocrine response to the surgical aggression. By means of a simple randomization, two study groups are established: group A, consisting of 17 patients subjected to laparoscopic cholecystectomy, and group B, consisting of 18 patients subjected to different techniques of open surgery. EXCLUSION CRITERIA: transfusion of blood derivatives or therapy with corticosteroids. The groups are homogeneous with regard to age, sex, Quetelet index, duration of the intervention, and anaesthetic drugs. A postoperative increase of plasma ACTH, growth hormone, insulin, cortisol and T3 was found in both groups (p < 0.05), and a significant postoperative increase of cortisol and catecholamines in 24 hour urine was found especially in group B. It can be concluded that even though there is an increase of the contraregulatory hormones in the postoperative phase of both groups, the neuroendocrine response is lower after laparoscopic cholecystectomy.

[Subcutaneous injection chambers for central venous access: a multicenter clinical trial. The Interhospital Group of Valencia (GIHV)]. / Cámaras de inyección subcutánea para acceso venoso central: un ensayo clínico multicéntrico. Grupo Interhospitalario Valenciano (GIHV).

UNLABELLED: A multicentric clinical trial was performed to evaluate two routes of access for implantable subcutaneous central venous devices: by way of the subclavian vein (group A) and peripheral access by way of the veins of the flexion side of the elbow (group B). The indications for implantation were: antineoplastic treatment of solid tumors, myelo- and lymphoproliferative syndromes, antiviral treatment, and parenteral nutrition at home. The study was composed of 87 patients, 48 men and 39 women, with a mean age of 57.1 years (SD = 12.6). Group A was made up of 48 patients, and group B of 39. RESULTS: Implantation failure was 8.3% in group A and 5.1% in group B (p = n.s.). Complications of implantation were 23.4% in group A and 15.4% in group B (p = n.s.). The complications of permanence were diagnosed at 27.6% in group A and at 15.4% in group B (p = n.s.). CONCLUSIONS: We have not been able to find significant differences between the two groups, probably due to the fact that the series is still short. Nevertheless, the manageability, comfort for the nursing staff and for the patients, appears to be greater with the devices implanted in the infraclavicular region, by means of a subclavian vein puncture.