Impact of creating a hemodynamics room, a coronary care unit, and a primary angioplasty program on the prognosis of acute coronary syndrome in a district hospital.

OBJECTIVE: This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program. METHODS: We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432). RESULTS: There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). CONCLUSIONS: With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events, and mortality.

Impacto de la creación de una sala de hemodinámica, una unidad coronaria y un programa de angioplastia primaria en el pronóstico del síndrome coronario agudo en un hospital comarcal / Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital

Objetivo Analizar el pronóstico y mortalidad de los pacientes ingresados en un hospital por síndrome coronario agudo antes y después de la implantación de la unidad coronaria, la sala de hemodinámica y el programa de angioplastia primaria (Código corazón). Métodos Estudio observacional y retrospectivo. Se analizaron las características epidemiológicas, las estrategias de reperfusión, los eventos adversos cardiovasculares y la mortalidad durante 5 años de seguimiento. Los resultados del periodo post-código (1 marzo 2012-31 diciembre 2012; n=471) se compararon con la etapa precódigo (1 marzo 2009-31 diciembre 2009; n=432). Resultados No hubo diferencias en las características basales de ambos grupos, pero en la fase poscódigo se observó un incremento del síndrome coronario agudo con elevación del ST (SCACEST) del 17,6 al 34,8% (p<0,001). Se generalizó el intervencionismo coronario percutáneo, que alcanzó cifras del 64,8% en el síndrome coronario agudo sin elevación del ST (SCASEST) y del 95,5% en el SCACEST. Se redujeron los reingresos (38,2 vs. 25,1% en el SCASEST, p=0,001 y 23,7 vs. 11% en el SCACEST, p=0,018), la variable pronóstica combinada de eventos adversos cardiovasculares y mortalidad en 5 años de seguimiento (58,7 vs. 45%, p=0,001 en el SCASEST y 40,8 vs. 23,8%, p=0,009 en el SCACEST) y, además, en el SCACEST disminuyó la mortalidad a los 30 días (11,8 vs. 3,7%, p=0,021). Conclusiones Con los cambios estructurales realizados en el hospital se ha generalizado el intervencionismo coronario percutáneo y ha mejorado el pronóstico de los pacientes con síndrome coronario agudo, disminuyendo los ingresos, los eventos adversos cardiovasculares y la mortalidad (AU)

Objective This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program Methods We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 – December 31, 2012; n=471) were compared with those from the pre-code period (March 1 – December 31, 2009; n=432). Results There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). Conclusions With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality (AU)

Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital. / Impacto de la creación de una sala de hemodinámica, una unidad coronaria y un programa de angioplastia primaria en el pronóstico del síndrome coronario agudo en un hospital comarcal.

OBJECTIVE: To analyse the prognosis and mortality of patients hospitalised for acute coronary syndrome before and after the implementation of a coronary unit, haemodynamics room and the Código corazón primary angioplasty programme. METHODS: We conducted an observational and retrospective study that analysed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events and mortality for 5 years of follow-up. The results of the post-code period (March 1 - December 31, 2012; n=471) were compared with those of the pre-code stage (March 1 - December 31, 2009; n=432). RESULTS: There were no differences in the baseline characteristics of the 2 groups; however, an increase in ST-segment elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (P<.001) was observed during the post-code phase. The use of percutaneous coronary intervention was made widespread at the hospital, achieving rates of 64.8% in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and of 95.5% in STE-ACS. Readmissions were reduced (from 38.2% to 25.1% for NSTE-ACS [P=.001] and from 23.7% to 11.0% for STE-ACS [P=.018]), the combined prognostic variable of adverse cardiovascular events and mortality at 5 years of follow-up was reduced (from 58.7% to 45% [P=.001] for NSTE-ACS and from 40.8% to 23.8% [p=.009] for STE-ACS), and 30-day mortality was decreased for STE-ACS (from 11.8% to 3.7%; P=.021). CONCLUSIONS: With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality.

Impacto de un programa de intervención destinado a la mejora de la prescripción potencialmente inapropiada en pacientes ancianos hospitalizados / Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients

Introducción y objetivos: La prescripción potencialmente inapropiada (PPI) es frecuente en ancianos. Se ha convertido en un problema de salud pública mundial por su relación con efectos adversos a medicamentos (EAM), aumento de la morbimortalidad, visitas a urgencias y consumo de recursos. El objetivo principal de este estudio fue determinar si el uso de un programa de notificación de PPI en pacientes ancianos hospitalizados condujo a una reducción en su prescripción. Método: Se realizó un estudio quasi-experimental pre-post. La identificación de las PPI se llevó a cabo según los criterios de Beers (actualización 2012) y STOPP-START (versión 2008). Se elaboró un informe individualizado sobre PPI y se evaluó el efecto de esta intervención. Resultados: Se incluyeron 174 pacientes con 284 PPI. Se aceptaron el 54% (153) de las recomendaciones. La única variable que demostró contribuir a la presencia de modificaciones en la PPI fue el índice de Barthel. Los pacientes a los que se les modificó la PPI se caracterizaron por ser significativamente más dependientes (p=0,005), presentar deterioro cognitivo (p=0,001) y encontrarse más institucionalizados (p=0,039) que aquellos a los que no se les realizó ninguna modificación. Se produjeron menos reingresos, visitas a urgencias y menor mortalidad al comparar los pacientes con y sin modificaciones de PPI, pero sin diferencias significativas. Se identificaron 32 EAM, 29 relacionados con fármacos inapropiados. Los EAM se asociaron con PPI respecto a otros fármacos de manera significativa (p<0,001), odds ratio 242,5 (IC 95%: 56,9-1.023,6). Conclusiones: La revisión de la medicación en pacientes de edad avanzada, junto con el uso de herramientas que ayudan en la identificación de fármacos inapropiados, conlleva una reducción de la PPI y contribuye de manera significativa a la mejora continua de la medicación crónica en los ancianos

Introduction and objectives: Potentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. Method: A quasi-experimental before-after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. Results: 174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p=0.005), presented cognitive impairment (p=0.001) and were more institutionalized (p=0.039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p<0.001), odds ratio 242.5 (CI95%: 56.9-1023.6). Conclusions: Review of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders

Carcinoma de células de Merkel de localización y presentación atípica / Merkel cell carcinoma. Report of a case with an atypical location and presentation

El tumor de células de Merkel es un tumor cutáneo raro, de elevada malignidad, mal pronóstico y baja supervivencia. Se caracteriza por su tendencia a la invasión ganglionar y vascular, y por un alto porcentaje de recurrencia locorregional en el año siguiente a la extirpación quirúrgica. Afecta a adultos entre los 60 y 80 años, y se localiza preferentemente en cabeza y cuello. Presentamos el caso de un varón de 85 años que acude por masa glútea ulcerada de 4 meses de evolución. El diagnóstico se realizó por estudio histopatológico e inmunohistoquímico. Un diagnóstico precoz y un tratamiento adecuado son importantes para mejorar el pronóstico de estos enfermos

Merkel cell tumour is a rare skin tumour of high malignancy, poor prognosis and low survival. It is characterized by its tendency to lymph node and vascular invasion and by a high percentage of locoregional recurrence in the year following surgical removal. It affects adults between 60 and 80 years of age and often occurs in the head and neck. We present the case of an 85-year-old man presenting with an ulcerated gluteal mass of 4 months' evolution. Diagnosis was by histopathological and immunohistochemical study. Early diagnosis and appropriate treatment are important to improve the prognosis of these patients

Merkel cell carcinoma. Report of a case with an atypical location and presentation. / Carcinoma de células de Merkel de localización y presentación atípica.

Merkel cell tumour is a rare skin tumour of high malignancy, poor prognosis and low survival. It is characterized by its tendency to lymph node and vascular invasion and by a high percentage of locoregional recurrence in the year following surgical removal. It affects adults between 60 and 80 years of age and often occurs in the head and neck. We present the case of an 85-year-old man presenting with an ulcerated gluteal mass of 4 months' evolution. Diagnosis was by histopathological and immunohistochemical study. Early diagnosis and appropriate treatment are important to improve the prognosis of these patients.

Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients. / Impacto de un programa de intervención destinado a la mejora de la prescripción potencialmente inapropiada en pacientes ancianos hospitalizados.

INTRODUCTION AND OBJECTIVES: Potentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. METHOD: A quasi-experimental before-after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. RESULTS: 174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p=0.005), presented cognitive impairment (p=0.001) and were more institutionalized (p=0.039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p<0.001), odds ratio 242.5 (CI95%: 56.9-1023.6). CONCLUSIONS: Review of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders.

[Knowledge and willingness to perform basic life support by local police officers]. / Conocimientos y disposición para realizar soporte vital básico por agentes de la policía local.

BACKGROUND: To determine the knowledge and willingness of local police officers (PO) to perform cardiopulmonary resuscitation (CPR), as well as to explore the association between CPR training and these variables. METHODS: Cross-sectional study with a sample of 390 PO from Asturias (Spain). An anonymous questionnaire was used to measure nine basic aspects of CPR from the European Resuscitation Council and four indicators of attitude towards performing CPR in a real context. Information on CPR training and its periodicity was also collected, as well as basic socio-demographic and occupational variables. RESULTS: Lack of CPR training was seen in 19.7% of PO, and 36.4% had received such training more than two years ago. Almost one out of four PO had performed at least one CPR in a real situation (24.1%), of which 9.6% had not been trained. The least remembered aspects of CPR were depth (11%) and frequency of chest compressions (24.4%). Only 49.7% of the agents felt sufficiently prepared to perform a CPR. Knowledge and disposition were significantly associated with having received training with a periodicity of less than two years. CONCLUSIONS: Given that PO are frequently first responders in situations of out-of-hospital cardiorespiratory arrest, specific training in CPR should be mandatory and periodic, with at least one course every two years. It would be interesting to determine which didactic instrumentation is most efficient for disseminating these training courses among police officers. Key words. Police. Cardiopulmonary resuscitation. Out-of-hospital cardiac arrest; attitude. Emergencies.

Conocimientos y disposición para realizar soporte vital básico por agentes de la policía local / Knowledge and willingness to perform basic life support by local police officers

Fundamento: Determinar los conocimientos de los agentes de la policía local (PL) sobre la reanimación cardiopulmonar (RCP) y su disposición para realizarla, así como explorar la asociación entre la formación en RCP y estas variables. Sujetos y método: Estudio transversal sobre una muestra de 390 agentes de la PL de Asturias (España). Se utilizó un cuestionario anónimo que midió nueve aspectos básicos sobre la RCP del Consejo Europeo de Reanimación y cuatro indicadores de la disposición para realizarla en situaciones reales. También se recogió información sobre la formación en RCP y su periodicidad, así como variables sociodemográficas y laborales básicas. Resultados: El 19,7% de los PL no había recibido formación en RCP y el 36,4% la había recibido hacía más de dos. El 24,1% habían realizado al menos una RCP en situación real, de los cuales el 9,6% no estaba formado. Los aspectos de la RCP menos recordados fueron la profundidad (11%) y la frecuencia de las compresiones (24,4%). El 49,7% de los agentes se siente con suficiente preparación para realizar una RCP. Los conocimientos y la disposición se asociaron significativamente con haber realizado cursos de formación con una periodicidad menor de dos años. Conclusiones: Dado que los agentes de PL deben intervenir con frecuencia en situaciones de parada cardiorrespiratoria como primeros intervinientes, la formación específica en RCP de los agentes de PL debería ser obligatoria y periódica, con al menos un curso cada dos años. Sería interesante determinar qué instrumentación didáctica es más eficiente para difundir estos cursos entre los policías (AU)

Background: To determine the knowledge and willingness of local police officers (PO) to perform cardiopulmonary resuscitation (CPR), as well as to explore the association between CPR training and these variables. Methods: Cross-sectional study with a sample of 390 PO from Asturias (Spain). An anonymous questionnaire was used to measure nine basic aspects of CPR from the European Resuscitation Council and four indicators of attitude towards performing CPR in a real context. Information on CPR training and its periodicity was also collected, as well as basic socio-demographic and occupational variables. Results: Lack of CPR training was seen in 19.7% of PO, and 36.4% had received such training more than two years ago. Almost one out of four PO had performed at least one CPR in a real situation (24.1%), of which 9.6% had not been trained. The least remembered aspects of CPR were depth (11%) and frequency of chest compressions (24.4%). Only 49.7% of the agents felt sufficiently prepared to perform a CPR. Knowledge and disposition were significantly associated with having received training with a periodicity of less than two years. Conclusions: Given that PO are frequently first responders in situations of out-of-hospital cardiorespiratory arrest, specific training in CPR should be mandatory and periodic, with at least one course every two years. It would be interesting to determine which didactic instrumentation is most efficient for disseminating these training courses among police officers (AU)

Fibrosis retroperitoneal relacionada con IgG4 / IgG4-Related Retroperitoneal fibrosis

OBJETIVO: Reportar dos nuevos casos de fibrosis retroperitoneal relacionada con IgG4, patología recientemente descrita. MÉTODO: Analizamos dos casos diagnosticados en nuestro centro y revisión de la literatura.RESULTADO: La enfermedad relacionada con IgG4 es una nueva entidad que agrupa diversas patologías fibroinflamatorias hasta ahora no relacionadas entre sí. Las manifestaciones clínicas son muy variables y la presentación suele ser subaguda. El tratamiento de elección son los corticoides. En el primer caso la evolución fue favorable con corticoides y azatioprina. En cambio, el segundo caso precisó cirugía en 2 ocasiones con nefrectomía radical. El diagnostico del segundo caso se realizó 9 años desde el inicio de los síntomas tras revisión de la biopsia; en ese momento no se inicio tratamiento inmunosupresor. CONCLUSIONES: Es muy importante conocerla y diagnosticarla dada la buena respuesta al tratamiento que evita complicaciones

OBJECTIVE: To report two new cases of IgG4-related retroperitoneal fibrosis, a recently described pathology. METHODS: We analyze two cases diagnosed in our center and performed a literature review. RESULT: IgG4 related disease is a recently described entity that includes previously not related pathologies. The clinical manifestations are highly variable and its presentation is usually subacute. The treatment of choice is glucocorticoids. In our first case the outcome was favorable with corticosteroids and azathioprine. However, the second case required surgery on 2 occasions with radical nephrectomy. The diagnosis of the latter was made nine years after the onset of symptoms when the biopsy was reviewed; at that moment immunosuppressive therapy was not started. CONCLUSIONS: It is very important to know and diagnose this disease because of the good response to treatment that prevents complications

Prescripción inadecuada y efectos adversos a medicamentos en pacientes de edad avanzada / Inappropriate drug prescription and adverse drug effects in elderly patients

Objetivos. La prescripción inadecuada de medicamentos se ha relacionado con el aumento de las tasas de hospitalización y la aparición de efectos adversos. Hemos examinado los fármacos de prescripción inadecuada que reciben los pacientes de edad avanzada que ingresan en el hospital, así como la frecuencia y gravedad de los eventos adversos relacionados con ellos. Pacientes y método. Estudio prospectivo en pacientes mayores de 65 años, ingresados en un servicio de Medicina Interna, en quienes se identificó al menos un fármaco de prescripción inadecuada (criterios de Beers y STOPP [Screening Tool of Older Person′s Prescriptions]), en régimen ambulatorio y/o en las primeras 48 de su hospitalización. La relación de los eventos adversos con los fármacos de prescripción inadecuada se estableció según el algoritmo de Naranjo. Resultados. Se incluyeron 97 pacientes con una edad media de 81 años (rango: 66-101). El total de medicamentos prescritos durante la hospitalización fue de 865, con una media de 9 fármacos (rango: 3-16). Un 32% de los enfermos estaba siendo tratado con más de 10 fármacos. Se identificaron un total de 153 (17,7%) fármacos de prescripción inadecuada. Se produjeron 26 reacciones adversas a medicamentos, de las cuales 18 (69%) se relacionaron con fármacos de prescripción inadecuada. La digoxina y el lorazepam fueron los fármacos de prescripción inadecuada más comunes y con los que se relacionaron un mayor número de reacciones adversas a medicamentos. El 56% de estas reacciones se consideraron graves. Los pacientes institucionalizados recibían más fármacos, pero no más fármacos de prescripción inadecuada. Conclusiones. En pacientes de edad avanzada, la frecuencia de reacciones adversas a medicamentos en relación con fármacos de prescripción inadecuada es elevada. La implementación de estrategias para identificar las prescripciones inadecuadas y para utilizar estos fármacos apropiadamente en pacientes de edad avanzada es necesaria(AU)

Aims. Inappropriate drug prescription (IP) has been related to higher hospitalization rates and development of adverse drug effects (ADE). We have studied the inappropriate drug prescriptions given to elderly patients admitted to the hospital and the frequency and severity of the adverse events related with them. Patients and methods. A prospective study was conducted in a sample of 100 patients over 65 years admitted in an Internal Medicine Department in whom at least one inappropriate drug prescription (Beers and STOPP (B-S) criteria [Screening Tool of Older Person′s Prescriptions]) as outpatients or during the first 48hours after the admission. The relationship of the adverse events with the inappropriate drug prescription was established using the Naranjo algorithm. Results. A total of 97 patients, mean age 81 years (range 66-101) were included. The total amount of medicines prescribed during the hospital stay was 865, average of 9 (range 3-16). Thirty two percent was being treated with more than 10 drugs. A total of 153 (17.7%) were B-S drugs. There were 26 ADEs, 18 related with B-S drugs. Digoxin and lorazepam were the IP drugs most frequently prescribed and those related with a larger number of ADE. Fifty six percent of the ADEs were considered severe. Institutionalized elderly patients were treated with more drugs, but not more B-S medicaments. Conclusions. The frequency of ADEs related to IP is very high in the elderly. It is necessary to implement strategies to identify, and use properly these drugs in elderly population(AU)

[Inappropriate drug prescription and adverse drug effects in elderly patients]. / Prescripción inadecuada y efectos adversos a medicamentos en pacientes de edad avanzada.

AIMS: Inappropriate drug prescription (IP) has been related to higher hospitalization rates and development of adverse drug effects (ADE). We have studied the inappropriate drug prescriptions given to elderly patients admitted to the hospital and the frequency and severity of the adverse events related with them. PATIENTS AND METHODS: A prospective study was conducted in a sample of 100 patients over 65 years admitted in an Internal Medicine Department in whom at least one inappropriate drug prescription (Beers and STOPP (B-S) criteria [Screening Tool of Older Person's Prescriptions]) as outpatients or during the first 48 hours after the admission. The relationship of the adverse events with the inappropriate drug prescription was established using the Naranjo algorithm. RESULTS: A total of 97 patients, mean age 81 years (range 66-101) were included. The total amount of medicines prescribed during the hospital stay was 865, average of 9 (range 3-16). Thirty two percent was being treated with more than 10 drugs. A total of 153 (17.7%) were B-S drugs. There were 26 ADEs, 18 related with B-S drugs. Digoxin and lorazepam were the IP drugs most frequently prescribed and those related with a larger number of ADE. Fifty six percent of the ADEs were considered severe. Institutionalized elderly patients were treated with more drugs, but not more B-S medicaments. CONCLUSIONS: The frequency of ADEs related to IP is very high in the elderly. It is necessary to implement strategies to identify, and use properly these drugs in elderly population.

Identificación inequívoca de pacientes ingresados en hospitales del Sistema Nacional de Salud / Unique patient identification in hospitals in the National Health Service

En las organizaciones sanitarias actuales, la identificación de los pacientes comporta riesgos de los que pueden derivarse desde diagnósticos erróneos hasta la realización de pruebas o intervenciones quirúrgicas, o la administración de medicamentos o hemoderivados, a pacientes equivocados. Los organismos que velan por la seguridad de los pacientes propugnan la instauración de métodos que aseguren la identificación inequí- voca como una de las acciones clave en las estrategias de mejora de la seguridad. Las políticas de identificación deben garantizar la identificación de todos los pacientes mediante métodos inequívocos de implantación universal. A los profesionales nos compete confirmar la identidad del paciente, mediante los documentos apropiados, siempre que se realice un procedimiento diagnóstico o terapéutico que suponga riesgos para él. En este trabajo se revisan las bases para una identificación inequívoca de los pacientes y se exponen las experiencias de 5 comunidades autónomas implicadas en el desarrollo de las estrategias de mejora de la seguridad de los pacientes promovidas por la Agencia de Calidad del Ministerio de Sanidad y Consumo (AU)

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs (AU)

Serie de 618 casos de gammapatías monoclonales de significado indeterminado (GMSI): factores predictivos de desaparición del componente monoclonal o de evolución a gammapatías malignas / A series of 618 of monoclonal gammopathy of undeterminated significance: variables asocciated with disappearance and progression

Introducción. La identificación de las gammapatíasmonoclonales de significado incierto (GMSI) conriesgo elevado de progresión se viene estudiandoen los últimos años.Objetivos. Evaluar la incidencia de las GMSI enun área de 300.000 habitantes y sus factoresasociados: la desaparición del componentemonoclonal (CM), gammapatías transitorias (GMT) ysu evolución a gammapatías malignas (GMM).Métodos. Estudio de 618 GMSI.Resultados. Incidencia: 30-40 casos nuevos/año, conun incremento en los últimos años de hasta 70 casospor año. Edad y sexo: 71,4 años (32-100); relaciónH/F 1,4. Patología asociada: infecciosa 328,cardiológica 249, reumatoidea 211, hepática 108,neoplasia 80 y neuropatía 43. Características del CM:IgG 407, IgA 93, IgM 78, IgD 2, biclonales 16,triclonal 1 y ninguna cadena pesada 21. Cadenasligeras: kappa 389 casos. Variables (media): CM 14 g/l, VSG 32,5 mm, MO porcentaje de células plasmáticas 5,9%, ß2-microglobulina 2,59 mg/l, albúmina 3,1 g/l, serie ósea normal 39,5%. Evolución: GMT 20 casos. Tiempo medio de desaparición 2,6meses (1,4-4,6), GM transformadas a GMM 24 casosTiempo medio de progresión 3 años (IC 1,82-4,3).Resultados. Se identifican como factoresasociados a transformación a GMM: cadena pesadaIgA (p < 0,002), VSG (p < 0,001), edad < 70 años(p < 0,05), porcentaje de CP (p < 0,002) yosteoporosis (p < 0,005). Se propone un modelo de seguimiento de GMSI

Introduction. How to identify monoclonalgammopathies of undeterminated significance(MGUS) at risk for progression has been studied forthe last years. Aims. To study the incidence ofMGUS in a region with 300,000 inhabitants andfactors which associate with a) monoclonalgammopathy disappearance (transient MGUS)b) evolution to malignant gammopathy.Methods. Study of 618 MGUS.Results. Incidence: 30/40 new cases a year withincrease to 70 cases a years in the latest years ofstudy. Age and gender: 71,4 y (32-100),male/female ratio 1.4. Associated pathology:infection 328, heart diseases 249, rheumaticdiseases 211, liver diseases 108, cancer 80,neuropathy 43. Monoclonal proteins: IgG 407,IgM 78, IgD 2, biclonal 16, triclonal 1; no heavychain 21, light chain Kappa 389. Variables (mean):monoclonal component: 14 g/l, ESR 32,5, bonemarrow: 5,9% plasma cells ß2-microglobulin: 2,59 mg/l, albumin: 3,1g/l, bone survey: normal 39,5%. Evolution: transient MGUS 20 cases. Time to disappearance 2,6 months (1,4-4,6). Evolution to malignant gammopathy 24 cases, time to progression 3 years (IC 1,82-4,3).Results. Several factors were associatedçwith malignant transformation: heavy chain IgA (p < 0,002), ESR (p < 0,001), age < 70 (p < 0,05), bone marrow percentage of plasma cells (p < 0,002) y ostheoporosis (p < 0,005). A MGUS follow up model is suggested

[Unique patient identification in hospitals in the National Health Service]. / Identificación inequívoca de pacientes ingresados en hospitales del Sistema Nacional de Salud.

Currently, patient misidentification in healthcare organizations is a risk that can lead to diagnostic errors, performing of surgical procedures, and administration of medicines or hemoderivates to wrong patients. The organizations that deal with patient safety promote methods that guarantee unique identifications within the strategies for improving safety in healthcare. Identification policies are obligatory to ensure the accuracy of the identification in all patients using universally implemented unique methods, and healthcare workers have the responsibility of verifying patient identification with appropriate documents when a diagnostic or therapeutic procedure is planned. In this paper we review the bases for an unmistakable unique identification and present the experiences of five regional health services that develop the policies promoted in Spain by the Quality Agency of the Ministry of Health and Consumer Affairs.

[Are short stay medical units an appropriate place to manage community-acquired pneumonia?]. / ¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad?

INTRODUCTION: Evaluate patients with community acquired pneumonia (CAP) admitted to our Short Stay Medical Unit (SSMU) in order to establish, using Fines s criteria, whether reducing the length of stay of maximum risk groups (IV and V) is associated with reduction of quality with either an increase of mortality or readmissions. A further objective was to pinpoint the variables associated with a prolongation of hospital stay. PATIENTS AND METHODS: All CAP patients admitted to our unit over a eighteen-month period were included in the study. We conducted an univariate analysis and a step wise multivariate analysis of all the variables in the univariate analysis showing a significant statistical relation. RESULTS: 182 patients with a mean age of 73 years were studied. The length of hospital stay was 4.3 days. Stratified by Fine's criteria, 91.2% were included in the groups of maximum risk: 12.1% in group III, 60.4% IV and 18.7% in V. The medium length of stay for each category was 4.3, 4.1 y 5.3 days respectively. The mortality rate was 2.7% and only 5 patients required readmission within one month alter the discharge. Of the variables analyzed only Fine's group V, chronic liver disease and/or renal insufficiency as comorbidities, a pulse rate over 125 per minute and blood glucose level > 250 mg/l showed a significant relation with more than five days hospitalization, and out of them, only the three latter stayed in the multivariate analysis. CONCLUSIONS: All CAP patients, including those in Fine's groups IV and V, can be treated safely and efficiently in a SSMU, providing there is an outpatient clinic for immediate consultation available.

Morbilidad hospitalaria en pacientes con infección por VIH / Hospital morbidity in HIV infected patients

Fundamento y objetivo: Con el aumento de la esperanza de vida en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) tras el tratamiento antirretroviral de gran actividad (TARGA), las causas de hospitalización han cambiado. Predominan ahora comorbilidades como la hepatopatía crónica, la patología cardiovascular o los efectos secundarios de los tratamientos. Nuestro objetivo es determinar las características clinicoepidemiológicas actuales de estos pacientes. Material y métodos: Estudio descriptivo y retrospectivo. Revisamos las historias clínicas de los ingresos de pacientes con infección por el VIH hospitalizados en los servicios médicos de nuestro hospital en el transcurso de un año. Resultados: Hubo 125 ingresos de 82 pacientes, un 77% varones y un 71% con infección por el virus de la hepatitis C (VHC). La edad media fue de 42 años. En el 64% la vía de transmisión fue la drogadicción parenteral. Un 36% recibían TARGA y un 51% reunían criterios sida. Los motivos de ingreso más frecuentes fueron la patologia respiratoria (32%) y las enfermedades definitorias de sida (EDS) con un 22%, de las que la tuberculosis (TBC) fue la más frecuente. Un 10% fueron ingresados en la Unidad de Cuidados Intensivos (UCI). La mortalidad fue del 11% pacientes/año. Conclusiones: La mayoría de los pacientes fueron varones, con coinfección por el VHC y usuarios de drogas vía parenteral, siendo las causas de ingreso más frecuentes las patologías respiratorias y las enfermedades oportunistas. La TBC permanece siendo la EDS más frecuente

Background and objetive: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver patology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. Material and methods: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. Results: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract patology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. Conclusions: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness

¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad? / Are short stay medical units an appropiate place to manage community acquired pneumonia?

Introducción: Evaluar los pacientes ingresados por neumonía adquirida en la comunidad (NAC) en una unidad de corta estancia médica (UCEM) para determinar, mediante los criterios de Fine para, si la reducción de la estancia en los grupos de máximo riesgo (grupos IV y V) lleva asociada una disminución de la calidad asistencial en forma de mortalidad y reingresos. Pacientes y métodos: Se incluyeron todos los pacientes con NAC ingresados en la UCEM en un periodo de 18 meses. Se realizó un estudio univariante contrastando cada variable con la variable resultado (estancia > o 250 mg/l, se relacionaron con una estancia mayor de 5 días y de ellas únicamente las 3 últimas permanecieron en el modelo final en el análisis multivariante. Conclusiones: La NAC se puede tratar de forma eficiente en una UCEM incluso en pacientes incluidos en los grupos IV y V de Fine, apoyados en una consulta externa ágil y precoz que permita una revisión temprana

Introduction: Evaluate patients with community acquired pneumonia (CAP) admitted to our Short Stay Medical Unit (SSMU) in order to establish, using Fines’s criteria, whether reducing the length of stay of maximum risk groups (IV and V) is associated with reduction of quality with either an increase of mortality or readmissions. A further objective was to pinpoint the variables associated with a prolongation of hospital stay. Patients and methods: All CAP patients admitted to our unit over a eighteen-month period were included in the study. We conducted an univariate analysis and a step wise multivariate analysis of all the variables in the univariate analysis showing a significant statistical relation. Results: 182 patients with a mean age of 73 years were studied. The length of hospital stay was 4.3 days. Stratified by Fines’s criteria, 91.2% were included in the groups of maximum risk: 12.1% in group III, 60.4% IV and 18.7% in V. The medium length of stay for each category was 4.3, 4.1 y 5.3 days respectively. The mortality rate was 2.7% and only 5 patients required readmission within one month alter the discharge. Of the variables analyzed only Fine’s group V, chronic liver disease and/or renal insufficiency as comorbidities, a pulse rate over 125 per minute and blood glucose level > 250 mg/l showed a significant relation with more than five days hospitalization, and out of them, only the three latter stayed in the multivariate analysis. Conclusions: All CAP patients, including those in Fine’s groups IV and V, can be treated safely and efficiently in a SSMU, providing there is an outpatient clinic for inmmediate consultation available

[Hospital morbidity in HIV infected patients]. / Morbilidad hospitalaria en pacientes con infección por VIH.

BACKGROUND AND OBJECTIVE: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver pathology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. MATERIAL AND METHODS: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. RESULTS: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract pathology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. CONCLUSIONS: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness.