[Analysis of infectious diseases care in Spanish hospitals from 2016-2020, including the first year of the SARS-CoV-2 pandemic]. / Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2.

Aims: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2 / Analysis of infectious diseases care in Spanish hospitals from 2016–2020, including the first year of the SARS-CoV-2 pandemic

Objetivo Revisar los pacientes atendidos en los hospitales españoles dados de alta con un diagnóstico principal de infección en un periodo de 5 años, incluyendo el primer año de la pandemia por SARS-CoV-2. Material y métodos Se han analizado los datos del Conjunto Mínimo Básico de Datos (CMBD) de los pacientes dados de alta durante el periodo 2016-2020 de los hospitales del Sistema Nacional de Salud de España identificando aquellos que tuvieran un diagnóstico principal de enfermedad infecciosa según el código CIE-10-S. Se han incluido en el análisis todos los pacientes mayores de 14 años que hubieran ingresado en una planta convencional o de cuidados intensivos, excluyendo los partos, y se han evaluado las altas en función del servicio de alta. Resultados Los pacientes dados de alta con patología infecciosa han aumentado del 10% al 19% en los últimos años, y gran parte del crecimiento se debe a la epidemia por SARS-CoV-2. Los servicios de medicina interna atienden a más del 50% de estos pacientes, seguidos de neumología (9%) y cirugía general (5%). En el año 2020 el 57% de los pacientes con diagnóstico principal de infección fueron dados de alta por internistas, que atendieron al 67% de los pacientes con SARS-CoV-2. Conclusiones Actualmente más de la mitad de los pacientes que ingresan con diagnóstico principal de infección son dados de alta en medicina interna. Dada la complejidad creciente de las infecciones, abogamos por un abordaje en el que un área de capacitación permita una especialización, pero dentro de un contexto generalista, para el mejor manejo de estos pacientes (AU)

Aims This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients (AU)

Analysis of infectious diseases care in Spanish hospitals from 2016 to 2020, including the first year of the SARS-CoV-2 pandemic.

AIMS: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. MATERIALS AND METHOD: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016⬜2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. RESULTS: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. CONCLUSIONS: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

La importancia de evaluar la fragilidad y la dependencia / The importance of evaluating fragility and dependence

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Compresión medular metastásica: incidencia, epidemiología y factores pronóstico / Metastatic spinal cord compression: incidence, epidemiology and prognostic factors

Introducción: La compresión medular metastásica (CMM) es una complicación severa en pacientes con cáncer cuya incidencia es difícil de estimar con exactitud. El objetivo del presente estudio es describir la incidencia, las características epidemiológicas y el pronóstico de la compresión medular metastásica en pacientes con cáncer. Material y métodos: Analizamos una cohorte con un total de 1.736 pacientes con diagnóstico de cáncer de cualquier origen ingresados en una unidad de cuidados paliativos. De los pacientes con diagnóstico de CMM, se recogieron datos epidemiológicos, signos y síntomas, tiempo medio hasta el diagnóstico, régimen de tratamiento, respuesta al tratamiento y mortalidad. Resultados: De un total de 1.736 pacientes, se identificaron 28 (1,6%) casos de CMM. La edad promedio fue de 67,2 (DE: 12,7) años siendo el cáncer de pulmón el tumor primario más frecuente (42,8%). La columna torácica fue la localización más afectada (42,8%; n=12) y el dolor el síntoma predominante (46,4%, n=13). La mediana de supervivencia después del diagnóstico de CMM fue de 84,5 días. Conclusiones: Hemos obtenido una incidencia del 1,6% (N=28) de CMM en una cohorte de 1.736 pacientes con cáncer. La CMM es un marcador de mal pronóstico con una supervivencia media menor de 3 meses desde el diagnóstico y una mortalidad intrahospitalaria del 32,4%

Background: Metastatic spinal cord compression (MSCC) is a severe complication in patients with cancer, and its incidence rate is difficult to accurately estimate. The aim of this study is to report the incidence and epidemiological and prognostic characteristics of MSCC in patients with cancer. Material and methods: We analysed a cohort of 1736 patients diagnosed with cancer of any origin who were hospitalised in a palliative care unit. We collected epidemiological data, signs and symptoms, mean time to diagnosis, treatment regimen, response to treatment and mortality for the patients diagnosed with MSCC. Results: In the 1736 patients, we identified 28 (1.6%) cases of MSCC. The average age was 67.2 (SD, 12.7) years, and lung cancer was the most common primary tumour (42.8%). The thoracic spine was the most affected location (12 cases, 42.8%), and pain was the predominant symptom (13 cases, 46.4%). The median survival after the MSCC diagnosis was 84.5 days. Conclusions: We observed an incidence rate of 1.6% (N=28) for MSCC in a cohort of 1736 patients with cancer. MSCC is a marker of poor prognosis, with a mean survival of less than 3 months from diagnosis and a hospital mortality of 32.4%

Estimación de pronóstico a corto plazo para adecuar el traslado de pacientes oncológicos terminales a unidades de cuidados paliativos de media estancia / Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units

Introducción y objetivos: La gestión clínica aplicada a pacientes terminales debería considerar diferentes aspectos, particularmente la valoración funcional que correlaciona bien con pronóstico a corto plazo. La estimación pronóstica podría mejorar si se incluyera la presencia de síntomas fuertemente asociados a peor evolución. El objetivo principal del estudio fue evaluar si el pronóstico según Palliative Performance Scale (PPS) mejoraba con la presencia/ausencia de los síntomas dolor-disnea-delirium. Secundariamente estimar la satisfacción de los cuidadores con el traslado a Unidades de Cuidados Paliativos de Media Estancia (UCPME), preparadas para estancias medias deseables en torno al mes. Pacientes y método: Estudio prospectivo, observacional, multicéntrico (autonómico). Se analizó supervivencia en UCPME según PPS dicotomizado en>o≤20%. Se estimaron sus funciones de supervivencia mediante método Kaplan-Meier y se compararon según riesgo proporcional de Cox (HR). La satisfacción de los cuidadores se estudió mediante cuestionario anónimo autocumplimentado tipo Likert. Resultados: Incluimos 130 pacientes. Los subgrupos PPS ≤ 20% y PPS>20% tuvieron una mediana de supervivencia de 6[3-13] y 21[11-42] días respectivamente, con HR no ajustado 3,1 veces mayor de fallecer en PPS≤20%. El HR no se modificó ajustando para los síntomas. El 83% de cuidadores encontró el traslado beneficioso y el 40% apreciaron mejores cuidados sanitarios. Conclusiones: En pacientes trasladados desde hospitales generales a UCPME puntuaciones PPS<20% se asocian a supervivencia menor de una semana con HR 3 veces superior de fallecer que pacientes PPS>20%, sin que el análisis ajustado por presencia de dolor-disnea-delirium aporte mayor precisión pronóstica. Los cuidadores encontraron beneficio fundamentalmente en comodidad de instalaciones y distancia

Background and objectives: Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month. Patients and method: We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to>20% and≤20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire. Results: The study included 130 patients. The PPS≤20% and PPS>20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS≤20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care. Conclusions: For patients transferred from general hospitals to MSPCUs, PPS scores≤20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores>20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance

Los internistas y la muerte en el hospital / Internists and death in the hospital

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Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units. / Estimación de pronóstico a corto plazo para adecuar el traslado de pacientes oncológicos terminales a unidades de cuidados paliativos de media estancia.

BACKGROUND AND OBJECTIVES: Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month. PATIENTS AND METHOD: We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to>20% and≤20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire. RESULTS: The study included 130 patients. The PPS≤20% and PPS>20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS≤20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care. CONCLUSIONS: For patients transferred from general hospitals to MSPCUs, PPS scores≤20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores>20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance.

Metastatic spinal cord compression: Incidence, epidemiology and prognostic factors. / Compresión medular metastásica: incidencia, epidemiología y factores pronóstico.

BACKGROUND: Metastatic spinal cord compression (MSCC) is a severe complication in patients with cancer, and its incidence rate is difficult to accurately estimate. The aim of this study is to report the incidence and epidemiological and prognostic characteristics of MSCC in patients with cancer. MATERIAL AND METHODS: We analysed a cohort of 1736 patients diagnosed with cancer of any origin who were hospitalised in a palliative care unit. We collected epidemiological data, signs and symptoms, mean time to diagnosis, treatment regimen, response to treatment and mortality for the patients diagnosed with MSCC. RESULTS: In the 1736 patients, we identified 28 (1.6%) cases of MSCC. The average age was 67.2 (SD, 12.7) years, and lung cancer was the most common primary tumour (42.8%). The thoracic spine was the most affected location (12 cases, 42.8%), and pain was the predominant symptom (13 cases, 46.4%). The median survival after the MSCC diagnosis was 84.5 days. CONCLUSIONS: We observed an incidence rate of 1.6% (N=28) for MSCC in a cohort of 1736 patients with cancer. MSCC is a marker of poor prognosis, with a mean survival of less than 3 months from diagnosis and a hospital mortality of 32.4%.

Toxicidad pulmonar grave relacionada con la administración de gemcitabina / Fatal gemcitabine administration related pulmonary toxicity

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Obstrucción intestinal secundaria a carcinomatosis peritoneal. Estudio descriptivo de 98 episodios / No disponible

Objetivo: describir la evolución de pacientes ingresados por obstrucción intestinal secundaria a carcinomatosis peritoneal desde el diagnóstico del tumor hasta el fallecimiento, medir su supervivencia, mostrar marcadores analíticos que se relacionan con el pronóstico, detectar factores Que empeoran su calidad de vida, revisar los tratamientos empleados y el lugar donde fallecen. Material y método: estudio descriptivo, retrospectivo. Se revisaron las historias clínicas de los pacientes ingresados en la Unidad de Cuidados Paliativos del Hospital Severo Ochoa (Leganés, Madrid) desde el año 2002 hasta 2008, con diagnóstico de carcinomatosis peritoneal y obstrucción intestinal. Entre las variables destacamos: edad, sexo, etiología del tumor primario, sintomatología al ingreso, tratamiento recibido durante el ingreso, niveles de hemoglobina y albúmina, tiempo entre el diagnóstico del tumor primario y el fallecimiento, tiempo entre el primer episodio de obstrucción intestinal maligna y el fallecimiento y ubicación en el fallecimiento. Resultados: se registraron 98 episodios de obstrucción intestinal secundaria a carcinomatosis peritoneal, Que correspondían a 72 pacientes. Veinte pacientes ingresaron en más de una ocasión por esta complicación. Los tumores más prevalentes fueron colon (31 %), gástrico (26%) y ovario (21 %). El 100% de los pacientes presentaron sintomatología abdominal al ingreso. La media de las cifras de albúmina y hemoglobina en el primer ingreso fue 3,18 y 10,84 g/di respectivamente, mientras que en los reingresos sucesivos fue 2,89 y 10,65 g/di respectivamente (diferencia estadísticamente significativa). Los tratamientos empleados fueron: corticoides (95,92%), procinéticos (80,61%), opioides (77,55%), otros analgésicos (69,39%) y butilbromuro de hioscina (16,32%). Fue frecuente el empleo de combinaciones analgésicas. El tiempo entre el diagnóstico del tumor y el fallecimiento fue 14 meses (P25-75:,2-25,3). El tiempo entre el diagnóstico de la obstrucción intestinal maligna y el fallecimiento fue 33 días (P25-75: 0-67). El 67% de los pacientes fallecen en el primer episodio de obstrucción intestinal maligna. El 69% de los pacientes fallecen en una unidad de cuidados paliativos. Conclusiones: los tumores abdominales son la causa más frecuente de obstrucción intestinal maligna. Todos los pacientes con este cuadro presentan sintomatología abdominal en el momento del diagnóstico. Los reingresos por esta complicación son frecuentes. Los pacientes con niveles más bajos de hemoglobina y albúmina tienen una mayor probabilidad de fallecer a corto plazo (AU)

Objective: to describe the evolution of patients with malignant bowel obstruction due to peritoneal carcinomatosis since diagnosis until death; to analyze survival of these patients, to demonstrate the relationship between some laboratory tests and prognosis, to detect problems that worsen Quality of life, to review treatment received, and to collect place of death. Material and method: a descriptive study. We retrospectively reviewed inpatients diagnosed with malignant bowel obstruction due to peritoneal carcinomatosis at the Palliative Care Unit in University Hospital Severo Ochoa (Leganés, Madrid) between 2002 and 2008. Variables we analyzed included: age, sex, etiology of tumor, symptoms and treatments during admission to hospital, hemoglobin and albumin levels at admission, time between tumor diagnosis and death, time between first episode of malignant bowel obstruction and death, and place where these patients die. Results: we reviewed 98 cases of malignant bowel obstruction due to peritoneal carcinomatosis in 72 patients. Twenty patients were admitted to hospital at least twice for this complication. The most predominant tumors were colon (31%), gastric (26%) and ovary (21%) malignancies. AII patients suffered from abdominal symptoms at admission. Mean hemoglobin and albumin values at first admission were, respectively: 3.18 gldL and 10.84 g/dL; average values at readmission were 2.89 gldL and 10.65 gldL (statistically significant). Treatments prescribed were: corticoids (95.92%), prokinetic drugs (80.61%), opioids (77.55%), other analgesic drugs (69.39%), and hyoscine butylbromide (16.32%). Several analgesic drugs were often prescribed at the same time. Time between tumor diagnosis and death was 14 months (P25-75:5.2-25.3). Time between first episode of malignant bowel obstruction and death was 33 days (P25-75-75:0-67); 67% of patients die during their first admission to hospital because of this condition; 69% of patients die at a palliative care unit. Conclusions: abdominal tumors are the main cause of malignant bowel obstruction. AII patients with this entity suffer from abdominal symptoms at admission. Readmissions are frequent. Patients with lower hemoglobin and albumin levels probably die sooner. Dexamethasone was the most commonly prescribed treatment; hyoscine butylbromide was least commonly prescribed. Patients with malignant bowel obstruction due to peritoneal carcinomatosis have decreased survival. These patients die frequently during their first admission and in the hospital setting (AU)

Acontecimientos adversos causados por medicamentos en pacientes ingresados en medicina interna / Adverse drug events in patients hospitalized in internal medicine

ObjetivoLos acontecimientos adversos causados por medicamentos (AAM) son un problema de salud pública, cuya magnitud es difícil de cuantificar debido a su infranotificación. Nuestro objetivo fue identificar y describir los AAM registrados en el conjunto mínimo básico de datos de los servicios de medicina interna durante los años 2005–07.Pacientes y métodosEstudio transversal. Se seleccionaron los episodios codificados, según la CIE-9-MC, como tales en los informes de alta de todos los pacientes hospitalizados durante 2005–07 en todo el territorio español. Se describieron y analizaron las variables sociodemográficas, las categorías diagnósticas y los tipos de fármacos, entre otras.ResultadosDe las 1.567.659 altas codificadas en el conjunto mínimo de datos, se registraron 96.607 AAM en 86.880 episodios (5,55%) de los cuales un 82,86% eran no prevenibles y un 17,14% prevenibles. Un 4,5% de los episodios registraron una reacción adversa a medicamentos. Los AAM fueron más frecuentes en mujeres y la aparición de una reacción adversa a los medicamentos durante el ingreso se acompaña de prolongación de la estancia hospitalaria.ConclusionesEl conjunto mínimo básico de datos es una herramienta útil para la identificación, la cuantificación y el análisis de las reacciones adversas a los medicamentos, aunque limitada por el bajo registro en los informes de alta(AU)

ObjectiveAdverse drug events (ADE) are a public health problem, the dimension of which is difficult to quantify because it is under-reported. We have aimed to identify and describe the ADEs recorded in the minimum basic data set (MBDS) of the Internal Medicine Services during the years 2005–7.Patients and methodsA cross-sectional study. Those episodes coded as such, according to the ICD-9-CM, in the discharge reports of all the patients hospitalized during 2005–07 in the entire Spanish territory, were selected. The sociodemographic variables, diagnostic categories and types of drugs, among others, were described and analyzed.ResultsOf the 1,567,659 discharges coded in the Minimum Basic Data Set" (MBDS), 96,607 ADEs were recorded in 86,880 episodes (5.55%). Of these 82.86% were not preventable and 17.14% were preventable. A total of 4.5% of the episodes recorded an adverse drug reaction (ADR). The ADE's were more frequent in women and the appearance of an ADR during admission was accompanied by an increase in the hospital stay.ConclusionsThe MBDS is a useful tool for the identification, quantification and analysis of the ADRs, however, it is limited by the low recording of the discharge reports(AU)

[Adverse drug events in patients hospitalized in internal medicine]. / Acontecimientos adversos causados por medicamentos en pacientes ingresados en medicina interna.

OBJECTIVE: Adverse drug events (ADE) are a public health problem, the dimension of which is difficult to quantify because it is under-reported. We have aimed to identify and describe the ADEs recorded in the minimum basic data set (MBDS) of the Internal Medicine Services during the years 2005-7. PATIENTS AND METHODS: A cross-sectional study. Those episodes coded as such, according to the ICD-9-CM, in the discharge reports of all the patients hospitalized during 2005-07 in the entire Spanish territory, were selected. The sociodemographic variables, diagnostic categories and types of drugs, among others, were described and analyzed. RESULTS: Of the 1,567,659 discharges coded in the Minimum Basic Data Set" (MBDS), 96,607 ADEs were recorded in 86,880 episodes (5.55%). Of these 82.86% were not preventable and 17.14% were preventable. A total of 4.5% of the episodes recorded an adverse drug reaction (ADR). The ADE's were more frequent in women and the appearance of an ADR during admission was accompanied by an increase in the hospital stay. CONCLUSIONS: The MBDS is a useful tool for the identification, quantification and analysis of the ADRs, however, it is limited by the low recording of the discharge reports.

[Two-year analysis of Internal Medicine activity in the National Health Care System hospitals]. / Análisis de dos años de actividad de Medicina Interna en los hospitales del sistema nacional de salud.

INTRODUCTION: We present a summary of the results of the hospital activities of the Internal Medicine (IM) Departments of the National Health Care System during the years 2005-2006. MATERIAL AND METHODS: The patients hospitalized in the IM departments of Spain during 2005 and 2006 were analyzed according to the data obtained from the minimum basic data set (MBDS), in which the administrative data were collected (age, gender, personal data) and clinical data (one principal diagnosis and up to 1 secondary diagnosis and 19 clinical procedures) for all the patients hospitalized in the public and private hospitals of Spain. RESULTS: During this period, there were 7,130.85 discharges in our country, 1,099.65 of these being from IM. A total of 53.6% of the patients were male, with mean age of 70.6 years, mean stay of 10 days (standard deviation [SD] 11.7) and 9.9% deaths. A total of 9.7% of the patients were admitted through the Emergency Department. Mean weight was 1.74 (SD 1.41) according to the American classification system and 1.1 (SD 0.73) according to the National Health System data. Respiratory failure diagnostic related group (DRG-541, 88 and 101) accounted for 14% of the discharges and heart failure (DRG 17, 544 and 87) accounted for 1.4% of all the episodes. CONCLUSIONS: In Spain, the internal medicine doctors attended one out of every 6 hospitalized patients. Admissions for more than half of the patients admitted due to cardiorespiratory disorder were unscheduled and one out of every 10 died during their stay. These data illustrate the importance of this specialty in the context of health care of our country. (c) 2009 Elsevier España, S.L. All rights reserved.

Análisis de 2 años de actividad de Medicina Interna en los hospitales del Sistema Nacional de Salud / Two-year analysis of Internal Medicine activity in the National Health Care System hospitals

Introducción. Presentamos un resumen de los resultados de la actividad hospitalaria delos servicios de Medicina Interna (MI) del Sistema Nacional de Salud (SNS), durante el bienio 2005-2006.Material y métodos. Se analizaron los pacientes ingresados en los servicios de MI de España en los años 2005 y 2006 según los datos obtenidos del conjunto mínimo básico de datos(CMBD), en el que se recogen datos administrativos (edad, sexo, filiación) y clínicos (un diagnóstico principal y hasta 12 diagnósticos secundarios y 19 procedimientos clínicos) de todos los pacientes ingresados en los hospitales públicos y privados de España. Resultados. Durante este periodo se dieron en nuestro país 7.130.825 altas, ingresando a cargo de MI 1.099.652, (15,4%). Un 53,6% de los pacientes eran varones, la edad media fue de 70,6 años, la estancia media de 10 días (desviación estándar [DE] 11,7) y fallecieron el 9,9%. El 92,7% de los pacientes ingresaron por urgencias. El peso medio fue de1,74 (DE 1,41) según el sistema de clasificación americano y 1,1 (DE 0,73) según los datos del SNS. La insuficiencia respiratoria (grupo relacionado de diagnóstico [GRD] 541, 88 y101) supone un 14% de las altas, y la insuficiencia cardiaca (GRD 127, 544 y 87) el 12,4%de todos los episodios. Conclusiones. En España los internistas atienden a uno de cada seis pacientes hospitalizados. Más de la mitad de los pacientes que ingresan por una patología cardiorrespiratoria lo hacen de forma no programada, y uno de cada 10 fallece durante el ingreso. Estos datos dan una muestra de la importancia de esta especialidad en el contexto de la atención sanitaria de nuestro país (AU)

Introduction. We present a summary of the results of the hospital activities of the Internal Medicine (IM) Departments of the National Health Care System during the years 2005-2006.Material and methods. The patients hospitalized in the IM departments of Spain during2005 and 2006 were analyzed according to the data obtained from the minimum basic data set (MBDS), in which the administrative data were collected (age, gender, personal data) and clinical data (one principal diagnosis and up to 1 secondary diagnosis and 19clinical procedures) for all the patients hospitalized in the public and private hospitals of Spain. Results. During this period, there were 7,130.85 discharges in our country, 1,099.65 of these being from IM. A total of 53.6% of the patients were male, with mean age of 70.6years, mean stay of 10 days (standard deviation [SD] 11.7) and 9.9% deaths. A total of9.7% of the patients were admitted through the Emergency Department. Mean weight was 1.74 (SD 1.41) according to the American classification system and 1.1 (SD 0.73)according to the National Health System data. Respiratory failure diagnostic related group (DRG-541, 88 and 101) accounted for 14% of the discharges and heart failure (DRG17, 544 and 87) accounted for 1.4% of all the episodes. Conclusions. In Spain, the internal medicine doctors attended one out of every 6hospitalized patients. Admissions for more than half of the patients admitted due to cardiorespiratory disorder were unscheduled and one out of every 10 died during their stay. These data illustrate the importance of this specialty in the context of health care of our country (AU)

[Retrospective study of early readmissions at an internal medicine service]. / Estudio retrospectivo de los reingresos precoces de un servicio de medicina interna.

OBJECTIVE: To determine the frequency of hospital re-admissions to an Internal Medicine Department at a Community General Hospital as well as variables associated with them. METHODS: Analysis of hospital discharges during 1997. Data were provided by the Coding and Filing Service, and included sociodemographic data and aspects related to medical care to each patient, as well as discharge DRF according to the HCFA version. A logistic regression model was developed to identify variables independently associated with early re-admission risk (less than 30 days after discharge). RESULTS: The rate of early re-admission was 7.4%. The variables associated with a higher risk of admission included age, a hospital stay longer than the mean at first admission, and AIDS-associated conditions and heart diseases as main discharge diagnoses. CONCLUSIONS: Based on our data, we cannot consider the readmission rates as a reliable index in itself to be assessed negatively, as some re-admissions come unexpectedly and/or are unavoidable.

Estudio retrospectivo de los reingresos precoces de un servicio de medicina interna / Retrospective study of early readmissions to an Internal Medicine Department

Objetivo. Determinar la frecuencia del reingreso hospitalario en un servicio de Medicina Interna de un Hospital General de la Comunidad, así como las variables asociadas al mismo. Métodos. Análisis de las altas durante el año 1997. Los datos fueron facilitados por el Servicio de Codificación y Archivo, incluyendo características sociodemográficas y aspectos relacionados con el proceso asistencial de cada paciente, así como sus GRD al alta según la versión HCFA. Se construyó un modelo de regresión logística para identificar las variables que se asocian independientemente con el riesgo de reingresar precozmente (menos de 30 días tras el alta). Resultados. La tasa de reingresos precoces es del 7,4 por ciento. Las variables asociadas a un mayor riesgo de reingreso fueron la edad, una estancia superior a la media en el primer ingreso, así como la patología asociada con el síndrome de inmunodeficiencia adquirida (SIDA) y la cardiopatía como diagnósticos principales al alta. Conclusiones. Con los datos obtenidos no podemos considerar la tasa de reingresos como un índice fiable de calidad en sí mismo que deba ser valorado negativamente, ya que algunos reingresos son inesperados y/o inevitables. (AU)