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1.
Rev. clín. esp. (Ed. impr.) ; 224(1): 48-56, ene. 2024. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-EMG-530

RESUMO

La polimialgia reumática y la arteritis de células gigantes pueden suponer una emergencia médica en la que el retraso en su correcto diagnóstico y manejo terapéutico pueden asociar complicaciones graves. Con el objetivo de mejorar la atención de los pacientes con estas patologías en el entorno de la Comunidad de Madrid, se diseñó un estudio para identificar las causas y las posibles soluciones para hacer frente los problemas relacionados con el diagnóstico de estas patologías. Tras un análisis preliminar, se identificaron 11 áreas de mejora relacionadas con cuatro aspectos diferenciados del proceso asistencial: coordinación y protocolos, equipamientos, formación y concienciación sobre las patologías y experiencia del paciente. De todas ellas, se priorizó resolver aquellas relacionadas con la generación de protocolos de abordaje integral de las patologías y que contemplen todas las especialidades y niveles asistenciales implicados. Otro aspecto crucial es el incremento del grado de sospecha clínica de estas patologías. (AU)


Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies. (AU)


Assuntos
Polimialgia Reumática/complicações , Polimialgia Reumática/diagnóstico , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Assistência ao Paciente
2.
Rev. clín. esp. (Ed. impr.) ; 224(1): 48-56, ene. 2024. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-229912

RESUMO

La polimialgia reumática y la arteritis de células gigantes pueden suponer una emergencia médica en la que el retraso en su correcto diagnóstico y manejo terapéutico pueden asociar complicaciones graves. Con el objetivo de mejorar la atención de los pacientes con estas patologías en el entorno de la Comunidad de Madrid, se diseñó un estudio para identificar las causas y las posibles soluciones para hacer frente los problemas relacionados con el diagnóstico de estas patologías. Tras un análisis preliminar, se identificaron 11 áreas de mejora relacionadas con cuatro aspectos diferenciados del proceso asistencial: coordinación y protocolos, equipamientos, formación y concienciación sobre las patologías y experiencia del paciente. De todas ellas, se priorizó resolver aquellas relacionadas con la generación de protocolos de abordaje integral de las patologías y que contemplen todas las especialidades y niveles asistenciales implicados. Otro aspecto crucial es el incremento del grado de sospecha clínica de estas patologías. (AU)


Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies. (AU)


Assuntos
Polimialgia Reumática/complicações , Polimialgia Reumática/diagnóstico , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Assistência ao Paciente
3.
Rev Clin Esp (Barc) ; 224(1): 48-56, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38142973

RESUMO

Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies.


Assuntos
Arterite de Células Gigantes , Polimialgia Reumática , Humanos , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/terapia , Arterite de Células Gigantes/complicações , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/terapia , Polimialgia Reumática/complicações
4.
An Sist Sanit Navar ; 38(1): 53-60, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25963458

RESUMO

BACKGROUND: To study the clinical characteristics of patients with infection attending the emergency department (ED) and compare those admitted to a short stay unit (SSU) with those admitted to a conventional hospital ward (CHW). METHODS: A descriptive multicenter cross-sectional analysis of infected patients requiring admission from 10 ED with SSU. Data were collected for age, gender, comorbidities, risk factors for multiresistant pathogens, type of infection, sepsis criteria, microbiology and antibiotic treatment. RESULTS: We documented 780 admitted patients, mean age 70.43 years, 31% with heart disease, 29% COPD, 26% diabetes mellitus, 15% prior antibiotic therapy and solid neoplasm. Fifty-four percent were respiratory infections, 22% urinary infections and 8% intra-abdominal infections. Thirteen percent had septic syndrome and beta-lactam (64%) and fluoroquinolones (29%) were the most prescribed antibiotics. When comparing patients admitted to SSU (183) with those admitted to CHW (597), in the latter group there were more comorbidities (86% vs. 78%), more risk factors for multidrug-resistant pathogens (42% vs. 25%) and cultures from different sources were more frequently undertaken (80% vs. 64%) (p <0.05). CONCLUSIONS: According to our results, SSU may be an excellent alternative to CHW for patients with prevalent infection and less comorbidity and fewer risk factors for multidrug resistance.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infecções , Idoso , Estudos Transversais , Feminino , Humanos , Infecções/epidemiologia , Infecções/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Espanha
5.
An. sist. sanit. Navar ; 38(1): 53-60, ene.-abr. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-136584

RESUMO

Fundamento: Determinar las características clínicas de los enfermos con infección que ingresan desde urgencias y comparar las que lo hacen en una unidad de corta estancia (UCE) con las unidades de hospitalización convencional (UHC). Material y métodos: Estudio descriptivo multicéntrico con análisis transversal en 10 servicios de urgencias con UCE de pacientes con infección que ingresan. Se analizó edad, género, comorbilidad, factores de riesgo para patógenos multirresistentes, tipo de infección, criterios de sepsis, microbiología y antibioticoterapia. Resultados: Ingresaron 780 enfermos; edad media 70,43 años; 31% con cardiopatía, 29% con EPOC, 26% con diabetes mellitus, 15% con antibioticoterapia previa y neoplasia sólida. El 54% eran infecciones respiratorias, 22% urinarias y 8% intraabdominales. El 13% presentó síndrome séptico y los antibióticos más prescritos fueron betalactámicos (64%) y fluorquinolonas (29%). Al comparar los episodios que ingresaron en UCE (183) respecto UHC (597), estos últimos tenían más comorbilidad (86% vs. 78%) y factores de riesgo de patógenos multirresistentes (42% vs. 25%) y se practicaban más cultivos (80% vs. 64%) (p<0,05). Conclusiones: Las UCE son una excelente alternativa a las UHC para enfermos con infección prevalente y con menor comorbilidad y factores de riesgo de multirresistencia (AU)


Background: To study the clinical characteristics of patients with infection attending the emergency department (ED) and compare those admitted to a short stay unit (SSU) with those admitted to a conventional hospital ward (CHW). Methods: A descriptive multicenter cross-sectional analysis of infected patients requiring admission from 10 ED with SSU. Data were collected for age, gender, comorbidities, risk factors for multiresistant pathogens, type of infection, sepsis criteria, microbiology and antibiotic treatment. Results: We documented 780 admitted patients, mean age 70.43 years, 31% with heart disease, 29% COPD, 26% diabetes mellitus, 15% prior antibiotic therapy and solid neoplasm. Fifty-four percent were respiratory infections, 22% urinary infections and 8% intra-abdominal infections. Thirteen percent had septic syndrome and beta-lactam (64%) and fluoroquinolones (29%) were the most prescribed antibiotics. When comparing patients admitted to SSU (183) with those admitted to CHW (597), in the latter group there were more comorbidities (86% vs. 78%), more risk factors for multidrug-resistant pathogens (42% vs. 25%) and cultures from different sources were more frequently undertaken (80% vs. 64%) (p<0,05). Conclusions: According to our results, SSU may be an excellent alternative to CHW for patients with prevalent infection and less comorbidity and fewer risk factors for multidrug resistance (AU)


Assuntos
Humanos , Infecções/epidemiologia , Doenças Transmissíveis/epidemiologia , Hospitalização/estatística & dados numéricos , Controle de Infecções/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Comorbidade , Resistência a Múltiplos Medicamentos
6.
Med. intensiva (Madr., Ed. impr.) ; 37(1): 12-18, ene.-feb. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-113768

RESUMO

Objetivos Describir y evaluar la repercusión de un sistema de detección e intervención precoz en pacientes de riesgo fuera de la UCI en la evolución de los pacientes ingresados en UCI y el número de paradas cardiorrespiratorias (PCR) hospitalarias. Ámbito Hospital de nivel 2 en la Comunidad de Madrid con historia clínica electrónica. Métodos Un intensivista revisa cada uno de los pacientes que cumplan los criterios de inclusión y decide la necesidad o no de intervención. Posteriormente, junto al médico a cargo del paciente, se determina cuál es el nivel de cuidados que necesita y se decide la pauta a seguir a continuación. Diseño Estudio descriptivo y cuasi-experimental «before-after». Resultados En el periodo de estudio se intervino en un total de 202 pacientes. Ciento cuarenta y siete fueron incluidos tras detectarse analíticas alteradas a través de nuestro programa informático. En el periodo de control la mortalidad en UCI fue 9 frente al 4,4% en el periodo de intervención (p=0,03). En el análisis multivariable, los 2 factores que guardaron relación significativa con la mortalidad fueron el haber ingresado durante el periodo de intervención OR 0,42 (IC95%; 0,18 a 0,98) (p=0,04) y el SAPS 3 OR 1,11 (IC95%; 1,07 a 1,14) (p<0,05). El número de avisos por PCR en el periodo control fue 10 frente 3 en el periodo de intervención (p=0,07).Conclusiones La actividad de detección precoz de pacientes en riesgo fuera de la UCI puede producir un efecto beneficioso sobre los pacientes ingresados en UCI así como una reducción de las PCR hospitalarias (AU)


Objectives To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. Setting A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories Methods An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. Design A descriptive and quasi-experimental “before-after” study was made. Results A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07).Conclusions Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests (AU)


Assuntos
Humanos , Unidades de Terapia Intensiva/organização & administração , Administração de Caso/organização & administração , Fatores de Risco , Diagnóstico Precoce , Assistência Centrada no Paciente/organização & administração , Registros Eletrônicos de Saúde
7.
Med Intensiva ; 37(1): 12-8, 2013.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23059055

RESUMO

OBJECTIVES: To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. SETTING: A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories. METHODS: An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. DESIGN: A descriptive and quasi-experimental "before-after" study was made. RESULTS: A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07). CONCLUSIONS: Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests.


Assuntos
Diagnóstico Precoce , Intervenção Médica Precoce , Unidades de Terapia Intensiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
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