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1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185134

RESUMO

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Métodos Epidemiológicos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Estudos Retrospectivos , Fatores de Risco , Análise de Variância
2.
Emergencias ; 31(6): 377-384, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31777208

RESUMO

OBJECTIVES: To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. MATERIAL AND METHODS: All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. RESULTS: A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). CONCLUSION: The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time.

3.
Maturitas ; 129: 50-56, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31547913

RESUMO

OBJECTIVES: To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall. STUDY DESIGN: Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors. MAIN OUTCOME MEASURES: Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline. RESULTS: 452 patients (mean age 80 ±â€¯8 years; 70.8% women) were included. Baseline BI was 79.3 ±â€¯23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23-4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43-4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11-3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline. CONCLUSION: Patients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.


Assuntos
Acidentes por Quedas , Atividades Cotidianas , Nível de Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Fraturas Ósseas/fisiopatologia , Hospitalização , Humanos , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
4.
Eur J Intern Med ; 65: 69-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076345

RESUMO

BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

5.
Emergencias (Sant Vicenç dels Horts) ; 30(4): 231-240, ago. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180057

RESUMO

Objetivo: Estudiar el perfil de los pacientes de 65 años o más atendidos por una caída en los servicios de urgencias (SU), las características de las caídas, y el grado y los factores asociados con la realización de recomendaciones para prevenir las caídas (RPC). Método: FALL-ER es un registro de cohortes multipropósito, prospectivo y multicéntrico, con muestreo sistemático, que incluyó todos los pacientes de 65 años o más atendidos por caída en 5 SU durante 52 días en un año. Se recogieron 68 variables independientes. Los pacientes se clasificaron en función de recibir o no RPC (cualquiera de las siguientes: ejercicio, educación sobre prevención de las caídas, derivación a especialista o modificación de fármacos relacionados con las caídas). Resultados: Se analizaron 1.507 (93,6%) del total de 1.610 pacientes. Los pacientes tenían una edad muy avanzada y alto grado de comorbilidad, polifarmacia y síndromes geriátricos previos. La caída suele suceder de día, en domicilio y en la mitad de casos sin testigo. Un 48% refirió miedo a caerse, un 22% presentó deterioro funcional agudo, un 16% ingresó y un 0,6% falleció. Se realizaron RPC en 509 (33,8%) casos. La disminución de la agudeza auditiva, deterioro cognitivo autorreferido, atención médica en el lugar de la caída, miedo a volver a caerse, deterioro funcional agudo y hospitalización se asociaron con mayor probabilidad de RPC, y la disminución de la agudeza visual con menor probabilidad. Conclusiones: Solo tres de cada diez pacientes ancianos atendidos por una caída en urgencias recibe RPC posteriores, aunque existen ciertas características relacionadas con el paciente y la caída que se asocian a una mayor probabilidad de recibirlas


Objective: To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. Methods: The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. Results: A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. Conclusions: Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ferimentos e Lesões/etiologia , Estudos Prospectivos , Melhoria de Qualidade , Fatores de Risco , Prevenção Secundária/métodos , Prevenção Secundária/estatística & dados numéricos , Prevenção Secundária/normas , Espanha/epidemiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Sistema de Registros
6.
Emergencias ; 30(4): 231-240, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30033696

RESUMO

OBJECTIVES: To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. MATERIAL AND METHODS: The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. RESULTS: . A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. CONCLUSION: Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.


Assuntos
Acidentes por Quedas , Serviço Hospitalar de Emergência , Ferimentos e Lesões/etiologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Prospectivos , Melhoria de Qualidade , Sistema de Registros , Fatores de Risco , Prevenção Secundária/métodos , Prevenção Secundária/normas , Prevenção Secundária/estatística & dados numéricos , Espanha/epidemiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
7.
Clin Res Cardiol ; 107(8): 698-710, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29594372

RESUMO

AIMS: To compare short-term outcomes after an episode of acute heart failure (AHF) in patients with reduced and preserved ejection fractions (HFrEF, < 40%; and HFpEF, > 49%; respectively) according to their destinations after emergency department (ED) care. METHODS AND RESULTS: This secondary analysis of the EAHFE Registry (consecutive AHF patients diagnosed in 41 Spanish EDs) investigated 30-day all-cause mortality, in-hospital all-cause mortality, prolonged hospitalisation (> 7 days), and 30-day post-discharge ED revisit due to AHF, all-cause death, and combined endpoint (ED revisit/death) in 5829 patients with echocardiographically documented HFrEF and HfpEF (HFrEF/HFpEF: 1,442/4,387). Adjusted ratios were calculated for patients admitted to internal medicine (IM), short stay unit (SSU), and discharged from the ED without hospitalisation (DEDWH) and compared with those admitted to cardiology. For HFrEF, the only significant differences were lower in-hospital mortality (OR = 0.26; 95% CI 0.08-0.81; p = 0.021) and prolonged hospitalisation (OR = 0.07; 95% CI 0.04-0.13; p < 0.001) related to SSU admission. For HFpEF, IM admission had a higher post-discharge 30-day mortality (HR = 1.85; 95% CI 1.05-3.25; p = 0.033) and combined endpoint (HR = 1.24; 95% CI 1.01-1.64; p = 0.044); SSU admission had a lower in-hospital mortality (OR = 0.43; 95% CI 0.23-0.80; p = 0.008) and prolonged hospitalisation (OR = 0.17; 95% CI 0.13-0.23; p < 0.001) but a higher post-discharge 30-day combined endpoint (HR = 1.29; 95% CI 1.01-1.64; p = 0.041); and DEDDWH had a lower 30-day mortality (HR = 0.46; 95% CI 0.28-0.75; p = 0.002) but higher post-discharge ED revisit (HR = 1.62; 95% CI 1.31-2.00; p < 0.001). CONCLUSION: While HFrEF patients have similar short-term outcomes irrespective of the destination after ED care for an AHF episode, HFpEF patients present worse short-term outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.


Assuntos
Serviço Hospitalar de Emergência , Insuficiência Cardíaca/mortalidade , Sistema de Registros , Volume Sistólico/fisiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
8.
Med. clín (Ed. impr.) ; 150(5): 167-177, mar. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-171016

RESUMO

Fundamento y objetivos: Definir en pacientes con insuficiencia cardiaca aguda (ICA) dados de alta directamente desde Urgencias: las tasas de reconsulta a Urgencias y hospitalización por ICA y de muerte por cualquier causa a 30 días; la tasa de estos 3 episodios combinados a 7 días; y los factores asociados con tales episodios. Pacientes y método: Incluimos pacientes diagnosticados consecutivamente de ICA durante 2 meses en 27 servicios de urgencias hospitalarios (SUH) dados de alta sin hospitalización. Recogimos 43 variables independientes, con seguimiento a 30 días, e investigamos los factores predictivos para episodios adversos mediante regresión de Cox. Resultados: Evaluamos 785 pacientes (78±9 años, 54,7% mujeres). Las tasas de reconsulta, hospitalización y mortalidad a 30 días, y de episodio combinado a 7 días fueron de 26,1, 15,7, 1,7 y 10,6%, respectivamente. Los factores independientes asociados a reconsulta fueron no administrar diuréticos intravenosos en urgencias (HR 2,86; IC 95% 2,01-4,04), tasa de filtrado glomerular (TFG)<60ml/min/m2 (1,94; 1,37-2,76) y episodios previos de ICA (1,48; 1,02-2,13); los asociados a hospitalización fueron no administrar diuréticos intravenosos (2,97; 1,96-4,48), tener cardiopatía valvular (1,61; 1,04-2,48) y saturación arterial de oxígeno a la llegada al SUH<95% (1,60; 1,06-2,42); y los asociados a episodio combinado, no administrar diurético intravenoso (3,65; 2,19-6,10), TFG<60ml/min/m2 (2,22; 1,31-3,25), episodios previos de ICA (1,95; 1,04-3,25) y uso de nitratos intravenosos (0,13; 0,02-0,99). Conclusión: Presentamos por primera vez en España las tasas de episodios adversos en pacientes con ICA dados de alta directamente desde los SUH y definimos los factores asociados, lo cual debería ayudar a determinar acciones para mejorar la selección de los pacientes candidatos al alta directa desde Urgencias (AU)


Background and objectives: The aim of this study was to define the following in patients with acute heart failure (AHF) discharged directly from accident and emergency (A&E): rates of reconsultation to A&E and hospitalisation for AHF, and all-cause death at 30 days, rate of combined event at 7 days and the factors associated with these rates. Patients and method: The study included patients consecutively diagnosed with AHF during 2 months in 27 Spanish A&E departments who were discharged from A&E without hospitalisation. We collected 43 independent variables, monitored patients for 30 days and evaluated predictive factors for adverse events using Cox regression analysis. Results: We evaluated 785 patients (78±9) years, 54.7% women). The rates of reconsultation, hospitalisation, and death at 30 days and the combined event at 7 days were: 26.1, 15.7, 1.7 and 10.6%, respectively. The independent factors associated with reconsultation were no endovenous diuretics administered in A&E (HR 2.86; 95% CI 2.01-4.04), glomerular filtration rate (GFR)<60ml/min/m2 (1.94; 1.37-2.76) and previous AHF episodes (1.48; 1.02-2.13); for hospitalisation these factors were no endovenous diuretics in A&E (2.97; 1.96-4.48), having heart valve disease (1.61; 1.04-2.48), blood oxygen saturation at arrival to A&E<95% (1.60; 1.06-2.42); and for the combined event no endovenous diuretics in A&E (3.65; 2.19-6.10), GFR<60ml/min/m2 (2.22; 1.31-3.25), previous AHF episodes (1.95; 1.04-3.25), and use of endovenous nitrates (0.13; 0.02-0.99). Conclusion: This is the first study in Spain to describe the rates of adverse events in patients with AHF discharged directly from A&E and define the associated factors. These data should help establish the most adequate approaches to managing these patients (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Fatores de Risco , Prognóstico , Espanha/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos
9.
Stress ; 21(1): 36-42, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29063803

RESUMO

Caregiving induces chronic stress with physical and psychological impact on informal caregivers health. Therefore, subjective and objective indicators are needed for the early diagnosis of pathologic stress to prevent the risk of developing stress-related diseases in caregivers. Our aim was to assess the self-perceived stress, that is, how and how much the stressor affects the individual, through endocrine, metabolic, and immunologic biomarkers levels in geriatric and oncologic informal caregivers. Informal caregivers and non-caregivers were invited to participate in a cross-sectional study at the Clinic Hospital of Barcelona. Demographic and lifestyle characteristics, self-perceived stress (Perceived Stress Scale, State-Trait Anxiety Inventory and Stress Visual Analogue Scale), and biomarkers (copeptin, glucose, glycated hemoglobin, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), cholesterol, triglycerides, α-amylase, cortisol, tumor necrosis factor (TNF-α), and Interleukins (IL-6 and IL-10)) were evaluated. Descriptive and non-parametric statistical data analysis were performed. Fifty-six subjects (19 non-caregivers, 17 geriatric caregivers, and 20 oncologic caregivers) participated. Median age (IQR) was 57 years (47-66) and 71.46% were women. Self-perceived stress was higher in oncologic caregivers than geriatric caregivers in all psychometric test analyzed (Wilcoxon Rank Sum test, p value < .05). Glucose concentrations and glycated hemoglobin levels differed statistically among groups (Kruskal-Wallis test (K-W tests), p value < .05), even though the median levels were not clinically relevant. Levels of other biomarkers did not differ significantly (K-W tests, p value > .05). These findings suggest that perceived stress is not homogeneous in the caregivers community and thus these two groups could be differentiated. These results provide the baseline information to initiate social actions addressed to each group of caregivers to increase their wellbeing.


Assuntos
Cuidadores/psicologia , Neoplasias/enfermagem , Estresse Psicológico/psicologia , Idoso , Ansiedade/psicologia , Glicemia/metabolismo , Estudos de Casos e Controles , Colesterol/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Estudos Transversais , Feminino , Hemoglobina A Glicada/metabolismo , Glicopeptídeos/metabolismo , Serviços de Saúde para Idosos , Humanos , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Psicometria , alfa-Amilases Salivares/metabolismo , Autoimagem , Autorrelato , Estresse Psicológico/metabolismo , Triglicerídeos/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Escala Visual Analógica
10.
Med Clin (Barc) ; 150(5): 167-177, 2018 03 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28736061

RESUMO

BACKGROUND AND OBJECTIVES: The aim of this study was to define the following in patients with acute heart failure (AHF) discharged directly from accident and emergency (A&E): rates of reconsultation to A&E and hospitalisation for AHF, and all-cause death at 30 days, rate of combined event at 7 days and the factors associated with these rates. PATIENTS AND METHOD: The study included patients consecutively diagnosed with AHF during 2 months in 27 Spanish A&E departments who were discharged from A&E without hospitalisation. We collected 43 independent variables, monitored patients for 30 days and evaluated predictive factors for adverse events using Cox regression analysis. RESULTS: We evaluated 785 patients (78±9) years, 54.7% women). The rates of reconsultation, hospitalisation, and death at 30 days and the combined event at 7 days were: 26.1, 15.7, 1.7 and 10.6%, respectively. The independent factors associated with reconsultation were no endovenous diuretics administered in A&E (HR 2.86; 95% CI 2.01-4.04), glomerular filtration rate (GFR)<60ml/min/m2 (1.94; 1.37-2.76) and previous AHF episodes (1.48; 1.02-2.13); for hospitalisation these factors were no endovenous diuretics in A&E (2.97; 1.96-4.48), having heart valve disease (1.61; 1.04-2.48), blood oxygen saturation at arrival to A&E<95% (1.60; 1.06-2.42); and for the combined event no endovenous diuretics in A&E (3.65; 2.19-6.10), GFR<60ml/min/m2 (2.22; 1.31-3.25), previous AHF episodes (1.95; 1.04-3.25), and use of endovenous nitrates (0.13; 0.02-0.99). CONCLUSION: This is the first study in Spain to describe the rates of adverse events in patients with AHF discharged directly from A&E and define the associated factors. These data should help establish the most adequate approaches to managing these patients.


Assuntos
Serviço Hospitalar de Emergência , Insuficiência Cardíaca/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Doença Aguda , Idoso , Causas de Morte , Gerenciamento Clínico , Diuréticos/uso terapêutico , Feminino , Seguimentos , Taxa de Filtração Glomerular , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Hipóxia/epidemiologia , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco , Espanha/epidemiologia
11.
Emergencias ; 29(4): 223-230, 2017 07.
Artigo em Espanhol | MEDLINE | ID: mdl-28825276

RESUMO

OBJECTIVES: To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. MATERIAL AND METHODS: We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. RESULTS: A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. CONCLUSION: Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.


Assuntos
Serviços Médicos de Emergência , Insuficiência Cardíaca , Transporte de Pacientes/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Ambulâncias , Comorbidade , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espanha , Transporte de Pacientes/métodos , Triagem
12.
Emergencias (St. Vicenç dels Horts) ; 29(4): 223-230, ago. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-165026

RESUMO

Objetivo. Investigar, en los pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) en servicios de urgencias hospitalarios (SUH), su forma de llegada, los factores asociados al tipo de transporte usado y el tratamiento prehospitalario administrado. Método. En pacientes diagnosticados consecutivamente de ICA en 34 SUH españoles se recogió: forma de llegada (transporte sanitario medicalizado -TSM-, no medicalizado -TSNM- o propio -TP-) y tratamiento prehospitalario administrado. Se estudiaron 27 variables independientes potencialmente relacionadas con el tipo de transporte utilizado. Como indicadores de gravedad se registraron nivel de triaje en urgencias, necesidad de ingreso y de cuidados intensivos, mortalidad intrahospitalaria y a 30 días. Resultados. Se incluyeron 6.106 pacientes [edad: 80 años (DE:10), 56,5% mujeres]; 47,2% llegaron en TP, 37,8% en TSNM y 15,0% en TSM. El uso de transporte sanitario se asoció a ser mujer, edad > 80 años, enfermedad pulmonar obstructiva crónica, antecedentes de ICA, dependencia funcional, NYHA III-IV, incontinencia esfínteres y presentar disnea, ortopnea, piel fría y depresión del sensorio/inquietud. La asignación de TSM se asoció directamente a vivir solo, antecedente de cardiopatía isquémica, presentar piel fría, depresión del sensorio o inquietud y temperatura elevada e inversamente al antecedente de caídas. Los traslados en TP, TSNM y TSM registraron porcentajes crecientes de tratamiento prehospitalario, y su gravedad también fue progresivamente creciente. El 73% de pacientes trasladados con TSM recibió oxígeno, el 29% diurético, el 13,5% vasodilatador y el 4,7% ventilación no invasiva. Conclusiones. Existen características del paciente con ICA relacionadas con el tipo de recurso asignado para su traslado al SUH, y dicha asignación parece corresponderse con la gravedad del episodio. El tratamiento durante el TSM podría incrementarse (AU)


Objectives. To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. Methods. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. Results. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Conclusions. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased (AU)


Assuntos
Humanos , Assistência Pré-Hospitalar/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Tratamento de Emergência/métodos , Transferência de Pacientes/organização & administração , Mortalidade , Oxigenoterapia , Vasodilatadores/uso terapêutico , Ventilação não Invasiva , Diuréticos/uso terapêutico
13.
Clin Res Cardiol ; 106(5): 369-378, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28005170

RESUMO

OBJECTIVE: To define the short- and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization. METHODS: We performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four variables on epidemiology, comorbidity, baseline status, vital signs, signs of congestion, laboratory tests, and treatment were collected in every patient. The primary outcome was a combined endpoint of ED revisit (without hospitalization) or hospitalization due to ADHF, or all-cause death. Secondary outcomes were each of these three events individually. Outcomes were obtained by survival analysis at different timepoints in the entire cohort, and crude and adjusted comparisons were carried out between patients discharged directly from the ED and after hospitalization. RESULTS: Of the 3233 patients diagnosed with ADHF during a 2-month period, we analyzed 2986 patients discharged alive: 787 (26.4%) discharged from the ED and 2199 (73.6%) after hospitalization. The cumulative percentages of events for the whole cohort (at 7/30/180 days) for the combined endpoint were 7.8/24.7/57.8; for ED revisit 2.5/9.4/25.5; for hospitalization 4.6/15.3/40.7; and for death 0.9/4.3/16.8. After adjustment for patient profile and center, significant increases were found in the hazard ratios for ED- compared to hospital-discharged patients in the combined endpoint, ED revisit and hospitalization, being higher at short-term [at 7 days, 2.373 (1.678-3.355), 2.069 (1.188-3.602), and 3.071 (1.915-4.922), respectively] than at mid-term [at 180 days, 1.368 (1.160-1.614), 1.642 (1.265-2.132), and 1.302 (1.044-1.623), respectively]. No significant differences were found in death. CONCLUSIONS: Patients with ADHF discharged from the ED have worse outcomes, especially at short term, than those discharged after hospitalization. The definition and implementation of effective strategies to improve patient selection for direct ED discharge are needed.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Quartos de Pacientes/estatística & dados numéricos , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Incidência , Estudos Longitudinais , Masculino , Recidiva , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento
16.
Rev. neurol. (Ed. impr.) ; 61(9): 405-415, 1 nov., 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-145394

RESUMO

Introducción. La Organización Mundial de la Salud ha calificado al estrés de ‘epidemia mundial’, debido a su cada vez mayor incidencia en la salud. El trabajo que se presenta en este artículo representa un intento de cuantificar objetivamente el nivel de estrés. Objetivo. La metodología desarrollada tiene como objetivo medir cuán lejos o cuán cerca se encuentra un sujeto de una situación considerada médica y socialmente como ‘normal’. Sujetos y métodos. Se ha realizado un estudio bibliográfico de la fisiopatología del estrés y sus métodos de estudio, en experimentación animal y en humanos. Se han puesto en marcha nueve estudios prospectivos observacionales con distintas tipologías de sujetos y estresores que cubren las diferentes tipologías de estrés. Resultados. Como resultado del estudio bibliográfico, se han identificado las distintas tipologías de estrés, los indicadores que describen resultados significativos, los tests psicométricos y los ‘agentes estresantes’ bien documentados. Este material ha permitido diseñar la metodología general y el detalle de los nueve ensayos clínicos. Los resultados preliminares obtenidos en algunos de los estudios han servido para validar los indicadores, así como la eficacia de las técnicas utilizadas experimentalmente para disminuir el estrés o para producirlo. Conclusiones. Los resultados preliminares obtenidos en los ensayos experimentales muestran que se está en el camino correcto hacia la definición y validación de marcadores multivariable para la cuantificación de los niveles de estrés, y sugieren que la metodología puede ser aplicada de forma similar al estudio de trastornos mentales (AU)


Introduction. The WHO has qualified stress as a ‘world epidemic’ due to its increasingly greater incidence on health. The work described in this paper represents an attempt to objectively quantify the level of stress. Aim. The aim of the method developed here is to measure how close or how far a subject is from a situation that can be considered ‘normal’ in medical and social terms. Subjects and methods. The literature on the pathophysiology of stress and its methods of study in experiments on both animals and humans was reviewed. Nine prospective observational studies were undertaken with different types of subjects and stressors covering the different types of stress. Results. The results of the literature review made it possible to identify the different types of stress, the indicators that yield significant results, the psychometric tests and the well-documented ‘stressors’. This material was then used to design the general method and the details of the nine clinical trials. The preliminary results obtained in some of the studies were used to validate the indicators as well as the efficacy of the techniques used experimentally to diminish stress or to produce it. Conclusions. The early results obtained in the experimental trials show that we are on the right path towards defining and validating multivariable markers for quantifying levels of stress and also suggest that the method can be applied in a similar way to the study of mental disorders (AU)


Assuntos
Animais , Humanos , Estresse Psicológico/patologia , Organização Mundial da Saúde/organização & administração , Saúde Global/classificação , Saúde Global/tendências , Biomarcadores/metabolismo , Homeostase/genética , Transtornos Mentais/metabolismo , Transtornos Mentais/psicologia , Ansiedade/psicologia , Teste de Stroop/estatística & dados numéricos , Estresse Psicológico/metabolismo , Pesos e Medidas , Organização Mundial da Saúde/economia , Saúde Global , Biomarcadores/análise , Homeostase/fisiologia , Transtornos Mentais/patologia , Ansiedade/metabolismo , Teste de Stroop/normas , Estudos Prospectivos
17.
Rev Neurol ; 61(9): 405-15, 2015 Nov 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26503316

RESUMO

INTRODUCTION: The WHO has qualified stress as a 'world epidemic' due to its increasingly greater incidence on health. The work described in this paper represents an attempt to objectively quantify the level of stress. AIM: The aim of the method developed here is to measure how close or how far a subject is from a situation that can be considered 'normal' in medical and social terms. SUBJECTS AND METHODS: The literature on the pathophysiology of stress and its methods of study in experiments on both animals and humans was reviewed. Nine prospective observational studies were undertaken with different types of subjects and stressors covering the different types of stress. RESULTS: The results of the literature review made it possible to identify the different types of stress, the indicators that yield significant results, the psychometric tests and the well-documented 'stressors'. This material was then used to design the general method and the details of the nine clinical trials. The preliminary results obtained in some of the studies were used to validate the indicators as well as the efficacy of the techniques used experimentally to diminish stress or to produce it. CONCLUSIONS: The early results obtained in the experimental trials show that we are on the right path towards defining and validating multivariable markers for quantifying levels of stress and also suggest that the method can be applied in a similar way to the study of mental disorders.


Assuntos
Estresse Fisiológico/fisiologia , Estresse Psicológico/fisiopatologia , Adulto , Biomarcadores/análise , Glicemia/análise , Criança , Eletrofisiologia , Feminino , Cabelo/química , Humanos , Hidrocortisona/análise , Masculino , Testes Neuropsicológicos , Psicometria , Saliva/química , Estresse Psicológico/psicologia
18.
PLoS One ; 9(7): e101616, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24988226

RESUMO

Autoimmune polyglandular syndrome type 1 (APS-1, OMIM 240300) is a rare autosomal recessive disorder, characterized by the presence of at least two of three major diseases: hypoparathyroidism, Addison's disease, and chronic mucocutaneous candidiasis. We aim to identify the molecular defects and investigate the clinical and mutational characteristics in an index case and other members of a consanguineous family. We identified a novel homozygous mutation in the splice site acceptor (SSA) of intron 5 (c.653-1G>A) in two siblings with different clinical outcomes of APS-1. Coding DNA sequencing revealed that this AIRE mutation potentially compromised the recognition of the constitutive SSA of intron 5, splicing upstream onto a nearby cryptic SSA in intron 5. Surprisingly, the use of an alternative SSA entails the uncovering of a cryptic donor splice site in exon 5. This new transcript generates a truncated protein (p.A214fs67X) containing the first 213 amino acids and followed by 68 aberrant amino acids. The mutation affects the proper splicing, not only at the acceptor but also at the donor splice site, highlighting the complexity of recognizing suitable splicing sites and the importance of sequencing the intron-exon junctions for a more precise molecular diagnosis and correct genetic counseling. As both siblings were carrying the same mutation but exhibited a different APS-1 onset, and one of the brothers was not clinically diagnosed, our finding highlights the possibility to suspect mutations in the AIRE gene in cases of childhood chronic candidiasis and/or hypoparathyroidism otherwise unexplained, especially when the phenotype is associated with other autoimmune diseases.


Assuntos
Mutação , Poliendocrinopatias Autoimunes/genética , Sítios de Splice de RNA , Fatores de Transcrição/genética , Sequência de Bases , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Moleculares , Dados de Sequência Molecular
19.
Med. clín (Ed. impr.) ; 137(13): 587-590, nov. 2011.
Artigo em Espanhol | IBECS | ID: ibc-92062

RESUMO

Fundamento y objetivo: Comparar la calidad técnica, los resultados de salud y el grado de satisfacción de los pacientes ingresados en una Unidad de Hospitalización a Domicilio (UHDOM) desde urgencias de los que lo hicieron desde una sala de hospitalización convencional. Pacientes y métodos: Estudio comparativo y descriptivo, con recogida de datos efectuada mediante revisión del informe de alta de los pacientes ingresados en la UHDOM y entrevista telefónica posterior. Se analizaron aspectos clínicos y de comorbilidad, resultados de salud, indicadores de calidad técnica y calidad percibida por pacientes y cuidadores.Resultados: Se incluyeron 111 pacientes (65 de urgencias y 46 de salas convencionales). Se realizó entrevista telefónica a 76 pacientes y 57 cuidadores. No se observaron diferencias en relación a los resultados de salud, indicadores de calidad técnica o calidad percibida de los pacientes. El tiempo de estancia hospitalaria fue inferior en los pacientes procedentes de urgencias (media [DE] de 1,02 [0,44] frente a 2,23 [0,94] días, p<0,0005).Conclusiones: Podría obviarse el período de hospitalización convencional y todos los pacientes candidatos, tras un período de observación en urgencias, podrían ingresar directamente en hospitalización domiciliaria (AU)


Background and objective: To compare technical quality, patient health outcomes, and satisfaction degree of patients admitted to hospital at home (HAH) from the emergency department (ED) with those with standard hospitalization (SH). Patients and methods: Comparative prospective study. Medical records of patients admitted to the HAH were reviewed and then they were also called and surveyed. The following variables were recorded: demographic and clinical aspects, patient health status at the time of phone survey, technical and perceived quality. Results: Patients included: 111 (65 from the ED and 46 from the SH). Phone survey was performed to 76 patients and 57 carers. Length of stay was significantly shorter in patients from the ED compared with those from SH (1.02±0.44 vs 2.23±0.94 days, P<.0005). No other differences were observed in patients’ demographics, clinical aspects and health status, in technical quality, and in perceived quality between both groups.Conclusion: When HAH is an option, these results seem to indicate that patient hospital stay can be shortened if HAH admittance is obvious, after a period of patient treatment and stabilization, from the ED instead from HAH (AU)


Assuntos
Humanos , Serviços Hospitalares de Assistência Domiciliar/tendências , Serviços Médicos de Emergência/organização & administração , Hospitalização/tendências , Satisfação do Paciente
20.
Med Clin (Barc) ; 137(13): 587-90, 2011 Nov 19.
Artigo em Espanhol | MEDLINE | ID: mdl-21940003

RESUMO

BACKGROUND AND OBJECTIVE: To compare technical quality, patient health outcomes, and satisfaction degree of patients admitted to hospital at home (HAH) from the emergency department (ED) with those with standard hospitalization (SH). PATIENTS AND METHODS: Comparative prospective study. Medical records of patients admitted to the HAH were reviewed and then they were also called and surveyed. The following variables were recorded: demographic and clinical aspects, patient health status at the time of phone survey, technical and perceived quality. RESULTS: Patients included: 111 (65 from the ED and 46 from the SH). Phone survey was performed to 76 patients and 57 carers. Length of stay was significantly shorter in patients from the ED compared with those from SH (1.02 ± 0.44 vs 2.23 ± 0.94 days, P<.0005). No other differences were observed in patients' demographics, clinical aspects and health status, in technical quality, and in perceived quality between both groups. CONCLUSION: When HAH is an option, these results seem to indicate that patient hospital stay can be shortened if HAH admittance is obvious, after a period of patient treatment and stabilization, from the ED instead from HAH.


Assuntos
Serviço Hospitalar de Emergência , Serviços Hospitalares de Assistência Domiciliar , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Eficiência Organizacional , Feminino , Serviços Hospitalares de Assistência Domiciliar/economia , Serviços Hospitalares de Assistência Domiciliar/normas , Hospitalização/economia , Hospitais Universitários , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Espanha
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