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6.
FEM (Ed. impr.) ; 18(4): 231-238, jul.-ago. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-142686

RESUMO

La asistencia médica en España ha experimentado en las últimas décadas del siglo pasado un importante desarrollo que ha dotado al país de un Sistema Nacional de Salud eficaz y acorde con los postulados de la medicina moderna. La evolución y el desarrollo normativo de la formación de los médicos especialistas en España arranca con la ley de 20 de julio de 1955, comienza el sistema de internado y residencia en 1966, y alcanza con el real decreto de 1978 el reconocimiento de las comisiones nacionales de las especialidades. Posteriormente, en el estatuto del residente de 2006, se desarrolla la relación laboral de residencia de los especialistas en ciencias de la salud, hasta finalizar con el real decreto de 2008, donde se clasifican las especialidades y se desarrolla el sistema de formación sanitaria especializada. En esta transformación de la práctica médica, se ha partido desde un sistema tradicional sin regulación, basado únicamente en la experiencia adquirida, hasta un sistema de formación de especialistas, conocido como sistema MIR, considerado en la actualidad como la columna vertebral de la organización y funcionamiento de nuestra medicina asistencial (AU)


Health care in Spain has experienced in the last decades of the last century an important development, which has provided the country with a National Health System, effective and consistent with the principles of modern medicine. The evolution and development of training policy for medical specialists in Spain starts with the law of 20 July 1955, the system begins internship and residency program starts in 1966, and reached with the royal decree of 1978, the recognition of national commissions specialties. Later in 2006 resident status of residence employment specialists develops in Health Sciences, finishing with royal decree of 2008 where the specialties are classified, and the system of specialized health training is developed. In this transformation of medical practice, a traditional party system without regulation based solely on the experience has changed into a specialist training system, known as MIR system, now regarded as the backbone of the organization and operation of our medical care (AU)


Assuntos
Humanos , Especialização/tendências , Educação Médica/tendências , Programas de Pós-Graduação em Saúde , Internato e Residência/organização & administração , História da Medicina
7.
Rev Esp Cardiol ; 63(1): 28-35, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20089223

RESUMO

INTRODUCTION AND OBJECTIVES: To investigate changes in the clinical characteristics, etiology and prognosis of prosthetic valve endocarditis at a tertiary-care hospital. METHODS: Retrospective cohort study of all patients diagnosed with prosthetic valve endocarditis using modified Duke criteria between 1986 and 2005. The analysis covered two time periods: January 1986 to December 1995 (P1) and January 1996 to December 2005 (P2). RESULTS: In total, 133 episodes of endocarditis occurred in 122 patients. Of these, 73 (54.9%) were diagnosed in P1 and 60 (45.1%) in P2, with incidences of 2.19% and 2.18%, respectively. The patients' mean age (SD) was 52.6+/-16.6 years in P1 and 66.2+/-11.5 years in P2 (P=.0001). Clinical characteristics were similar in the two study periods. The increase in Enterococcus infection was remarkable (12.5% in P2 vs. 4.9% in P1; relative risk [RR]=2.5; 95% confidence interval [CI], 0.7-9.6), as was the decrease in viridans group Streptococcus infection (12.5% in P2 vs. 31.1% in P1; RR=0.4; 95% CI, 0.2-0.9). Some 90.4% of patients (63/73) underwent surgery in P1, while 68.3% (41/60) underwent surgery in P2. The difference was significant (RR=0.8; 95% CI, 0.6-0.9). The in-hospital mortality rate was 28.8% in P1 and 30% in P2 (RR=1; 95% CI, 0.6-1.7). CONCLUSIONS: Changes in the epidemiology and microbiological etiology of prosthetic valve endocarditis were observed over the 20-year study period. Diagnostic and therapeutic approaches also changed, but mortality remained high.


Assuntos
Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Rev. esp. cardiol. (Ed. impr.) ; 63(1): 28-35, ene. 2010. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-75490

RESUMO

Introducción y objetivos. Estudiar la evolución de las características clínicas, la etiología y el pronóstico de la endocarditis sobre válvula protésica en un hospital de tercer nivel. Métodos. Estudio de cohortes retrospectivo de todos los pacientes diagnosticados de endocarditis sobre válvula protésica desde 1986 a 2005 según los criterios de Duke modificados. Se analizaron dos periodos temporales: enero de 1986 a diciembre de 1995 (P1) y enero de1996 a diciembre de 2005 (P2).Resultados. Se estudiaron 133 episodios en 122 pacientes. En 73 episodios (54,9%) la endocarditis fue diagnosticada en el P1 y en 60 (45,1%), en el P2 (incidencia del 2,19 y el 2,18% respectivamente). La edad, media ± desviación estándar, fue de 52,6 ± 16,6 años en el P1 y 66,2 ± 11,5 años en el P2 (p = 0,0001). Las características clínicas fueron similares en ambos periodos de estudio. Fue llamativo el incremento de infecciones por enterococo (el 12,5% en el P2 y el 4,9% en elP1; riesgo relativo [RR] = 2,5; intervalo de confianza [IC]del 95%, 0,7-9,6) así como el descenso de las infecciones por estreptococos del grupo viridans (el 12,5% en el P2 y el 31,1% en el P1; RR = 0,4; IC del 95%, 0,2-0,9). Los pacientes intervenidos en el P1 fueron el 90,4%(63/73), mientras que en el P2 fueron el 68,3% (41/60),diferencias que resultaron estadísticamente significativas(RR = 0,8; IC del 95%, 0,6-0,9). La mortalidad intrahospitalaria fue del 28,8% en el P1 y el 30% en el P2 (RR = 1;IC del 95%, 0,6-1,7).Conclusiones. Durante los 20 años de estudio, se ha observado un cambio en la epidemiología y la etiología microbiológica de la endocarditis sobre válvula protésica. El abordaje diagnóstico y terapéutico también se ha modificado, aunque la mortalidad se ha mantenido elevada (AU)


Introduction and objectives. To investigate changes in the clinical characteristics, etiology and prognosis of prosthetic valve endocarditis at a tertiary-care hospital. Methods. Retrospective cohort study of all patients diagnosed with prosthetic valve endocarditis using modified Duke criteria between 1986 and 2005. The analysis covered two time periods: January 1986 to December 1995 (P1) and January 1996 to December 2005 (P2).Results. In total, 133 episodes of endocarditis occurred in 122 patients. Of these, 73 (54.9%) were diagnosed in P1and 60 (45.1%) in P2, with incidences of 2.19% and 2.18%,respectively. The patients’ mean age (SD) was 52.6±16.6years in P1 and 66.2±11.5 years in P2 (P=.0001). Clinical characteristics were similar in the two study periods. The increase in Enterococcus infection was remarkable (12.5%in P2 vs. 4.9% in P1; relative risk [RR]=2.5; 95% confidence interval [CI], 0.7-9.6), as was the decrease in viridans group Streptococcus infection (12.5% in P2 vs. 31.1% in P1;RR=0.4; 95% CI, 0.2-0.9). Some 90.4% of patients (63/73)underwent surgery in P1, while 68.3% (41/60) underwent surgery in P2. The difference was significant (RR=0.8; 95%CI, 0.6-0.9). The in-hospital mortality rate was 28.8% in P1and 30% in P2 (RR=1; 95% CI, 0.6-1.7).Conclusions. Changes in the epidemiology and microbiological etiology of prosthetic valve endocarditis were observed over the 20-year study period. Diagnostic and therapeutic approaches also changed, but mortality remained high (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Endocardite/epidemiologia , Endocardite/terapia , Valva Tricúspide , Prognóstico , Fatores de Risco , Endocardite/classificação , Endocardite/complicações , Estudos Retrospectivos , Mortalidade Hospitalar
9.
J Thorac Cardiovasc Surg ; 139(4): 887-93, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19660339

RESUMO

OBJECTIVE: To compare early and late outcome of patients with prosthetic valve endocarditis treated medically versus surgically and to determine predictors of in-hospital death. We retrospectively reviewed patient's clinical records, including laboratory findings, surgery, and pathologic files, in an acute-care, 1200-bed teaching hospital. METHODS: One hundred thirty-three episodes of definite prosthetic valve endocarditis as defined by the Duke University diagnostic criteria occurred in 122 patients from January 1986 to December 2005. Logistic regression model was used to identify prognostic factors of in-hospital mortality. Long-term follow-up was made to assess late prognosis. RESULTS: Bioprostheses were involved in 52% of cases and mechanical valves in 48%. The aortic valve was affected in 45% of patients. Staphylococcus epidermidis was isolated in 23% of cases, Streptococcus spp in 21%, S aureus in 13%, and Enterococcus in 8%. Cultures were negative in 18% of cases. Twenty-six patients were treated medically and 107 with combined antibiotics and valve replacement. The operative mortality was 6.5% and the in-hospital mortality, 29%. Presence of an abscess at echocardiography, urgent surgical treatment, heart failure, thrombocytopenia, and renal failure were significant predictors of in-hospital death. Kaplan-Meier survival at 12 months was 42% in patients treated medically and 71% in those treated surgically (P = .0007). Freedom from endocarditis was 91% at the end of follow-up. CONCLUSIONS: Prosthetic valve endocarditis is a serious condition with high mortality. Patients with perivalvular abscess had a worse prognosis, and combined surgical and medical treatment could be the preferred approach to improve outcome.


Assuntos
Endocardite/mortalidade , Próteses Valvulares Cardíacas/microbiologia , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
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