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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 40-44, feb. 2020. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3435

RESUMO

Objetivo. Determinar el impacto pronóstico de la enfermedad pulmonar obstructiva crónica (EPOC) en los pacientes diagnosticados de enfermedad tromboembólica venosa (ETV) en servicios de urgencias (SU) españoles. Método. Análisis secundario del registro ESPHERIA que incluyó pacientes consecutivos con ETV sintomática en 53 SU. Resultados. Se incluyeron 801 pacientes de los que 71 (9%) tenían EPOC, siendo la tromboembolia pulmonar la forma de presentación más frecuente de ETV en este subgrupo de pacientes (77,5% vs 47,1%, p < 0,001). Los pacientes con EPOC tuvieron con más frecuencia disfunción de ventrículo derecho en la angiotomografía pulmonar (18,2% vs 13,1%; p < 0,001) y necesidad de soporte ventilatorio (7% vs 0,5%; p < 0,001). Los pacientes con ETV y EPOC tuvieron mayor incidencia de reingreso o mortalidad en el seguimiento a 180 días [HR 1,52 (IC 95% 1,00-2,29; p = 0,048)], comparados con los pacientes con ETV sin EPOC. Conclusiones. La EPOC tiene impacto pronóstico en los pacientes diagnosticados de ETV en SU españoles, en términos de mortalidad y reingreso hospitalario


Objective. To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments. Methods. Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry. Results. A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD. Conclusions. COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality

2.
Emergencias ; 32(1): 40-44, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909911

RESUMO

OBJECTIVES: To determine the impact of chronic obstructive pulmonary disease (COPD) on prognosis in patients diagnosed with venous thromboembolic disease (VTED) in Spanish emergency departments. MATERIAL AND METHODS: Secondary analysis of data from the ESPHERIA (Spanish acronym for Risk Profile of Patients VTED Attended in Spanish Emergency Departments) registry. RESULTS: A total of 801 patients, 71 (9%) with COPD, were included. Pulmonary thromboembolism was recorded in 77.%% of the patients with COPD (vs in 47.1% of patients without COPD; P<.001). Patients with COPD had evidence of right ventricular dysfunction on computed tomography angiography more often than other VTED patients (18.2% vs 13.1%; P<.001) and more often required ventilatory support (7% vs 0.5%; P<.001). VTED patients with COPD also had a higher rate of readmission or mortality at 180 days (hazard ratio, 1.52; 95% CI, 1.00-2.29; P = .048)] than patients without COPD. CONCLUSION: COPD affects the prognosis of patients diagnosed with VTED in Spanish emergency departments as evidenced by hospital readmission and mortality.

3.
BMC Infect Dis ; 19(1): 883, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646969

RESUMO

BACKGROUND: Penicillin G Benzathine (PGB) is the cornerstone of syphilis treatment. However, its intramuscular (IM) administration is associated with pain at the site of injection. The dilution of PGB with local anesthetics is recommended in some guidelines, but the evidence that supports it, particularly in adults and in HIV infection, is scarce. Preliminary clinical experience also suggests that the IM administration of PGB through increased needle gauges might improve its tolerability. The aim of the study to identify less painful ways of administering IM PGB in the treatment of syphilis in adults. METHODS: Multicenter, randomized, double-blinded clinical trial in patients diagnosed with primary syphilis that required a single IM injection of PGB 2400,00 IU. Patients were randomized to receive PGB diluted with 0.5 mL mepivacaine 1% (MV) or PGB alone, and both groups either with a long 19G or short 21G IM needle. The primary objective was the effect on local pain immediately after the administration through a visual scale questionnaire on pain (0 to 10). RESULTS: One hundred eight patients were included, 27 in each group. Ninety-four (94.4%) were male, and 41.7% were also HIV-infected. Mean age 36.6 years (SD 11). Significant differences in immediate pain intensity were observed when comparing the long 19G group with anesthesia (mean pain intensity, [MPI] 2.92 [CI 95% 1.08-4.07]) vs long 19G without anesthesia (MPI 5.56 [CI 95% 4.39-6.73), p < 0.001; and also between short 21G group with anesthesia (MPI 3.36 [CI 95% 2.22-4.50]) vs short 21G without anesthesia (MPI 5.06 [CI 95% 3.93-6.19]), p = 0.015). No significant differences in immediate pain were observed between 19G and 21G in the presence or absence of anesthesia (p = 1.0 in both cases). No differences were found between study arms after 6 and 24 h. CONCLUSIONS: The IM administration of 1% mepivacaine-diluted PGB induces significantly less immediate local pain as compared to PGB alone. The needle gauge did not have any effect on the pain. Based on these results, we suggest anesthetic-diluted IM PGB as the standard treatment for primary syphilis. TRIAL REGISTRATION: EudraCT 2014-003969-24 (Date of registration 18/09/2014).

4.
Rev. neurol. (Ed. impr.) ; 69(5): 181-189, 1 sept., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184455

RESUMO

Objetivo. Evaluar la adecuación y el efecto del tratamiento antiepiléptico preventivo en pacientes adultos con una primera crisis epiléptica en cuanto a resultados adversos a los 30 días del alta del servicio de urgencias hospitalario (SUH). Pacientes y métodos. ACESUR fue un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático. Se realizó seguimiento telefónico a los 30 días. Se recogieron variables clínicas en la visita índice y de resultado en seguimiento. La variable principal fue "tratamiento preventivo adecuado según indicaciones", y la de resultado, "algún resultado adverso" (recurrencia de crisis epiléptica, revisita a SUH, hospitalización o muerte) a los 30 días del alta de urgencias. Se realizó un modelo de regresión logística para aislar el efecto del tratamiento preventivo adecuado. Resultados. Se incluyó a 151 (22,7%) pacientes con una media de 55 años con primera crisis epiléptica, dados de alta de 18 SUH con datos de seguimiento. El tratamiento preventivo se consideró adecuado en 128 (84,8%) pacientes. Cuarenta y un (27,2%) pacientes presentaron algún resultado adverso a los 30 días del alta. Tras la regresión logística, el tratamiento preventivo adecuado al alta del SUH ejerce un efecto protector sobre la variable "algún resultado adverso a 30 días". Conclusiones. En el registro ACESUR, el tratamiento preventivo fue adecuado en la mayoría de los pacientes y su efecto resultó, de forma independiente, protector a los 30 días. Por tanto, el tratamiento preventivo adecuado podría mejorar los resultados a corto plazo de pacientes adultos dados de alta con una primera crisis epiléptica del SUH


Aim. To evaluate the adequacy and effect of preventive antiepileptic treatment in adult patients with the first epileptic seizure in adverse outcomes at 30 days after discharge from the hospital emergency department (HED). Patients and methods. ACESUR was an observational registry of multipurpose, prospective and multicentric cohorts with a systematic sampling. Phone follow-up was done at 30 days. Clinical variables were collected in the index visit and the follow-up result. The main variable was "adequate preventive treatment according to indications" and the result of "some adverse outcome" (recurrence of epileptic seizure, revisits to HED, hospitalization or death) 30 days after discharge from HED. A logistic regression model was used to isolate the effect of adequate preventive treatment. Results. 151 (22.7%) patients with a mean age of 55 years old were included with first epileptic seizure discharged from 18 HED with follow-up data. Preventive treatment was considered adequate in 128 (84.8%) patients. 41 (27.2%) patients presented some adverse outcome 30 days after discharge. After the logistic regression, the appropriate preventive treatment to the discharge of the HED exerts a protective effect on the variable "some adverse outcome to 30 days". Conclusions. In the ACESUR registry, preventive treatment was adequate for most patients and its effect was independent protective at 30 days. Therefore, adequate preventive treatment could improve the short-term results of adult patients discharged with the first epileptic seizure of the HED


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Anticonvulsivantes/administração & dosagem , Serviço Hospitalar de Emergência , Anticonvulsivantes/efeitos adversos , Convulsões/prevenção & controle , Epilepsia/tratamento farmacológico , Estudos Prospectivos , Seguimentos
5.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 245-251, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182765

RESUMO

Objetivo: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). Metodología: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. Resultados: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,283,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). Conclusiones: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias


Objective: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. Results: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). Conclusion: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Convulsões/epidemiologia , Alta do Paciente , Cuidados Críticos/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Estudos Prospectivos , Amostragem Aleatória e Sistemática
6.
Emergencias ; 31(4): 245-251, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31347804

RESUMO

OBJECTIVES: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. RESULTS: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). CONCLUSION: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure.

7.
Rev Esp Geriatr Gerontol ; 54(4): 195-202, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31128930

RESUMO

OBJECTIVES: To determine whether there are differences in the profile and in the care of adult patients with epileptic seizures in emergency department according to age ≥75 years, and if this is independently associated with results in the emergency department and 30 days after discharge. MATERIAL AND METHODS: ACESUR is a multicentre, prospective, observational cohort multipurpose register that was carried out in 2017. The distribution of the variables corresponding to the clinical presentation and care according to age ≥75 years were compared. Subsequently, logistic regression models were performed with the objective of evaluating the effect of age ≥75 years on the outcome variables. RESULTS: A total of 541 (81.5%) cases younger than 75 years were analysed compared to 123 adult patients (18.5%) of ≥75 years or more. In the group of long-lived it was observed significantly greater probability of dependence, co-morbidity, polypharmacy, a previous visit to the hospital emergency department, arrived by ambulance, first seizures and a symptomatic aetiopathogenic classification. In the multivariate analysis, after adjusting for the above variables, it is observed that age >75 years is associated independently with a higher incidence of specific supplementary tests (OR: 2.31; 95% CI: 1.21-4.44), but not pharmacological intervention (OR: 1.63; 95% CI: 0.96-2.80), or hospitalisation or extended stay in emergency departments (OR: 1.56; 95% CI: 0.94-2.59). On adjusting for all previous variables, age >75 years is associated with lower incidence of adverse events at 30 days (OR: 0.43; 95% CI: 0.25-0.77). CONCLUSIONS: In the ACESUR Registry, differences in clinical presentation and in the care of patients with seizures in emergency departments were identified when comparing those patients >75 years with those <75 years. Age ≥75 years is not independently associated with a higher incidence of intervention in emergency departments, or with more adverse outcomes at 30 days after discharge.

8.
Emergencias (Sant Vicenç dels Horts) ; 31(2): 91-98, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182525

RESUMO

Objetivo: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. Método: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. Resultados: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. Conclusiones: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido


Objective: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. Results: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). Conclusions: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs


Assuntos
Humanos , Adulto , Registros/normas , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Epilepsia/diagnóstico , Recidiva , Serviço Hospitalar de Emergência , Estudos Prospectivos , Amostragem Aleatória e Sistemática , Hospitais/estatística & dados numéricos , Convulsões/classificação , Convulsões/epidemiologia , Anticonvulsivantes/administração & dosagem , Tempo de Internação , Diagnóstico Diferencial
9.
Rev. esp. quimioter ; 32(2): 156-164, abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182817

RESUMO

Objetivo: Evaluar la capacidad del lactato o el índice de Charlson para mejorar la capacidad del SIRS y el qSOFA para identificar el riesgo de muerte a corto plazo de los pacientes ancianos, sin deterioro funcional grave, atendidos por sospecha de infección en urgencias. Metodología: Estudio de cohorte observacional prospectivo que incluyó a todos los pacientes de 75 años o más, sin deterioro funcional, atendidos por una infección aguda en 69 servicios de urgencias españoles durante 2 días en cada periodo estacional. Se recogieron datos demográficos, clínicos y analíticos. La variable de resultado principal fue la mortalidad por cualquier causa a los 30 días de la visita índice. Resultados: Se incluyeron 739 pacientes con una edad media de 84,9 (DE 6,0) años y 375 (50,7%) fueron mujeres. Noventa y un (12,3%) pacientes fallecieron dentro de los 30 días posteriores a la visita a urgencias. El ABC para el SIRS ≥ 2 y el qSOFA ≥ 2 fue de 0,637 (IC 95% 0,587-0,688; p<0,001) y 0,698 (IC 95% 0,635-0,761; p<0,001), respectivamente. La comparación entre esta curvas muestra una mejor capacidad de clasificación por parte del qSOFA ≥ 2 (p=0,041). Ambas escalas incrementan su capacidad de clasificación al añadir el lactato, siendo el ABC para SIRS más lactato de 0,705 (IC95% 0,652-0,758; p<0,001) y para qSOFA más lactato de 0,755 (IC95% 0,696-0,814; p<0,001), existiendo una tendencia estadística a un mejor rendimiento pronóstico de la segunda estrategia (p=0,0727). No ocurre lo mismo con el índice de Charlson, que no tiene efectos de mejora en la clasificación realizada con el SIRS (p=0,2269) ni con qSOFA (p=0,2573). Conclusiones: La inclusión de la valoración del lactato a las escalas SIRS y qSOFA mejoran su capacidad para identificar pacientes ancianos atendidos por infección en riesgo de muerte a corto plazo. La valoración del índice de Charlson no tiene efecto


Objective: The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). Methods: We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. Results: We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS ≥ 2 and 0.698 (IC 95% 0.635-0.761; p<0,001) for qSOFA ≥ 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). Conclusions: Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis/mortalidade , Tratamento de Emergência/métodos , Sepse/mortalidade , Antibacterianos/uso terapêutico , Valor Preditivo dos Testes , Risco Ajustado/métodos , Idoso Fragilizado/estatística & dados numéricos , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Resistência Microbiana a Medicamentos
10.
PLoS One ; 14(2): e0211732, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726278

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the main reasons for healthcare appointments and use of healthcare resources. In recent years, clinics specializing in COPD have been developed to offer improved care and optimization of recourses for patients with high complexity and frequent decompensations. However, little is known about the clinical practice in this clinical model specializing in COPD. The objectives of this study were to assess the prevalence, characteristics of specialized COPD outpatient respiratory clinics and to evaluate clinical practice in this healthcare model. METHODS: EPOCONSUL is a Spanish nationwide, observational, cross-sectional, clinical audit with prospective case recruitment including the clinical records for 4508 COPD cases from outpatient respiratory clinics over a 12-month period (May 2014-May 2015). The study evaluated clinical practice in 2378 cases from 28 hospitals with both general and specialized COPD outpatient respiratory clinics. RESULTS: Only 28 (47.5%) centers had an outpatient clinic specializing in COPD, which was characterized by longer patient visits and a higher prevalence of written protocols compared to a general clinic. Patients treated in a specialized clinic had greater obstruction severity, a higher degree of dyspnea and also suffered from more comorbidities. The majority of patients at both types of clinic were classified as high risk (81.1% versus 83%, p = 0.384) according to GesEPOC criteria. Clinical control of COPD was more frequent at specialized clinics, with significant differences in non-severe patients (70.5% versus 56.1%, p < 0.001). Testing was done more frequently in specialized clinics, with better adherence to good clinical practice recommendations. CONCLUSION: A specialized COPD outpatient clinic is a healthcare model found in few pulmonology departments that treats more severe patients and those with increased comorbidities. The COPD patients treated in a specialized clinic had a better clinical control, as defined by impact and clinical stability. It is a healthcare model to offer improved care with a higher degree of adherence to guidelines.


Assuntos
Instituições de Assistência Ambulatorial , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Auditoria Clínica , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Qualidade da Assistência à Saúde , Espanha
12.
Emergencias (Sant Vicenç dels Horts) ; 31(1): 27-35, feb. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182433

RESUMO

Objetivos: Demostrar la eficacia de una intervención integral en la transición de cuidados (Plan de Alta Guiado Multinivel, PAGM) para disminuir eventos adversos a 30 días en ancianos frágiles con insuficiencia cardiaca aguda (ICA) dados de alta desde servicios de urgencias (SU) y validar los resultados de dicha intervención en condiciones reales. Método: Se seleccionarán pacientes mayores de 70 años frágiles con diagnóstico principal de ICA dados del alta a su domicilio desde SU. La intervención consistirá en aplicar un PAGM: 1) lista de verificación sobre recomendaciones clínicas y activación de recursos; 2) programación de visita precoz; 3) transmisión de información a atención primaria; 4) hoja de instrucciones al paciente por escrito. Fase 1: ensayo clínico con asignación al azar por conglomerados emparejado. Se asignará de forma aleatoria 10 SU (N = 480) al grupo de intervención y 10 SU (N = 480) al grupo de control. Se compararán los resultados entre grupo de intervención y control. Fase 2: estudio cuasi-experimental. Se realizará la intervención en los 20 SU (N = 300). Se comparará los resultados entre la fase 1 y 2 del grupo de intervención y entre la fase 1 y 2 del grupo de control. La variable principal de resultado es compuesta (revisita a urgencias u hospitalización por ICA o mortalidad de origen cardiovascular) a los 30 días del alta. Conclusiones: El estudio valorará la eficacia y factibilidad de una intervención integral en la transición de cuidados para reducir resultados adversos a 30 días en ancianos frágiles con ICA dados de alta desde los SU


Objectives: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. Method: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. Conclusions: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home


Assuntos
Humanos , Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Transferência de Pacientes , Alta do Paciente , Doença Aguda , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
13.
Emergencias ; 31(1): 27-35, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30656870

RESUMO

OBJECTIVES: To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days of emergency department (ED) discharge. MATERIAL AND METHODS: We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs will be randomly assigned to the intervention group and 10 to the control group. Each group will enroll 480 patients, and the outcomes will be compared between groups. Phase 2 will be a quasi-experimental study of the intervention in 300 new patients enrolled by the same 20 EDs. The outcomes will be compared to those for each Phase-1 group. The main endpoint at 30 days will be a composite of 2 outcomes: revisits to an ED and/for hospitalization for AHF or cardiovascular death. CONCLUSION: The study will assess the efficacy and feasibility of comprehensive MGDP transfer of care for frail older AHF patients discharged home.


Assuntos
Assistência ao Convalescente/métodos , Idoso Fragilizado , Insuficiência Cardíaca/terapia , Planejamento de Assistência ao Paciente , Alta do Paciente , Transferência de Pacientes , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem , Protocolos Clínicos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Análise por Pareamento , Estudos Prospectivos , Projetos de Pesquisa
14.
Steroids ; 141: 104-113, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30503386

RESUMO

This article studies the genetic influence of polymorphism of the UGT2B17 gen on the urinary steroid profile and its implications for the anti-doping field. The study presents the results of a triple-blind randomized placebo-controlled crossover trial with healthy athletes submitted to a single dose of 250 mg of testosterone cypionate. Forty urine samples were collected from each participant. Mass spectrometry-based techniques commonly used in Anti-Doping laboratories, were employed to measure the urinary concentration and the Δδ13C values of a selection of target compounds for testosterone (T) administration together with LH. Twelve volunteers were included in the study; the polymorphism was evenly distributed among them. After T administration, the most meaningful change affected the Testosterone/Epitestosterone ratio (T/E) and the urinary concentration of LH. In relation with T/E, the wild type homozygous (ins/ins) group there was a mean relative increase of 30 (CI 95%: 25.2 to 36.7); in the heterozygous mutant (del/ins) group it was 19.8 (CI 95%:15.9 to 24.7); and in the homozygous mutant (del/del) group it was 19.7 (CI 95% 14.9 to 26.2). In the case of LH, it́s observed how LH values decrease significantly after the administration of Testex homogeneously among the three groups. The main outcome was related to the (del/del) group (homozygous mutant), where due to the depressed basal level of the steroid profile, if the longitudinal steroid profile of the athlete was not available, the analysis by GC/MS would not produce an "atypical" result according to the WADA TD2016EAAS despite the T administration. However, the genotyping of the UGT2B17 polymorphism, the follow up of LH and the use of GC-C-IRMS makes it possible to identify most of these samples as Adverse.


Assuntos
Glucuronosiltransferase/genética , Antígenos de Histocompatibilidade Menor/genética , Polimorfismo Genético/genética , Testosterona/análogos & derivados , Adulto , Atletas , Estudos Cross-Over , Cromatografia Gasosa-Espectrometria de Massas , Glucuronosiltransferase/sangue , Glucuronosiltransferase/deficiência , Humanos , Injeções Intramusculares , Masculino , Antígenos de Histocompatibilidade Menor/sangue , Mutação , Testosterona/administração & dosagem , Testosterona/urina
15.
Aten. prim. (Barc., Ed. impr.) ; 50(8): 467-476, oct. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179130

RESUMO

Objetivo: Estudiar la asociación entre prescripciones potencialmente inapropiadas (PPI) y eventos adversos a los 30 y 180 días tras el alta de una unidad de corta estancia (UCE). Material y método: Estudio analítico observacional de cohortes retrospectivo que incluyó pacientes ≥ 75 años al alta de una UCE. Se utilizó la versión2 de los criterios STOPP-START. La variable resultado fue la presencia de algún evento adverso a 30 y 180 días. Resultados: Se incluyeron 179 pacientes con una media de 84 (DE:5) años. La presencia de ≥ 1PPI al alta no se asoció con la aparición de algún evento adverso a los 30 ni a los 180días de manera global. La presencia de ≥ 1PPI al alta de fármacos del proceso cardiovascular tuvo mayor riesgo de presentar algún evento adverso a los 30 días del alta (OR ajustada 2,1; IC 95%: 1,0-3,2; p = 0,045), los fármacos del proceso "neuropsiquiátrico y riesgo de caídas" se relacionaron con deterioro funcional a los 30 días del alta (OR ajustada 6,3; IC 95%: 1,7-22,5; p = 0,005), y la omisión de fármacos del sistema cardiovascular se asoció con el reingreso a los 180 días (OR ajustada 3,6; IC95%: 1,5-8,3, p = 0,003). Conclusiones: La presencia de eventos adversos de pacientes ancianos dados de alta de una UCE podría relacionarse con PPI detectadas por algunos criterios STOPP-START, y concretamente con los fármacos de los procesos cardiovasculares, neuropsiquiátrico y relacionado con las caídas


Objective: To study the association between the potential inappropriate prescriptions (PIP) and the 30 and 180-day adverse event rate after discharge from a Short Stay Unit (SSU). Methodology: A retrospective cohort observational study was conducted on patients aged ≥ 75 years discharged from an SSU from February to April, 2014. STOPP-START criteria version2 was used. The main outcome was 30 and 180-day adverse event rate after being discharged. Results: A total of 179 patients, with a mean age of 84 (SD5) years were included. The presence of ≥ 1PIP after being discharged was not associated with a 30 and 180-day composite adverse event. Patients with ≥1PIP related to a cerebro-cardiovascular process were at higher risk of an adverse event at 30 days after discharge (adjusted OR, 2.1; 95% CI: 1.0-3.2; P = .045), those with ≥1PIP related to neuropsychiatric process and risk of fall were at higher risk of increased 30-day functional impairment (adjusted OR, 6.3; 95% CI: 1.7-22.5; P = .005), and those with ≥ 1PIP related to omission of cardiovascular system were at higher risk of 180-day hospital readmission (adjusted OR, 3.6; 95% CI: 1.5-8.3; P = .003). Conclusions: The presence of adverse events in older patients discharged from SSU may be associated with PIP, identified by STOPP-START criteria, and more specifically with drugs related to cardiovascular, neuropsychiatric disorders, and falls


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/estatística & dados numéricos , Assistência a Idosos/estatística & dados numéricos , Estudos Retrospectivos , Estudo Observacional , Estudos de Coortes
16.
Emergencias (Sant Vicenç dels Horts) ; 30(5): 315-320, oct. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179507

RESUMO

Objetivos. Diseñar una escala de puntuación multidimensional con el fin de estratificar el riesgo de mortalidad a 180 días entre los ancianos ingresados en las unidades de corta estancia (UCE). Métodos. Estudio analítico observacional de cohortes prospectivo multicéntrico que seleccionó todos los pacientes >= 75 años ingresados en 5 UCE españolas del 1 de febrero al 30 de abril de 2014. Se recogieron variables demográficas, clínicas y de la valoración geriátrica. Se derivó un modelo de regresión logística multinivel para identificar los factores independientemente asociados con la mortalidad a 180 días y después se construyó una escala de puntuación. Resultados. Se incluyeron 593 pacientes (edad media 83,4 años, DE: 5,9; 359 mujeres, 60,7%), y 92 (15,5%) fallecieron a los 180 días. La escala de puntuación 6M UCE-SCORE incluyó la edad >= 85 años (1 punto), sexo varón (1 punto), presencia de pérdida de apetito o peso involuntaria en los últimos 3 meses (1 punto), síndrome confusional agudo (2 puntos), dependencia en las actividades básicas de la vida diaria al ingreso (2 puntos) y úlceras por presión (2 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), intermedio (3-5 puntos) y alto (6-9 puntos) riesgo, con una mortalidad a 180 días de 5%, 18% y 54%, respectivamente. El ABC COR del modelo tras remuestreo fue de 0,72 (IC95%: 0,65-0,78). Conclusiones. La escala de puntuación 6M UCE-SCORE podría ser de utilidad a la hora de estratificar el riesgo a 6 meses entre los ancianos ingresados en las UCE con el fin de diseñar un plan individualizado de cuidados


Objectives. To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). Methods. Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. Results. Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65–0.78). Conclusion. The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Tempo de Internação/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Hospitais Universitários , Idoso , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estudos de Coortes , Estudo Observacional
17.
Emergencias ; 30(5): 315-320, 2018 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30260115

RESUMO

OBJECTIVES: To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). MATERIAL AND METHODS: Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. RESULTS: Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65-0.78). CONCLUSION: The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk.


Assuntos
Técnicas de Apoio para a Decisão , Mortalidade Hospitalar , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Unidades Hospitalares , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Estudos Prospectivos , Curva ROC , Medição de Risco , Fatores de Risco , Espanha
18.
PLoS One ; 13(6): e0198777, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29953442

RESUMO

BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing. METHODS: EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics. RESULTS: A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05). CONCLUSION: Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.


Assuntos
Assistência Ambulatorial , Auditoria Clínica , Doença Pulmonar Obstrutiva Crônica/sangue , Deficiência de alfa 1-Antitripsina/sangue , alfa 1-Antitripsina/sangue , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espanha/epidemiologia , Deficiência de alfa 1-Antitripsina/epidemiologia
19.
Arch. bronconeumol. (Ed. impr.) ; 54(5): 270-279, mayo 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176141

RESUMO

Introducción: EPOCONSUL es la primera auditoría nacional que analiza la atención sanitaria de la EPOC en consultas de neumología en España. El objetivo principal fue determinar, en un análisis retrospectivo, la distribución de los niveles de riesgo de la EPOC según GesEPOC 2017 y evaluar las actuaciones clínicas según las nuevas recomendaciones. Material y métodos: Es una auditoría clínica de diseño trasversal, con reclutamiento de casos consecutivos de EPOC durante un año. Se evaluó el nivel de riesgo y el fenotipo clínico según GesEPOC 2017 y su relación con las intervenciones clínicas realizadas. Resultados: El nivel de alto riesgo fue más frecuente (79,8 versus 20,2%; p < 0,001) y se caracterizó por un mayor nivel de gravedad medido por los índices BODE y BODEx, además de por mayor comorbilidad. El fenotipo clínico más frecuente fue el no agudizador. La opción más utilizada en el bajo riesgo fue la monoterapia broncodilatadora (en un 34,8%) y la triple terapia en el alto riesgo (en un 53,7%). En el alto riesgo fue más frecuente la caracterización por fenotipos (57,6 versus 52%; p = 0,014) y la realización de pruebas de función respiratoria: volúmenes pulmonares (47,7 versus 35,8%; p < 0,001), test de difusión (51,4 versus 42,1%; p < 0,001) y test de marcha (37,8 versus 15,8%; p < 0,001). Conclusiones: La mayoría de los pacientes atendidos en las consultas de neumología fueron de alto riesgo y con fenotipo clínico no agudizador. La práctica clínica realizada fue diferente según el nivel de riesgo y mayoritariamente acorde con las recomendaciones de GesEPOC, aunque con importantes áreas de mejora


Introduction: EPOCONSUL is the first national audit to analyze medical care for COPD in pulmonology departments in Spain. The main objective was to perform a retrospective analysis to determine the distribution of GesEPOC 2017 COPD risk levels and to evaluate clinical activity according to the new recommendations. Material and methods: This is a cross-sectional clinical audit in which consecutive COPD cases were recruited over one year. The study evaluated risk and clinical phenotype according to GesEPOC 2017, and their correlation with the clinical interventions employed. Results: The most common risk category was high risk (79.8% versus 20.2%; p < 0.001), characterized by a higher level of severity on BODE and BODEx indexes, and a higher comorbidity burden. The most common phenotype was non-exacerbator. The most commonly used treatment in low-risk patients was bronchodilator monotherapy (34.8%) and triple therapy in high-risk patients (53.7%). High risk was most frequently characterized by phenotype (57.6% versus 52%; p = 0.014) and pulmonary function test results: lung volume (47.7% versus 35.8%; p < 0.001), lung diffusion (51.4% versus 42.1%; p < 0.001) and walk test (37.8% versus 15.8%; p < 0.001). Conclusions: Most patients treated in pulmonology departments were high-risk and non-exacerbator phenotype. Clinical interventions differed according to risk level and mainly followed GesEPOC recommendations, although there is significant room for improvement


Assuntos
Humanos , Masculino , Feminino , Atenção à Saúde , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fenótipo , Grau de Risco , Estudos Retrospectivos , Auditoria Médica
20.
Aten. prim. (Barc., Ed. impr.) ; 50(4): 222-227, abr. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173175

RESUMO

Objetivo: Identificar factores predictores de hiperfrecuentación en Atención Primaria (AP) en una muestra de pacientes hiperfrecuentadores (HF) en servicios de urgencias hospitalarios (SUH). Diseño: Estudio observacional retrospectivo multicéntrico. Participantes: Se seleccionaron pacientes mayores de 14 años HF en el SUH entre el 1 de enero y el 31 de diciembre de 2013. Emplazamiento: se reclutaron pacientes atendidos en los SUH de 17 hospitales públicos de la Comunidad de Madrid. Método: Se recogieron variables relativas a la visita índice del SUH. Se analizó la muestra en función de ser o no HF en AP. Se considera HF al paciente que realizó al menos 10 visitas en cada nivel asistencial durante un año. Resultados: Se incluyeron 1.284 pacientes HF en SUH. Se analizaron 423 (32,9%) HF en AP con 16 visitas (RIC 12-25) frente a 861 (67,1%) pacientes no HF en AP con 4 visitas (RIC 2-6). Factores independientes predictores de HF en AP fueron la edad > 65 años (OR: 1,51; IC 95%: 1,07-2,13; p = 0,019), el deterioro cognitivo (OR: 1,63; IC 95%: 1,01-2,65; p = 0,049), el número de fármacos ≥3 (OR: 1,56; IC 95%: 1,06-2,30; p = 0,025) y vivir en la comunidad frente a vivir institucionalizado o en la calle (OR: 3,05; IC 95%: 1,14-8,16; p = 0,026). Conclusiones: En una muestra de pacientes HF en los SUH, el hecho de ser mayor de 65 años, tomar 3 o más fármacos, presentar deterioro cognitivo y vivir en la comunidad se consideran factores predictores de ser HF también en AP


Objective: To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED). Design: This was an observational, retrospective, multicentre cohort study. Participants: The HF patients were selected from patients seen in the ED between January 1 and December 31, 2013. Setting Patients were recruited from 17 public hospitals of the Community of Madrid, Spain. Method: Variables on the index visit to the ED were collected. The sample was analysed in terms of being or not being an HF user in PHC. An HF user is considered a patient who made at least 10 visits in each level of care for a year. Results: A total of 1284 HF patients were included. An analysis was performed on 423 (32.9%) HF users in ED with 16 (12-25) visits to PHC vs. 861 (67.1%) non-HF users in ED, with 4 (2-6) visits to PHC. Independent predictors of HF in PHC: over 65 years (OR: 1.51; 95% CI: 1.07-2.13; P=.019), cognitive impairment (OR: 1.63; 95% CI: 1.01-2.65; P = .049), taking > 3 drugs (OR: 1.56; 95% CI: 1.06-2.30; P = .025), and living in the community vs. nursing home or homeless (OR: 3.05; 95% CI: 1.14-8.16; P = .026). Conclusions: Among HF patients in the ED, the fact that of being over 65 years, taking 3 or more drugs, suffering cognitive impairment, and living in the community, are also considered to be predictors of HF in PHC


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Serviços Médicos de Emergência/métodos , Atenção Primária à Saúde , Polimedicação , Fatores de Risco , Visita a Consultório Médico/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Comorbidade , Intervalos de Confiança , Razão de Chances , Disfunção Cognitiva/epidemiologia
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