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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 9-18, feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-3431

RESUMO

Objetivos. Analizar qué características clínicas y del ECG de la primera valoración de pacientes con dolor torácico no traumático (DNT) se asocian con una clasificación inicial de sospecha de síndrome coronario agudo (SCA) y con el diagnóstico final de SCA, e identificar cuáles resultan sobre o infravaloradas durante la clasificación inicial. Método. Se incluyeron las consultas consecutivas por DTNT en una unidad de dolor torácico durante 10 años (2008-2017) en las que se disponía de los diagnósticos inicial de sospecha (SCA/no SCA) y final de alta de urgencias (SCA/no SCA). Se incluyeron 33 variables independientes (2 demográficas, 5 comorbilidad cardiovascular, 22 dolor torácico, 4 datos ECG). Se calcularon las odds ratio (OR) para la clasificación (inicial y final) como SCA para cada variable independiente, crudas y ajustadas en modelos globales que incluían todas ellas. En estos modelos ajustados se comparó si las OR para la clasificación inicial y final como SCA eran significativamente diferentes. Resultados. Se incluyeron 34.552 visitas. Las 33 variables analizadas mostraron asociación significativa para la clasificación inicial y final del DTNT como SCA, y en muchos casos esta asociación se mantuvo en el modelo ajustado. Diecinueve variables mostraron OR significativamente diferentes para la sospecha inicial de SCA que para el diagnóstico final de SCA: 10 sobrestimaban la asociación final y 9 la subestimaban. Conclusión. Los datos clínicos iniciales clásicamente utilizados para sospechar SCA pacientes con DTNT en urgencias identifican todos ellos individualmente a pacientes con riesgo incrementado de ser clasificado inicial y finalmente como SCA; sin embargo, algunos de ellos sobreestiman y otros subestiman inicialmente el riesgo final. Los urgenciólogos debieran sensibilizarse más con estos datos subestimados


Objectives. To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS. Methods. Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008–2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables. Results. A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it. Conclusions. The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Análise de Dados , Ficha Clínica , Eletrocardiografia/estatística & dados numéricos , Dor no Peito/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Indicadores Básicos de Saúde , Razão de Chances , Modelos Logísticos , Análise Multivariada
2.
Emergencias ; 32(1): 9-18, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909907

RESUMO

OBJECTIVES: To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS. MATERIAL AND METHODS: Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008-2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables. RESULTS: A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it. CONCLUSION: The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk.

4.
Emergencias ; 30(5): 365, 2018 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30260133
5.
Med Sci (Basel) ; 6(3)2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30087300

RESUMO

Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented. On the other hand, the implementation of those interventions also involves different challenges. Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs.

6.
Emergencias (Sant Vicenç dels Horts) ; 30(3): 163-168, jun. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-172956

RESUMO

Objetivo. Investigar la relación entre las características demográficas y experiencia de los enfermeros que realizan triaje y la asignación de pacientes a un determinado nivel de urgencia. Método. Estudio observacional retrospectivo llevado a cabo durante 1 año en el área de triaje de un hospital universitario terciario que usa el Model Andorrà de Triatge/Sistema Español de Triage (MAT/SET). Variables: edad, sexo, experiencia en enfermería, experiencia en triaje, turno de trabajo, nivel asistencial donde trabajaban, número de triajes realizados y porcentaje de pacientes asignados a cada nivel de triaje. Resultados. Se incluyeron 50 enfermeros (5 hombres y 45 mujeres) con una edad de 45 (DE 9) años que efectuaron 67.803 triajes. Los enfermeros del turno mañana clasificaban más pacientes en el nivel 5 que las de turno tarde (7,9% frente a 5,5%, p = 0,003). Este mayor porcentaje en el nivel 5 también se registraba de forma significativa cuanta más edad tenía el enfermero (β = 0,092, p = 0,037) y cuanta mayor experiencia acumulaba (β = 0,103, p = 0,017). El número de triajes efectuados por cada enfermero se relacionó, significativa y directamente, con el porcentaje de pacientes clasificados en nivel 3 (β = 0,003, p = 0,006) e, inversamente, con el porcentaje de pacientes clasificados en nivel 4 (β = -0,002, p = 0,008) y en nivel 5 (β = -0,001, p = 0,017). Conclusión. Se ha objetivado una relación entre la edad, la experiencia acumulada, el turno de trabajo y el número total de triajes que efectúa un enfermero con el nivel de triaje asignado


Objective. To study the relation between nursing staff demographics and experience and their assignment of triage level in the emergency department. Methods. One-year retrospective observational study in the triage area of a tertiary care urban university hospital that applies the Andorran–Spanish triage model. Variables studied were age, gender, nursing experience, triage experience, shift, usual level of emergency work the nurse undertakes, number of triage decisions made, and percentage of patients assigned to each level. Results. Fifty nurses (5 men, 45 women) with a mean (SD) age of 45 (9) years triaged 67 803 patients during the year. Nurses classified more patients in level 5 on the morning shift (7.9%) than on the afternoon shift (5.5%) (P=.003). The difference in the rate of level-5 triage classification became significant when nurses were older (β = 0.092, P=.037) and experience was greater (β = 0.103, P=.017). The number of triages recorded by a nurse was significantly and directly related to the percentage of patients assigned to level 3 (β = 0.003, P=.006) and inversely related to the percentages assigned to level 4 (β = -0.002, P=.008) and level 5 (β = -0.001, P=.017). Conclusion. We found that triage level assignments were related to age, experience, shift, and total number of patients triaged by a nurse


Assuntos
Humanos , Triagem/classificação , Cuidados de Enfermagem/métodos , Tratamento de Emergência/classificação , Competência Profissional , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Serviço Hospitalar de Emergência/estatística & dados numéricos
7.
Emergencias ; 30(3): 163-168, 2018 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29687670

RESUMO

OBJECTIVES: To study the relation between nursing staff demographics and experience and their assignment of triage level in the emergency department. MATERIAL AND METHODS: One-year retrospective observational study in the triage area of a tertiary care urban university hospital that applies the Andorran-Spanish triage model. Variables studied were age, gender, nursing experience, triage experience, shift, usual level of emergency work the nurse undertakes, number of triage decisions made, and percentage of patients assigned to each level. RESULTS: Fifty nurses (5 men, 45 women) with a mean (SD) age of 45 (9) years triaged 67 803 patients during the year. Nurses classified more patients in level 5 on the morning shift (7.9%) than on the afternoon shift (5.5%) (P=.003). The difference in the rate of level-5 triage classification became significant when nurses were older (ß = 0.092, P=.037) and experience was greater (ß = 0.103, P=.017). The number of triages recorded by a nurse was significantly and directly related to the percentage of patients assigned to level 3 (ß = 0.003, P=.006) and inversely related to the percentages assigned to level 4 (ß = -0.002, P=.008) and level 5 (ß = -0.001, P=.017). CONCLUSION: We found that triage level assignments were related to age, experience, shift, and total number of patients triaged by a nurse.


Assuntos
Competência Clínica/estatística & dados numéricos , Serviço Hospitalar de Emergência , Recursos Humanos de Enfermagem no Hospital , Padrões de Prática em Enfermagem/estatística & dados numéricos , Triagem/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha
8.
Emerg Med J ; 28(10): 841-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20961935

RESUMO

OBJECTIVE: To validate a triage flowchart to rule out acute coronary syndrome (ACS) in chest pain patients attending the emergency department (ED). METHODS: An observational cohort study of consecutive patients. In all cases, a previously derived five-step triage flowchart (age ≤ 40 years, absence of diabetes, not previously known coronary artery disease, non-oppressive and non-retrosternal pain) was applied. Patients meeting all five discriminators were grouped as 'five-step triage non-ACS', the rest as 'five-step triage ACS'. The same strategy was used with a four-step model (without age ≤ 40 years). After ED study and 1-month follow-up, patients were definitively classified as 'true ACS' or 'true non-ACS'. Validity indexes and receiver operating characteristics curves were calculated. RESULTS: 4231 patients were included: 918 (21.7%) were 'true ACS', 3303 (78.1%) 'true non-ACS'; 10 (0.2%) were lost to follow-up. The five-step triage flowchart classified 4000 (94.8%) as 'triage ACS' and 221 (5.2%) as 'triage non-ACS'; none of the latter was 'true ACS'. The four-step model classified 3194 (75.6%) as 'triage ACS' and 1027 (24.4%) as 'triage non-ACS'. A 'true ACS' was seen in 26 patients from the latter group. Accordingly, five-step triage flowchart specificity and positive predictive value (PPV) to rule out ACS were 100% (95% CI 100% to 100%). For the four-step model specificity and PPV were 97% (95% CI 96% to 98%). CONCLUSION: The five-step triage flowchart identifies chest pain patients without an ACS. However, only 5% of these patients meet these five criteria. A simpler model allows greater patient inclusion but a higher risk of misclassification of true ACS.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Árvores de Decisões , Triagem/métodos , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
10.
Am J Emerg Med ; 27(6): 660-7, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19751622

RESUMO

AIM: To determine predictors of frequent chest pain unit (CPU) users and to identify characteristics and outcomes of their CPU visits. PATIENTS AND METHODS: Observational prospective case-control study. Frequent CPU user was defined by 3 or more CPU visits within the study year. A control patient and a control visit were randomly selected for each case patient and case visit. Demographic, clinical, and outcome variables were collected from medical record and phone interview performed in a 30-day interval. A multivariate logistic regression analysis was used to identify frequent CPU users' predictors. RESULTS: Of 1934 patients presenting during the year, 80 (4.1%) met the definition for case patient. They accounted for 352 (13%) of 2709 CPU visits. Sixty-seven (83.7%) case patients and 71 (88.7%) control patients were contacted. The final predictors were the following: Karnofsky Performance Scale of 70 or lesser (odds ratio [OR], 5.24 [95% confidence interval {CI}, 1.71-16.06]), previous hospitalization (OR, 3.76 [95% CI, 1.49-9.49]), previously known coronary artery disease (OR, 3.72 [95% CI, 1.32-10.52]), and symptoms of depression (OR, 2.98 [95% CI, 1.14-7.78]). Case visits were more likely at night (OR, 2.41 [95% CI, 1.64- 3.52]), generated more diagnostic uncertainty (OR, 2.39 [95% CI, 1.71-3.35]), but did not increase the need of hospital admission. CONCLUSIONS: Frequent CPU user is associated with previously known coronary artery disease, previous hospitalization, impaired performance status, and presence of symptoms of depression. They are more likely to arrive on CPU at night and generate more diagnostic uncertainty.


Assuntos
Dor no Peito/diagnóstico , Unidades Hospitalares/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Dor no Peito/psicologia , Doença da Artéria Coronariana/diagnóstico , Depressão/epidemiologia , Feminino , Hospitais com mais de 500 Leitos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva , Espanha
11.
Emergencias (St. Vicenç dels Horts) ; 21(2): 105-113, abr. 2009. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-59928

RESUMO

Objetivo: Analizar el desarrollo y los resultados obtenidos con la puesta en marcha del circuito “Código Ictus” (CI), tanto en su fase de implementación intrahospitalaria, en un primer periodo, como en la fase de implementación intra y extrahospitalaria, en un segundo periodo. Método: Se definieron 2 periodos: un primer periodo A de 8 meses con circuito CI intrahospitalario y un segundo periodo B de 12 meses con circuito CI intra y extrahospitalario. De cada periodo se contabilizaron el número de ictus con criterio de CI, los CI activados, los CI con estudio completado y aquéllos que acabaron recibiendo tratamiento fibrinolítico. Finalmente se compararon los 2 periodos descritos (..) (AU)


Conclusiones: Estos resultados reflejan que la puesta en marcha de una atención protocolizaday consensuada entre los dispositivos extra e intrahospitalarios para los pacientescon ictus de menos de 3 horas de evolución consigue un porcentaje final de ictus fibrinolizadosdel 6%, lo cual no supone un incremento porcentual de tratamiento fibrinolíticorespecto al periodo de protocolo exclusivamente intrahospitalario. De este estudio seextrae, además, que las principales causas por las que no se consigue aumentar esteporcentaje son por una parte la tardanza en la llegada del paciente a urgencias y la presenciade diagnósticos alternativos, por otra. [Emergencias 2009;21:105-113]


Objective: To analyze the implementation of a stroke code protocol and the results obtained in an initial phase inside a hospital and in a second phase during which the stroke code was also used for attending emergencies outside thehospital. Methods: Retrospective analysis of 20 months' application of the stroke code protocol. Two periods were defined for analysis. During the first period of 8 months, the code was used inside the hospital. In a second period of 12 months the code was used both inside and outside the hospital. Data collected for analysis of each period were the numbers of strokes diagnosed according to the stroke code criteria, the number of times the protocol was activated, the number of code procedures finalized, and the number of patients who received fibrinolytic therapy. The results obtained during the2 periods were compared (..) (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Avaliação de Processos e Resultados (Cuidados de Saúde) , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Protocolos Clínicos , Mortalidade Hospitalar , Fatores de Tempo , Espanha
12.
Am J Emerg Med ; 25(8): 865-72, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17920969

RESUMO

AIM: The aim of the study was to establish a triage flowchart to rule out acute coronary syndrome (ACS) among patients with chest pain (CP) arriving on an Emergency Department (ED). PATIENTS AND METHOD: This prospective observational study included 1000 consecutive patients with CP arriving on an ED CP unit. Demographic and clinical characteristics along with vital signs were recorded as independent variables. After CP unit protocol completion and 1-month follow-up, patients were classified as (dependent variable) (1) true non-ACS (all noncoronary patients at the first visit that kept this condition when called 1 month later) or (2) true ACS (all the remaining patients). Relationship among variables was assessed by multiple logistic regression analysis. A triage flowchart was obtained from significant variables and applied to patients with CP who were then grouped in "triage non-ACS" and "triage ACS." Validity indexes to exclude ACS for triage flowchart were measured. RESULTS: Variables significantly associated with non-ACS and included in the triage flowchart were age <40 years (odds ratio 3.61, 95% CI 1.63-7.99), absence of diabetes (2.74, 1.53-4.88), no previously known coronary artery disease (5.46, 3.42-8.71), nonoppressive pain (10.63, 6.04-18.70), and nonretrosternal pain (5.16, 2.82-9.42). For the triage flowchart, both specificity and positive predictive value to rule out ACS were 100%. CONCLUSIONS: The triage flowchart is able to accurately identify patients with CP not having an ACS. It may help triage nurses make quick decisions on who should be immediately seen and who could safely wait when delays in medical attention are unavoidable. Prospective validation is needed.


Assuntos
Angina Instável/diagnóstico , Dor no Peito/etiologia , Infarto do Miocárdio/diagnóstico , Triagem/métodos , Adulto , Fatores Etários , Idoso , Algoritmos , Análise de Variância , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade
13.
Med Clin (Barc) ; 123(19): 731-4, 2004 Nov 27.
Artigo em Espanhol | MEDLINE | ID: mdl-15574286

RESUMO

BACKGROUND AND OBJECTIVE: Blood pressure (BP) fluctuations may contribute to the development of target organ damage in essential hypertension. However, a possible relationship with left ventricular hypertrophy (LVH) is controversial. The aim of the present study was to analyze the association between BP variability, defined through different instrument measures, and LVH in a group of essential hypertensive patients. PATIENTS AND METHOD: Forty-three untreated hypertensive patients were studied. BP variability was evaluated by using both non-invasive, beat-to-beat finger 24-hour monitoring (Portapres) and discontinuous oscillometric ambulatory blood pressure monitoring (ABPM). All patients underwent echocardiography in order to detect the presence or absence of LVH. RESULTS: Thirty out of 43 patients studied (70%) exhibited LVH. Office [167.7 (19.5) versus 156.7 (14.9) mmHg; p = 0.032], 24-hour ambulatory [146.6 (15.7) versus 131.9 (15.1) mmHg; p = 0.003] and 24-hour continuous finger [147.5 (21.3) versus 135.7 (14.2) mmHg; p = 0.046] systolic BP were significantly higher in patients with LVH with respect to those without cardiac hypertrophy. No differences were observed in terms of nocturnal BP fall, ABPM 24-h standard deviation of BP or continuous finger BP variability estimates. CONCLUSION: Left ventricular hypertrophy is mainly correlated with the severity of systolic BP elevation, but not with BP variability, neither long-term nor short-term.


Assuntos
Pressão Sanguínea , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Am J Hypertens ; 17(8): 696-700, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15323065

RESUMO

BACKGROUND: It is recognized that blood pressure (BP) variability has prognostic significance in determining target organ damage and cardiovascular mortality and morbidity. The aim of this study was to analyze the association between blood pressure variability and the presence of silent cerebral white matter lesions in middle-aged asymptomatic essential hypertensives. METHODS: We studied 43 middle-aged untreated hypertensive patients. Blood pressure variabilities (short-term and long-term) were evaluated by using both non-invasive, beat-to-beat, continuous finger 24-hour monitoring (Portapres) and oscillometric automated discontinuous ambulatory blood pressure monitoring. All patients underwent cerebral magnetic resonance imaging to detect the presence or not of white matter lesions. RESULTS: Hypertensive patients with cerebral white matter lesions exhibited significantly higher values of long-term systolic blood pressure variability (standard deviation of 24-hour blood pressure) measured both by continuous beat-to-beat monitoring (16.2 +/- 3.7 v 13.7 +/- 3.6 mm Hg; P = 0.047) and by ambulatory blood pressure monitoring (15.2 +/- 3.8 v 12.8 +/- 2.7 mm Hg; P = 0.022). However, these differences were not independent on blood pressure elevation and did not maintain their significance after adjusting for 24-hour systolic blood pressure. Neither short-term systolic blood pressure variability, nor short-term or long-term diastolic blood pressure variabilities showed differences between patients with and without white matter lesions. CONCLUSION: The present study indicates that long-term systolic blood pressure variability is significantly related to the presence of silent cerebral white matter lesions in essential hypertensive patients, although this relationship is partially dependent on absolute blood pressure elevation.


Assuntos
Pressão Sanguínea , Encefalopatias/patologia , Encefalopatias/fisiopatologia , Hipertensão/patologia , Hipertensão/fisiopatologia , Biomarcadores , Monitorização Ambulatorial da Pressão Arterial , Diagnóstico Precoce , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
15.
Am J Hypertens ; 17(6): 529-34, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15177527

RESUMO

BACKGROUND: An association between midlife blood pressure levels and late-life cognitive impairment has been reported. Hypertension is one of the most important factors related to the presence of cerebral white matter lesions, which is a prognostic factor for the development of cognitive impairment. Studies have shown a relationship between white matter lesions and cognitive decline in elderly hypertensive patients. The aim of the present study was to evaluate cognitive function in asymptomatic middle-aged hypertensive patients according to the presence or absence of white matter lesions. METHODS: Sixty never-treated essential hypertensive patients (38 men, 22 women), aged 50 to 60 years (mean age, 54.4 +/- 3.8 years), without clinical evidence of target organ damage, were studied. All patients underwent brain magnetic resonance imaging to establish the presence or absence of white matter lesions, using the Rotterdam criteria. Cognitive function was evaluated by a neuropsychologic test battery measuring attention, memory, intelligence, anxiety, and depression. RESULTS: Twenty-three hypertensive patients (38%) were found to have white matter lesions on brain resonance. These patients exhibited a significantly worse performance on digit span forward, a standardized measure of attention than hypertensives without white matter lesions (4.86 +/- 1.14 v 5.51 +/- 0.97; P =.027). Hypertensive patients with white matter lesions showed no differences on both visual and logical memory tests when compared with patients without lesions. CONCLUSIONS: We conclude that the presence of silent cerebral white matter lesions in middle-aged hypertensive patients is associated with a mild decline in basic attention.


Assuntos
Encefalopatias/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Cognição/fisiologia , Hipertensão/fisiopatologia , Pressão Sanguínea/fisiologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalopatias/diagnóstico por imagem , Diástole/fisiologia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Índice de Gravidade de Doença , Espanha , Estatística como Assunto , Sístole/fisiologia
16.
Med Clin (Barc) ; 121(5): 161-72, 2003 Jul 05.
Artigo em Espanhol | MEDLINE | ID: mdl-12867001

RESUMO

BACKGROUND AND OBJECTIVE: Emergency department (ED) overcrowding has been increasing over the last years. The aims are to define ED overcrowding, and to determine and quantify which factors explain it. PATIENTS AND METHOD: For 3 consecutive weeks throughout 3 years (2000-2002), we recorded every 3-hour period, the arrivals, the occupancy rate (OR) of patients in ED, in first aid area (FAA), and in observation area (OA) according to the reason for their stay. The data was subjected to multiple logistic regression analysis including as a dependent variable non overcrowding/overcrowding for each area (ED, FAA, and OA). Overcrowding was defined as an OR >= 100%. Models from the three areas were calculated according to goodness of fit and were discriminated by ROC methodology. Models were set up after randomizing data in two groups: selection set (88% of data) and validation set (12% of data). RESULTS: Variables associated with overcrowding in the ED model were OR of patients waiting for test results, for a bed going to be left, to find a bed, for test performed out of ED, and for outcome. In the FAA model, they were OR of patients being seen, and waiting for test results. Finally, in the OA model they were OR of patients waiting for a bed going to be left, to find a bed, for test performed out of ED, and for outcome. For all models sensitivity and specificity were greater than 85%, with a ROC area greater than 0.97. We did not find any relationship between number of arrivals and overcrowding for none model. Results were corroborated on the validation data set. CONCLUSIONS: Patients remaining in the ED due to factors related to both hospital (waiting for a bed going to be left, or to find a bed), and ED itself (waiting for outcome) are the main reason for ED overcrowding.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Análise de Regressão , Espanha/epidemiologia
17.
Med. clín (Ed. impr.) ; 121(5): 167-172, mayo 2003.
Artigo em Espanhol | IBECS | ID: ibc-23819

RESUMO

FUNDAMENTO Y OBJETIVO: La utilización de los servicios de urgencias hospitalarios (SUH) es cada vez mayor, lo que conduce a su masificación. El objetivo del presente trabajo es definir la "saturación" de un SUH y determinar y cuantificar los factores que la condicionan. PACIENTES Y MÉTODO: Durante tres semanas consecutivas de años distintos (2000-2002) se contabilizaron cada 3 h las entradas, el índice de ocupación (IO) de los pacientes que permanecían en el SUH, en el área de primera asistencia (APA) y en el área de observación (AO) según la causa de dicha permanencia. Los datos se sometieron a análisis de regresión logística múltiple con la variable dependiente "saturación/no saturación" de cada una de las áreas (SUH, APA y AO). Se definió la saturación cuando el IO era igual o superior al 100 por ciento. Los modelos de cada área se calibraron por la prueba de Hosmer-Lemeshow y se discriminaron por metodología ROC. Los modelos explicativos se armaron separando aleatoriamente dos grupos: selección (88 por ciento de datos) y validación (12 por ciento de datos).RESULTADOS: Las variables que se asociaron de forma significativa a la saturación en el modelo del SUH fueron el IO debido a los pacientes que esperaban resultados, ir a una cama, encontrar cama, exploraciones complementarias y en evolución. En el modelo del APA, lo fueron el IO debido a los que estaban visitándose y esperaban resultados. Finalmente, para el modelo del AO lo fueron el IO debido a los que esperaban ir a una cama, encontrar cama, exploraciones complementarias y en evolución. Todos los modelos mostraron sensibilidad y especificidad superiores al 85 por ciento y un área ROC superior a 0,97. En ningún caso el número de pacientes que acuden a urgencias participó del modelo explicativo final. En el grupo de validación se confirmaron estos resultados. CONCLUSIONES: Los pacientes que permanecen en el servicio de urgencias por factores dependientes tanto del hospital (esperando ir a una cama o encontrar una cama) como del propio servicio de urgencias (esperando evolución) son la principal causa de saturación de los SUH (AU)


Assuntos
Criança , Masculino , Feminino , Humanos , Dieta , Espanha , Inquéritos e Questionários , Ingestão de Energia , Estudos Transversais
18.
Med Clin (Barc) ; 119(4): 125-9, 2002 Jun 29.
Artigo em Espanhol | MEDLINE | ID: mdl-12106523

RESUMO

BACKGROUND: The goal of this study was to evaluate the relative association of several components of blood pressure (BP), as measured in the office and by ambulatory monitoring (ABPM), with clinically useful indicators of target organ damage and cardiovascular events (CE) in essential hypertensive patients. PATIENTS AND METHOD: We retrospectively included 390 hypertensives (55% men; mean age: 56 years) between 1989 and 1998. All them had a baseline office BP measurement and a valid 24-hour ABPM record, both performed while the patient was free of antihypertensive therapy. Estimates of target organ damage included electrocardiographic indexes of left ventricular hypertrophy (Cornell and Sokolow-Lyon), serum creatinine, 24-hour urine protein excretion and creatinine clearance. Multiple linear regression and logistic regression analyses were used to evaluate the relationship between BP and target organ damage or CE. RESULTS: Forty-nine patients had CE (26 stroke, 18 myocardial infarction and 5 both). The BP parameter correlating better with cardiovascular events was office pulse pressure (multivariate odds ratio: 1.03; CI 95%: 1.00-1.05; p = 0.0095). Nevertheless, cardiac growth indexes correlated better with ABPM measurements. In fact, Cornell index correlated with night-time systolic BP (standardized regression coefficient beta: 0.260; p < 0.001) and Sokolow-Lyon index correlated with day-time systolic BP ( beta: 0.257; p < 0.001). Creatinine clearance inversely correlated with night-time pulse pressure ( beta: 0.122; p = 0.017) while proteinuria correlated better with 24-hour systolic BP ( beta: 0.390; p < 0.001). CONCLUSIONS: Whereas office BP (especially pulse pressure) is associated with the development of CE, ABPM estimates show a better association with target organ damage, especially systolic and pulse pressures.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão/complicações , Infarto do Miocárdio/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Creatinina/sangue , Creatinina/urina , Eletrocardiografia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Proteinúria/diagnóstico , Pulso Arterial , Estudos Retrospectivos , Sístole
19.
Am J Hypertens ; 15(6): 507-12, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12074351

RESUMO

BACKGROUND: It has been proposed that concentric left ventricular hypertrophy (LVH) is related to a worse degree of target organ damage in hypertensives with this feature than in those without. Moreover, the presence of cerebral white matter lesions (WMLs) is considered to be an early marker of brain damage in essential hypertension. The aim of this study was to assess the association between the presence of silent WMLs and left ventricular mass and geometry in middle-aged individuals with hypertension that had never been treated. METHODS: A total of 62 patients (39 men, 23 women, aged 50 to 60 years, mean age 54.4 +/- 3.2 years) with never-treated essential hypertension and without clinical evidence of target organ damage were studied. All patients underwent brain magnetic resonance imaging and were classified into two groups according to the presence or absence of WMLs. Echocardiography measuring posterior wall thickness (PWT), interventricular septum thickness (IVST) and left ventricular end-diastolic diameter (LVEDD) was also performed. Left ventricular mass index (LVMI) was calculated using the Penn convention criteria, and relative wall thickness ratio (RWT) was estimated by the standard formula: 2 x PWT/LVEDD. RESULTS: Hypertensive patients with WMLs exhibited significantly higher PWT, IVST, LVMI, and RWT when compared with hypertensive patients without WMLs. In addition, 23 of 26 hypertensive patients with WMLs showed echocardiographic criteria for LVH that was significantly higher than that observed in hypertensive patients without WMLs (21 of 36; P = .01). Concentric hypertrophy (LVH and RWT > or = 0.45) was present in 14 hypertensive patients with WMLs and in only four patients without WMLs (P = .002). CONCLUSION: There is a close association between cerebral WMLs and concentric LVH in asymptomatic middle-aged hypertensive patients, independent of blood pressure values.


Assuntos
Encéfalo/patologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/patologia , Pressão Sanguínea/fisiologia , Ecocardiografia , Feminino , Humanos , Hipertensão/patologia , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
20.
Med. clín (Ed. impr.) ; 119(4): 125-129, jun. 2002.
Artigo em Espanhol | IBECS | ID: ibc-15885

RESUMO

FUNDAMENTO: Evaluar el impacto de los diferentes componentes de la presión arterial (PA), determinados tanto en la consulta como por monitorización ambulatoria de la PA (MAPA), sobre el desarrollo de la lesión de órgano diana y los episodios cardiovasculares (ECV) de la hipertensión arterial (HTA).PACIENTES Y MÉTODO: Estudio retrospectivo llevado a cabo en 390 pacientes (55 per cent varones; edad media de 56 años) atendidos en una unidad de HTA entre 1989 y 1998. En todos los pacientes se disponía de las determinaciones iniciales de la PA clínica mediante esfigmomanómetro de mercurio y de MAPA de 24 h, con el paciente libre de tratamiento antihipertensivo. Se obtuvieron los índices de Cornell y Sokolow del ECG como reflejo de la afección cardíaca hipertensiva y la creatinina sérica, aclaramiento de creatinina y excreción urinaria de proteínas en 24 h, como medida del daño renal. La metodología estadística empleada fue la regresión lineal múltiple y la regresión logística. RESULTADOS: Cuarenta y nueve pacientes desarrollaron ECV (26 accidentes cerebrovasculares, 18 infartos de miocardio y 5 pacientes con ambos episodios). De todas las mediciones de PA, fue el aumento de la presión de pulso (PP) en la clínica el factor independiente mejor relacionado con la aparición de ECV (odds ratio multivariado = 1,03; intervalo de confianza [IC] del 95 per cent, 1,00-1,05; p = 0,0095).Respecto a la correlación con los diferentes indicadores de lesión del órgano diana, los análisis de regresión lineal múltiple pusieron de manifiesto una asociación del índice de Cornell del ECG con la PAS nocturna obtenida en MAPA (coeficiente estandarizado Beta = 0,260; p < 0,001), del índice de Sokolow con la PAS diurna (Beta = 0,257; p < 0,001), del aclaramiento de creatinina con la PP nocturna (correlación inversa Beta = -0,122; p = 0,017) y de la proteinuria con la PAS de 24 h (Beta = 0,390; p < 0,001).CONCLUSIONES: El desarrollo de ECV en la HTA se correlaciona con las cifras de PA clínica (especialmente con la PP), mientras que los indicadores de la lesión del órgano diana (hipertrofia cardíaca, lesión renal) se correlacionan mejor con la PA obtenida mediante MAPA (especialmente con la PAS y PP) (AU)


Assuntos
Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Humanos , Monitorização Ambulatorial da Pressão Arterial , Sístole , Modelos Lineares , Modelos Logísticos , Razão de Chances , Hipertrofia Ventricular Esquerda , Infarto do Miocárdio , Proteinúria , Estudos Retrospectivos , Pulso Arterial , Acidente Vascular Cerebral , Creatinina , Hipertensão , Eletrocardiografia
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