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1.
Cuad. psicol. deporte ; 19(1): 95-105, ene. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183221

RESUMO

Introducción: El envejecimiento se acompaña de factores de riesgo cuya reducción mejora la supervivencia. La actividad física incide sobre ellos, lo que realza su papel preventivo y su valor como tratamiento no-farmacológico. Dada la escasez de programas de entrenamiento específicos para ancianos pluripatológicos, sobre todo durante el periodo de inicio de resolución de la actividad clínica de una enfermedad aguda, o de la exacerbación de una o varias de las enfermedades crónicas, el presente estudio piloto analiza la viabilidad y efectos de un programa corto de entrenamiento neuromotor en estos pacientes ingresados en UHD (Unidad de Hospitalización Domiciliaria). Método: 11 ancianos pluripatológicos (82,2±6,9 años, 8 hombres) completaron 4 semanas de entrenamiento funcional con orientación neuromuscular y cognitiva, con evaluación pre-post sobre capacidad funcional (equilibrio, marcha, fuerza de tren inferior y agilidad), composición corporal y calidad de vida -6 semanas, incluida la evaluación-. Se realizaron dos sesiones domiciliarias supervisadas y una tercera autónoma semanalmente. Resultados: Los ancianos mejoraron en equilibrio y marcha (Tinetti-total: 14,0±9,0 vs 17,9±7,3 puntos; p =0,007), fuerza (test sentarse y levantarse 30-s: 3,0±3,7 vs 4,1±4,1 reps.; p =0,034), agilidad (TUG-test categorizado; p =0,001) y peso (82,2±14,0 vs 79,2±13,9 kg; p =0,036), aunque no en calidad de vida relacionada con la salud (SF-36-v2: 32,9±7,8 vs 31,2±7,7 puntos; p =0,722). La presencia del técnico aumentó el cumplimiento un 20%. Conclusiones: El dinamismo de UHD es idóneo para implantar programas de actividad física especializada que frenen los efectos devastadores del binomio envejecimiento-inactividad. Una corta duración no les resta eficacia


Introduction: Aging is linked to a various risk factors whose reduction improves survival. Physical activity affects many of them, what enhances its preventive role and its value as a non-pharmacological treatment. Given the scarcity of specific training programs for elderly people with multiple pathologies, especially during the start period of resolution of the clinical activity of an acute disease, or the exacerbation of one or several of the chronic diseases, the present pilot study aims to analyze the feasibility and effects of a short neuromotor training program in these patients admitted to UHD (Home Hospitalization Unit). Methods: 11 elderly patients (82.2±6.9 years, 8 men; acute phase of disease) completed 4 weeks of a neuromuscular and cognitive orientated functional training program, with pre-post assessment of functional capacity (i.e. balance, gait speed, lower limb strength and agility), body composition and quality of life -6 weeks, including the evaluation-. There were 2 supervised sessions and a third autonomous session every week. Results: Significant improvements were found in balance and gait (Tinetti-total: 14.0±9.0 vs 17.9±7.3 points; p =0.007), strength (30-seconds Chair Stand Test: 3.0±3; p =0.001), agility (TUG-test categorized; p =0.001) and weight (82.2±14.0 vs. 79.2±13.9 kg; p =0.036), but not in health-related quality of life (SF-36-v2: 32.9±7.8 vs 31.2±7.7 points; p =0.722). The technician's presence increased adherence to the program by 20%. Conclusions: The dynamism of UHD is ideal for implementing specialized physical activity programs that counteract the devastating effects of the binomial aging-inactivity. A short duration does not reduce effectiveness


Introdução: O envelhecimento é acompanhado por fatores de risco cuja redução melhora a sobrevida. A atividade física os afeta, o que aumenta seu papel preventivo e seu valor como tratamento não farmacológico. Dada a escassez de programas específicos de treinamento para pacientes idosos, especialmente durante o período da iniciação da resolução da atividade clínica de uma doença aguda, ou da exacerbação de uma ou mais das doenças crônicas, o presente estudo piloto analisa a viabilidade e os efeitos de um programa curto de treinamento neuromotor nesses pacientes internados em UHD (Unidade de Internação Domiciliar). Método: 11 idosos com múltiplas patologias (82,2±6,9 anos, 8 homens, doença de fase aguda) completaram 4 semanas de treinamento funcional com orientação neuromuscular e cognitiva, com avaliação pré-pós de capacidade funcional (equilíbrio, marcha, menor força e agilidade do trem), composição corporal e qualidade de vida -6 semanas, incluindo avaliação-. Foram realizadas duas sessões domiciliares supervisionadas e uma sessão semanal autônoma. Resultados: Os idosos melhoraram em equilíbrio e marcha (Tinetti-total: 14,0±9,0 vs 17,9±7,3 pontos, p=0,007), força (teste de sentar e levantar 30-s: 3,0±3,7 vs 4,1±4,1 repetições, p=0,034), agilidade (teste categorizado pelo TUG, p=0,001) e peso (82,2±14,0 vs 79,2±13,9 kg; p=0,036), embora não na qualidade de vida relacionada à saúde (SF-36-v2: 32,9±7,8 vs 31,2±7,7 pontos, p=0,722). A presença do técnico aumentou a conformidade em 20%. Conclusões: O dinamismo da UHD é ideal para a implementação de programas especializados de atividade física que neutralizam os efeitos devastadores do binômio envelhecimento-inatividade. Uma curta duração não reduz a eficácia


Assuntos
Humanos , Masculino , Feminino , Idoso , Terapia por Exercício/métodos , Desempenho Psicomotor/fisiologia , Transtornos Psicomotores/terapia , Fragilidade/terapia , Múltiplas Afecções Crônicas/epidemiologia , Aptidão Física/psicologia , Envelhecimento/fisiologia , Avaliação de Resultado de Intervenções Terapêuticas , Autoeficácia
2.
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
3.
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
4.
Madrid; España. Ministerio de Sanidad, Servicios Sociales e Igualdad; 2016. tab.
Não convencional em Espanhol | BIGG | ID: biblio-964011

RESUMO

El objetivo general de la Guía de Práctica Clínica es proporcionar a los agentes encargados de la asistencia y cuidados de este tipo de pacientes, una herramienta que les permita tomar las mejores decisiones sobre algunos de los problemas que ocasionan su atención y que no han sido resueltos. Esta Guía ha sido desarrollada para generar recomendaciones sobre el tratamiento de la insuficiencia cardiaca crónica (ICC). Abarca los siguientes aspectos: TRATAMIENTO FARMACOLÓGICO: - Inhibidores de la enzima convertidora de la angiotensina ( o antagonistas de los receptores de la angiotensina), Betabloqueantes y antagonistas de la aldosterona en pacientes mayores de 65 años con disfunción sistólica. En pacientes con con fracción de eyección preservada o ligeramente deprimida. - Efectividad de la eplerona frente a espironolactona. - Eficacia del sacubitrilo/valsartán sustituyendo a un inhibidor de la enzima convertidora de la angiotensina (o a un antagonista del receptor de la angiotensina II), junto a betabloqueante y antagonistas de la aldosterona. TRATAMIENTO NO FARMACOLÓGICO: -Control temprano tras el alta hospitalaria. -Eficacia de las medidas higiénico-dietéticas. -Monitorización mediante péptidos natriuréticos para control del tratamiento farmacológico. -Eficacia de los programas de telemedicina. -Eficacia de las rehabilitación cardiaca basada en el ejercicio. -Eficacia de los desfibriladores automáticos implantables en mayores de 65 años.


Assuntos
Humanos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Desfibriladores Implantáveis , Antagonistas Adrenérgicos beta/uso terapêutico , Terapia por Exercício/métodos , Valsartana/uso terapêutico , Dieta Saudável/métodos
5.
Emergencias (St. Vicenç dels Horts) ; 27(2): 87-94, abr. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-138656

RESUMO

Objetivo. Desarrollar una serie de recomendaciones y propuestas de mejora basadas en un consenso clínico de expertos sobre aspectos relacionados con la atención del paciente anciano con sospecha de infección en los Servicios de Urgencias y Emergencias (SUH-E) de la Comunidad Valenciana (CV). Metodología. El estudio se divide en tres fases: 1) Diseño de un cuestionario por consenso de un grupo de expertos;2) Realización de una encuesta electrónica para conocer la opinión de los médicos de urgencias y emergencias (MUyE) de la CV; 3) Elaboración de una serie de recomendaciones y propuestas de mejora por consenso de un grupo de expertos a partir de los resultados de dicha encuesta. El consenso se llevó a cabo mediante una metodología Delphi y la encuesta a través de una página web. Resultados. Un grupo de expertos de 21 MUyE consensuaron, tras dos rondas de votación, un cuestionario final de 15 preguntas de las 30 inicialmente planteadas [4 (26,6%) relativas a la clasificación y ubicación del paciente, 5(33,3%) al diagnóstico, y 6 (40,0%) al tratamiento]. El cuestionario final fue sometido a una votación, mediante una encuesta electrónica, de 142 MUyE (77,2%) de los 184 posibles procedentes de 21 SUH-E de la CV. De las 15 recomendación esplanteadas por el grupo coordinador tras la encuesta, se alcanzó un alto grado de consenso (mediana con puntuación > 7) en 11 (73,3%) de ellas por parte del grupo de expertos. Conclusiones. Se establecieron once recomendaciones y propuestas de mejora con un alto grado de consenso para la atención del paciente anciano con sospecha de infección en los SUH-E de la CV (AU)


Objective. To develop expert consensus-based recommendations and proposals on how to improve the care of elderly emergency patients with suspected infection in the autonomous community of Valencia. Methods. This project was carried out in 3 phases: 1) design of a questionnaire by means of consensus among a group of experts; 2) online survey to determine the opinions of emergency physicians in the community of Valencia; and 3) drafting of expert consensus-based recommendations and proposals arising from the results of the survey. The experts used the Delphi method to reach consensus and the survey was posted online. Results. After 2 rounds of voting, 21 emergency medicine experts reached consensus on 15 of the 30 survey items initially proposed: 4 items (26.6%) referred to patient classification and placement, 5 (33.3%) to diagnosis, and 6 (40.0%) to treatment. The resulting online questionnaire was returned by 142 (77.2%) of the 184 emergency physicians belong into 21 hospital emergency departments in the community of Valencia. The experts reached a high level of consensus(mean score, > 7) on 11 (73.3%) of the 15 recommendations posed by the group’s coordinator after the survey. Conclusions. The experts were able to propose 11 consensus-based recommendations and proposals for improving the care of elderly patients with suspected infection in emergency departments in Valencia (AU)


Assuntos
Idoso de 80 Anos ou mais , Idoso , Feminino , Humanos , Masculino , Doenças Transmissíveis/tratamento farmacológico , Controle de Infecções/métodos , Infecção/epidemiologia , Sepse/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/métodos , Fatores de Risco
6.
Emergencias (St. Vicenç dels Horts) ; 27(2): 109-112, abr. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-138659

RESUMO

Objetivo. Comparar los resultados de gestión clínica de las unidades de corta estancia (UCE) según su dependencia funcional. Metodología. Estudio de análisis transversal realizado en 40 hospitales con UCE (1 junio-31 diciembre 2012). Se recogieron datos de actividad y gestión clínica, considerando como variables directamente relacionadas con la eficiencia la estancia media, el índice de rotación por cama y el porcentaje de altas en fin de semana. Resultados. Se analizaron 40 UCE, 25 (62,5%) dependientes del servicio de urgencias (UCEU), 9 (22,5%) de medicina interna (UCEMI), 5 (12,5%) independientes (UCEI) y 1 con dependencia mixta (UCEU + UCEMI). El número total de altas fue de 45.140. Los diagnósticos más frecuentes fueron la exacerbación de la patología crónica cardiaca y respiratoria, la infección urinaria y la respiratoria. En relación a su dependencia funcional no se observaron diferencias en los parámetros analizados intergrupos salvo en la edad media (UCEI 75,6 años vs UCEU 67,2 vs UCEMI 57,8; p = 0,02). Al realizar la comparación intragrupos, la estancia media fue menor en las UCEU que las UCEMI (2,65 días vs 3,73;p = 0,047) y la mortalidad global menor en las UCEMI que las UCEU (0,64% vs 3%; p = 0,033), pero sin diferencias al comparar la mortalidad no esperada una vez excluidos los pacientes paliativos y/o en situación de últimas horas. Conclusión. En la serie analizada no se observan diferencias destacables al comparar las UCE en conjunto según dependencia funcional. Sin embargo, en el análisis intragrupos las UCEU lograron menor estancia media que las UCEMI (AU)


Objective. To compare the efficiency of short-stay units (SSUs) managed by different departments within hospitals. Methods. Cross-sectional study in 40 hospitals with SSUs. From June 1 to December 31, 2012,we gathered data on clinical caseloads and management. Variables directly related to efficiency were mean length of stay, bed rotation index, and weekend discharge rate. Results. Forty SSUs were studied; 25 (62.5%) were managed by the hospital’s emergency department (ED), 9 (22.5%) were managed by the internal medicine department (IMD), 5 (12.5%) were independent, and 1 was jointly managed by the hospital’s ED and the IMD. A total of 45 140 patients were discharged from the SSUs. The most common diagnoses were exacerbation of chronic heart or respiratory disease, urinary tract infection, and respiratory infection. Age was the only variable that was related to the hospital department designated to manage these SSUs. The mean ages by management type were as follows: independent SSUs (75.6 years) vs ED-managed SSUs (67.2 years) vs IMD-managed SSUs(57.8 years) (P=.02). Group-by-group comparisons showed that the mean length of stay was shorter in ED-managed SSUs than in IMD-managed units (2.65 vs 3.73 respectively; P=.047), and overall mortality was lower in IMD-managed SSUs than in ED-managed SSUs (0.64% vs 3%; P=.033). However, unforeseen mortality (after excluding patients under palliative care or judged to be in the final hours of life) did not differ significantly between groups. Conclusions. We did not detect important differences between SSUs managed by different departments in the hospitals in this series. However, mean length of stay was found to be shorter in ED-managed SSUs than in IMD-managed un (AU)


Assuntos
Humanos , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/métodos , Administração dos Cuidados ao Paciente/organização & administração , /tendências , Unidades Hospitalares/organização & administração , Inter-Relação
7.
Emergencias ; 27(2): 87-94, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-29077349

RESUMO

OBJECTIVES: To develop expert consensus-based recommendations and proposals on how to improve the care of elderly emergency patients with suspected infection in the autonomous community of Valencia. MATERIAL AND METHODS: This project was carried out in 3 phases: 1) design of a questionnaire by means of consensus among a group of experts; 2) online survey to determine the opinions of emergency physicians in the community of Valencia; and 3) drafting of expert consensus-based recommendations and proposals arising from the results of the survey. The experts used the Delphi method to reach consensus and the survey was posted online. RESULTS: After 2 rounds of voting, 21 emergency medicine experts reached consensus on 15 of the 30 survey items initially proposed: 4 items (26.6%) referred to patient classification and placement, 5 (33.3%) to diagnosis, and 6 (40.0%) to treatment. The resulting online questionnaire was returned by 142 (77.2%) of the 184 emergency physicians belonging to 21 hospital emergency departments in the community of Valencia. The experts reached a high level of consensus (mean score, > 7) on 11 (73.3%) of the 15 recommendations posed by the group's coordinator after the survey. CONCLUSION: The experts were able to propose 11 consensus-based recommendations and proposals for improving the care of elderly patients with suspected infection in emergency departments in Valencia.

8.
Emergencias ; 27(2): 109-112, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-29077352

RESUMO

OBJECTIVES: To compare the efficiency of short-stay units (SSUs) managed by different departments within hospitals. MATERIAL AND METHODS: Cross-sectional study in 40 hospitals with SSUs. From June 1 to December 31, 2012,we gathered data on clinical caseloads and management. Variables directly related to efficiency were mean length of stay, bed rotation index, and weekend discharge rate. RESULTS: Forty SSUs were studied; 25 (62.5%) were managed by the hospital's emergency department (ED), 9 (22.5%) were managed by the internal medicine department (IMD), 5 (12.5%) were independent, and 1 was jointly managed by the hospital's ED and the IMD. A total of 45 140 patients were discharged from the SSUs. The most common diagnoses were exacerbation of chronic heart or respiratory disease, urinary tract infection, and respiratory infection. Age was the only variable that was related to the hospital department designated to manage these SSUs. The mean ages by management type were as follows: independent SSUs (75.6 years) vs ED-managed SSUs (67.2 years) vs IMD-managed SSUs (57.8 years) (P=.02). Group-by-group comparisons showed that the mean length of stay was shorter in ED-managed SSUs than in IMD-managed units (2.65 vs 3.73 respectively; P=.047), and overall mortality was lower in IMD-managed SSUs than in ED-managed SSUs (0.64% vs 3%; P=.033). However, unforeseen mortality (after excluding patients under palliative care or judged to be in the final hours of life) did not differ significantly between groups. CONCLUSION: We did not detect important differences between SSUs managed by different departments in the hospitals in this series. However, mean length of stay was found to be shorter in ED-managed SSUs than in IMD-managed units.

9.
Emergencias (Sant Vicenç dels Horts) ; 26(5): 349-353, oct. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-181350

RESUMO

Objetivos: Existen pocos datos sobre las diferencias entre las escalas utilizadas, en los servicios de urgencias hospitalarios (SUH), para la valoración del riesgo de enfermedad tromboembólica venosa (ETV) en pacientes que ingresan por patología médica. El objetivo fue analizar la concordancia entre la guía PRETEMED y el Padua Prediction Score (PPS). Método: Estudio de cohortes prospectivo multicéntrico, realizado en seis SUH españoles. Se incluyeron pacientes con patología médica que requirieron ingreso hospitalario entre diciembre de 2011 y julio de 2012. Se evaluó la concordancia de ambas escalas para clasificar a los pacientes en las diferentes categorías de riesgo. Además, se recogieron los acontecimientos tromboembólicos durante 90 días. Resultados: Se reclutaron 610 pacientes, de los que 580 fueron evaluables (edad media 70,1 (16,9) años, 45,3% mujeres). Los pacientes clasificados como de riesgo moderado o alto según PRETEMED fueron 256 (44,1%) y según PPS 368 (63,4%). Al evaluar la concordancia entre ambas escalas, se observó un índice kappa de 0,39 (IC95%: 0,32-0.46), con una discordancia del 31,3%. La incidencia de ETV en los 129 pacientes sin tromboprofilaxis clasificados de moderado o alto riesgo, según PRETEMED, fue de 2,3% y en los 201 pacientes de alto riesgo, según PPS, fue del 3,5%. Conclusiones: Existe discordancia significativa entre las escalas utilizadas (PRETEMED y PPS) para valorar el riesgo de ETV en los pacientes hospitalizados por patología médica. PPS fue la que más pacientes clasificó de alto riesgo, y lo hizo mejor, en base al desarrollo posterior de ETV


Background and objective: Little information is available on differences between scales used to assess risk for venous thromboembolism (VTE) in patients with medical conditions admitted from hospital emergency departments. We aimed to evaluate the agreement between 2 risk prediction tools: a scale based on the PRETEMED guideline and the Padua Prediction Score (PPS). Methods: Prospective multicenter cohort study in 6 Spanish hospital emergency departments. Patients with medical conditions requiring hospital admission were included between December 2011 and July 2012. The concordance correlation between the 2 scales was calculated. The development of VTE was registered for 90 days. Results: Of 610 patients recruited, data for 580 patients (mean [SD] age, 70.1 [16.9] years; 45.3% women) were valid for assessment. Patients classified as having moderate or high risk numbered 256 (44.1%) with the PRETEMED scale and 368 (63.4%) with the PPS. The κ index of concordance between the 2 scales was 0.39 (95% CI, 0.32-0.46) (discordance, 31.3%). Among patients who did not receive thromboprophylaxis, the incidence of VTE was 2.3% among the 129 patients the PRETEMED scale classified as being at moderate or high risk and 3.5% among patients at high risk according to the PPS. Conclusions: There is disagreement between PRETEMED and PPS scale assessments of risk for VTE in patients with medical conditions. The PPS classified more patients as being at high risk, and the predictions were more accurate based on their later development of VTE


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Índice de Gravidade de Doença , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Estudos Prospectivos , Estudos de Coortes , Medição de Risco
10.
Emergencias (Sant Vicenç dels Horts) ; 26(5): 359-362, oct. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-181351

RESUMO

Objetivo: El proyecto REGICE analiza las unidades de corta estancia (UCE) en España. El estudio REGICE 2 ofrece información sobre actividad y gestión clínica. Método: Estudio transversal basado en una encuesta a los 48 hospitales con UCE que participaron en el estudio REGICE 1. Se realizó mediante un formulario estandarizado que se envió vía electrónica al médico de contacto de cada UCE entre el 1 de junio y el 31 de diciembre de 2012, con inclusión de datos sobre actividad y gestión clínica. Resultados: Cuarenta UCE participaron en el estudio REGICE 2. El número de ingresos fue 45.140, la estancia media global 3,05 (1,28) días y la edad media de los pacientes 66,7 (10,4) años. El porcentaje de altas a domicilio fue del 80,6%, la mortalidad global intrahospitalaria del 2,8% y de reingreso a los 30 días del 6,1%. La exacerbación de la patología cardiaca y respiratoria crónicas y la infección urinaria y respiratoria fueron uno de los primeros tres diagnósticos en el 72,5% de UCE. Conclusiones: Las UCE constituyen una alternativa a la hospitalización convencional y responden a la necesidad de ingreso urgente en pacientes con patología de alta prevalencia con buenos resultados en términos de actividad, eficacia y seguridad. Son necesarios futuros trabajos que determinen los estándares de calidad de estas unidades


Background and objective: The aim of the REGICE (Register of Short-Stay Units in Spain) project is to describe the real situation of short-stay units in Spanish hospitals. The second REGICE study analyzed information on short-stay units' caseloads and clinical management practices. Methods: A cross-sectional questionnaire was sent to the 48 hospitals with short-stay units that participated in the REGICE 1 study. The standardized data collection instrument was emailed to the contact person at each short-stay unit between June 1 and December 31, 2012. Items asked about the unit's caseload and clinical management practices. Results: Forty short-stay units responded to the REGICE 2 survey. A total of 45140 admissions were made (mean [SD] length of stay, 3.05 [1.28] days; mean age, 66.7 [10.4] years). The units discharged 80.6% of the patients to home, in-hospital mortality was 2.8%, and the 30-day readmission rate was 6.1%. The diagnostic-related groups that 72.5% of the units ranked among their first 3 reasons for admissions involved exacerbation of heart disease or chronic respiratory disease and urinary tract or respiratory infection. Conclusions: Short-stay units offer an alternative to conventional hospital admission. They answer a need for urgent admission of patients with highly prevalent conditions and give good results, allowing hospitals to manage caseloads safely and effectively. Further studies of quality standards in these units are necessary


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tempo de Internação , Administração Hospitalar , Estudos Transversais , Espanha
13.
Medicina (Kaunas) ; 46(6): 393-400, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20944447

RESUMO

BACKGROUND: Hospitalization processes are known to increase depressive symptoms arising among elderly population. Meanwhile, dysregulation of cardiac autonomic function has been suggested to link depression and cardiovascular mortality. In this context, analysis of heart rate variability (HRV) is emerging as a powerful mortality risk stratifier clinical tool. The purpose of the study was to examine the relationship among HRV, depression, and comorbidity risk among an elderly inpatient population. MATERIAL AND METHODS: Twenty-six subjects (aged 78±9 years) were recruited from the Short-Term Stay Unit at the Hospital General de Alicante. Before joining a Physical Activity Program aimed to prevent functional impairment and after medical selection and written consent, inpatients were tested for heart rate variability, Yesavage Geriatric Depression Scale, and Charlson comorbidity index score. RESULTS: Men compared to women showed a significantly larger CCI score. Short-term scaling exponent (α(1)), derived from detrended fluctuation analysis, showed a negative correlation with Charlson comorbidity index. Conversely, a positive correlation was found between sample entropy (SampEn) and Yesavage Scale. CONCLUSIONS: On the one hand, fractal analysis of HRV confirms to be useful as a risk stratifier tool. On the other hand, SampEn is proposed to be reflecting a non-neurally generated complexity when accompanied with low values of α(1). Accordingly, in this regime, it would be indicative of a paradoxical gradual reduction in cardiac autonomic control, accentuated with the severity of depressive symptoms.


Assuntos
Depressão/epidemiologia , Cardiopatias/epidemiologia , Frequência Cardíaca/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Comorbidade , Interpretação Estatística de Dados , Depressão/complicações , Depressão/diagnóstico , Depressão/mortalidade , Eletrocardiografia , Feminino , Avaliação Geriátrica , Cardiopatias/mortalidade , Humanos , Pacientes Internados , Masculino , Dinâmica não Linear , Prevalência , Medição de Risco , Amostragem , Fatores Sexuais
18.
Emergencias (St. Vicenç dels Horts) ; 21(1): 5-11, feb. 2009. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-60094

RESUMO

Objetivos: Analizar la epidemiología asistencial en la patología de causa deportiva y su impacto en el servicio de urgencias hospitalario (SUH).Método: Estudio observacional, descriptivo y prospectivo, de 2.000 lesiones deportivas consecutivas atendidas en un SUH durante un periodo de 4 años. Las variables seleccionadas fueron: edad, género, actividad deportiva, tipo de lesión, localización de la lesión, tratamiento y destino tras la atención urgente. Resultados: La mayoría de asistencias por lesiones deportivas se producen en varones(85%), con una edad media de 26 ± 10 años. El deporte que más lesiones aporta es el fútbol (49,5%), seguido del ciclismo (9,5%) y del baloncesto (8,7%). La mayoría de las lesiones se localizan en el miembro inferior (56%), principalmente contusiones (33,8%)y lesiones ligamentosas (30,1%). La mayoría de los pacientes precisó tratamiento ortopédico(79,2%), el 92% de las atenciones fueron resueltas por el propio SUH. Cuando precisaron ingreso, éste se produjo principalmente en traumatología (64%).Conclusiones: El paciente que consulta por lesión deportiva en nuestra área es un varón joven que sufre una contusión en el miembro inferior, recibe tratamiento ortopédico y es resuelto por el SUH sin intervención de otras especialidades. La elevada incidencia de lesiones deportivas, que conllevan tratamiento ortopédico, en personas jóvenes debe ser tenida en cuenta en relación con su repercusión socio-laboral (AU)


Objectives: To analyze epidemiologic patterns related to the treatment of sports-related injuries and the impact these injuries have on a hospital emergency department’s caseload. Methods: We carried out a prospective observational study to describe 2000 sports injuries treated consecutively over a period of 4 years. The variables studied were age, gender, sport, type of injury, location of injury, treatment provided in the hospital emergency department, and destination at discharge from the department. Results: Most sports lesions were in males (85%). The mean (SD) age of all sports-injured patients was 25.99 (10) years. Football (soccer) caused the largest proportion of injuries (49.5%) and was followed by cycling (9.5%) and basketball (8.7%).Most injuries involved a lower limb (56%). Bruises accounted for 33.8% of the caseload and ligament injuries for 30.1%.Orthopedic treatment was applied in 79.2% of the cases. Ninety-two percent of the injuries were treated inside the emergency department. When patients required hospitalization, the admitting department was usually traumatology (64%).Conclusions: The patient who seeks treatment for a sports injury in our practice area is usually male and around 25 years of age. The injury, usually bruising of a lower limb, is generally resolved by emergency department staff without assistance from other departments. The elevated incidence of sports injuries, require orthopedic treatment in young persons should be taken into consideration given the social and employment-related repercussions (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Espanha/epidemiologia , Estudos Prospectivos
20.
Rev Esp Cardiol ; 62(3): 334-5, 2009 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-23040486
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