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1.
Emergencias ; 31(3): 167-172, 2019 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31210448

RESUMO

OBJECTIVES: To assess the accuracy, safety, and efficiency of ultrasound images obtained by emergency physician to diagnose deep vein thrombosis (DVT). patients with acute heart failure (AHF) attended in a hospital emergency department (ED). MATERIAL AND METHODS: Prospective multicenter cohort study. We assigned patients suspected of having DVT to an intervention or control group. Emergency physicians took ultrasound images that were later evaluated by a radiologist in the intervention group. In the control group, images were evaluated only by the radiologist. We analyzed patient, physician, and episode variables. Test results, times until imaging, and 30-day adverse events were also analyzed. Sensitivity, specificity, positive and negative likelihood ratios, and agreement between physicians and radiologists (κ statistic) were calculated. RESULTS: A total of 304 patients (209 in the intervention group and 95 controls) were included. The groups were comparable. The overall prevalence of DVT was 35.5% (95% CI, 30.3-41.0). The sensitivity of ultrasound images obtained by emergency physicians was superior in relation to experience: 71.4 (95% CI, 50.0-86.0) for those in a training course, 75.0 (95% CI, 80.0-95.4) for those with at least 2 months' practical experience, and 94.7 (95% CI, 82.7-98.5) for routine users. Specificity statistics for the 3 levels of physician experience were 83.3 (95% CI 55.2- 95.2), 100 (95% CI 83.0-100), and 96.6 (95% CI 88.4-99.0), respectively. The positive and negative likelihood ratios for ultrasound imaging by physicians were 27.94 and 0.054, respectively. The κ statistic was 0.80. Mean (SD) time until a physician took ultrasound images was 1.81 (1.46) hours versus 4.39 (1.81) hours until a radiologist obtained images (P = .007). Three deaths occurred within 30 days. They were not attributable to recurrence or bleeding. CONCLUSION: Ultrasound images taken by emergency physicians to diagnose DVT are accurate and safe and may be efficient. However, routine experience with ultrasound is necessary.

2.
Emergencias (Sant Vicenç dels Horts) ; 31(3): 167-172, jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182726

RESUMO

Objetivos: Evaluar la precisión, la seguridad y la eficiencia de la ecografía realizada por urgenciólogos para el diagnóstico de la trombosis venosa profunda (TVP). Métodos: Estudio prospectivo multicéntrico de cohortes que incluyó pacientes con sospecha de TVP asignados a un grupo intervención (evaluados ecográficamente por el urgenciólogo y posteriormente por el radiólogo) y a un grupo control (evaluados únicamente por el radiólogo). Se analizaron las variables relacionadas con el paciente, el urgenciólogo, el episodio, el resultado de la prueba y los tiempos de estancia y acontecimientos a 30 días. Se calcularon la sensibilidad, la especificidad, las razones de verosimilitud positiva y negativa, y el índice kappa. Resultados: Se incluyeron 304 pacientes (95 control, 209 intervención). Ambos grupos fueron comparables. La prevalencia de TVP en la cohorte global fue de 35,5% (IC 95% 30,3-41,0). La sensibilidad de la ecografía realizada por urgenciólogos fue superior según la experiencia-curso vs meses vs uso habitual: 71,4 (IC 95% 50,0-86,0) vs 75,0 (IC 95% 80,0-95,4) vs 94,7 (IC 95% 82,7-98,5), así como la especificidad 83,3 (IC 95% 55,2-95,2) vs 100 (IC 95% 83,0100) vs 96,6 (IC 95% 88,4-99,0). Las razones de verosimilitud positiva y negativa para la ecografía realizada por urgenciólogos fueron del 27,94 y del 0,054, respectivamente. El índice de kappa fue de 0,80. El tiempo hasta la realización de la ecografía por el urgenciólogo fue de 1,81 (DE 1,46) frente a 4,39 (DE 1,81) horas del radiólogo (p = 0,007). Durante el seguimiento a 30 días, se registraron 3 muertes, ninguna de ellas por recurrencia o hemorragia. Conclusión: La ecografía realizada por urgenciólogos para el diagnóstico de TVP es precisa, segura y podría resultar eficiente. Sin embargo, se requiere de experiencia basada en el uso habitual de esta técnica


Objective: To assess the accuracy, safety, and efficiency of ultrasound images obtained by emergency physician to diagnose deep vein thrombosis (DVT). Methods: Prospective multicenter cohort study. We assigned patients suspected of having DVT to an intervention or control group. Emergency physicians took ultrasound images that were later evaluated by a radiologist in the intervention group. In the control group, images were evaluated only by the radiologist. We analyzed patient, physician, and episode variables. Test results, times until imaging, and 30-day adverse events were also analyzed. Sensitivity, specificity, positive and negative likelihood ratios, and agreement between physicians and radiologists ( Kappa statistic) were calculated. Results: A total of 304 patients (209 in the intervention group and 95 controls) were included. The groups were comparable. The overall prevalence of DVT was 35.5% (95% CI, 30.3-41.0). The sensitivity of ultrasound images obtained by emergency physicians was superior in relation to experience: 71.4 (95% CI, 50.0-86.0) for those in a training course, 75.0 (95% CI, 80.0-95.4) for those with at least 2 months' practical experience, and 94.7 (95% CI, 82.7-98.5) for routine users. Specificity statistics for the 3 levels of physician experience were 83.3 (95% CI 55.2- 95.2), 100 (95% CI 83.0-100), and 96.6 (95% CI 88.4-99.0), respectively. The positive and negative likelihood ratios for ultrasound imaging by physicians were 27.94 and 0.054, respectively. The Kappa statistic was 0.80. Mean (SD) time until a physician took ultrasound images was 1.81 (1.46) hours versus 4.39 (1.81) hours until a radiologist obtained images (P = .007). Three deaths occurred within 30 days. They were not attributable to recurrence or bleeding. Conclusions: Ultrasound images taken by emergency physicians to diagnose DVT are accurate and safe and may be efficient. However, routine experience with ultrasound is necessary


Assuntos
Humanos , Trombose Venosa/diagnóstico por imagem , Serviços Médicos de Emergência/estatística & dados numéricos , Ultrassonografia/métodos , Eficiência , Fatores de Risco , Trombose Venosa/epidemiologia , Sensibilidade e Especificidade , Tempo de Internação
4.
Emergencias ; 28(1): 67-68, 2016 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-29094831
5.
Emergencias (St. Vicenç dels Horts) ; 27(6): 386-395, dic. 2015. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-147858

RESUMO

La monitorización hemodinámica no invasiva o mínimamente invasiva es una herramienta que se utiliza cada vez más en los servicios de urgencias y emergencias, para garantizar el adecuado aporte de oxígeno a los tejidos en el paciente crítico. Ayuda a establecer el diagnóstico diferencial de las posibles causas de shock y a optimizar el tratamiento, cuantificar sus efectos y evitar las posibles complicaciones derivadas del mismo. Los métodos convencionales de monitorización, por sí solos, se han mostrado insuficientes o poco eficientes, como la presión venosa central (SvcO2), para la evaluación hemodinámica de los pacientes críticos. En los últimos años el desarrollo tecnológico ha permitido disponer de monitores que miden de forma continua el gasto cardiaco (GC) del paciente de forma no invasiva (mediante electrodos cutáneos manguito hinchable digital o sensores de fotoespectrometría) o mínimamente invasiva (mediante la canalización de una arteria periférica). Es importante conocer en la práctica clínica, las ventajas y limitaciones que tienen los sistemas de estimación del GC antes de su aplicación. La combinación de las variables clásicas, las variables hemodinámicas y la información anatómica y funcional que nos proporciona la ecografía va a permitir establecer algoritmos de actuación en los servicios de urgencias y emergencias y sistematizar el proceso de reanimación con la intención de obtener una recuperación más rápida (AU)


Noninvasive and minimally invasive hemodynamic monitoring systems are used increasingly in emergency departments to provide adequate tissue oxygenation in critically ill patients. Such monitoring assists in the differential diagnosis of shock, the optimization of treatment and assessment of its effects, and the prevention of complications during care. Recent years have seen the development of noninvasive monitors that measure cardiac output continuously by means of electrodes applied to the skin or spectrophotometric sensors. Minimally invasive systems connected to a peripheral artery catheter have also been developed. Conventional hemodynamic monitoring methods alone have sometimes proven inadequate or inefficient in this setting; an example is the measurement of central venous pressure. The clinician therefore needs to understand the advantages and limitations of the different systems for estimating cardiac output before choosing a monitor. Resuscitation protocols that facilitate the fastest possible recovery in emergency care can be established based on the combination of traditional variables, hemodynamic variables, and anatomical and functional data provided by ultrasonography (AU)


Assuntos
Humanos , Estado Terminal , Monitorização Fisiológica/métodos , Hemodinâmica/fisiologia , Ultrassonografia , Serviço Hospitalar de Emergência/estatística & dados numéricos
7.
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
8.
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.

10.
Emergencias ; 27(6): 386-395, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-29094841

RESUMO

EN: Noninvasive and minimally invasive hemodynamic monitoring systems are used increasingly in emergency departments to provide adequate tissue oxygenation in critically ill patients. Such monitoring assists in the differential diagnosis of shock, the optimization of treatment and assessment of its effects, and the prevention of complications during care. Recent years have seen the development of noninvasive monitors that measure cardiac output continuously by means of electrodes applied to the skin or spectrophotometric sensors. Minimally invasive systems connected to a peripheral artery catheter have also been developed. Conventional hemodynamic monitoring methods alone have sometimes proven inadequate or inefficient in this setting; an example is the measurement of central venous pressure. The clinician therefore needs to understand the advantages and limitations of the different systems for estimating cardiac output before choosing a monitor. Resuscitation protocols that facilitate the fastest possible recovery in emergency care can be established based on the combination of traditional variables, hemodynamic variables, and anatomical and functional data provided by ultrasonography.

11.
J Med Microbiol ; 59(Pt 9): 1126-9, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20558586

RESUMO

Here we report two cases of isolation of Aurantimonas altamirensis from pleural fluid and blood. The strains were identified by 16S rRNA gene sequencing. A. altamirensis appears to be a rare pathogen involved in unusual infectious processes, and must be isolated and studied at the molecular level for correct clinical diagnosis.


Assuntos
Alphaproteobacteria/isolamento & purificação , Infecções Bacterianas/microbiologia , Derrame Pleural/microbiologia , Idoso , Idoso de 80 Anos ou mais , Alphaproteobacteria/classificação , Alphaproteobacteria/genética , Humanos , Masculino , Filogenia
12.
Emergencias (St. Vicenç dels Horts) ; 20(1): 8-14, feb. 2008. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-058793

RESUMO

Objetivo: Valorar el impacto que tiene un modelo único de gestión que integra las distintas áreas de urgencias de un Departamento de Salud sobre la actividad de un servicio de urgencias hospitalario (SUH), así como la repercusión de la creación de un centro se salud integrada (CSI) que actúa como eslabón intermedio entre la asistencia urgente que se presta en los puntos de atención continuada (PAC) y el SUH. Método: Se estructurarán dos subestudios en el ámbito del Departamento de Salud en el periodo de dos años a partir de abril de 2003. En primer lugar, estudio descriptivo de los distintos elementos para avanzar hacia un sistema integrado de prestación de servicios urgentes. En segundo lugar, la valoración de la implantación del CSI (estudio evaluativo antes-después). Resultados: Tras la creación del Centro de Salud Integral (CSI) se observa un descenso de asistencia en el SUH de pacientes de su zona de influencia (30%). El descenso directamente se corresponde con el porcentaje de aumento que ahora acude inicialmente al CSI (34%). Se observa inversión en la curva de crecimiento de asistencia urgente hospitalaria (116.085 personas durante 2005 frente a una estimación de 135.000). Conclusiones: La gestión única de los servicios asistenciales conlleva un mejor aprovechamiento de los recursos en la búsqueda de satisfacer las necesidades actuales del usuario (AU)


Aim: To assess the impact of a unique management model combining the different emergency areas included in a Department of Health on the activity of an emergency department (ED) and the results of developing a Center for Integrated Health (CIH) which acts as a link between emergency attention at continued attention points (CAP) and the ED. Methods: Over a 2-year period from April 2003 to 2005 we performed two separate studies in the Department of Health. The first descriptive study evaluated different elements necessary to provide emergency assistance in an integrated system. The second study assessed the usefulness of the CIH (before-after study). Results: The number of emergency department visits in the area of influence decreased by 30% in the ED since the Center for Integral Health (CIH) started to work. This percentage was equivalent to the increase in the number of visits to the CIH (34%). The emergency assistance curve of growth diminished from 135 000 patients in 2003 to 116 085 patients in 2005. Conclusions: The unique healthcare management model improves the use of the available resources in order to satisfy the patient care needs (AU)


Assuntos
Humanos , Serviço Hospitalar de Emergência/organização & administração , Assistência Integral à Saúde/organização & administração , Epidemiologia Descritiva , Atenção Primária à Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos
13.
Rev. esp. reumatol. (Ed. impr.) ; 27(3): 112-115, mar. 2000.
Artigo em Espanhol | IBECS | ID: ibc-7489

RESUMO

Las artritis reactivas son episodios inflamatorios articulares que aparecen tras un proceso infeccioso, habitualmente intestinal o genital, no pudiéndose cultivar el germen del material obtenido en la articulación inflamada. La artritis reactiva tras infección de vías aéreas es infrecuente; en este sentido son pocos los casos descritos tras infección por Chlamydia pneumoniae. Se describen 3 pacientes que presentaron artritis, dos de ellos con infección de vías respiratorias altas previa al inicio de la artritis, sin evidencia de infección por los gérmenes habitualmente responsables de artritis reactiva ni de infección viral, con cultivos de líquido sinovial negativos y con seroconversión de los anticuerpos específicos para Chlamydia pneumoniae. Tras recibir tratamiento con tetraciclinas, el cuadro se resolvió completamente en los 3 pacientes. Existen muy pocos casos en la bibliografía científica que asocien Chlamydia pneumoniae como causa de artritis reactiva. Su similitud clínica con la fiebre reumática obliga a pensar en este germen como agente causal de toda artritis precedida por un cuadro de vías respiratorias y a iniciar un tratamiento antibiótico adecuado para evitar cronicidad y/o recidivas. (AU)


Assuntos
Adulto , Idoso , Feminino , Masculino , Humanos , Artrite Reativa/microbiologia , Infecções por Chlamydia , Doxiciclina/uso terapêutico , Chlamydophila pneumoniae , Antibacterianos/uso terapêutico , Seguimentos , Artrite Reativa/tratamento farmacológico , Artrite Reativa/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/diagnóstico
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